Severe Symptoms Research Articles

Caregiver Global Impression Observations from EMBARK: A Phase 3 Study Evaluating Delandistrogene Moxeparvovec in Ambulatory Patients with Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is a rare, progressive, debilitating neuromuscular disease. The early childhood onset and debilitating nature of the disease necessitate decades of caretaking for most patients. Caregivers have a critical role in evaluating patients' physical functioning and/or response to treatment. Using DMD-specific caregiver-reported scales, the impact of delandistrogene moxeparvovec gene therapy on caregivers' perceived change in patient disease status or severity was evaluated using the Caregiver Global Impression of Change and Severity (CaGI-C and CaGI-S, respectively). In the Phase 3 randomized, double-blind, placebo-controlled trial (EMBARK; NCT05096221), the CaGI-C at week 52 and change from baseline to week 52 in CaGI-S were evaluated in a post hoc analysis. The CaGI-C assesses caregivers' impressions of change in DMD symptoms, physical ability, ability to perform daily activities, and overall health. The CaGI-S evaluates current severity of DMD symptoms, physical ability, ability to perform activities of daily living, and overall health. Data were evaluated using multi-domain responder index (MDRI) and ordinal regression analyses. MDRI analyses across all four CaGI-C items yielded a treatment difference of 1.7 (95% confidence interval [CI]: 0.90-2.5) favoring delandistrogene moxeparvovec; a treatment difference of 1.1 (95% CI 0.30-1.9) was observed for the CaGI-S favoring delandistrogene moxeparvovec. After adjusting for age, ordinal regression analysis showed a nominally significant increase in the odds of achieving a better rating for delandistrogene moxeparvovec-treated patients on all four CaGI-C items (≥ 3.8-fold increase). After adjusting for baseline severity and age, ordinal regression analysis showed a nominally significant increase in the odds of improvement on all four CaGI-S items (≥ 2.2-fold increase). These exploratory findings captured by caregiver-reported outcomes add to the totality of evidence that supports the clinical benefits of delandistrogene moxeparvovec for patients with DMD. ClinicalTrials.gov identifier, NCT05096221.

Occurrence of atypical Pseudomonas viridiflava strains on different host plants in southern Italy

AbstractSince 1997, severe bacterial disease symptoms were observed during surveys carried out in farms with field‐grown Molfettese Catalogna chicory (Cichorium intybus var. sylvestre, Catalogna group), sugarloaf chicory (C. intybus var. porphyreum), curly type lettuce (Lactuca sativa var. crispa) cvs Langero and Aleppo, and safflower (Carthamus tinctorius) located in the Apulia and Basilicata regions of southern Italy. Convex colonies with yellowish mucoid material on hypersucrose medium (5% sucrose nutrient agar), producing fluorescent pigments on King's medium B, were isolated from all symptomatic plants. Based on conventional biochemical and nutritional tests, Biolog assays, and analysis of partial 16S rDNA and rpoB sequences, these atypical fluorescent Pseudomonas isolates were identified as Pseudomonas viridiflava. The pathogenicity of the isolates was ascertained by artificial inoculation on their respective original hosts. The analysis of rpoB gene sequences and RAPD‐PCR profiles showed a high genetic variability among the P. viridiflava isolates. To the best of our knowledge, this is the first report of bacterial diseases on horticultural crops caused by atypical strains of P. viridiflava in Italy and the first report of the bacterium on safflower. In addition, P. viridiflava is reported for the first time as a causal agent of leaf spot on potato (Solanum tuberosum). The economic importance of chicory and curly type lettuce in southern Italy and recent spread of atypical and highly virulent P. viridiflava strains require more extensive and careful phytosanitary surveillance, as well as an adjustment of sustainable crop protection management to cope with this new challenge.

Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled study.

