Duration Of Symptoms Research Articles

Characterising Long COVID in an Irish cohort: a study of symptom type, severity and determinants

Abstract Long COVID (LC) is a multisystem disorder impacting 65 million people globally. This secondary analysis of data from the Follow-up After Disease Acquisition (FADA) retrospective cohort study of COVID-19 recovery, aimed to characterise the nature and severity of LC in an Irish sample. The Modified COVID-19 Yorkshire Rehabilitation Scale categorised symptoms. Data analysis employed descriptive statistics and logistic regression. Of 4,671 respondents, 2,338 (50.1%) self-reported LC. LC participants were predominantly female (1,543, 66%), White Irish (1,512, 84.9%), and highly-educated (1,174, 65.8%). 907 (51.5%), had ≥one baseline co-morbidity. Most (1,076, 59.1%) had never smoked. Only 6.9% (162) of LC cases were ever hospitalised with acute COVID-19. Recovery was reported by 979 (41.9%). Of those with persistent symptoms 306 (31.6%) were classified as “moderate/severe.” Fatigue was predominant, (1,021, 75.1%) accompanied by cognitive dysfunction (932, 68.5%) and breathlessness (870, 64.0%). Functional impairment, assessed by the EQ-5D-5L score, was evident. Factors associated with LC persistence and severity included baseline co-morbidities (aOR persistent LC 1.44 [95% CI 1.12-1.85], p = 0.005; aOR moderate/severe LC 2.90 [1.92-4.37] p < 0.001)), smoking (aOR persistent LC 1.59 [1.11-2.28] p = 0.01, aOR moderate/severe=1.65 [1.0-2.71] p = 0.05), and meeting/exceeding WHO’s physical activity guidelines (aOR persistent LC 1.49 [1.16-1.92], p = 0.002, aOR moderate/severe=1.69 [1.12-2.54], p = 0.01). LC’s diverse symptomatology and functional impairment serve as a call to action to the health service to equip itself to address this complexity. This study offers insights into LC symptom type, duration, and determinants, emphasising the need for Public Health to traverse domains, to improve all facets of population health. These findings add to the current understanding of LC, providing a foundation for the development of tailored LC services. Key messages • Long COVID causes a constellation of diverse symptoms. • The Irish Health service needs to be equipped to manage the diverse symptomatologu.

Protein quantitative trait loci identifies genetic biomarkers of proteins associated with measures of myocardial fibrosis in new-onset, treatment naive rheumatoid arthritis

Abstract Introduction The excess risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) compared to the general population is attributed to chronic inflammation. Identifying the underlying mechanisms and shared inflammatory pathways more precisely would enable tailored treatment. Purpose To identify genetic variants associated with the cardio-metabolic-inflammatory proteomic signature in patients with early, treatment-naïve RA and low CVD risk. Methods The Coronary Artery Disease Evaluation in RA (CADERA) study was a bolt-on to a RCT of patients with early, treatment-naïve RA and low CVD risk profile (maximum of 1 traditional CVD risk factor and no diabetes mellitus). Normalised expression of 334 proteins from 75 CADERA patients who underwent cardiovascular magnetic resonance imaging (CMR) was measured using the Olink Proximity Extension Immunoassay across Inflammation, Cardiovascular II, III and Cardiometabolic panels. Genome-wide single nucleotide polymorphism (SNP) data were generated using the Illumina Global Screening Array and was imputed and checked for data quality using standard approaches. Proteins associated with CMR parameters were identified using Bayesian mixed effects linear regression. Protein quantitative trait locus (pQTL) analysis was then performed using linear regression models adjusted for age, gender, and systolic blood pressure. Cis-pQTLs were defined as SNPs within 1Mb of the protein-encoding gene, and significance threshold was set at 1e-5. Due to sample size, trans-pQTLs were not considered in this analysis. Linkage disequilibrium (LD) clumping was performed using PLINK software to identify index SNPs defined as the most significant variant in LD (r2 <0.5) within a region of +/- 250Kb. Results Following quality control 318 proteins and 5,971,781 SNPs were available for analysis in 75 CADERA patients. The median age was 51 years [inter-quartile range (IQR) 40 - 61] with 52/75 (69%) females, 40/75 (53%) current/ex-smokers, and median body mass index (BMI) 26.4kg/m2 (IQR 23.3 - 28). Participants had a median RA symptom duration of 21.9 weeks (IQR 14.4 - 32.7). Only 8/75 (10%) reported a history of hypertension, hypercholesteroaemia or family history of CVD. 54 out of 318 proteins were associated with CMR measures of myocardial fibrosis and/or vascular stiffness. 460 cis-pQTLs were identified for 20 out of the 318 proteins. LD clumping revealed 40 cis-pQTLs independently associated with these 20 proteins. Of these, NOTCH3 (rs34763630) was positively associated with extracellular volume, and SELPLG (rs7980427) was negatively associated with late gadolinium enhancement as detected on CMR (table 1). No other proteins with genetic support were associated with CMR measures. Conclusion This study for the first time, implicates genetic markers associated with two proteins as putative candidate biomarkers of CMR-identified myocardial fibrosis in new-onset RA that now warrant validation in an independent cohort.

