Symptoms Of Syndrome Research Articles

Design and methodology of a randomized clinical trial of quetiapine to reduce central nervous system polypharmacy in veterans with postconcussive syndrome symptoms

Lack of evidence to guide medication treatments for mild traumatic brain injury (mTBI) in veterans too often results in polypharmacy practices attempting to provide symptomatic relief from multiple postconcussive syndrome symptoms. Therefore, the field needs to find an effective medication that reduces the burden of postconcussive symptoms without complicating the treatment burden of veterans. This clinical trial seeks to determine whether switching veterans to quetiapine monotherapy (intervention) is superior to continuing to receive treatment as usual (TAU, control) polypharmacy for veterans with symptoms of postconcussive syndrome and posttraumatic stress disorder who are receiving rehabilitation treatment for mTBI. This study will test the conceptual mediation model hypothesis that quetiapine monotherapy may enhance recovery from mTBI by (1) increasing engagement in rehabilitation services, and/or (2) reducing the adverse effects of TAU polypharmacy. This study will enroll 146 patients from two Veterans Administration Medical Centers into a 12- week phase III, randomized, pragmatic clinical trial comparing outcomes from treatment with quetiapine monotherapy and TAU. Quetiapine will be cross tapered up to a maximum dose of 200 mg (as tolerated) as other medications are discontinued. The primary outcome measures are postconcussive syndrome symptoms (Neurobehavioral Symptom Inventory), functional disability (World Health Organization Disability Assessment), and quality of life (World Health Organization Quality of Life Assessment). Overall, this study aims to determine whether quetiapine monotherapy is superior to TAU polypharmacy and improves the quality of life for veterans with comorbid postconcussive syndrome and posttraumatic stress disorder symptoms who are receiving rehabilitation treatment for mTBI.

Effect of Clinical Nutrition and Healthy Lifestyle in Treating Symptoms of Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women and is associated with both reproductive and metabolic disorders, affecting about one in every 15 women worldwide. This study was done in two parts, the descriptive part and the experimental part, during the period (November 2020- February 2021). Objective: the objective of this study was to know the spread of PCOS in the University of Sciences and Technology, Aden, Yemen and to assess the effect of clinical nutrition and healthy lifestyle in women with PCOS. Method: The blood was withdrawn from the sample of the study and transferred to the Almadeinah Medical center to measurement the hormones (FSH - LH) and also sample of blood transferred to the laboratory of the Faculty of Medicine and Health Sciences at the University of Science and Technology, Aden, Yemen to measurement CBC. Results: In this study, we selected 60 girl and recorded 16 cases of have been suffered of polycystic ovaries , this number form about 26.7% of the total cases. At the end of the study, results showed a statistically significant progress at (P=> 0.05) in alleviating some symptoms associated with PCOS such as hair dropping (P= 0.024), acne (P= 0.002), and menstrual days (P= 0.002), with a marked improvement in the level of hormones (FSH - LH) and the level of CBC (HB – WBC – Platelet) in the groups that underwent clinical nutrition, but with no significant differences. Conclusion: Healthy life style can be a good alternative for medications in women with PCOS..

Response of Irritable Bowel Syndrome to Abdominal Fat Reduction

Objectives: The study aimed to evaluate the response of Irritable Bowel Syndrome (IBS) among patients having central obesity to reducing abdominal fat using Focused Ultrasound (cavitation) in addition with aerobic exercise as well as a low calorie, low-FODMAPs diet. Methods: A total of 60 individuals, between the ages of 20 and 45, who were diagnosed with both irritable bowel syndrome (IBS) as well as abdominal obesity, having a body mass index (BMI) ranging from 30 to 39.9 kg/m², were divided into two groups of similar size by a random assignment process. Group A were given focused ultrasound cavitation accompanied by moderate aerobic exercise and a low calorie, low-FODMAPs diet over a period of three months, whereas Group B (control group) were given moderate aerobic exercise and a low calorie, low-FODMAPs diet only. Assessments of total body fat, abdominal fat, severity of IBS, as well as quality of life related to IBS were conducted prior to and after the study period. Results: Overall body fat mass, abdominal fat mass, IBS severity, and IBS quality of life were all significantly improved in both groups. All evaluated variables showed a highly significant improvement in favor of the study group when comparing the two groups. Conclusion: Focused Ultrasound (cavitation) in addition with aerobic exercise as well as a low calorie, low-FODMAPs diet cause more improvement of irritable bowel syndrome symptoms and quality of life.

