Frequency Of Symptoms Research Articles

Long-read sequencing solves complex structure of CYP21A2 in a large 21-hydroxylase deficiency cohort.

Genetic testing for 21-hydroxylase deficiency (21-OHD) is always challenging. Current approaches, short-read sequencing and multiplex ligation-dependent probe amplification (MLPA), are insufficient for the detection of chimeric genes or complicated variants from multiple copies. Recently developed long-read sequencing (LRS) can solve this problem. To investigate the clinical utility of LRS in precision diagnosis of 21-hydroxylase deficiency. In the cohort of 832 patients with 21-OHD, the current approaches provided the precise molecular diagnosis for 81.7% (680/832) of cases. LRS was performed to solve the remaining 144 cases with complex chimeric variants and eight cases with variants from multiple copies. Clinical manifestations in patients with continuous deletions of CYP21A2 extending to TNXB (namely CAH-X) were further evaluated. Using LRS in combination with previous genetic test results, a total of 16.9% (281/1664) CYP21A1P/CYP21A2 or TNXA/TNXB chimeric alleles were identified in 832 patients, with CYP21A1P/CYP21A2 accounting for 10.4% and TNXA/TNXB for 6.5%. The top three common chimeras were CYP21 CH-1, TNX CH-1 and TNX CH-2, accounting for 77.2% (217/281) of all chimeric alleles. The eight patients with variants on multiple copies of CYP21A2 were accurately identified with LRS. The prevalence of CAH-X in our cohort was 12.1%, and a high frequency of connective tissue-related symptoms was observed in CAH-X patients. LRS can detect all types of CYP21A2 variants, including complex chimeras and pathogenic variants on multiple copies in patients with 21-OHD, which could be utilized as a first-tier routine test for the precision diagnosis and categorization of congenital adrenal hyperplasia.

Developing the EPI Symptom Questionnaire (EPI-SQ): a qualitative study to understand the symptom experience of patients with exocrine pancreatic insufficiency (EPI)

BackgroundSymptom assessment is the key factor in determining disease status and optimal management of exocrine pancreatic insufficiency (EPI). There is a need for a standardized patient-reported outcome (PRO) questionnaire to assess symptoms in patients diagnosed with EPI. The purpose of this qualitative study was to increase understanding of the EPI symptom experience from the patients’ perspective, and to develop and evaluate the content validity of the EPI Symptom Questionnaire (EPI-SQ) in US patients with EPI.MethodsConcept elicitation interviews (Phase I) were conducted to understand the symptom experience in patients with a clinical diagnosis of EPI (i.e., fecal pancreatic elastase value of ≤ 200 mcg/g based on most recent value) due to chronic pancreatitis or pancreatectomy. The EPI-SQ was developed based on the data extracted from Phase I interviews and feedback from clinical experts. Next, separate cognitive interviews (Phase II) were conducted to evaluate participants’ understanding of the instructions, items, response scales, and recall periods of the instrument.ResultsDuring Phase I interviews (n = 21), 19 participants (90%) reported abdominal pain as the most frequent EPI symptom and lifestyle changes were the most frequently endorsed impacts (n = 18; 86%). Phase II results indicated that all participants (n = 7) felt the 12-item EPI-SQ was relevant to their symptom experience and that they understood the items, instructions, and response options as intended.ConclusionThe qualitative data from this study support the content validity of the EPI-SQ in measuring EPI symptom severity in US patient populations diagnosed with EPI.

Von Willebrand disease.

von Willebrand disease (VWD) is the most common inherited bleeding disorder. The disorder is characterized by excessive mucocutaneous bleeding. The most common bleeding manifestations of this condition include nosebleeds, bruising, bleeding from minor wounds, menorrhagia or postpartum bleeding in women as well as bleeding after surgery. Other less frequent symptoms include gastrointestinal bleeding, haematomas or haemarthroses. VWD pathophysiology is complex and results from defects in von Willebrand factor (VWF) glycoprotein. Quantitative deficiencies are responsible for type 1 VWD with a partial decrease of VWF and type 3 with the complete absence of VWF. Qualitative abnormalities cause type 2 VWD, being further divided into types 2A, 2B, 2M and 2N. Although common, VWD is at risk of misdiagnosis, overdiagnosis and underdiagnosis owing to several factors, including complex diagnosis, variability of bleeding symptoms, presence of external variables (blood groups and other physiological modifiers such as exercise, thyroid hormones, oestrogens, and ageing), and lack of disease awareness among non-specialist health-care providers. Establishing the correct VWD diagnosis requires an array of specialized phenotypic assays and/or molecular genetic testing of the VWF gene. The management of bleeding includes increasing endogenous VWF levels with desmopressin or infusion of exogenous VWF concentrates (plasma-derived or recombinant). Fibrinolytic inhibitors, topical haemostatic agents and hormonal therapies are used as effective adjunctive measures.