Appendectomy for suspected appendicitis during pregnancy– a retrospective comparative study of 99 pregnant and 1796 non-pregnant women

IntroductionSuspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.ResultsBetween January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).ConclusionThe diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of “atypical presentation” which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

Evaluation of the efficacy of upper eyelid gold implant surgery in the treatment of lagophthalmos

Material and method: The study included 12 eyes of 12 patients, comprising 5 men and 7 women, with an average age of 55 years. Surgeries were performed on 6 right upper eyelids and 6 left upper eyelids affected by lagophthalmos due to various causes. The average duration of symptoms before surgery was 3 years and 6 months. Patients were eligible for surgery at least 6 months after the onset of paralysis. During the qualification examination, the weight of the implant was estimated using steel trial weights attached to the skin of the upper eyelid, and 0.2 g was added to this measured weight to determine the final implant weight. All patients underwent gold implant insertion into the upper eyelid, with the implants fixed to the tarsal plate using absorbable sutures to prevent prosthesis migration. Special attention was paid to precise layered tissue suturing. Subsequent ophthalmological examinations were conducted at various intervals post-surgery to evaluate the outcomes. Results: Complete eyelid closure was achieved in 50% of the cases, while 100% of the patients reported subjective satisfaction with the surgical outcomes. The patients’ quality of life improved by an average of 85%. The average frequency of using moisturizing eye drops decreased from 7 times daily to 2 times daily. Improvement in the ocular surface condition was noted in all patients. Conclusions: Gold implant insertion into the upper eyelid facilitates improvement in eyelid function and ocular surface condition, significantly enhancing the quality of life for patients with paralytic lagophthalmos.

Adult-Onset EIF2B-Pathies: A Clinical, Imaging and Genetic Profiling with Literature Review.

Vanishing white matter syndrome is one of the leukoencephalopathies caused by recessive mutations in gene EIF2B1-5. Adult-onset EIF2B-pathies (clinical onset after age 16 years) have been reported to be less common. Description of the clinical, imaging and genetic profile of adult-onset EIF2B-pathies and comparison of Indian cohort with Asian and European cohorts. Report of two cases of adult-onset EIF2B-pathies and a comprehensive review of genetically confirmed adult-onset EIF2B-pathies since 2001 from Indian, Asian and European cohorts. Two patients were females, with median age at presentation of 25.5 years (24-27 years) and onset at 19 years (18-20 years). The median duration of symptoms was 6.5 years (6-7 years). Both had cerebellar ataxia, spasticity, cognitive impairment and bladder involvement. Brain magnetic resonance imaging (MRI) showed leukoencephalopathy with rarefaction in both patients and corpus callosum involvement in one patient. Genetics showed homozygous missense variant in the EIF2B3 gene in both patients. The Indian cohort of seven patients had similar clinical and radiological features and common variants in EIF2B3 (n = 4). The Asian cohort had 24 cases, and the European cohort had 61 cases with similar clinical features, radiological features and common variants in EIF2B5. Adult-onset EIF2B-pathies have a distinct clinical profile of female predominance with cerebellar ataxia, spasticity and cognitive decline as the commonest triad of clinical manifestations and leukoencephalopathy with rarefaction on brain MRI. Variants in EIF2B5 were common in the Asian and European cohorts and EIF2B3 in the Indian cohort.