Lactobacillus helveticus HY7801 Improves Premenstrual Syndrome Symptoms by Regulating Sex Hormones and Inflammatory Cytokines in a Mouse Model of Metoclopramide-Induced Hyperprolactinemia

Background/Objectives: Premenstrual syndrome (PMS), a clinical condition that manifests in the form of various physical and psychological symptoms, occurs periodically during the luteal phase of the menstrual cycle and reduces quality of life. Methods: Here, we conducted in vitro and in vivo experiments to investigate the effects of Lactobacillus helveticus HY7801 (HY7801) on PMS symptoms. Results: Data from the in vitro experiments showed that HY7801 inhibits prolactin secretion by estradiol-induced GH3 cells, as well as the secretion of pro-inflammatory cytokines by LPS-induced Raw 264.7 cells. Additionally, the oral administration of HY7801 (109 colony-forming units/kg/day) to mice with metoclopramide-induced hyperprolactinemia reduced uterine tissue mass and endometrial thickness, both of which were increased excessively in the presence of prolactin. HY7801 also regulated the serum levels of follicle-stimulating hormone and prostaglandin E1/E2, as well as recovering the progesterone/estradiol ratio. HY7801 also downregulated the serum levels of prolactin and pro-inflammatory cytokines such as interleukin (Il)-6, tumor necrosis factor-alpha (Tnf), and IL-1β. Finally, HY7801 reduced the expression of genes encoding inflammatory cytokines (i.e., Tnf and Il-6), cyclooxygenase-2 (Cox-2), and inducible nitric oxide synthase (iNOS) in mice with hyperprolactinemia. Conclusion: In summary, HY7801 may be a functional bacterium that alleviates PMS symptoms by modulating hormones and inflammatory markers.

Cognitive and behavioral response of mosquitofish (Gambusia affinis) to environmental factors: Microplastics, predator cues, and detour design methods.

Urban stream syndrome is the collective term used to describe the physical and ecological degradation of streams draining urban lands that poses substantial threats to freshwater ecosystems. Among various consequences of urban expansion, microplastic pollution and shifts in predator-prey dynamics are prominent alterations to natural habitat that could impact the cognitive and behavioral responses of aquatic species. To explore how symptoms of urban stream syndrome impact the cognitive and behavioral responses of fish, we conducted two experiments using a delayed detour test to measure risk-taking and inhibitory control in Gambusia affinis. In the first experiment, we hypothesized that G. affinis exposed to different concentrations of microplastics would show altered inhibitory control and risk-taking. In the second experiment, we hypothesized that exposure to predator chemical cues during the detour task would alter inhibitory control and risk-taking in G. affinis. We did not find significant differences in inhibitory control or risk-taking in G. affinis exposed to microplastics or predator cues. We then compared the effect size and confidence intervals (CI) of these results with published results that used the same detour test to study inhibitory control and risk-taking in G. affinis in response to different environmental conditions. Our investigations revealed that the CIs of the two studies presented here were larger than the CIs in the previously published studies. We consider potential changes to the experimental design that might have affected our ability to detect differences, such as the dimensions of the testing tanks. We also suggest extending the duration of the test to allow ample time for both exiting the starting chamber and solving the detour. We also propose considering the size and age of the species under study and adjusting the dimensions used in the detour paradigm design. Although our findings are specific to G. affinis, our results underscore the importance of considering aspects of the detour test design that are ecologically relevant to the study species when analysing cognitive and behavioral responses in fish. With our discussion, we contribute to the understanding of detour test methodologies and highlight potential ecological factors that could influence cognitive and behavioral outcomes.

Successful Percutaneous Transcatheter Aortic Valve Replacement for Severe Aortic Regurgitation in a High-risk Patient with Cardiorenal Syndrome

The absence of a Food and Drug Administration-approved percutaneous valve technology for the treatment of severe aortic regurgitation (AR) presents a challenge for high-risk patients. In this report, we describe the successful treatment of an 84-year-old male patient suffering from severe symptomatic AR and concomitant cardiorenal syndrome with renal failure using a 34-mm Evolut R (Medtronic) self-expanding transcatheter aortic valve replacement. This intervention resulted in the resolution of AR, cardiorenal syndrome, and congestive heart failure symptoms.