Acne vulgaris (AV) is a chronic inflammatory skin condition predominantly observed during adolescence. Interoception accuracy (IAc) refers to the ability to perceive internal bodily states such as hunger and thirst. Since the brain and skin originate from the same embryological layer, the ectoderm, it is hypothesized that skin changes and disorders might affect individual perceptions. The purpose of this study is to evaluate the relationship between IAc and AV. This study included 94 AV patients and 94 sex- and age-matched healthy controls. The participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Dermatology Life Quality Index (DLQI), and heartbeat perception task to assess IAc. The severity of acne was assessed using the Global Acne Grading System (GAGS). Acne patients had lower IAc scores than controls did (P = 0.026). Severe depression or anxiety symptoms were associated with lower IAc scores (P = 0.027, P = 0.046). Acne severity did not significantly affect IAc scores. There was a weak negative connection between the DLQI score and IAc (r = -0.208, P = 0.022), suggesting that lower quality of life is correlated with reduced IAc. Gender significantly influenced IAc. As a result, individuals with acne may have a reduced capacity to accurately perceive internal bodily states, potentially impacting overall well-being. Enhancing interoception might positively contribute to AV treatment and management.

Immediate consecutive microvascular decompression for bilateral classical trigeminal neuralgia

BackgroundClassical trigeminal neuralgia (TN) is characterized by sudden, severe facial pain, typically resulting from a neurovascular conflict affecting the trigeminal nerve. In rare cases, both nerves are affected simultaneously causing bilateral TN (BTN), increasing the complexity of the treatment. Microvascular decompression (MVD) is a well-established treatment for TN; however, the experience with immediate consecutive bilateral MVD procedures is limited and requires further evaluation.ObjectiveTo evaluate the safety and efficacy of immediate consecutive bilateral MVD in patients with severe BTN compared to non-consecutive bilateral MVD procedures.MethodsA retrospective analysis was conducted on 15 patients with BTN who underwent bilateral MVD. The data on clinical presentation, surgical technique, perioperative findings, complications, and follow-up outcomes of three cases of BTN treated with consecutive bilateral MVD surgeries were analyzed and compared to 12 who received separated procedures. Moreover, a detailed presentation of the three cases of consecutive MVD is provided to illustrate clinical decision-making, surgical nuances, and individual outcomes.ResultsBoth groups achieved significant pain relief (p < 0.001) without notable differences in Barrow Neurological Institute (BNI) pain intensity score (p = 0.305), indicating that both approaches were equally effective. The consecutive MVD group experienced a shorter total surgical duration (p = 0.025), while postoperative complications were comparable (p = 0.077), mostly transient with no major adverse events or mortality. At the last follow-up, the patients remained pain-free without recurrence of TN symptoms.ConclusionConsecutive bilateral MVD is a safe and effective option, comparable to non-consecutive procedures for treating BTN. This approach provides a viable alternative for patients with severe bilateral symptoms or when medical constraints limit the possibility of two separate surgeries. Further studies with larger cohorts and extended follow-up periods are needed to support these results.

Nurse-delivered brief behavioral treatment for insomnia in cancer survivors: a randomized controlled trial.

To determine the efficacy of nurse-delivered brief behavioral treatment for insomnia (BBTI) compared to an attention control, in a heterogeneous sample of cancer survivors to reduce insomnia symptom severity. We recruited 132 participants from cancer care clinics, who had an Insomnia Severity Index (ISI) score ≥ 8. Participants were randomized into two groups: an experimental BBTI group and a healthy eating attention control group. Demographics survey at baseline, and sleep-related questionnaires, self-reported sleep diaries, and wrist-worn actigraphy at baseline, 1, 3, and 12months were collected. Statistical analyses used analysis of covariance (ANCOVA) models with two-sided 0.05 nominal significance level for treatment effect for primary outcome of insomnia severity at 1month. Participants were cancer survivors with a mean age of 63.7years, 55% female, 88.6% white, with breast, prostate, colorectal, and lung cancer. Statistically significant group differences were observed at all time points for ISI and sleep quality (ISI effect sizes 0.56, 0.59, and 0.54 respectively). Additionally, at 1month, those in insomnia remission (ISI ≤ 8) were higher for the BBTI (55.1%) compared to the control group (43.3%). Secondary outcomes from sleep diary measures (i.e., sleep efficiency, sleep onset latency, wake after sleep onset) were significant at 1month. The BBTI group was significantly effective in reducing insomnia severity and improving sleep quality over time compared to the control among cancer survivors. Clinical trials identifier: http://ClinicalTrials.gov , NCT03810365. Implementing BBTI in survivorship settings can effectively address and manage insomnia symptoms, thus bridging a crucial gap in care for cancer survivors.