Imaging of Osteomyelitis

In this paper, an analysis of the demographic attributes, presenting symptoms, and infective agents, as well as the areas affected by skull osteomyelitis, of fifty male and fifty female patients is offered. A rough age estimate of around 61 years was found among the patients, with average symptom durations of about 6.8 months or longer. A significant percentage of diabetes (62%) and cranial nerve involvement (62%) were observed. The dominant symptom was headaches, representing 78% of cases, followed by cranial nerve palsy (62%) and hearing loss (48%). S. aureus was found to be the second most common causative agent, following only P. aeruginosa, which was the most common agent (54%). It became clear that there was a relevant infection in the temporomandibular joint and the retropharyngeal joint upon examining regional cases of the illness. In spite of therapy, only 38 percent of patients exhibited a cure, while 46 percent demonstrated improvement and 16 percent experienced a worsening of their condition.

Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes.

Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina. We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes. Systematic review of the current literature using PRISMA 2020 recommendations. We queried the literature and systematically selected relevant studies according to PRISMA guidelines. Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures. In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.

Morphologic Stages of Full-Thickness Macular Hole on Spectral Domain Optical Coherence Tomography

ObjectiveTo describe the sequential morphological changes of the outer retina after full-thickness macular hole formation, utilizing a novel, objective staging system based on optical coherence tomography (OCT), and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months. DesignRetrospective, observational, multicenter study. ParticipantsPatients with idiopathic full-thickness macular hole (FTMH) presenting to St. Michael’s Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, USA, from 2009-2022. MethodsThe medical charts of 1000 patients with FTMH were reviewed and those with at least two preoperative SD-OCTs were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans. Main Outcome MeasuresSequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes. ResultsFifty-two eyes of 52 patients with a mean age of 65.4 ±8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages as follows: Stage A: separation of the neurosensory retina from the RPE with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) (4/52, 7.6%); Stage B: thickening of EZ (27/52, 51.9%); Stage C: patchy (moth-eaten) photoreceptor loss (16/52, 30.7%) and Stage D: severe or complete loss of ISs and OSs and/or bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 days (SD 350.4,[5 -1841]), 28.8%(15/52 ) of eyes were in Stage B, 28.8% (15/52) were in Stage C and 42.3 %(22/52 ) were in Stage D.There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (p=0.032) and worse visual acuity at baseline (p<0.001). Additionally, patients presenting with Stages B and C at the time point closest to surgery had better visual acuity outcomes three months postoperatively compared to those with Stage D(P=0.04). ConclusionsThis SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation providing a novel imaging biomarker.

Evaluation of functional measures and laboratory parameters to portend limitations of spinal mobility in patients with radiographic axial spondyloarthritis

Aim of the workTo specify clinical and laboratory parameters related to limited spinal mobility in radiographic axial spondyloarthritis (r-axSpA) patients. Patients and methodsThe study included 202 adult r-axSpA patients. Clinical characteristics, medications, investigations including serum C-reactive protein (CRP) and human leukocytic antigen-B27 positivity were noted. Lateral lumbar flexion (LLF), chest expansion (CE) and tragus-to-wall distance (TWD) were measured. Values <2.5 percentile in LLF, CE and TWD were noted as reduced mobility of lumbar, thoracic and cervical spine, respectively. ResultsThe median age of patients was 43 years, male:female was 3.7:1. The time to diagnosis was 7.5 (3–40) years and were followed-up for 7.2 (4–22) years. Disease duration and high baseline CRP (>10 mg/L) were critical risk factors for reduced spinal mobility (p = 0.001 and p < 0.01). The duration to impaired LLF was significantly shorter in smokers (n = 105) (10.3;0–30.5 years) vs non-smokers (15.2;4.5–35 years) (p = 0.001) and in those with positive family history (n = 50) (9.7;0–20 years) compared to those without (12.9;4–35 years) (p = 0.09). LLF, CE and TWD were impaired in 40 % vs 75 %, 10 % vs 55 % and 12 % vs 60 % of patients with symptom duration of 10 vs 30 years respectively. Those with delayed introduction of biologics had significantly more impaired LLF, CE and TWD: 10.1(2–25) vs 14(3–33) years; 10.4(3–26) vs 17.5(8–33) years; 10.7(3–27) vs 16.7(5–33) years; p = 0.001 for all, respectively). ConclusionsThe most prominent factors affecting spinal mobility were the duration of symptoms and high serum CRP levels. The decreased spinal mobility was markedly less in patients with the early introduction of biologic therapy.

What is new on peri- and postmenopause?