Mepolizumab in Severe Pediatric Asthma: Certainties and Doubts through a Single-Center Experience and Review of the Literature.

Although, in most children with asthma, good symptom control is achieved with a low to moderate dose of inhaled corticosteroids, a small group of patients still experiences frequent symptoms, and even severe exacerbations, impairment of lung function, and reduced quality of life. Some of these subjects with severe asthma require biologic drugs as add-on therapy. In the past decade, numerous monoclonal antibodies have been approved for children or adolescents with severe asthma, in addition to their increasing use in adult asthma. However, the available evidence on how to select the most appropriate biologic based on a single patient's clinical, functional, and laboratory characteristics is still scant, and is insufficient to guide clinicians in the decision-making process of a personalized treatment. We report a case series of four patients with severe eosinophilic asthma treated with mepolizumab, an anti-interleukin-5 monoclonal antibody, and review the existing literature on this treatment in children and adolescents. Our patients, all with blood eosinophilia and elevated fractional exhaled nitric oxide levels, developed poor symptom control despite prolonged treatment with high-dose inhaled corticosteroids plus a second controller, addressing the addition of a biologic drug. In all of them, a 12-month treatment with subcutaneous mepolizumab showed a reduction in the blood eosinophil count and in asthma exacerbations, as well as an improvement on the Asthma Control Test. The results of the literature search focused on the strengths and limitations of the pediatric use of mepolizumab and highlighted the areas worthy of further research. Mepolizumab has proven effective in improving symptom control in pediatric patients with severe asthma. Additional well-powered clinical trials will be helpful in developing evidence-based guidelines regarding biologic drugs in the pediatric population.

Secondhand cannabis smoke exposure and respiratory symptoms among adults living in a state with legalized medical cannabis with limited smoke-free protections

BackgroundLittle is known about the demographic and health correlates of secondhand cannabis smoke (SHCS) exposure, despite increased availability and use of cannabis across the U.S. This study examined the prevalence and correlates of SHCS exposure in a sample of N=5,410 adults living in Oklahoma and the association of SHCS exposure with self-reported respiratory problems. MethodsData were from a repeated cross-sectional online survey of adults ages 18 and older who completed measurements of past 30-day SHCS exposure in the respondent’s home, in a vehicle, and/or in an indoor setting; harm perceptions of SHCS exposure; frequency of current respiratory symptoms; past 30-day use of cannabis, alcohol, and cigarettes ResultsAlmost half (42 %) reported past 30-day SHCS exposure. In bivariate tests, those exposed were male, younger, non-Hispanic (NH) black or Hispanic, reported lower educational and financial attainment, had lower harm perceptions of SHCS exposure, endorsed more respiratory symptoms, and reported past 30-day cannabis and cigarette use (all p’s < 0.01). In an adjusted regression model, young adulthood (ages 18–24), NH black race (vs NH White), and past 30-day cigarette smoking and cannabis use emerged as the strongest correlates of SHCS exposure. In interaction models, respiratory symptoms were highest among those reporting past 30-day SHCS exposure and past 30-day cannabis use. ConclusionSHCS exposure is common and associated with more frequent respiratory symptoms, particularly among cannabis users. Those exposed were more socially and economically vulnerable.

Spatiotemporal Progression Patterns of Dopamine Availability and Deep Gray Matter Volume in Parkinson Disease-Related Cognitive Impairment.