Cold Intolerance Following Digital Nerve Injury: A Multicenter Prospective Randomized Comparison of Decellularized Nerve Allograft Versus Nerve Conduits.

Cold intolerance following digital nerve injury burdens patients significantly. To better understand how cold intolerance evolves in the setting of digital nerve injuries, a sub-analysis of a trial comparing conduit-based (CONDUIT) and processed nerve allograft (PNA) repairs was conducted. It was hypothesized that PNA repairs would alleviate cold intolerance more effectively, especially for longer nerve gaps. A multicenter trial across 20 US-based medical centers was undertaken of patients 18- to 69-year-old presenting with 5 to 25 mm digital nerve gaps within 24 weeks of injury. Patients were randomized (1:1) to PNA or collagen CONDUIT repairs. Cold Intolerance Symptom Severity (CISS) scores and sensory function testers were assessed at first patient visit (FPV), 1-, 3-, 6-, 9-, and 12-months post-surgery, with patients and assessors blinded to treatment. In total, 220 patients were enrolled, with 183 patients included in final analysis with ≥6 months follow-up. At the last evaluable visit (LEV), mean CISS score decreased from FPV for both PNA (from 31.2 ± 27 to 20.8 ± 19) and CONDUIT (from 31.2 ± 30 to 25.9 ± 24). On sub-analysis, more patients converted from severe/extremely severe cold intolerance to mild cold intolerance for PNA compared with CONDUIT at 1 month and LEV (P < 0.05). The CISS scores correlated significantly with sensory function testing. Although no correlation was demonstrated with nerve gap size, digital nerve gap repaired with PNA had significantly improved cold tolerance outcomes for patients with more severe cold intolerance at FPV relative to nerves repaired with CONDUIT.

Application of Action Observation Therapy in Swallowing Rehabilitation: A Randomised Controlled Study.

Action Observation Therapy (AOT) has emerged as a potential neurorehabilitation therapy to promote motor control for individuals with neurological dysphagia (ND), facilitating neural plasticity through activation of the mirror nervous system. The aim of this study was to investigate the effect of AOT-based dysphagia rehabilitation on suprahyoid (SH) muscle activation, swallowing difficulties, swallowing function, depressive symptom and quality of life in ND patients. Thirty-four participants with ND were randomly allocated to the AOT group (n = 17) or control group (n = 17). All participants underwent a 4-week (5 sessions per week) conventional swallowing therapy. The AOT group watched exercise videos before doing these exercises, and the control group performed the same exercises without the videos. Surface electromyographic (sEMG) activation of suprahyoid muscles, Eating Assessment Tool 10 Turkish Version (T-EAT 10) and Swallowing Ability and Function Evaluation (SAFE) for swallowing difficulties and swallowing function, Swallow Quality of Life Questionnaire (SWAL-QOL) and Beck Depression Inventory (BDI) for quality of life and depressive symptom severity were evaluated. Post-treatment SH amplitude level and T-EAT-10 scores were significantly lower in the AOT group compared to the control group (p = 0.001, p = 0.012). There was a significant improvement in SAFE after treatment in the AOT group (p < 0.05); however, there was no significant difference between the two groups (p > 0.05). Both groups showed similar improvement in quality of life and depression. This study showed that AOT can be a good option for improving the SH muscle activation and dysphagia difficulties in ND patients. ClinicalTrials.gov identifier: NCT05782790.

The Physical Condition and Mental Health of Chinese College Students 3 Months After COVID-19 Recovery

Purpose: The study was to evaluate the physical condition and mental health of Chinese college student COVID-19 survivors, and to perform severity clustering of physical symptoms. Participants: The study finally included 1912 Chinese college students. Methods: A total of 33 symptoms including general physical symptoms, cardiopulmonary system, digestive system, neurological system, mental health and other symptoms were investigated three months after recovery from COVID-19, and these symptoms are identified using latent class analysis. Results: Three clusters were identified through latent class analysis: 13.2% with severe impairment (cluster 1), 27.2% with mild physical symptoms (cluster 2), and 59.5% with no or mild symptoms (cluster 3). The students who smoked, drank alcohol, did not exercise, or had a history of underlying medical conditions were more likely to have moderate to severe symptoms. Conclusions: Young COVID-19 survivors with a history of underlying diseases and unhealthy habits are more likely to have moderate to severe COVID-19 sequelae. Varying degrees of symptoms should be treated with different rehabilitation plans.