Menopause is an increasingly discussed topic in recent years. More women are demanding consultancy and help from their doctors via different channels, be it online or in menopause centers.The term genitourinary syndrome of menopause (GSM) comprises vaginal and urological symptoms such as mucosal dryness, itching and burning, dysuria or bleeding and pain during sexual intercourse. GSM can strongly affect quality of life, is common if estrogen deficiency has lasted for 3 months and can be treated locally with very low doses of the weak estrogen estriol."Not feeling like myself anymore" - symptomatic perimenopause may present with sleep disturbances, mastalgia, mood swings, palpitations, panic attacks, but also entail joint pain, vertigo, headache, and brain fog - even years before menopause and in the presence of still adequate estrogen levels. In an online study, 20% of women in the menopausal transition reported symptoms which they could not explain, and which may cause fears of serious illness. This can lead to extensive medical work-ups if the possibility of perimenopause as the cause is disregarded.(Peri-)menopausal complaints last much longer than previously thought: The Study of women's health across the nation (SWAN) reported longer duration of vasomotor symptoms (median: 11,8 years) in women who were already affected in early perimenopause, while those in whom VMS started only after menopause experienced a shorter duration of symptoms (median: 3,4 years).Female hormones protect women from fatty streaks and hypertension, but menopausal hormone therapy (MHT) has positive effects only if started in the first decade after menopause. The interaction with stress, aging and lifestyle factors is complex.For the treatment of VMS, German and international guidelines list both drug and non-drug or non-prescription options, although there is no clear data on their effectiveness.Fezolinetant, a Neurokinin-3 receptor antagonist, is now available in Germany for the treatment of vasomotor symptoms in postmenopausal women with contraindications or aversion against steroid hormones. It modulates the thermoregulation center in the hypothalamus by blocking the KNDy-neurons. Studies on Elinzanetant, another representative of this class of drugs, are still ongoing.

Endoscopic dacrocystorhinostomy: Reasons for failure and possible solutions.

Endoscopic dacryocystorhinostomy is a well-established procedure with high success rate. There are multiple causes of failure of this procedure which affect surgical success. To analyze causes of failure in endoscopic dacryocystorhinostomy and ascertain methods to overcome causes of failure. After approval from the Institutional Review Board a retrospective review of 119 patients was undertaken over an 11-year period from 2008 to 2018. A tertiary care hospital in North India. Patients presenting to the Otorhinolaryngology out-patient department and diagnosed as failed endoscopic dacryocystorhinostomy cases. After thorough preoperative workup consisting of history, examination and diagnostic nasal endoscopy, patients underwent revision endoscopic dacryocystorhinostomy. After exclusion of 2 cases, 117 patients were included in the study. The mean age at presentation was 31.4 years. Number of previous surgeries: 92 patients had had one surgery, 20 patients had had two surgeries, 5 patients had had three surgeries and 9 patients had had multiple surgeries before presentation. All patients (100%) had epiphora, 75 (64.1%) patients had associated discharge and 4 (3.4%) had persistent medial canthal swelling. Duration of symptoms following previous surgery was 1-6 weeks. Commonest cause of failure was incomplete sac exposure in 117/117 cases (100%). Other causes were cicatricial closure of ostium in 47 (40.1%), synechiae in 20 (17%), canalicular obstruction in 4(3.4%), lacrimal sac diverticulum in 3 (2.5%), nasal polyps in 2 (1.7%), concha with adhesion in 2 (1.7%), septal deviation in 2 (1.7%) cases. Meticulous and thorough sac exposure is the most important factor affecting surgical success. Comprehensive preoperative assessment of cases, meticulous surgical technique, and postoperative follow up are needed for successful outcomes.

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.

