Symptoms In Patients Research Articles

Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis.

One of the most disabling symptoms of patients with multiple sclerosis (MS) is spasticity which affects their quality of life. Nowadays, cannabinoids are used for spasticity control in patients with MS, while the efficacy and safety are not clearly understood. So, we designed this systematic review and meta-analysis to assess the efficacy of cannabinoids for controlling MS-related spasticity. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were systematically searched by two independent researchers on 1 May 2023. They also searched gray literature (references of included studies, as well as conference abstracts). A literature search revealed 6552 records, 95 full-texts were evaluated, and finally, 31 studies remained for systematic review. Among included studies, six randomized trials were included. Nabiximols was the most commonly used medication for controlling MS-related spasticity. Mean Expanded Disability Status Scale ranged between 4.6 and 7. Most studies (17 studies) were done in Italy, followed by Germany (4 studies). The pooled standardized mean difference (SMD) of NRS (Numeric Rating Scale) (after-before) is estimated as -1.41 (95% confidence interval (CI): -1.65, -1.17) (I2 = 97%, p < 0.001). The pooled standardized mean difference (SMD) of Ashworth (after-before) is estimated as -0.39 (95% CI: -0.72, -0.06) (I2 = 69.9%, p = 0.005). The results of this systematic review and meta-analysis showed that nabiximols was the most common cannabinoid which was used to control MS-related spasticity, and it was effective in controlling MS-related spasticity (significantly decreased SMD of NRS, and Ashworth after treatment).

Improvements in Sleep Quality in Patients With Major Depressive and Generalized Anxiety Disorders Treated With Individualized, Parcel-Guided Transcranial Magnetic Stimulation.

Poor quality sleep has often been cited as a cause of lowered quality of life in patients with affective disorders such as major depressive disorder (MDD) and generalized anxiety disorder (GAD). As sleep and affective disorders are affected by multi-network interactions, we hypothesize that the modulation of the central executive network (CEN), salience, and default mode networks (DMNs) through individualized repetitive transcranial magnetic stimulation (rTMS) may improve sleep and quality of life. A retrospective analysis from 2020 to 2023 was conducted in patients with affective disorders at Cingulum Health. Multiple targets were selected based on anomalies detected from individual, functional connectivity networks from a machine-learning connectivity software. rTMS was conducted with accelerated continuous or intermittent theta burst stimulation (TBS) based on the anomaly detected. Pittsburgh Sleep Quality Index (PSQI), EuroQol (EQ5D), Beck's Depression Inventory (BDI), and the General Anxiety Disorder-7 (GAD-7) questionnaires were administered prior to, after, and at follow-up of rTMS. Twenty-seven patients were identified, and the most common diagnoses were MDD (41%) or MDD with GAD (41%). All patients had at least one rTMS target in the CEN. The most common target (19 patients) was L8Av in the dorsolateral prefrontal cortex (dlPFC). Patients experienced significant improvements in sleep, quality of life, depressive, and anxiety symptoms after rTMS and during follow-up. Improvements in sleep correlated with quality of life at follow-up. This study suggests that personalized, parcel-guided rTMS is safe and may provide sustained improvements in sleep, quality of life, and affective symptoms for patients with affective disorders.

Identification of the mutations in BTD gene in Iranian patients with biotinidase deficiency and evaluating their genotype-phenotype correlations