Abstract 4136277: The Lay Public Misconceives Characteristics of Acute Coronary Syndrome-Related Chest Pain

Introduction: The most common acute coronary syndrome (ACS) symptom is chest pain. Chest pain is an umbrella term more precisely described using words like pressure or tightness. Previous studies have not explored the lay public’s conceptions of ACS-related chest pain. Misconceptions about chest pain make it difficult for individuals to recognize this symptom if they were to experience it, delaying care seeking. Research Question: How does the lay public conceive of ACS-related chest pain? Methods: Participants from across the U.S. were recruited in May and June 2023. Participants completed an online survey including the Chest Pain Conception Questionnaire. Descriptive statistics were used to characterize conceptions of chest pain quality, timing, intensity, and distress. Conceptions of men and women were compared using the independent-samples t -test and Chi-square test. Results: Participants (n=597) were mostly women (n=355; 59.5%) with a mean age of 54.0 years (SD = 11.5). The sample was diverse: White (n=414, 69.2%), Black (n=101; 16.9%), Hispanic or Latina/o/e/x (n=96; 16.1%), and Asian (n=67; 11.2%). Participants often thought of pressure (78.9%), tightness (77.4%), squeezing (75.5%), gripping (72.9%), and heaviness (72.5%) as possible descriptors of ACS-related chest pain. They less often thought of discomfort (48.7%), fullness (16.8%), and indigestion (13.4%). Participants expected ACS-related chest pain to be “intense” and to bother them “a lot,” both with median scores of 4.0 on a 5-point Likert scale. Participants felt that ACS-related chest pain would “often” (median 4.0) occur with activity and “sometimes” (median 3.0) occur at rest. Women were more likely to rate specific descriptors of chest pain (i.e., pressure, tightness) and general descriptors of chest pain (i.e., discomfort, pain) as more likely ACS-related chest pain descriptors than men, (all ps ≤ .05). Women (n=58; 16.3%) were about twice as likely as men (n=22; 9.2%) to endorse indigestion as a possible descriptor of ACS-related chest pain, ( p = .013, OR = 0.52 [95% CI = 0.31-0.87]). Conclusions: As many as 1 in 5 participants did not endorse common descriptors such as pressure and tightness as potentially characterizing ACS-related chest pain. Most believed this symptom would be intense and bother them a lot. They also more often associated ACS-related chest pain with activity than with rest. Clinical and research interventions can target the misconceptions identified in this study.

Dumping syndrome: Update on pathophysiology, diagnosis, and management.

Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti-reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches. In this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies. Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad-spectrum somatostatin analogue pasireotide, GLP-1 receptor antagonists, GLP-1 receptor agonists and administration of stable forms of glucagon are currently under study. Dumping syndrome is a well-defined but probably under-diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.

Efficacy of Nigella sativa seed oil against psychophysical stress induced irritable bowel syndrome and anxiety-like symptoms in Wistar rats.

Stressors play a critical role in the progression of irritable bowel syndrome (IBS). Heterogenous stress causes alterations in our bowel movements which can further cause anxiety and depression-like symptoms, decreasing the ability of individuals worldwide to function in social, academic, and employment settings. This study was aimed to investigate the effect of orally administered Nigella sativa (0.2mL/kg b.wt.) seed oil (NSSO) on stress-induced IBS, anxiety, and depression-like symptoms in Wistar rats. In the present study, modelling IBS induced anxiety and depression-like symptoms in rodents have been employed to correlate the pathophysiological mechanisms behind this disorder. Moreover, evaluation of ameliorative potential of traditionally used NSSO in IBS was also carried out. Present investigation indicated that acute stress of 1.5h daily for 20days induced hyper cortisol, gastrointestinal (GI) hypermotility, diarrhoea, altered levels of short chain fatty acids (SCFAs), and inflammation which are common symptoms of IBS. Furthermore, depression and anxiety-like symptoms were validated in test groups by various behavioral tests and decreased levels of 5-HT-Transporter mRNA gene expression, which are clear indicators of cognitive impairment. It is possible that these IBS-like symptoms may have contributed to the pathogenesis of cognitive deficits and depression. However, the anti-oxidative, anti-inflammatory, anti-spasmodic, and possibly the anti-anxiolytic properties of NSSO helped in the mitigation of altered gut-brain axis. Because the concurrent treatment of NSSO alleviated the symptoms of modified GI function and consequently, the anxious & depressive behavior of the animals. Overall, this research explored the protective efficacy of NSSO against stress-induced IBS and depression-like symptoms, shedding light on the potential of this natural compound as a therapeutic option in the field of gastroenterology and psychiatry.