Cognitive impairment is a frequent nonmotor symptom in patients with Parkinson disease (PD), and early cognitive decline is often attributed to dopaminergic system dysfunction. We aimed to explore spatiotemporal progression patterns of striatal dopamine availability and regional brain volume based on cognitive status among patients with PD. This retrospective, cross-sectional study included patients with newly diagnosed PD who were not taking medication for this condition who visited a university-affiliated hospital in Seoul between January 2018 and December 2020. Patients were classified as having normal cognition (PD-NC), mild cognitive impairment (PD-MCI), or PD dementia (PDD) based on Seoul Neuropsychological Screening Battery-II, which includes 31 subsets covering activities of daily living and 5 cognitive domains. They all had brain imaging with MRI and PET with 18F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane at baseline. Subsequently, standardized uptake value ratios (SUVRs) for regional dopamine availability and regional gray matter volumes were obtained using automated segmentation. These metrics were compared across cognitive status groups, and spatiotemporal progression patterns were analyzed using the Subtype and Stage Inference machine learning technique. Among 168 patients (mean age, 73.3 ± 6.1 years; 81 [48.2%] women), 65 had PD-NC, 65 had PD-MCI, and 38 had PDD. Patients with PD-MCI exhibited lower SUVRs (3.61 ± 1.31, p < 0.001) in the caudate than patients with PD-NC (4.43 ± 1.21) but higher SUVRs than patients with PDD (2.39 ± 1.06). Patients with PD-NC had higher thalamic SUVRs (1.55 ± 0.16, p < 0.001) than patients with both PD-MCI (1.45 ± 0.16) and PDD (1.38 ± 0.19). Regional deep gray matter volumes of the caudate (p = 0.015), putamen (p = 0.012), globus pallidus (p < 0.001), thalamus (p < 0.001), hippocampus (p < 0.001), and amygdala (p < 0.001) were more reduced in patients with PD-MCI or PDD than in patients with PD-NC, and the SUVR of the caudate correlated with caudate volume (r = 0.187, p = 0.015). Hippocampal atrophy was the initial change influencing cognitive impairment. The reduced dopamine availability of the thalamus preceded reductions in volume across most deep gray matter regions. Our finding underscores the association between decreased dopamine availability and volume of the caudate and thalamus with cognitive dysfunction in PD. The dopamine availability of the caudate and thalamus was reduced before the volume of the caudate and thalamus was decreased, highlighting the spatiotemporal association between dopaminergic and structural pathology in cognitive impairment in PD.

Psychometric properties of the KCCQ-12 in an european cohort of patients with heart failure

Abstract Background Despite medical advances, patients with heart failure continue to suffer from poor quality of life due to worsening symptoms and functional limitations. Therefore, it is important to understand the multidimensional facets of quality of life in these patients. The Kansas City Cardiomyopathy Questionnaire is a commonly used quality of life assessment tool worldwide. However, However, there is still a lack of knowledge about its psychometric properties. Purpose The aim of this study was to investigate the psychometric properties of the KCCQ-12 and its measurement invariance in a cohort of European patients with heart failure. Methods Participants (n=510, median age=72, IQR=18, 58% males) completed the KCCQ-12 alongside measures of clinical psychosocial severity. A confirmatory factor analysis was used to establish factorial validity; internal consistency was determined using the Omega coefficient and the model-based internal consistency coefficient. Zero-order correlations between the KCCQ-12 scores and clinical and psychosocial measures were performed to test convergent validity. Multigroup confirmatory factor analysis was conducted to test measurement invariance across patients with preserved vs reduced ejection fraction. Results Confirmatory factor analysis confirmed a four-factor solution, with the domains of physical limitations, symptom frequency, quality of life, and social interference. Internal consistency was excellent (Omega coefficients ranging from 0.83 and 0.90, and internal consistency index of 0.94). The KCCQ-12 scores significantly correlated with ejection fraction, New York Heart Association class, quality of life, anxiety, depression, symptom burden, and the KCCQ-23 Overall Summary score, which adequately supported the convergent validity of the KCCQ-12. Measurement invariance was confirmed at the partial scalar and strict level. Conclusions These findings support the validity and reliability of the KCCQ-12, both in patients with reduced and preserved ejection fraction. Hence, this version can be confidently used both in research and clinical practice to measure quality of life of heart failure patients.