Efficacy of medical compression stockings class I on the reduction of symptoms in patients with uncomplicated varicose veins.

Background: Aim of this study was to analyze the effect of medical compression stockings (MCS) class I (according to the German classification "RAL-GZ 387"; 18-21mmHg) on symptoms in patients with uncomplicated varicose veins (C2s-C4a). Patients and methods: We conducted a randomized (1:1), controlled, clinical trial enrolling patients with uncomplicated varicose veins (CEAP: C2s-C4a). The study consisted of a one-week baseline period and a four-week follow-up period with MCS treatment (compression class I, 18-21mmHg) in the intervention group and non-treatment in the control group. The frequency and severity of symptoms on the leg including heaviness, pain, swelling, throbbing and itching were measured every evening using an app-based measuring tool. The primary endpoint was the reduction of symptoms during compression therapy, measured by a symptom sum score over a period of 5 weeks ranging from 0 (no symptoms during the day) to 25 (symptoms all day). Results: Patients treated with MCS (n = 25) showed a significant improvement in the overall symptom sum score from 8.90 ± 4.26 at baseline to 6.37 ± 3.55 at follow-up (p = 0.004) whereas for patients in the control group without MCS (n = 25) the overall score remained unchanged (baseline: 7.46 ± 3.71; follow-up: 7.67 ± 4.74; p = 0.293). The intervention group reported significant improvements in symptom frequency scores for pain, leg swelling and feeling of leg heaviness (p ≤ 0.002). In the control group the score for pain significantly increased during the follow-up period. Leg itching was numerically more frequent in patients with MCS. Conclusion: This study indicates that medical compression stockings class I (according to the German classification "RAL-GZ 387"; 18-21 mmHg) significantly improve the frequency and severity of symptoms in patients with uncomplicated varicose veins (CEAP: C2s-C4a).

Associations of motor and neuropsychiatric symptoms with comorbidities in prodromal Parkinson’s disease

ObjectiveTo investigate the associations between comorbidities and multimorbidity patterns with motor and neuropsychiatric symptoms in patients with Parkinson’s disease (PD) in prodromal PD.MethodsMultimorbidity is defined as the coexistence of two or more long-term conditions (LTCs) (also known as multiple comorbidities). A total of 921 participants without PD were included in the Parkinson’s Progression Markers Initiative (PPMI) database and were categorized according to the LTC count. Participants were evaluated on motor and psychiatric symptoms. Pearson correlation to examine relationship of comorbidities and target symptoms. The baseline population was analyzed using Multiple linear regression model, while mixed effects model was utilized for longitudinal analysis. Fuzzy C-means clustering analysis was conducted to identify comorbidity patterns, followed by multiple linear regression for further analysis.ResultsAt baseline, a higher LTC count was significantly correlated with more severe motor (MDS-UPDRS I, II, ADL, all P &amp;lt; 0.05) and neuropsychiatric symptoms (QUIP, P &amp;lt; 0.001). Three multimorbidity patterns were identified. Among them, the cardiometabolic multimorbidity pattern (CAR) had the most significant correlation with the aforementioned symptoms. Our longitudinal analysis indicated that an increase in the LTC count was associated with the exacerbation of motor and neuropsychiatric symptoms.ConclusionComorbidities were cross-sectionally and longitudinally associated with the motor and neuropsychiatric symptoms of patients with prodromal PD. Among the three multimorbidity patterns, CAR posed the highest threat to the risk of more severe motor and neuropsychiatric symptoms.

Neural Divergence between Individuals with and without Minor Depression during Dynamic Emotion Processing: A Movie-fMRI Study.