Clinical Profile and Surgical Management of Intramedullary Spinal Cord Tumors

Background and Aim: Intramedullary spinal cord tumors (IMSCTs) are rare tumors of the spine. The study aims to analyze the clinical profile and surgical management of IMSCTs. Methods and Materials/Patients: This is a retrospective study to review the IMSCTs operated between January 2007 to December 2021. Myxopapillary ependymomas were excluded from the study. Results: There were twenty-seven operated cases of IMSCTs. The Mean±SD age was 39±22 years. Fifteen (55.5%) were males and 12(44.5%) were female patients. There were 6(22%) cervical, 7(26%) cervicodorsal, 9 (33%) dorsal, and 5(19%) dorsolumbar IMSCTs. The Mean±SD duration of symptoms was 10±14 months. Ten (37%) patients had spinal cord syrinx. Motor weakness and pain were the most common symptoms. Intraoperative gross total resection (GTR) was achieved in 12(44.4%) patients, near-total resection in 4(14.8%) patients, subtotal resection in 2(7.4%) patients, decompression in 7(26%) patients, and biopsy in 2(7.4%) patients. Eighteen (66.6%) patients had neurological status same as preoperative status. Four (14.8%) patients had improvement and 5(18.5%) patients had deterioration in neurological status. Ependymoma was the most common histological type of IMSCT (40.5%). Other lesions are glioma, hemangioblastoma, lipoma, schwannoma, lymphoma, capillary hemangioma, arachnoid cyst, and epidermoid cyst with spinal dysraphism. Ependymomas had well-defined margins compared to other gliomas. Duration of stay in the hospital was 9±3.5 days. Conclusion: Dorsal spine is the most common location of IMSCTs and ependymoma is the most common histological type. It is the surgeon’s intraoperative decision regarding the extent of resection of the tumor based on the spinal cord infiltration and tumor type. GTR is possible in the majority of ependymomas and some other histological tumors like schwannoma, arachnoid cyst, and epidermoid cyst.

Women's self-reported symptoms of reproductive tract infection, medical consultations, and factors influencing them in less developed regions: perimenopausal and older women in need of urgent attention.

Reproductive tract infections (RTIs) represent a critical public health concern impacting women's health, particularly pronounced in developing countries. We aim to investigates the prevalence of self-reported RTI symptoms in women aged 18 to 65 and the factors influencing gynecological examination behavior and associated risks are explored. From May 6, 2022, to September 20, 2022, a comprehensive survey engaged 20,864 women aged 18 to 65 in 19 townships in Lueyang, Shaanxi. Each survey team, comprising a gynecologist, two female health center staff, and a master's student, conducted face-to-face questionnaire surveys in villages and households. The questionnaire featured three sections: prevalence of self-reported RTI symptoms, gynecological examination history, and factors influencing examination behavior. The high response rate of 98.69% yielded 20,590 valid questionnaires. Among surveyed women, 42.04% reported RTI symptoms, with a higher prevalence in those aged 30 and above, peaking at 44.88% in the 50-59 age group. Vulvar itching (24.73%), abnormal vaginal discharge (17.41%), and urinary tract irritation signs (11.73%) were most common. Older adult women (≥60) reported higher frequency and longer duration of symptoms. Only 9.88% of symptomatic women underwent gynecological examinations in 2022. Examination likelihood decreased with age, presenting a critical gap in healthcare utilization among older women. Reasons for checkups included routine checkups (47.02%), symptom concerns (41.29%), and the availability of free medical checkup programs (9.82%). Barriers included perceived lack of serious symptoms (23.7%), lack of necessity (4.41%) and lack of time (3.98%). Among those examined, 40.58% had a diagnosis of gynecological disorders, including pelvic inflammatory disease, human papilloma virus infection and cervical cancer. Widespread RTI symptoms, particularly in perimenopausal and older women, underscore the need for enhanced healthcare. Barriers to gynecological examinations include awareness, education, and accessibility issues. Strategies must prioritize health education, routine examinations, and improved healthcare infrastructure in underdeveloped regions.

Administration of Lactobacillus plantarum GUANKE alleviates SARS-CoV-2-induced pneumonia in mice.

Most otherwise healthy individuals develop only mild or moderate symptoms of coronavirus disease 2019 (COVID-19) caused by current strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and virus replication is mainly confined to the upper respiratory tract; however, the virus can infect the lower respiratory tract and promote inflammation. Probiotic supplementation has been shown to reduce nasopharyngeal SARS-CoV-2 viral load, reduce the overall number and duration of symptoms, and attenuate inflammation in clinical trials. We showed that a novel L. plantarum GUANKE strain alleviated SARS-CoV-2-induced pneumonia in mice. The transcription and production of inflammatory cytokines were suppressed, and GUANKE moderately reduced the viral load. L. plantarum GUANKE has the potential to become a candidate drug for the treatment of COVID-19 or other viral respiratory infections.

Effects of Neurodevelopmental Disorders on the Clinical Presentations and Therapeutic Outcomes of Children and Adolescents with Severe Mood Disorders: A Multicenter Observational Study.