The Efficacy of the Herbal Formula of Bunium persicum and Coriandrum sativum on Clinical Symptoms of Patients with Functional Dyspepsia: A Double-Blind Randomized Controlled Trial

Introduction: Functional dyspepsia (FD) is one of the most prevalent chronic disorders affecting up to 30% of the world population with considerable impairment of quality of life. This study evaluated the efficacy of the herbal preparation of Bunium persicum (Boiss.) B.Fedtsch. and Coriandrum sativum L. on symptom severity, symptom frequency, and quality of life of patients with FD. Methods: This double-blind randomized controlled clinical trial, with parallel groups allocation ratio of 1:1, was conducted in a referral clinic of Afzalipour Hospital affiliated with Kerman University of Medical Sciences in Kerman, southeastern Iran. A total of 90 patients with FD (diagnosed based on the Rome IV criteria) were included in this study. The patients with complications during the intervention, pregnancy or lactation, a history of allergy to herbal drugs, use of other medication that affect the symptoms of FD during the study, and severe organic or psychiatric disorders were excluded. The participants received one capsule containing 500 mg of herbal preparation or placebo twice a day for 4 weeks and were subsequently followed up for 4 more weeks. Clinical outcomes were assessed via the Dyspepsia Severity Questionnaire, the Rome IV Diagnostic Questionnaire, and Nepean Dyspepsia Index Questionnaire. Results: A total 40 participants in each group completed the follow-up period, and their data were analyzed statistically. All clinical outcomes showed significant improvements by herbal preparation compared to the placebo without serious side effects (p < 0.05). Conclusions: This herbal preparation can significantly improve the quality of life, and symptoms of FD compared to placebo.

Xerostomia in patients with heart failure - prevalence, intensity and reported strategies of symptom reduction

Abstract Background Xerostomia is a common symptom in patients with chronic heart failure (CHF), with a reported prevalence rate of up to 62%. It is defined as the perception of oral dryness, along with swallowing difficulties, oral burning, and altered taste. Despite being a widespread symptom, xerostomia is insufficiently studied CHF patients from german-speaking countries. Purpose The purpose of this study was to assess the prevalence, perceived intensity, and severity of xerostomia in German CHF patients. Additionally, patients´ reported strategies of symptom reduction were investigated. Methods Multi-center, cross-sectional study. Patients with a confirmed diagnosis of heart failure were recruited during visits to heart failure outpatient clinics or while hospitalized for any reason. If they consented to participate, they received a self-administered questionnaire containing questions about xerostomia, perceived distress and severity of xerostomia, and patients' measures to reduce xerostomia. Disease-related data were extracted from the patients' medical records. Perceived intensity of mouth dryness was measured using a visual analog scale (VAS) with 0 for "little dry" and 100 for "maximum imaginable dryness." To assess the severity of xerostomia, the short version of the xerostomia inventory (XI) was used with 5 items inquiring about the frequency of specific xerostomia symptoms. Sumscores of the XI ranged from 5 to 15, with higher scores indicating a higher severity of xerostomia. Measures to reduce dry mouth could be stated in patients' own words. Results Overall, 371 patients with a mean age of 62.4 (± 14.9) took part in this study. Most patients (230; 62%) had CHF with reduced ejection fraction. The main aetiology for heart failure was ischemic heart disease (118; 31.8%), followed by dilated cardiomyopathy (116; 31.3%). Out of 371 patients, 361 answered the question of whether they had suffered from dry mouth in the last three days. The prevalence rate of xerostomia was 65% (n=234) (95% CI: 60%; 70%). Perceived intensity of mouth dryness, using VAS, was 55.5 (± 22.3). The median severity score of the XI was 9 (Interquartile-Range: 8;11). Patients mostly experienced dry mouth in the morning and at night. The most frequently mentioned measures against dry mouth were drinking something (water, juice, coffee, tea, buttermilk), rinsing or moistening the mouth, sucking candies (sugar-free candies, peppermint, lemon, menthol), eating fruits, and using chewing gums. Conclusion Xerostomia is a widespread symptom in German heart failure patients, affecting more than half of the patients included in the study. The intensity and degree of severity appear to be in a medium range. CHF patients used various interventions to relieve the burden of xerostomia. These measures should be further investigated for their effectiveness.