Research on the neuropathological mechanisms underlying minor depression (MD), particularly in individuals with a history of recurrent minor depressive episodes, is very limited. This study focuses on the abnormality in processing real-life emotional stimuli among MD. Thirty-two individuals with MD and thirty-one normal controls (NC) were recruited and underwent comprehensive clinical interview, cognitive assessment, and magnetic resonance imaging (MRI) scans. During functional MRI scanning, subjects watched positive, negative, and neutral emotional movie clips. We used the inter-subject correlation and inter-subject functional connectivity analysis to investigate the neural differentiation between MD and NC during film viewing. The relationships between neural differentiation, symptom severity, and psychological resilience were analysed. We found that neural differentiations between MD and NC in the post cingulate cortex (PCC) and precuneus (PCUN) were consistent across three emotional conditions. Notably, the similarity of neural responses in the PCC and PCUN with NC but not MD was negatively correlated with depressive symptoms. Furthermore, this neural similarity mediated the relationship between psychological resilience and depression severity. Our findings support that the PCC and PCUN, two core areas of the default mode network, play a critical role in MD's emotion processing deficit.

Loss of empathy in stroke

BackgroundLoss of empathy (LoE) is common among stroke survivors, yet often undiagnosed and thus untreated. LoE is related to the loss of a caring marital relationship, higher care burden and poorer quality of life in carers. The present study will evaluate the clinical and MRI correlates of LoE in a cohort of stroke survivors. The secondary objective is to describe the 12-month course of LoE.MethodsThe current study is a prospective cohort study. We will recruit 246 subjects. Subjects and carers will receive a detailed assessment at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The Chinese version of the Interpersonal Reactivity Index (IRI), a 28-item personality assessment tool, will be completed by a carer for each subject. LoE is defined as an IRI total score of 39 or less. Patients will be examined by MRI including diffusion weighted imaging (DWI) within 1 week after the onset of stroke. A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest. To examine the predictors of LoE remission, the demographic, clinical and MRI variables of remitters and non-remitters at T2/T3 will be examined by logistic regression.DiscussionThis project will be the first longitudinal study on LoE in stroke survivors. The results will shed light on the association between prefrontal cortex and subcortical lesions and LoE risk, symptom severity and outcome. The findings will provide data to advance our understanding of the pathogenesis and clinical course of LoE in stroke as well as other neurological conditions. They are thus likely to be applicable to the large population of neurological patients at risk of LoE and should also stimulate further research in this field.

Variation of Stomach Shapes in Gastric Emptying Scintigraphy: Correlation With Gastric Emptying Results, Body Weight, and Symptoms.

Although different gastric shapes are encountered in gastric emptying scintigraphy (GES), it is not known whether gastric shape is related to gastric emptying (GE) or symptoms. To investigate different stomach shapes observed during GES and examine their associations with GE, body weight, and gastrointestinal (GI) symptoms. This was a retrospective review of GES studies performed at our institution. Patients with prior gastric surgery were excluded. A classification of gastric shapes included: crescentic, J-shaped, reversed-L, cylindrical, and bag-like. Gastric shapes were correlated with GE, BMI, and GI symptoms using PAGI-SYM. 397 GES studies were reviewed (317 females, age 40.0 ± 20.3 years, BMI 27.8 ± 13.8 kg/m2). Gastric shapes were: 41.8% crescentic/comma-shaped, 34.0% J-shaped, 19.9% reversed L-shape, 2.8% cylindrical, and 1.5% bag-like. BMI was highest in crescentic/comma-shaped stomachs (30.1 ± 12.4 kg/m2) and lowest in bag-like stomachs (25.2 ± 9.9 kg/m2; p = 0.022). Delayed GE was most pronounced in bag-like stomachs (34.4 ± 33.1% retention at 4 h) and lowest in reversed-L shape (10.3 ± 15.6% retention at 4 h; p = 0.008). Regurgitation severity was greatest in bag-like stomachs (2.2 ± 1.5) compared to milder symptoms in reversed-L shape (1.3 ± 1.4; p = 0.029). Heartburn severity was increased in bag-like stomachs (2.3 ± 1.6) while patients with cylindrical stomachs reported least heartburn severity (1.1 ± 1.3; p = 0.11). A classification system based on five gastric shapes observed during GES showed that crescent-shaped stomach was the most common shape and correlated with higher BMIs. Delayed GE was most pronounced in bag-like stomachs and lowest in reversed-L stomachs. Regurgitation and heartburn severity were greatest in bag-like stomachs with milder symptoms in reversed-L stomachs. Thus, gastric shape during GES is associated with gastric emptying, BMI, and symptom severity.