BackgroundBiotinidase (BTD, encoded by the BTD gene) deficiency is an autosomal recessive neurometabolic disease caused by abnormal BTD activity in the biotin cycle. The clinical symptoms of patients, which are mainly neurocutaneous, range from mild to severe based on the enzyme activity level. This study aimed to identify BTD gene mutations in suspected BTD deficiency patients for the first time in the southwest of Iran and evaluate their genotype-phenotype correlations. Methods11 clinically and biochemically suspected patients from nine unrelated families and their available family members were subjected to Sanger sequencing. Segregation analysis was performed for novel mutation. The effect of each mutation on protein stability and hydropathicity, as well as the pathogenicity prediction of all detected mutations were assessed using various in silico analysis tools. ResultsSix mutations including a novel and five previously reported mutations were identified in patients with different ethnicities. Three out of five known mutations were reported for the first time in Iran. Various common clinical manifestations and a rarely reported coexistence of celiac disease in biotinidase deficiency patients were observed. The novel missense variant c.787G > A (p.Glu263Lys) was detected in exon 4 of the BTD gene, within the biotinidase-like domain of the BTD protein. This variation was found in two cousins of a family, both developed the same initial clinical presentation. In silico analysis revealed that this missense substitution decreased protein stability and increased protein hydrophilicity. Additionally, the known frameshift mutation c.1264delG (p.val422serfster59), was the most frequent allele in the studied population. We also predicted and visualized the effects of the novel and frameshift mutations on protein structure. ConclusionOur findings expanded the mutational spectrum of the BTD gene and provided valuable data on genotype-phenotype correlations, which helps in genetic counseling. Furthermore, the necessity of performing molecular analysis along with enzymatic analysis was highlighted by this study.

Evaluation of the Symptoms and Clinical Characteristics of Crohn's Disease and Ulcerative Colitis That Affect Healthcare Providers' Treatment Choices.

Treatment of inflammatory bowel disease-Crohn's disease (CD) and ulcerative colitis (UC)-is dependent on healthcare providers' (HCPs') clinical assessment of patient symptoms. We therefore evaluated which CD and UC symptoms impact HCPs' treatment choices and assessed the impact of those symptoms on treatment decision-making. We also examined the role of complete control (mucosal/histologic healing, clinical remission, no bowel urgency) in treatment decision-making, considerations for dose escalation or switching treatments, and HCPs' willingness to use the Urgency Numeric Rating Scale (NRS) to assess bowel urgency severity. We conducted an observational, cross-sectional, self-administered survey among HCPs (N = 459, across types/specialties) who work in direct patient care and treat patients with CD and UC in the United States. Data were collected from eligible participants between November 21, 2022, and December 6, 2022, and responses were summarized through descriptive statistics. For CD and UC, the symptoms of greatest importance when deciding on the course of treatment included cramping or abdominal pain, rectal bleeding, diarrhea, anemia, weight loss, and bowel urgency. Furthermore, most HCPs ranked rectal bleeding, clinical remission, abdominal pain, and complete control as "very" to "extremely" important in decisions about the course of treatment, dose escalation, or switching treatments. In total, 22.9% of HCPs indicated that they use the Urgency NRS, while 89.3% were at least somewhat willing to use it in the future. Our study provides real-world insights into the symptoms and clinical characteristics that most impact HCPs' treatment choices for CD and UC in clinical practice.

Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian spine outcomes and research network

Degenerative cervical myelopathy (DCM) is the most common cause of acquired non-traumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients. To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response. An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015-2022. We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year. Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ-5D) at 12 months post-surgery. A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 pre-operative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values. Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04 - 1.07), then symptom duration (OR 0.65; 95% CI 0.44-0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03 - 0.78), living independently (OR 2.17; 95% CI 1.22 - 3.85), symptom duration (OR 0.62; 95% CI 0.40 - 0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67 - 0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright x-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond. Our findings suggest patients with shorter symptom duration, higher baseline patient NDI, lower EQ-5D, younger age, living independently, without kyphosis on pre-operative x-ray, and fewer affected levels are more likely to respond to treatment. Timing of surgery with respect to patient symptoms is underscored as a crucial and modifiable patient factor associated with improved surgical outcomes in DCM.

Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting

BackgroundPatients with heart failure (HF) can experience a poor quality-of-life (QOL), recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) include integration of patients’ voices into clinical care, by assessing patient symptoms, function, and QOL. In 2022, PROMs were incorporated into the electronic health record system (Epic) at a large academic hospital in Toronto, Ontario, Canada. The purpose of this study was to use implementation-science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care. MethodsThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year, quality-improvement project. Data sources included the following: clinician use of PROMs; patient-level data on completed PROMs; and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF—symptom frequency, physical limitations, social limitations, and QOL. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using behaviour-change frameworks and latent content analysis. ResultsOver the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 80% of patients had high scores on the questionnaire. Clinicians experience barriers—related to attention and decision processes, the environmental context, and their professional role—to integrating PROMs into practice. Suggested changes to improve PROM uptake include adding language licenses for PROM translations, reducing cognitive load for clinicians who are assigning and interpreting PROMs in the Epic system, and championing modelling of use of PROMs in practice. ConclusionsThis study demonstrates the benefit of using implementation science frameworks, to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.

Swedish Translation and Cultural Adaptation of the Head and Neck Patient Symptom Checklist: An Instrument to Screen for Nutrition Impact Symptoms in Clinical Practice and Research.

The Head and Neck Patient Symptom Checklist (HNSC) is a validated 2-part instrument used to ask patients with head and neck cancer about the nutrition impact symptoms they experience (part 1) and how these interfere with their eating (part 2). The purpose of this work was to translate and culturally adapt the HNSC into Swedish in accordance with the guidelines of the International Society for Health Economics and Outcomes Research (ISPOR). The ISPOR guidelines include 10 steps, and these were thoroughly followed. In step 7, 9 health care professionals from the field of head and neck cancer assessed the perceived relevance (content validity) of each item in the HNSC, as well as the full HNSC. A total of 522 participants with head and neck cancer were included and followed up on 7 occasions using the HNSC to assess internal consistency. The HNSC was translated from English into Swedish, ensuring accuracy through forward and backward translation and harmonization in the research team. Content validity for each part of the HNSC was rated excellent (scale content validity index 0.96). Internal consistency demonstrated a good Cronbach's alpha score (>0.8) across the 7 follow-up time points (from baseline [before the start of treatment] and up to 24 months posttreatment). The HNSC has been successfully translated and culturally adapted into Swedish. The HNSC can be used in both clinical practice and research to screen for nutrition impact symptoms and symptoms that interfere with eating in patients with head and neck cancer. ClinicalTrials.gov NCT03343236 (date of registration: November 17, 2017).

A multi-center, randomized, double-blind, sham-stimulation controlled study of transcranial magnetic stimulation with precision navigation for the treatment of multiple system atrophy

BackgroundMultiple system atrophy (MSA) is recognized as an atypical Parkinsonian syndrome, distinguished by a more rapid progression than that observed in Parkinson’s disease. Unfortunately, the prognosis for MSA remains poor, with a notable absence of globally recognized effective treatments. Although preliminary studies suggest that transcranial magnetic stimulation (TMS) could potentially alleviate clinical symptoms in MSA patients, there is a significant gap in the literature regarding the optimal stimulation parameters. Furthermore, the field lacks consensus due to the paucity of robust, large-scale, multicenter trials.MethodsThis investigation is a multi-center, randomized, double-blind, sham-controlled trial. We aim to enroll 96 individuals diagnosed with MSA, categorized into Parkinsonian type (MSA-P) and cerebellar type (MSA-C) according to their predominant clinical features. Participants will be randomly allocated in a 1:1 ratio to either the TMS or sham stimulation group. Utilizing advanced navigation techniques, we will ensure precise targeting for the intervention, applying theta burst stimulation (TBS). To assess the efficacy of TBS on both motor and non-motor functions, a comprehensive evaluation will be conducted using internationally recognized clinical scales and gait analysis. To objectively assess changes in brain connectivity, functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) will be employed as sensitive indicators before and after the intervention.DiscussionThe primary aim of this study is to ascertain whether TBS can alleviate both motor and non-motor symptoms in patients with MSA. Additionally, a critical component of our research involves elucidating the underlying mechanisms through which TBS exerts its potential therapeutic effects.Ethics and disseminationAll study protocols have been reviewed and approved by the First Affiliated Medical Ethics Committee of the Air Force Military Medical University (KY20232118-F-1).Trial registrationChinese Clinical Trial Registry ChiCTR2300072658. Registered on 20 June 2023.