Individuals with neurodevelopmental disorders (NDDs) are more susceptible to developing severe or resistant mood disorders. However, they often face challenges in accessing specific treatments. To understand the barriers to treatment in this group, we conducted a secondary analysis of a multicenter observational study on 305 adolescents referred to specialized care (mean age 14.38 ± 0.13 years, 57% girls, 9% bipolar disorder, 91% depressive disorders). NDDs were categorized based on the number of co-occurring NDDs for each subject (none: 67%, one: 18%, two: 7%, three: 5%, four and more: 2%). We explored the predictive value of the number of NDDs on various clinical and therapeutic factors. The analysis revealed significant associations between the number of NDDs and the duration of mood symptoms, persistent irritability, associated disruptive behavioral disorders, lower scores on the Children's Global Assessment Scale (CGAS) at baseline, and polypharmacy. The number of NDDs did not correlate with the use of antidepressants, the Clinical Global Impression-Improvement scale (CGI-I) at discharge, or changes in the CGAS score during the stay. The challenges in distinguishing mood disorders from chronic emotional and behavioral difficulties may contribute to the difficulties in accessing specific care for mood disorders. These results suggest that treatments for mood disorders demonstrate comparable effectiveness when provided regardless of the associations with NDDs.

Medium- to Long-term Outcomes of Fasciotomy for Chronic Exertional Compartment Syndrome: A 6-Year Mean Follow-up Study.

Operative treatment of chronic exertional compartment syndrome (CECS) with fasciotomy is effective for symptomatic resolution, but outcomes at medium- to long-term follow-up are unclear. Patients will have favorable satisfaction at medium- to long-term follow-up and a high return to sport (RTS) rate after fasciotomy for treatment of CECS. Cross-sectional. Level 3. Retrospective review of patients who underwent fasciotomy for treatment of CECS from 2010 to 2021. Outcomes were assessed using Tegner Activity Scale, symptom resolution, patient satisfaction, return to activities, and EQ-5D-5L survey. Fifty patients (23 male and 27 female) were included. Mean age at time of surgery was 29.0 ± 11.6 years with mean follow-up 6.0 ± 2.3 years (range, 2.6-10.9). Tegner activity scores at final follow-up were improved compared with symptom onset (mean, 5.2 vs 3.3; P < 0.01). Increased preoperative symptom duration correlated with decreased RTS (β = -0.447; P = 0.01) and return to work (RTW) (β = -0.572; P = 0.01). Patients with a previous psychiatric diagnosis (n = 15) had lower rates of RTS (β = -0.358; P = 0.03) and RTW (β = -0.471, P = 0.02). Mean time to RTS was 5.5 ± 6.1 months. Mean visual analogue scale satisfaction rate was 74.4; 36 (72.0%) patients would be willing to have their fasciotomy again. Patients with fasciotomy of 1 to 2 compartments had higher Tegner score at final follow-up (P = 0.02) than those who had fasciotomy of >3 compartments; 19 (38.0%) patients reported experiencing paresthesia after their operation. No patients experienced major complications. Medium- to long-term outcomes of patients with CECS treated with fasciotomy demonstrated high satisfaction levels and high RTS rate. However, rate of minor complications including paresthesia, swelling, and cramping was high.

Characterization of middle ear microbiome in otitis media with effusion in Hungarian children: Alloiococcus otitidis may potentially hamper the microbial diversity

IntroductionAlthough otitis media with effusion (OME) is a common cause of hearing impairment in children, little is known about its microbiological background. We aimed to analyse the microbiome of the middle ear fluid (MEF) in OME to identify microbiological, demographic and environmental factors that may potentially influence the middle ear microbiome. In addition, we aimed to compare the results of conventional culture techniques and PCR-based methods. Methods39 samples from children with OME were investigated using conventional culture and 16S rRNA sequencing. Bioinformatic analyses were carried out to assess the microbial communities and their association with clinical data. ResultsBy conventional culture technique bacteria could be cultured in 33 % of the MEF samples; the most frequent bacterium was Haemophilus influenzae, followed by Staphylococcus species, Cutibacterium acne, and Streptococcus species. The 16S rRNA analysis showed that Alloiococcus was the most abundant bacterium, followed by Haemophilus, Streptococcus. and Sphingobium.A “High Alloiococcus group” with significantly lower and a “Low Alloiococcus group” with significantly higher alpha and beta diversity could be defined. Children born by Caesarean sections had lower beta and Shannon diversity than patients born by natural birth. Breastfeeding for at least six months showed a negative correlation with alpha diversity. Age, previous antibiotic treatment, parental smoking, duration of symptoms, existence of siblings, did not alter the significantly bacterial composition of MEF samples and there were no significant differences in regard to alpha or beta diversity. ConclusionThe conventional culture technique and 16S rRNA results were not congruent. Remarkably, Alloiococcus could not be cultured at all, even by 16S rRNA analysis the presence of Alloiococcus seems to be important. Based on our results, A. otitidis possibly impacts the diversity of middle ear microbiome in children with OME. However, further studies are required to determine the role of A. otidis in middle ear pathologies.