The role of osteopathic manipulative treatment for dystonia: a literature review.

Dystonia is a movement disorder that causes involuntary muscle contractions leading to abnormal movements and postures, such as twisting. Dystonia is the third most common movement disorder in the United States, with as many as 250,000 people affected. Because of its complexity, dystonia presents a significant challenge in terms of management and treatment. Despite limited research, osteopathic manipulative treatment (OMT) has been considered as an adjunctive treatment due to its inexpensive and noninvasive nature, as opposed to other modalities such as botulinum toxin injections, deep brain stimulation (DBS), and transcranial magnetic stimulation, which are often expensive and inaccessible. OMT treatments performed in case studies and series such as balanced ligamentous tension/articular ligamentous strain (BLT/ALS), muscle energy (ME), high-velocity low-amplitude (HVLA), and myofascial release (MFR) have shown reduction of pain and muscle hypertonicity, including in patients with dystonia. The studies reviewed in this paper provide a snapshot of the literature regarding the current evidence of OMT's role for dystonia. A medical reference librarian conducted a thorough literature search across multiple databases including PubMed and Google Scholar to find articles relevant to the use of OMT for dystonia. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to osteopathic medicine and dystonia to ensure precise retrieval of relevant articles within the last 20 years. Despite limited research on the topic, all four relevant reports found in the literature were selected for review. Of the four relevant reports, case series and studies highlighted the potential benefits of OMT in managing dystonia, particularly cervical dystonia and foot dystonia. OMT has shown promising results addressing pain, stiffness, and impaired motor function. In cases of foot dystonia in Parkinson's disease, OMT has helped improve gait and reduce pain by targeting somatic dysfunctions (SDs) associated with dystonia, such as abnormalities in foot progression angle (FPA) and musculoskeletal imbalances. Also, OMT has been found to alleviate symptoms of cervical dystonia, including tremors, muscle spasms, and neck stiffness. These interventions performed in case studies and series led to improvements in gait biomechanics in foot dystonia and overall symptom severity in patients with cervical dystonia. Currently, botulinum toxin, oral medications, physical therapy, and rehabilitation are commonly utilized in managing dystonia. The studies reviewed in this paper suggest that these treatments may lead to improvements in pain and muscle hypertonicity in patients with dystonia. It is important to investigate whether factors such as the type of dystonia (eg, focal vs. segmental) and its underlying cause (eg, idiopathic, trauma, infection, autoimmune, medication side effects) influence treatment outcomes. Further research is recommended to explore the role of OMT in managing dystonia.

Temperament and executive functioning correlates of ADHD symptom severity during early versus middle childhood.

This study investigated associations among temperament, executive functioning (EF), and attention-deficit/hyperactivity disorder (ADHD) symptom severity at two developmental stages. Participants were 61 4-year-old children and 165 8-11-year-old children (126 ADHD, 39 typically developing [TD]). Caregivers reported on temperament (effortful control [EC], negative affect, and surgency), and ADHD symptoms. Three aspects of EF (working memory, inhibitory control, and processing speed) were measured with neuropsychological tests. Among 4-year-olds, variance in ADHD symptom severity was only explained by the temperament variables. EC was not significantly correlated with any of the EFs in this cohort. Among school-aged children, low EC, high surgency, high negative affect, and reduced working memory were associated with greater ADHD symptom severity. EC was significantly and positively correlated with processing speed in the school-aged children. Results are consistent with a neurodevelopmental model of ADHD, wherein dysregulated temperament is associated with ADHD in young children, while both dysregulated temperament and cognitive skills are associated with ADHD in middle childhood. Results could inform the selection of clinical tools for diagnostic evaluation of pediatric ADHD symptoms and clinical follow-up.