Clinical Characteristics and Visual Prognosis of Idiopathic Intracranial Hypertension in Korea: A Single-center Experience

Purpose: To examine the clinical characteristics, demographic features, and visual prognosis of idiopathic intracranial hypertension (IIH) in Korean patients.Methods: We conducted a retrospective chart review of patients diagnosed with IIH who visited the Neuro-ophthalmology Clinic at Samsung Medical Center from September 2011 to January 2023. This analysis focused on demographic characteristics at onset, clinical manifestations, and visual outcomes at the last follow-up.Results: Out of 34 patients, 20 met the modified Dandy criteria and 14 were presumed to have IIH. The mean age at onset was 32.97 ± 9.6 years with females comprising 85.3% (n = 29) of the sample. The average body mass index (BMI) was 29.15 ± 6.43, with 47.0% of patients (n = 16) classified as obese. The most frequent symptom was headache, reported by 85.3% (n = 29) of patients, followed by pulsatile tinnitus (64.7%, n = 22) and transient visual obscuration (TVO; 32.4%, n = 11). Treatment included observation for 3 patients (8.8%), acetazolamide therapy for 26 patients (76.5%), and ventriculo-peritoneal shunt (V-P shunt) for 2 patients (5.9%). Out of 23 patients with follow-up &gt; 6 months, 87.0%, 8.7%, and 4.3% showed good, fair, and poor visual outcomes, respectively; optic nerve atrophy was observed in 19.6% (9 eyes). The initial peripapillary retinal nerve fiber layer (pRNFL) thickness measured by OCT was 143.56 ± 62.41 μm in the right eye and 139.3 ± 76.38 μm in the left which decreased to 97.39 ± 25.72 and 94.91 ± 19.32 μm, respectively by the last examination.Conclusions: While the proportion of obese patients in this Korean cohort and the average BMI were lower than in western countries, both have increased relative to previous reports from Korea. Most patients experienced a benign course.

Immediate Effects of Mindful Awareness in Body-oriented Therapy as an Adjunct to Medication for Opioid Use Disorder.

While effective, medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. This study examined the pre-post effects of the mindfulness-based intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. People stabilized on medication for OUD (N = 303) from 6 community clinics in Northwestern United States were recruited and randomly assigned to MABT plus MOUD or MOUD only. In a mixed-methods study, we used an intent-to-treat approach to examine the proportion of days abstinent from non-prescribed opioids, and other substance use (primary outcomes) at baseline and 3 months post-intervention. Secondary outcomes included symptoms of mental health distress; emotional regulation difficulties; pain and physical symptom indicators; interoceptive awareness and mindfulness skills. Participant experience of MABT was collected through post-intervention surveys. Changes in outcomes were assessed using linear mixed models; content analysis was used to analyze the qualitative data. Levels of overall substance use were low and did not differ between groups. Significant improvements in PTSD symptoms, interoceptive awareness, pain severity, pain activity interference, and physical symptom frequency were found for those who received MABT compared to MOUD only. In this stable MOUD population, substance use outcomes were not improved, however MABT demonstrated significant positive changes across multiple health outcomes critical for improving MOUD treatment. Clinical Trials Registration: NCT04082637 on 9/3/2019.

School modality, race and ethnicity, and mental health of U.S. adolescents during the COVID-19 pandemic

BackgroundWhile minoritized ethnoracial groups were most likely to be in online learning during the COVID-19 pandemic, the impact of these ethnoracial disparities on adolescent mental health is unclear. Since past studies do not directly examine whether the association between school modality and self-reported mental health outcomes varied by race and ethnicity among U.S. adolescents during the COVID-19 pandemic, this study addresses the gap.MethodsAdolescents aged 13 to 17 years old (n = 510) were surveyed for self-reports of anxiety and depression symptoms using the 4-item Patient Health Questionnaire during Spring 2021. Seemingly unrelated regressions were used to estimate the differential association between school modality and mental health by respondents’ race and ethnicity.ResultsEstimates without interaction between school modality and race and ethnicity suggested that Latino respondents reported a significantly higher frequency of depressive symptoms than their White counterparts (b = 0.459; p < 0.05). Similarly, the estimates without the interaction suggested respondents reporting hybrid learning had a higher frequency of depressive symptoms than in-person learning (b = 0.504; p < 0.05). Estimates with interaction between school modality and race and ethnicity suggested fully online learning was associated with poorer mental health only among White respondents and better mental health among Black respondents. Among adolescents attending school fully online, Black adolescents reported fewer mental health symptoms than their White counterparts (anxiety, b =– 1.364; p < 0.05, and depression, b =– 1.647; p < 0.05).ConclusionsFully online learning may have benefitted the mental health of Black adolescents during the COVID-19 pandemic, perhaps because it buffered racial discrimination and social anxiety in schools. Additional interventions should be explored to promote in-person school environments that better support the mental health of Black adolescents. Moreover, prioritizing equitable access to broadband internet will provide better access to online learning and ensure positive mental health, particularly for adolescents from minoritized ethnoracial groups during instances of future pandemics. Future research should continue to consider the race and ethnicity of adolescents to promote mental well-being in schools across learning modalities.