Acupuncture for Meige syndrome: A case report

IntroductionMeige syndrome (MS) is a cranial dystonia disorder characterized by blepharospasm and oromandibular dystonia. Current treatments include botulinum toxin therapy, oral medications, and surgical interventions. Here, we present a case that the patient's symptoms improved significantly after treatment with acupuncture. Case descriptionA 72-year-old woman came to our acupuncture clinic with eyelid twitching and jaw muscle tension. She described being diagnosed with MS two years ago due to the same symptoms, and her symptoms gradually worsened over the past six months. After 4 weeks of acupuncture treatment, the patient's MS symptoms improved significantly. ConclusionAcupuncture may be a potentially salvage treatment option for MS.

Implications of genetic attributions for addiction among addiction professionals

Given increasing emphasis on understanding the role of genes in the etiology of addictive disorders, the present study aimed to investigate the implications of genetic explanations of addiction for attitudes and beliefs about patients among addiction treatment providers. Participants were recruited from addiction-related professional organizations. The sample included professionals with medical backgrounds (n = 153) and with nonmedical backgrounds (n = 232). They viewed a description of a fictitious patient with either alcohol use disorder or gambling disorder, which was experimentally varied to indicate the presence or absence of a genetic cause. They completed measures of their genetic attributions for the patient's symptoms as well as their attitudes and beliefs about the patient. The presence of a genetic explanation increased genetic attribution ratings but did not significantly affect other measured variables. However, participants' genetic attributions for the patient's symptoms were associated with significantly lower ascriptions of blame to the patient and greater belief in the effectiveness of medication, but also with reduced confidence in the effectiveness of psychotherapy and with pessimism about the patient's prognosis. Geneticized, biomedical conceptualizations of addiction may have implications for treatment providers' attitudes toward patients.

Characterization of adult patients with a diagnosis of migraine and osmophobia: the osmograine study

IntroductionOsmophobia is associated with a greater intensity of the headache, a more significant presence of affective symptoms, and the appearance of cutaneous allodynia.ObjectivesTo determine the sociodemographic and clinical characteristics of patients with episodic and chronic migraine associated with osmophobia.MethodsA cross-sectional analytical observational study, 100 patients were included.Results65% of the patients presented osmophobia, 64.6% of patients with osmophobia had chronic migraine, and 35.4% had episodic migraine without statistically significant differences p=0.120. Regarding the clinical characteristics, pulsatile pain was the most frequent in 49%, and severe intensity was present in 81%. Statistically significantrelationships were found between osmophobia and photophobia [(95.4 vs 77.1]; p=0.005), phonophobia ([96.9 vs 74.3); p=0.001) and allodynia ([75.4 vs 45.7); p=0.002). The that become chronic factors were more frequent in the group with osmophobia, in which an association with the excessive use of analgesics ([43.8%vs. 22.9%]; p=0.029) and a history of anxiety and depression ([32.8% vs. 14.3%]; p=0.045). In the multivariate model, the variables associated with osmophobia with statistically significant differences were photophobia, allodynia, and botulinum toxin application.ConclusionsIn this first study of osmophobia in migraine in Colombia, osmophobia is a frequent symptom in patients with chronic migraine; it has related to markers of central sensitization; it is also related to that become chronic factors and the use of botulinum toxin. Therefore, it is likely that osmophobia can predict the risk of that factor, causing the disease to become chronic.

Smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: Data from the TeleCheck-AF project.

Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms. Patients scheduled for at least one teleconsultation during the 12-month follow-up after AF ablation were instructed to use a smartphone photoplethysmography (PPG)-based application for simultaneous symptom and rhythm monitoring 3-times daily for 1 week. Proxies of time spent with AF and/or symptoms (%-recordings, load, %-days), temporal aggregation of AF and/or symptoms (density), and symptom-rhythm correlation (SRC) were assessed. In total 484 patients (60% male, 62±9.9 years) were included. Adherence, motivation and patient satisfaction were high. %AF-recordings, AF load and %AF-days (rs= 0.88-0.95) and %symptom-recordings, symptom load, %symptom-days (rs= 0.95-0.98) showed positive correlations. The SRC correlated negatively with time spent with symptoms (rs=-0.65--0.90) and with time spent with AF (rs=-0.31--0.34). In patients with paroxysmal AF before ablation and AF during the monitoring period, 87% (n=39/44) had a low-density score <50% ("paroxysmal AF pattern") while 5% (n=2/44) had a high-density score >90% ("persistent AF pattern"). Corresponding numbers for patients with persistent AF before ablation were 48% (n=11/23) and 43% (n=10/23), respectively. On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and symptom-rhythm correlation, which may assist in assessing AF and symptom outcomes after AF ablation.

The prevalence of neuropsychiatric symptoms and correlation with MRI findings in CADASIL patients.

To assess the prevalence, timing, and functional impact of neuropsychiatric symptoms in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to assess whether these neuropsychiatric symptoms are associated with magnetic resonance imaging (MRI) features of the patients. Our study included a total of 78 patients with CADASIL. To assess neuropsychiatric symptoms, we evaluated the caregivers using the Neuropsychiatric Inventory (NPI). Patients were considered to have an irritability, depression, apathy, aggression, or anxiety disorder if they scored ≥1 in the NPI. Subsequently, we conducted a more detailed assessment of irritability, depression, apathy, aggression, and anxiety. Multivariate logistic regression was employed to analyze the relationships between neuropsychiatric symptoms and clinical/MRI features in the patients. Overall, 57.69% of patients with CADASIL experienced neuropsychiatric symptoms. Among these symptoms, irritability was the most prevalent (52.56%), followed by depression (19.23%), apathy (17.95%), aggression (7.69%), and anxiety (6.41%). The mean age of onset for irritability was the youngest, followed by anxiety, apathy, aggression, and depression. Among patients with both stroke/TIA and neuropsychiatric symptoms, 31.03% reported experiencing neuropsychiatric symptoms prior to stroke/TIA. Furthermore, both irritability and apathy had a negative impact on the patients' daily functioning. Additionally, there was a correlation between the presence of neuropsychiatric symptoms and the patients' MRI lesion burden. Our study has discovered that neuropsychiatric symptoms are highly prevalent in patients with CADASIL and may occur before cerebrovascular events, suggesting that neuropsychiatric symptoms of CADASIL deserve more attention and earlier exploration.

Arthroscopic Subacromial Decompression in Patients With Subacromial Impingement Syndrome.

Subacromial impingement syndrome (SIS) is a prevalent cause of shoulder dysfunction, affecting a significant portion of the adult population. It is associated with considerable pain, functional limitations, and disability. The evolution of treatment options, including arthroscopic subacromial decompression (ASAD), necessitates an updated evaluation of clinical outcomes and functional improvements. This study aims to assess the effectiveness of ASAD in patients with SIS by evaluating clinical signs and functional outcomes at three, six, and 12 months postsurgery. A prospective interventional study was conducted from August 2022 to November 2023 at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, India. Twenty-five patients diagnosed with SIS were included. Baseline sociodemographic and clinical characteristics were recorded. Patients underwent arthroscopic decompression, and functional outcomes were measured using the Constant score and American Shoulder and Elbow Surgeons (ASES) score at three, six, and 12 months. Data were analyzed using Statistical Product and Service Solutions (SPSS, version 21.0; IBM SPSS Statistics for Windows, Armonk, NY), with a significance level set at p<0.05. The study cohort comprised 64% females and 36% males, with a mean age of 46-55 years. The majority (72%) were engaged in labor work. The mean body mass index (BMI) was 24.89. Rotator cuff status was intact in 56% of patients, while 44% had partial tears. At baseline, 84% reported pain upon lifting the arm, and 92% experienced loss of motion. Postsurgery, the Constant-Murley score improved significantly from 36% poor at baseline to 92% excellent at 12 months. Similarly, the ASES score increased from a baseline mean of 17-84.9 by 12 months (p<0.01). Theacromiohumeraldistance increased from 9.7 mm before treatment to 10.4 mm after treatment (p=0.009). No infections or neurological deficits were reported. ASAD significantly improves shoulder function and reduces symptoms in patients with SIS. The Constant-Murley and ASES scores demonstrate substantial improvement over a 12-month follow-up period. The procedure is associated with favorable outcomes and minimal complications, supporting its effectiveness as a treatment modality for SIS.