Effect of surgical resection extent on neurological prognosis of adult intradural spinal teratomas.

Intradural spinal teratomas are very rare in adults and may cause severe neurological deficits. Tumors often tightly attached to the spinal cord, making complete resection difficult. The purpose of this study was to evaluate the impact of surgical resection extent on neurologic outcomes in these patients. A retrospective study of IST patients who underwent microsurgery in our center was performed. Age, sex, symptoms, duration of symptoms, tumors size, neurologic status, extent of resection, and surgical outcome were reviewed for each patient. The Kruskal-Wallis test and multivariate logistic regression were used to assess affecting factors on neurological outcomes. A total of 26 adult patients underwent microsurgical management were studied. The mean age at surgery was 41.3 years (range 23-66 years). The mean follow-up was 109.5 months (range 17-216 months). Gross total resection (GTR) was achieved in 12 (46.2%) cases and subtotal resection (STR) in 14 (53.8%) cases. 6 patients (23.1%) had recurrence, and the mean time to recurrence (TTR) was 86.0 months (range 3-168 months) after the first surgery. No recurrence was found after the second surgery during follow-up. All tumors were pathologically confirmed as mature teratomas. In analysis of neurological outcomes, patients with shorter symptom duration (p = 0.035) and lower MMcS grade (p = 0.025) had better postoperative neurological outcomes. The neurological prognosis of STR patients was better than that of GTR patients (p = 0.041). Multivariate logistic regression confirmed that the extent of resection differences remained significant (p = 0.017). Surgical resection is optimal therapeutical management of IST and can obtain a good prognosis. STR appeared to be superior to GTR in terms of neurological improvement. Considering the characteristics of slow growth and long TTR of IST, STR may be a feasible option for highly adherent tumors.

Early Onset Pancreatic Adenocarcinoma (EOPAC): presentation, clinical course and treatment outcomes in comparison to Average Onset Pancreatic Adenocarcinoma (AOPAC): a retrospective cohort study

BackgroundPancreatic adenocarcinoma (PAC) is a disease of decimal prognosis, with around 50% of patients presenting with metastatic disease. Previous trials reported a high incidence of early onset pancreatic cancer (EOPAC) in Egypt, presenting about 25% of patients with PAC. The clinic-pathological features and prognosis of EOPAC needs more study.Patients and methodsA retrospective analysis of patients’ records at Shefa Al-Orman comprehensive cancer center database. Patients with histo-pathologically confirmed diagnosis of PAC. We categorized patients according to the age at diagnosis into EOPAC (≤ 50 years) and average onset PAC (AOPAC). Data on risk factors, family history, presenting symptoms, clinic-pathological features, treatment, and prognosis were extracted. Patients with histopathologically confirmed diagnosis of pancreatic cancer diagnosed between December 2016-December 2022 were included.ResultsThe study cohort consisted of 412 patients. EOPAC represented 20.3% of patients, with no significant differences in risk factors and family history compared to AOPAC. Duration of symptoms before diagnosis is longer in EOPAC, with the majority of EOPAC presenting with localized disease (23.8%) and locally advanced tumors (28.5%) compared to AOPAC. AOPAC presented more with metastatic disease (64% vs. 45.2%, p = 0.003). EOPAC are usually submitted to more aggressive treatment including radical surgery, neoadjuvant therapy, and aggressive chemotherapy regimens in metastatic disease. Disease free survival (DFS) of EOPAC was shorter than AOPAC (11 months vs. 17 months, p = 0.889), but overall survival OS was significantly longer in EOPAC (10 months vs. 6 months, p = 0.013).ConclusionPatients with EOPAC in Egypt represent around 25% of cases. EOPAC tend to have a shorter disease free survival (DFS) in patients presenting with localized disease. The overall survival (OS) is longer in EOPAC compared to AOPAC. Further studies are mandatory to identify the epidemiological and risk factors of EOPAC in Egypt.