Stable Response and Sustained Improvement of Itch and Sleep Symptoms in Patients with Atopic Dermatitis Treated with Lebrikizumab over 52 Weeks.

Lebrikizumab demonstrated significant improvement versus placebo for measures of skin clearance and patient-reported outcomes at weeks 16 and 52 in patients with moderate-to-severe atopic dermatitis (AD). We report the sustained impact of lebrikizumab monotherapy, over 52 weeks and between visits, on the frequency of itch and sleep loss symptoms, as assessed by Patient-Oriented Eczema Measure (POEM), in patients with moderate-to-severe AD. In ADvocate1 and ADvocate2, Week-16 lebrikizumab responders (EASI75 or IGA 0/1 with ≥ 2-point improvement and without rescue medication) were randomized to lebrikizumab every 2 weeks (Q2W), every 4 weeks (Q4W), or placebo for 36 weeks. This pooled analysis reports improvement from Week 16 to 52 in patients achieving POEM response 0 (no days) or 1 (1-2 days) for Items 1 (itch) and 2 (sleep disturbance) for the lebrikizumab Q2W and Q4W treatment arms. Observed (excluding data collected after treatment discontinuation, rescue medication use, or patient transfer to escape arm) results were reported. At Week 16, for lebrikizumab Q2W and Q4W, 35.9% (n = 37/103) and 39.3% (n = 42/107) of patients responded 0 or 1 to Item 1 of POEM (Itch) and 12.6% (n = 13/103) and 12.1% (n = 13/107) responded 0. A total of 66.0% (n = 68/103) and 72.6% (n = 77/106) of patients responded 0 or 1 to Item 2 of POEM (Sleep) and 37.9% (n = 39/103) and 44.3% (n = 47/106) responded 0, respectively. By Week 52, for lebrikizumab Q2W and Q4W, 44.6% (n = 29/65) and 48.0% (n = 36/75) responded 0 or 1 to Item 1 of POEM (Itch), and 21.5% (n = 14/65) and 18.7% (n = 14/75) of patients responded 0. A total of 83.1% (n = 54/65) and 78.4% (n = 58/74) responded 0 or 1 to Item 2 of POEM (Sleep), and 67.7% (n = 44/65) and 59.5% (n = 44/74) responded 0, respectively. Weekly POEM responses for itch and sleep disturbance remained stable between doses and visits, and continued to improve from Week 16 through 52, in lebrikizumab-treated patients, demonstrating consistent improvement over time for key AD symptoms. ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967).

Prevalence and Correlates of Psychiatric Symptoms Among Medical Students in Punjab: A Comprehensive Cross-Sectional Study

Background: Pain is evident, pressure, hopelessness and anxiety-is equally well-known to students with each passing academic semester in medical school. To understand the frequency and reasons of mental symptoms in MBBS students, the current study aims at investigating the level of MBBS students at several medical colleges in Punjab, Pakistan. Objective: To compare the results of stress, depressive, and anxious symptoms of several numbers of medical students studying in different medical colleges in Punjab and secondly, to evaluate the role of several demographics on these mental health indicators. Methods: The cross-sectional survey was completed between September 2023 to May 2024 with 350 medical students from multiple private and government medical colleges in Punjab. A cross-sectional survey was carried out including the Depression Anxiety Stress Scale-21 (DASS-21) as the research tool and the data aspires to be statistically analyzed. Results: the results indicated that the percentage of the medical students who reported to be stressed, sad, or anxious was 47.3%, 55.7%, and 61.4%, respectively. Female students also claimed higher levels of depression compared to male students 58.3% vs. 50. 1%, (p ≤0.01) and higher levels of anxiety 65.2% vs. 55.1%, (p ≤0.03). Students in rural locations reported greater levels of stress (52.6% vs. 43.2%, p ≤0.04) than urban ones. Conclusion: The study linked high levels of mental symptoms among medical students in Punjab to characteristics such as being a female student or originating from a rural area. The current study emphasizes the necessity of targeted programs and activities in the areas of mental health promotion and preventive measures among medical college students.