The effect of group counseling based on positive psychology on the WhatsApp social media platform on the severity of premenstrual syndrome symptoms: a randomized clinical trial

BackgroundPremenstrual syndrome (PMS) is a prevalent health issue impacting women, significantly impacting their well-being and fostering a negative attitude of femininity and menstruation. We investigated the effect of group counseling based on positive psychology on the severity of PMS symptoms.MethodsParticipants in the intervention group engaged in six online sessions of group counseling focused on positive psychology via WhatsApp. Data were collected using the Premenstrual Symptoms Screening Questionnaire (PSST) before, immediately, and two months post-intervention. Analytical assessments were performed using SPSS 16 software using Chi-square, independent t-tests, and repeated measures analysis of variance (ANOVA). Comparative analyses were carried out using the Bonferroni post hoc test with a 95% confidence level.ResultsThe mean intensity of PMS symptoms in the intervention group significantly decreased from 21.60 (2.50) to 13.35 (4.727) and 14.750 (5.963) immediately and two months after the intervention; however, the difference was not significant in the control group. The results of repeated measures ANOVA showed that the effect of the intervention over time and the interaction between time and group were significant. The Eta effect size was about 0.20 and 16%, respectively (p = 0.001). According to Bonferroni post hoc test results, the difference in the mean scores of the severity of PMS symptoms before the intervention was statistically significant compared to both follow-up periods (p ≤ 0.007). However, the difference in mean scores immediately after the intervention compared to two months after the intervention was not statistically significant (p = 0.42).ConclusionUsing a positive counseling approach demonstrates efficacy in alleviating the severity of PMS symptoms in the short term. While all women can benefit from such interventions, targeting adolescents is particularly strategic, as early interventions can foster positive attitudes toward menstruation. Additionally, social media platforms like WhatsApp provide a feasible and engaging medium for adolescent health interventions. Integrating this approach into adolescent health promotion package appears to be a viable measure worthy of consideration by relevant policymakers.Trial registrationCurrent Controlled Trials IRCT20201113049377N1, Date of Registration 2020, 12, 08.

Association between cardiorenal syndrome and depressive symptoms among the US population: a mediation analysis via lipid indices

BackgroundCardiovascular diseases (CVD), chronic kidney disease (CKD), and lipids are positively correlated with the presence of depressive symptoms. However, investigation into the complex link that exists between cardiorenal syndrome (CRS) and lipid indices and depression remains scarce.MethodsThis study analyzed data from 11, 729 adults in the National Health and Nutritional Examination Surveys from 2005 to 2018. Weighted regression analysis was employed to examine the relationships between CRS and depression, CRS and the Patient Health Questionnaire-9 score, and lipid indices with depression. The restricted cubic spline analysis was used to determine whether there is a linear association between lipid indices and depression. Smooth curve fitting was employed to illustrate the relationship between lipids, depression, and cardiorenal diseases. Subgroup and sensitivity analyses were also conducted to enhance the stability of the results. Finally, we applied mediation analysis to explore whether the Atherogenic Index of Plasma (AIP), triglyceride glucose (TyG) index, and remnant cholesterol (RC) mediate the association between CRS and depression.ResultsAfter applying propensity score matching (PSM), 1,509 adults remained in the study. After PSM, more remarkable results were rendered that CRS was associated with depression compared with non-CRS (OR: 1. 240, 95% CI: 1. 237 ~ 1. 243), only-CVD (OR: 0. 646, 95% CI: 0. 644 ~ 0. 649), and only-CKD (OR: 1.432, 95% CI: 1.428 ~ 1.437) in a fully corrected model. Smooth curve fitting shows that the intersection point of the lines of CRS and non-CRS occurs at a higher value on the horizontal axis than the intersection point of the lines representing CVD and non-CVD. In the fully corrected model, AIP, TyG, and RC did not independently mediate the association between CRS and depression.ConclusionThere was a significant association between CRS and depression and a linear relationship between AIP, TyG, and RC and depression. However, the above lipid indicators did not mediate the association between CRS and depression.Graphical