Clinical characteristics of coronary artery involvement in children with Behcet's syndrome.

To review the clinical features, treatment, and prognosis of coronary involvement in Behcet's syndrome in children. Retrospectively analyzed medical records of BS patients admitted to our institution from 2012 to 2024. Six children with BS with coronary involvement were admitted, including 2 males and 4 females. The mean age was 5.7years and the mean course was 17.2months. All of them had coronary dilatation, including 1 case with aneurysmal dilatation, 2 cases with bilateral coronary dilatation, 4 cases with unilateral dilatation, and 4 cases with valvular disease. No symptom for coronary artery dilation and all of coronary dilatation were detected by echocardiography. Manifestations of extracardiac vascular involvement included arteriovenous wall thickness and thrombosis. Five cases had only arterial involvement and one case had both artery and vein involvement. Pulmonary artery was involved in 1 case. All of them were treated with glucocorticoid and immunosuppressant, 1 child was treated with TNF-α, and 1 received aortic valvuloplasty due to a large number of aortic regurgitations. The patient with coronary aneurysm died suddenly after giving up treatment, and the other 4 cases were all improved to varying degrees. Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. Patients with coronary involvement are occultic and difficult to diagnose. Both arteries and veins can be involved, and some patients have severe symptoms. Clinicians should attach great importance to early vascular screening, especially coronary artery. Early combined medication may help improve the prognosis. Key Points • Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. • Coronary involvement in BS is rare in children, which is predominantly coronary dilatation. • The onset of BS with coronary involvement is insidious and easy to be missed, so early coronary artery screening in children with BS should be emphasized. • Early combined medication may help improve the prognosis of BS with coronary involvement.

Therapeutic potential of hesperidin in diabetes mellitus-induced erectile dysfunction through Nrf2-mediated ferroptosis and oxidative stress.

Among erectile dysfunction (ED) caused by metabolic abnormalities, diabetes mellitus-induced ED (DMED) progresses rapidly, manifests with severe symptoms, and shows reduced responsiveness to conventional medications. Hyperglycemia in the corpus cavernosum has been linked to the induction of both ferroptosis and oxidative stress, which are mediated by nuclear factor E2 related factor 2 (Nrf2). Hesperidin (Hes), a flavonoid compound, has been revealed to activate Nrf2 in certain diabetic complications, yet the efficacy of Hes on DMED and the specific mechanism remain unclear. To elucidate the potential mechanism and efficacy of Hes in regulating Nrf2-mediated ferroptosis and oxidative stress in DMED. DMED rats were constructed through the intraperitoneal injection of streptozotocin (STZ), partially supplemented with Hes. In parallel, in vitro research utilized human umbilical vein endothelial cells (HUVECs), with glucose addition to simulating a high glucose (HG) environment, and induced with Hes or ML385 (an Nrf2 inhibitor). Penile tissues and HUVECs were harvested for subsequent analyses. The results of this study indicate that Hes partially reversed the impaired erectile function. The expression of Nrf2, glutathione peroxidase 4 (GPX4), and heme oxygenase-1 (HO-1) in the corpus cavernosum elevated after supplementing with Hes, resulted in an inhibition in ferroptosis and oxidative stress. Moreover, the quantity and function of erectile effector cells were restored, and cavernous fibrosis was ameliorated. In HG-induced HUVECs, Hes ameliorated Nrf2-mediated ferroptosis and oxidative stress, effects which ML385 partially reversed. Hes exerts a therapeutic effect on DMED rats and a regulatory mechanism on the Nrf2-HO-1/GPX4 axis, concurrently revitalizing endothelial and smooth muscle cells, and diminishing fibrosis. Our study provides robust preclinical evidence for employing Hes in treating DMED.

Prevalence of depressive symptoms and associated factors among older adults living in aged care homes of Kathmandu Metropolitan City, Nepal.