Functional seizures and binge eating disorder: A cross-sectional study

ObjectiveFunctional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation’s link to binge eating, and to explore psychological characteristics of FS individuals. MethodParticipants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders. ResultsWe found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet ’Perseveration’ predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people. DiscussionThis study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.

The Association Between Autism Symptomatology and Adaptive Functioning Over Six Months: Findings from the Pilot Phase of the PARC Study.

In the context of developmental trajectories, the association between adaptive functioning and core autism symptomatology remains unclear. The current study examines the associations of adaptive behavior with autism symptom sub-domains and with different facets of symptom expression. Participants include 36 children with a recent diagnosis of autism (33 males; mean age = 56.4 months; SD = 9 months). Families were recruited in the context of the Pediatric Autism Research Cohort (PARC) project. Parents filled out questionnaires at two time points, six months apart, regarding their child's autism symptoms and adaptive functioning. The longitudinal relationship between adaptive functioning and autism symptoms was investigated using Mixed Linear Model analyses: one assessing the relationship between general symptom levels and adaptive functioning, and another examining the associations between symptom frequency and impact with adaptive functioning. We conducted Pearson correlation tests at both time points to assess the associations between symptom sub-domains and adaptive functioning. Findings showed that higher autism symptoms associated with lower adaptive behavior skills, and that this association remained stable over time. Autism impact scores did not significantly relate to adaptive skills, as opposed to frequency scores. Associations between adaptive functioning and autism symptom sub-domains strengthened over time. These findings suggest that adaptive functioning is associated with parent-report autism symptomatology, and that this association changes and, on average, becomes stronger over time. Findings may indicate that frequency and impact of symptoms have differential roles in the development of adaptive skills and are worthy of further exploration.

Development and Effectiveness of a Pattern Management Educational Program Using Continuous Glucose Monitoring for Type 2 Diabetic Patients in Korea: A Quasi-Experimental Study.

The prevalence of diabetes has increased worldwide. Therefore, interest in improving glycemic control for diabetes has grown, and continuous glucose monitoring (CGM) has recently received attention as an effective glycemic control method. This study developed and evaluated the effectiveness of an education program for pattern management using CGM based on Whittemore and Roy's middle-range theory of adapting to diabetes mellitus. A quasi-experimental study was conducted on 50 adult patients with type 2 diabetes who visited the outpatient clinic of a university hospital. The experimental group was treated with a pattern management program using CGM for 12 weeks and six personalized education sessions were provided to the patients through face-to-face education and phone monitoring. The frequency of diabetes-related symptoms in the experimental group decreased, and social support (t = 2.95, p = 0.005), perceived benefits (t = 3.72, p < 0.001) and self-care significantly increased (t = 6.09, p < 0.001). Additionally, the program was found to be effective in improving HbA1c (t = -3.83, p < 0.001), FBS (t = -2.14, p = 0.038), and HDL-C (t = 2.39, p = 0.021). The educational program developed through this study can be implemented as a self-management approach for individuals with type 2 diabetes using CGM, aimed at enhancing glycemic control and preventing complications.

LIFESTYLE AND BEHAVIOR, NUTRITIONAL STATUS, AND DEPRESSION SYMPTOMS IN RELATION TO THE ACADEMIC ACHIEVEMENT OF JUNIOR AND SENIOR HIGH SCHOOL STUDENTS