The dimensional structure of the Positive and Negative Syndrome Scale in first-episode schizophrenia spectrum disorders: an Exploratory Graph Analysis from the OPTiMiSE trial

The Positive and Negative Syndrome Scale (PANSS) is the most widely used rating scale to assess psychotic symptoms in patients with schizophrenia and other primary psychoses. However, a definitive consensus regarding its dimensional structure remains elusive. The present work aims to determine the number of dimensions of the scale through a network analysis approach in a sample of individuals experiencing first-episode schizophrenia spectrum disorder (FE-SSD) with minimal or no prior exposure to antipsychotic treatment. Baseline data of 446 participants (age 25.96 ± 5.99 years, 70% males) enrolled in the OPTiMiSE trial were analysed. Exploratory Graph Analysis (EGA) was conducted to evaluate the dimensionality of the PANSS, and a bootstrap approach (bootEGA) was employed to assess model stability. The analysis was replicated, excluding unstable items with stability values below 0.75, until a stable model was achieved. The analysis of the 30 items of the PANSS revealed inadequate structural consistency, resulting in the exclusion of 9 unstable items. The final model comprised 21 symptoms distributed across four communities (Positive, Cognitive/Disorganised, Excited/Aggressive and Negative) but lacked a depressive domain. In conclusion, we propose a concise version of the PANSS, incorporating 21 items, to better assess the core symptoms of the first episode of SSD. This revised version provides clinicians with a robust psychometric tool with reduced administration time, but the complementary administration of a dedicated instrument for evaluating affective symptoms is advisable.

Diffuse Lepromatous Leprosy with Lucio Phenomenon Caused by Mycobacterium leprae

Mycobacterium lepromatosis is the primary cause of diffuse lepromatous leprosy and has previously been linked to the Lucio phenomenon in Mexico. In this study, we demonstrate that M. leprae and M. lepromatosis are responsible for many of the leprosy infections in which the Lucio phenomenon occurs. A 47-year-old female presented with chief complaints of erythematous and purpuric lesions on her left lower extremity and bilateral upper extremities. Over the past month, she had experienced recurrent tingling sensations in both legs. The patient had widespread infiltration, no nodules, madarosis (eyelash loss), and thickening in both ears. An acid-fast bacilli analysis revealed a bacterial index of 4+ and a microscopy index of 7%. Biopsy tissue was lacking the epidermal layer, and there was a dermal layer of dilated blood vessels, an area of bleeding, and infiltration of neutrophil inflammatory cells, perivascular plasma cells, foam cells, histiocytes, lymphocytes, the endothelium, and perivascular regions by acid-fast bacilli. A polymerase chain reaction identified the presence of both M. leprae and M. lepromatosis. The patient's symptoms worsened rapidly and she developed ulcers on both hands and both legs, extending to the soles of the feet. She was admitted to the hospital 3 days after presentation. Based on the clinical symptoms, examination of tissue samples, and the polymerase chain reaction identification of coinfection with M. leprae and M. lepromatosis, a diagnosis of diffuse lepromatous leprosy was made. The M. leprae bacteria were verified by DNA sequencing.