Depressive symptoms have become a global public health problem, with a predominant effect on the older adults. The studies on mental health status of older adults in Nepal are quite limited. In this study, we aim to assess the prevalence of depressive symptoms and associated factors among the older adults living in public aged care homes of Kathmandu Metropolitan City in Nepal. A cross-sectional study was conducted among 142 older adults; aged 60 years and above recruited through proportional simple random sampling from six aged care homes. The 15 item-Geriatric Depression Scale (GDS) was used to assess the depressive symptoms among the participants. Associated factors were tested using Chi-square test; and a p-value of less than 0.05 with a confidence interval of 95% was used for statistical significance. More than half of the study participants, 58.5% (95% CI: 49.9%-66.7%) were found to have depressive symptoms. Among them, 38.7% had mild symptoms, 16.2% had moderate symptoms and 3.5% had severe symptoms. Age (OR = 2.25, 95% CI: 1.08-4.66), sex (OR = 2.36, 95% CI: 1.17-4.75), past family type (OR = 0.44, 0.22-0.89), chronic physical health problem (OR = 0.34, 95% CI: 0.12-0.98) and feelings of loneliness were found to have significant association with depressive symptoms among the older adults' population. The prevalence of depressive symptoms among the older adults in aged care homes in Kathmandu Metropolitan City is quite high and is found to be associated with age, sex, past family type, chronic physical health problems and feeling of loneliness. It is a concerning issue that requires targeted mental health programs and interventions in order to bring about a positive shift in their mental health condition. It also demands a robust collaboration between the local bodies, health institutions, administrators, private as well as nonprofit institutions to bring desirable change.

Impact of oral health on COVID-19 outcomes in patients with pre-existing cardiovascular conditions: a questionnaire-based analysis of disease severity, recovery time, and C-reactive protein

Aim: This study aimed to assess oral health’s influence on COVID-19 outcomes in recovered individuals with pre-existing cardiovascular conditions. Methods: In the main study employing a cross-sectional design based on a questionnaire survey, 464 Egyptian patients who had recovered from COVID-19 were enrolled, with 86 individuals who had pre-existing cardiovascular conditions included in a subgroup analysis. Oral health was classified as poor and good based on scores from an 18-question survey with higher scores indicating better health. Severe COVID-19 was defined by criteria that included elevated respiratory and heart rates, severe dyspnea low oxygen saturation, high fever, and need for hospitalization or ICU care. Participants’ recovery duration was classified into three groups: fast (≤ 2 weeks), intermediate (4 weeks), and delayed (6 weeks), characterized by symptom-free status. Moreover, C-reactive protein (CRP) levels (&gt; 18 mg/L) were considered elevated. Results: Our results revealed that cardiac patients with poor oral health showed a significant association with severe COVID-19 cases, elevated CRP levels (&gt; 18 mg/L), and a prolonged recovery period (6 weeks) (p &lt; 0.001). In contrast, participants demonstrating good oral health were associated with milder COVID-19 cases, lower CRP levels, and faster recovery (p &lt; 0.001). Conclusions: Our findings indicate a significant link between the condition of oral health and the experienced severity of COVID-19 in cardiac patients. Poor oral health was associated with elevated CRP levels, delayed recovery, and more severe symptoms. These results highlight the importance of good oral hygiene as a modifiable factor in reducing infection severity, especially in vulnerable cardiac populations.

The Impact of Individual and Team‐Level Variables on Burnout in Healthcare Providers

ABSTRACTThis study evaluates the relationships between individual and team‐level factors in influencing burnout among clinical healthcare providers. Focusing on psychological safety, perceived autonomy, perceived team effectiveness, and emotional intelligence, the research aims to understand how these elements contribute to the prevalence and severity of burnout symptoms. Using electronic questionnaires analyzed through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), the study sampled 180 healthcare providers from one large US medical center. The study results found that psychological safety significantly decreases levels of burnout, particularly emotional exhaustion. The results on team effectiveness suggest a complex relationship with burnout, with different dimensions having varied impacts. The study did not find support for the negative prediction of burnout by perceived autonomy and emotional intelligence, contrary to expectations based on prior research. These findings have practical implications for healthcare management, stressing the importance of psychological safety and effective team dynamics in reducing burnout. Overall, this study contributes significantly to understanding burnout in healthcare, emphasizing the critical role of team structures and individual emotional resilience in managing workplace well‐being.