Microbiota alterations are related to migraine food triggers and inflammatory markers in chronic migraine patients with medication overuse headache

ObjectiveChronic migraine (CM) patients with medication overuse headache (MOH) were recently shown to be associated with leaky gut and inflammation. We aimed to investigate gut microbiota profiles of CM patients with MOH, and their correlations with inflammatory serum parameters, migraine food triggers, and comorbid anxiety and depression.Materials and methodsThe study included women participants (32 CM patients with NSAID overuse headache, and 16 healthy non-headache sufferers). Migraine duration, monthly migraine headache days, presence of irritable bowel syndrome symptoms, and HADS-D and HADS-A scores were recorded. Serum samples were collected to measure circulating LPS, HMGB1, HIF-1α, and IL-6. The gut microbiota profiles of the patients were evaluated using fecal samples.ResultsSerum LPS, HMGB1, HIF-1α, and IL-6 levels were significantly higher in the CM + MOH group compared to the healthy controls. HADS-A and HADS-D scores were considerably higher in the CM + MOH group compared to the healthy controls. In the microbiota analysis, alpha and beta diversities were similar between the two groups. The class Clostridia, the order Eubacteriales, and the genus Ruminococcus were less abundant in the CM + NSAID overuse headache group compared to the control group. At the genus level Desulfovibrio, Gemmiger, and Dialister and at the species level, Clostridium fessum, Blautia luti, Dorea longicatena, Eubacterium coprostanoligenes, and Gemmiger formicilis were more abundant in the CM + NSAID overuse headache group compared to the control group. Desulfovibrio, Gemmiger, Dialister, Ethanoligenens harbinense, Eubacterium coprostanoligenes, Dorea longicatena, and Thermoclostridium stercorarium showed positive correlations and Clostridia bacteria showed negative correlations with migraine food triggers. Positive correlations were found between LPS and Hapalosiphonaceae, HMGB1 and Melghirimyces, HIF1-α and Rouxeilla and Blautia luti, IL-6 and Melghirimyces and Ruminococcus.ConclusionIn CM patients with MOH, we have revealed the presence of dysbiosis towards an inflammatory state, and positive correlations were shown between altered gut microbiota and inflammatory serum parameters and migraine food triggers.

Prevalence of text neck syndrome, its impact on neck dysfunction, and its associated factors among medical students: A cross-sectional study.

Students increasingly rely on digital devices, leading to text neck syndrome, a common overuse syndrome caused by repetitive forward neck flexion. This study aimed to determine the prevalence of text neck syndrome among medical students and the resulting neck dysfunction and to investigate the possible associated factors. This cross-sectional study used an online self-developed questionnaire among medical students. Students' characteristics and data about smartphone usage were evaluated for diagnosis. Individuals with at least 3 of the 6 text neck syndrome symptoms and a history of more than four hours a day spent on a smartphone were diagnosed with text neck syndrome. Neck dysfunction was measured using the neck disability index. Descriptive statistics and the chi-square test were used. P values < 0.05 were considered statistically significant. The study found that 31.7% of students with text neck syndrome have mild neck disabilities, with a higher proportion of females (40%). The characteristics that have a significant relation to text neck syndrome include being female (p < 0.0001), overweight (p = 0.025), being right-handed (p = 0.001), using four digital devices or more (p = 0.002), having low levels of physical activity (P = 0.018), and spending more than three hours a day sitting down (P = 0.027). More than a quarter of medical students had text neck syndrome, and most of them had a mild neck disability. Text Neck Syndrome was linked to an increased number of gadgets used, low exercise, and more time spent in a sitting position.