A Case Report of Korean Medicine Treatment for Chronic Obstructive Pulmonary Disease Patient with Dyspepsia and Anorexia after Surgery for Colon Cancer and Chemotherapy

Objectives: The purpose of this case study was to report the therapeutic effect of Korean medicine treatment for chronic obstructive pulmonary disease (COPD) patient with dyspepsia and anorexia after surgery for colon cancer and chemotherapy.Methods: A patient with COPD was hospitalized to treat dyspnea, dyspepsia, and anorexia that occurred after surgery for colon cancer and chemotherapy during 22 days. The patient was treated with herbal medicine (Yangjin-tang), acupuncture, pharmaco-puncture, herbal steam therapy, moxibustion, and pulmonary rehabilitation. The effectiveness of the treatment was assessed with modified Medical Research Council (mMRC) scale, Numeric Rating Scale (NRS) for dyspnea and dyspepsia, walking distance, weight, peak expiratory flow (PEF), radiography, pulmonary function test, and laboratory test.Results: The Korean medicine treatment improved mMRC from Grade 4 to Grade 3, NRS of both dyspnea and dyspepsia, walking distance, and maxillary sinusitis on paranasal sinus X-ray. However, there were no changes in weight, PEF, and chest X-ray.Conclusion: The Korean medicine treatment was effective in improving the symptoms of the COPD patient, including dyspnea, dyspepsia, and anorexia. This study suggests that Korean medicine treatment can have therapeutic effect on comorbidities such as dyspepsia and anorexia.

Comparative Analysis of Platelet-rich Plasma and Triamcinolone Acetonide Injections in the Management of Plantar Fasciitis: A Prospective Study

Abstract Context: Plantar fasciitis, a prevalent cause of heel pain, poses challenges in treatment due to diverse therapeutic options and variable outcomes. Platelet-rich plasma (PRP) and triamcinolone acetonide (TA) injections have emerged as potential interventions, yet their comparative effectiveness remains debated. Aims: The aim of the study was to compare the effectiveness of PRP and TA injections in relieving pain, improving function, and promoting healing in individuals with plantar fasciitis. Settings and Design: The study design was a prospective, hospital-based, experimental study. Subjects and Methods: A 2-year prospective hospital-based experimental study was conducted, enrolling patients aged 30–60 years with plantar fasciitis. Patients received either PRP or TA injections. Preoperative assessments and 3 months of monitoring were performed. Foot and Ankle Outcome Score (FAOS) survey was utilized for outcome evaluation. Statistical Analysis Used: T-test was applied. Results: Ninety patients were included, with both treatment groups demonstrating significant improvement in foot symptoms. PRP administration showed superiority in descending and ascending stairs, rising from sitting, and walking on flat surfaces compared to TA. FAOS scores indicated significant improvement posttreatment in both groups, with PRP yielding better outcomes than TA. Conclusions: Both PRP and TA injections effectively alleviate foot symptoms in plantar fasciitis patients. However, PRP demonstrates superior outcomes in specific functional activities and quality-of-life components compared to TA. These findings suggest PRP as a preferred intervention in the management of plantar fasciitis.

Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study

AimsDepressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients.MethodsCHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models.ResultsOf 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19–4.03, and adjusted HR = 2.70; 95%CI 1.23–5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms.ConclusionDepressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association.Trial registrationThis research was registered at https://www.chictr.org.cn. Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.

Marginal Excision as a Surgical Treatment for The Schwannoma of Posterior Aspect of Femur: A Case Report

Introduction: Schwannoma is a benign nerve sheath neoplasm attached to a peripheral nerve that often develops in the middle-aged population. It usually presents as an asymptomatic mass at first but can be transformed into a pain, swelling, neurologic, or mechanical symptom in several patients. In this study, we are reporting a case of a schwannoma of the posterior aspect of the thigh, in a young adult male. Case Presentation: We reported a 31-year-old male complained of sharp pain, tingling sensation, and mechanical block in the posterior aspect of the right thigh. Radiological imaging showed the tumor of the posterior aspect of the right thigh, with associated soft tissue edema, the cortex is not invaded. Surgical resection was performed on the patient and the tumor was excised with marginal excision surgery technique. Conclusions: The schwannomas of the femur can successfully be excised with no postoperative complications. There is no sign of a recurrent tumor in six months after the procedure.