This study investigated the relationship between lifestyle and behavior, nutritional status, depression symptoms, and academic achievement of junior and senior high school students in selected secondary schools in the Division of Malaybalay City. The descriptive-correlational research design was employed. Data were gathered from 580 students chosen using total random sampling and were analyzed using descriptive statistics such as mean, frequency counts and percentage, Pearson-product moment correlation, and multiple linear regression. The findings revealed that in lifestyle and behavior, students’ physical activity involved 3 to 4 times of physical exercise per week. Their sleep patterns showed that they felt sleepy only 1 to 2 times weekly during their activities. Their screen time usage averaged 2 to 3 hours for different electronics, with mobile phones or smartphones more often used at over 3 hours. Moreover, the students’ nutritional status through their dietary behavior in terms of food choice revealed that they often put importance on choosing their foods. The diversity of their daily diet included vegetables, starches (e.g., rice and rice products) and meat/fish often, and fruits, milk, fats, sugar and beverage occasionally. The students’ anthropometric measurements had an average weight of 95.90 lbs. and an average height of 178.65 cm. The depression symptoms experienced by the students were borderline to moderate depression levels. The study also found that the students’ academic achievement was very satisfactory. Furthermore, correlation and regression analyses showed that the variables, sleep patterns and depression symptoms, negatively and significantly impact students’ academic achievement. Therefore, less frequency of daytime sleepiness and fewer depression symptoms could increase academic performance. Hence, these findings have implications for students’ academic success and well-being, especially in improving their sleep quality and supporting effective interventions for depression. KEYWORDS: Lifestyle and behavior, nutritional status, depression symptoms, academic achievement

Respiratory syncytial virus infection in children during SARS-CoV-2 pandemic at a referral center in Rio de Janeiro, Brazil.

In order to study the scenario of respiratory infections in pediatrics after the emergence of SARS-CoV-2 in Brazil, this study aimed to compare characteristics of children admitted for SARS or upper airway infection caused by either RSV or SARS-CoV-2. This was a cross-sectional study involving children up to 48 months of age admitted to a tertiary pediatric hospital with a diagnosis of SARS or upper airway infection between April of 2020 and April of 2021. Respiratory secretion samples were collected 2-5 days after hospitalization, and antigen/PCR tests for viral etiologies were performed. In this analysis, patients with laboratorial diagnosis of SARS-CoV-2 and/or RSV were selected, and their clinical and epidemiological characteristics were compared using logistic regression. Our sample initially comprised 369 participants. SARS-CoV-2 and RSV infections were confirmed in 55 (15%) and 59 children (16%), respectively. Mean age was 12 months (0-48 months), and 47 were female. The following characteristics were significantly more frequent in patients with RSV when compared with those with COVID-19: younger age (OR = 0.94; 95% CI: 0.90-0.98); lower frequency of fever (OR = 0.18; 95% CI: 0.05-0.66); and more frequent upper airway symptoms: cough (OR = 7.36; 95% CI: 1.04-52.25); and tachypnea (OR = 6.06; 95% CI: 1.31-28.0). Children with RSV-related SARS were younger, had lower frequency of fever at admission, but had a higher frequency of signs of upper airway infection and lower systemic inflammation when compared with children hospitalized for COVID-19 during the first year of the pandemic.

Therapeutic Efficacy of Spirulina Algae and N-Acetylcysteine in COVID-19 Hospitalized Patients: A Randomized Phase II Clinical Trial

Background: Spirulina algae are widely used in food, cosmetic, and dietary applications, and laboratory and clinical studies have reported their antiviral and immune-enhancing properties. Aim: We aimed to evaluate the prescription of spirulina, a safe food supplement with antiviral properties, and N-acetylcysteine in the treatment of hospitalized patients with Coronavirus Disease 2019 (COVID-19). Materials and Methods: This study was conducted as a multicenter, randomized, single-masked, open-label phase II clinical trial on 66 patients with COVID-19. Patients were randomly assigned to two intervention groups and one control group. The intervention groups were defined as follows: one group received spirulina algae (23 people), and the other group received N-acetylcysteine plus spirulina algae (21 people). In the control group (22 people), the patients only received the national standard treatment for COVID-19. The intervention groups were prescribed 80 mg/kg of spirulina green algae daily. Results: The duration of hospitalization (P = 0.874), Intensive Care Unit (ICU) admission (P = 0.320), and mortality (P = 0.320) of patients between the three groups did not show any significant difference. Side effects, including headache (P = 0.022) and nausea (P = 0.039), were significantly less common in the control group. No statistically significant difference was observed regarding the frequency of symptoms after discharge in the three-month follow-up (P = 0.420). Conclusion: Our study showed that administering spirulina with or without N-acetylcysteine did not affect the length of hospitalization, ICU admission, mortality, and the frequency of symptoms or long COVID.