Service evaluation: HRT regimens prescribed for complex menopausal patient cases

Abstract Introduction With government and NHS drivers, there has been an increase in menopause awareness and management. The NHS Business Services Authority reported a 29% increase in hormone replacement therapy (HRT) prescribing between 2022-2023, with expectation that this would rise further with introduction of the new HRT prepayment certificate in April 20231. Partly due to celebrity sway and supported by national guidance2,3 there is patient expectation towards transdermal oestrogen with natural progesterone HRT. Older women, some years since undergoing natural menopause, are also seeking advice on HRT use (3) with referrals accepted by specialist menopause clinics. Aims This service evaluation project was undertaken to evaluate the prescribing of HRT regimens in complex patient cases seen within a specialist menopause clinic and included assessment of those advised to use natural progesterone as part of their HRT regimen, for endometrial protection2,3. Method 366 specialist menopause clinic appointments over 6 months (05.01.23-22.06.23) were retrospectively evaluated, with patients seen by a multidisciplinary team within an outpatient secondary care setting. Exclusion criteria included appointments not attended, those that were incorrectly booked or patients with inaccessible records. Data was collected using electronic patient records with results analysed using Microsoft Excel. Results Of 327 (89%) appointments evaluated, the patient age ranged between 30-84 years (median age 53). HRT was recommended for 288 (88%) patients. HRT was not recommended in cases such as antiphospholipid syndrome, breast cancer without genitourinary symptoms, in those of advanced age or in line with patient choice with patient decision not to take HRT after an individualised risk benefit evaluation. For 26 (9%) patients, only topical oestrogen treatment for localised genitourinary syndrome symptoms was advised. 171 (52%) patients were postmenopausal, 61 (19%) perimenopausal, 46 (14%) with premature ovarian insufficiency and 20 (6%) with surgical menopause. For 22 patients (7%) with Mirena intra-uterine system in situ, their menopause phase could not be accurately defined. 243 (88%) of those recommended HRT were advised a combined regime; 154 (53%) continuous combined; 67 (23%) sequential combined and 22 (9%) oestrogen with Mirena coil. For patients accepting combined HRT, one third (81) were recommended natural progesterone, with the other patients using progestogens for endometrial protection. Of these 81 patients, 77 (95%) were recommended transdermal oestrogen in combination with natural progesterone. For patients recommended natural progesterone, 68 (84%) were for doses in line with licensing and current British Menopause Society guidance. For 10 patients the off-label recommendation involved doubled doses of natural progesterone to help with control of unfavourable bleeding. Discussion For prescribing of natural progesterone, we assumed that our recommendations to the GP were enacted. With retrospective evaluation of patient letters as a limitation, this project identified that within our specialist clinic complex patient population, a recommendation for natural progesterone was made for one third of patients suitable for combined HRT use. When not prescribed in line with licensing, this was due to issues with vaginal bleeding. Acknowledgments Biranavi Kirupakaran, Sahil Misri, Hernani Almeida, Medical Students, Imperial College London for data collection.

StepFit-18K: Improving Irritable Bowel Syndrome (IBS) Symptoms with a Simple, Structured Walking Intervention

StepFit-18K: Improving Irritable Bowel Syndrome (IBS) Symptoms with a Simple, Structured Walking Intervention

Effect of a psychoeducation program based on cognitive-behavioral psychodrama techniques on premenstrual syndrome symptoms: a randomized controlled trial

ABSTRACT Premenstrual syndrome is characterized by physical and psychological symptoms that negatively affect daily functioning. This study investigated the effect of a psychoeducation program based on cognitive-behavioral psychodrama techniques on premenstrual syndrome symptoms. This study utilized a 2 × 2 pretest-posttest, experimental-control group research design. The sample consisted of 32 participants randomized into experimental (n = 16) and control (n = 16) groups. The experimental group participated in a seven-session psychoeducation program based on cognitive-behavioral psychodrama techniques. Data were collected using a personal information questionnaire and the Premenstrual Syndrome Scale (PMSS). The experimental group demonstrated a significantly lower median posttest PMSS total and ‘depressive affect’, ‘fatigue’, ‘irritability’, ‘depressive thoughts’, ‘changes in appetite’ and ‘changes in sleeping habits’ subscale scores than the pretest score (p < .05). Moreover, the experimental group had a significantly lower median posttest ‘anxiety’ score than the control group (p = .021). A psychoeducational program based on cognitive-behavioral and psychodrama techniques can be used as an effective therapeutic intervention to relieve or managing premenstrual symptoms.

A pilot study of the impact of repeated blink refrainment on ocular surface temperature and the interblink period.

This study examines a potential stress test of repeated blink refrainment and its effects on the interblink period and the rate of evaporative ocular surface cooling. Such a test could aid in the study of computer vision syndrome, in which screen users unconsciously delay blinking, leading to onset of symptoms. This study aimed to examine the relationship between the length of the maximum achievable interblink time and the rate of ocular surface cooling under stress test conditions of repeated refrainment from blinking for as long as possible. Subjects acclimated to the examination room for 10 minutes before measurement and then were asked to hold the eyes open and refrain from blinking for as long as possible (the maximum blink interval), while ocular surface temperature was recorded using an infrared thermographic video camera. Subjects completed 20 trials with four successive blinks separating each trial. Fifteen subjects (8 female and 7 male subjects) completed the study. The grand mean ocular surface cooling rate was -0.027°C/s (range, -0.338 to +0.014°C/s). A faster ocular surface cooling rate was significantly related to an exponentially shorter maximum blink interval (p<0.001). An increasing number of trials was related to a clinically insignificant increase in the length of the maximum blink interval overall, and a post hoc analysis revealed subject subgroups for whom the stress test was effective or ineffective. The ocular surface evaporatively cools exponentially during periods of blink refrainment. With a subgroup of subjects with initially stable tear films and normal lipid layer thickness, cumulative tear film stress from repeated, longer-term blink refrainment could contribute to tear evaporation and symptoms of computer vision syndrome.

Prevalence of Anxiety Related Irritable Bowel Syndrome Symptoms Among Medical Students of Rawalpindi

Objective: The aim of the study was to find prevalence of Irritable Bowel Syndrome (IBS), compare its prevalence among male and female students and find association of IBS with anxiety among medical students of Rawalpindi. Study Design: Descriptive cross-sectional study Place and Duration of Study: It was conducted among the Medical Students of Army Medical College and Rawalpindi Medical University, Rawalpindi Pakistan, from Mar to May 2021. Methodology: A structured, self-administered questionnaire was distributed after obtaining consent. Systematic Random Sampling was done. Sample size was 363. Questionnaire consisted of two parts; IBS Questionnaire for healthcare professionals and Generalized Anxiety Disorder Questionnaire. Data analysis was done using SPSS 26. Results: All the questionnaires were inquired from the age group of 15 to 30 years. A total of 243 responses were collected from females and 120 from males. Analysis of the data revealed that 84 out of 363 respondents (23.1%) had probable IBS. There was a preponderance of females with IBS (26.7%) over males (15.8%). There was significant association of IBS with Gender. Out of 243 females, 37 had severe anxiety, 46 had moderate anxiety, 96 had mild anxiety and 64 had no anxiety. Six males had severe anxiety, 20 had moderate anxiety, 29 had mild anxiety and 65 had no anxiety. Overall prevalence of severe anxiety was 11.845%. 20.2% individuals with probable IBS had severe anxiety. Data analysis revealed (p&lt;0.05) implying that the association of IBS with anxiety is highly significant. Conclusions: The overall prevalence of Probable IBS was found to be 23.1%. A significant association was found between IBS and gender as well as IBS and anxiety levels. The problem can be addressed by managing the stress levels among medical students.

Metastatic pituitary lesion

Metastatic lesion of pituitary is a rare condition and is diagnosed in 1.8-4% of cases. Monitoring and treatment of such patients is a complex task and requires increased attention from a multidisciplinary team of specialists. The authors represent three patients with metastatic pituitary lesion who underwent neurosurgical treatment at the National Research Center of the National Research Institute of Endocrinology with subsequent pathomorphological confirmation of the diagnosis. The primary tumors were breast cancer, lung carcinoid, and clear cell kidney cancer. Two patients had distant metastases other than the pituitary gland. The clinical manifestation consisted in the appearance of symptoms of panhypopituitarism, chiasmal syndrome and mass effect in all cases. The follow-up period after surgical treatment was 0.25-2.5 years. Progression of the underlying disease was noted in two patients. One of them carried out stereotactic radiosurgical treatment and stereotactic oriented irradiation. One patient has a stable condition.