Three-month Follow-up Research Articles

A physiotherapist-led biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana: a mixed-methods feasibility study

BackgroundLow back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30–47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana.MethodsThis was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants’ experiences with the biopsychosocial intervention. Patients’ demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants’ experiences regarding the acceptability of the biopsychosocial intervention.ResultsThe results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week − 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants.ConclusionThis study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies.

Evaluation of the outcomes of equity-deserving individuals receiving services and support from integrated substance use health and mental health services: a pilot study protocol

BackgroundGiven the close relationship that can exist between substance use health and mental health (SUHMH) concerns, the need for more integrated services and support has been identified. However, research on the effective integration of SUHMH services and their impact on outcomes of individuals accessing them remains limited. In particular, the unique outcomes of individuals facing significant structural inequities in the health care system, i.e., Indigenous Peoples in Canada, including First Nations, Inuit and Métis (FNIM), and equity-deserving (ED) groups, have not been evaluated while receiving integrated SUHMH services. This paper describes the protocol for a pilot research project, which will evaluate the change in clinical and social outcomes of individuals receiving integrated SUHMH services in relation to their intersectionality status, a linear score ranging from identifying with no FNIM and ED groups to identifying with one or multiple groups.MethodsThis study recruits 100 individuals who receive SUHMH services and support from a community health center in Ottawa, Canada and assessed their FNIM and ED status and clinical and social outcomes at baseline and three-month follow-up. At the time of writing this manuscript, the baseline data collection was completed. Follow up assessment occurs three months after baseline data was collected. A smaller group of these participants will be purposefully selected match the proportion of FNIM and ED groups from the two-time assessment. They will be invited to participate in a post-data analysis validation consultation session to ensure that the findings are reflective of the experiences of individuals receiving SUHMH services, alternative interpretations are brought forward, and implications are driven by those who will be most impacted. This consultation may also inform knowledge mobilization activities and future studies. This study also recruited staff in different roles from the providing center to rate the implementation of key dimensions of equity-oriented care into their practices and their level and capability to provide integrated services and support to individuals with cooccurring substance use disorders and mental illnesses.DiscussionThe results of this study will inform integrated SUHMH services by emphasizing equity and inclusive approaches, and engagement with the community. Substance use health; Mental health; Integrated services and support; Equity-deserving populations; Equity-oriented care.

Effectiveness of balloon angioplasty under intravascular ultrasound guidance in calcified below-the-knee tibial arteries.

This study aimed to assess the optimal balloon diameter for intravascular ultrasound (IVUS)-guided balloon angioplasty in calcified below-the-knee (BTK) tibial artery lesions. Between February 2024 and April 2024, a retrospective review was conducted on 17 patients with Rutherford category 4-6 severely calcified tibial arteries with >70% stenosis, treated with IVUS-guided balloon angioplasty. Sequentially, 3 mm and then 3.5 mm diameter balloons were inflated. The minimum lumen diameter and area were measured before and after the procedure in the proximal, mid, and distal segments of the tibial arteries. One- and three-month follow-ups were conducted using Doppler ultrasound. Significant increases in lumen diameter (P < 0.001 for all) and lumen area (P < 0.001, P = 0.003, P = 0.002, respectively) were observed in the proximal, mid, and distal segments of the BTK arteries following IVUS-guided 3.5 mm balloon angioplasty. Ultra-low iodinated contrast media was used [median 2 mL (range, 1-4 mL)]. Lumen area increase ratios were similar among the proximal, mid, and distal segments (P = 0.905). No target vessel revascularization, major amputation, or mortality was observed during follow-up. Wound healing was seen in 62.5% of the cases with foot ulcers. In the treatment of calcified BTK tibial arteries, a gradual balloon diameter increase up to 3.5 mm in IVUS-guided balloon angioplasty is safe and effective. Gradual balloon diameter increase up to 3.5 mm under IVUS guidance in calcified BTK lesions demonstrates significant potential. It enables ultra-low contrast usage, provides low complication rates, and achieves high patency and limb salvage, along with satisfactory wound healing in the short term.

Psychedelic-assisted grief therapy: a mixed-method case study

ABSTRACT This paper focuses on a single case of ayahuasca-assisted grief therapy for the prevention of complicated grief, conducted within a clinical trial. The participant, a woman in her thirties who lost her father to cancer, completed a 9-session process of Meaning Reconstruction Therapy (MRT) organised around two ayahuasca sessions. Following each psychedelic experience, she also completed a psychedelic integration session. The case study investigates the effect of the intervention, the observed changes in the participant, and the potential processes of change which may account for this improvement. The analysis relies on a qualitative narrative approach to examine the content of each therapy session, as well as on the psychometric measures completed at baseline, post-treatment, and at the three-month follow-up. These results are linked to emerging theories in the field, with a particular focus on the role of meaning reconstruction, psychological flexibility, and a continuing bond with the deceased.

The Molecular Detection and Therapeutic Management of Pathogenic Theileria luwenshuni Infection in a Goat: A Case Report

A 2-year-old female Assam Hill goat was presented with a clinical history of anorexia, fever, mild anemia, rough body coat, dehydration, tachycardia, dyspnea and swelling of palpable lymph nodes. Hematology revealed low hemoglobin, packed cell volume, red blood cell and thrombocyte count. Biochemical analysis showed increased serum concentration of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and urea in comparison to the normal reference range. Microscopic examination showed intra-erythrocytic forms of Theileria species. Molecular and phylogenetic analysis of partial 18S rRNA gene sequence confirmed Theileria luwenshuni infection. The goat was treated with buparvaquone and oxytetracycline and recovered uneventfully. A three-month follow-up showed no recurrence. This study reveals the presence of T. luwenshuni in Assam, India and it should be considered in differential diagnosis and as one of the important pathogens of clinically sick goats. The present case report provides a rational approach to diagnosis and treatment for a goat infected with pathogenic T. luwenshuni in Assam, India. To our knowledge, the present communication describes about the first successful therapeutic management of pathogenic Tluwenshuni infection in a goat supported with molecular evidence from Assam, a north-eastern state of India.

Effects of mindfulness-based strengths practice (MBSP) among women undergraduates in enhancing positive mental health

ABSTRACT The study investigates the effectiveness of an 8-week Mindfulness-Based Strengths Practice (MBSP) intervention to enhance the positive mental health of women undergraduates by focusing on the development of character strengths, flourishing, mindfulness, and the reduction of psychological distress. Using a quasi-experimental design, the study involved 162 undergraduate women (mean age 18.55) from rural backgrounds; 80 volunteered for intervention and 82 for the control group. Participants completed pre-, post-, and three-month follow-up assessments, and the results showed significant gains in mindfulness, PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) flourishing, character strengths, and a reduction in psychological distress, with moderate to large effect sizes. A follow-up after three months showed persistent effects in certain aspects. This investigation among the Indian population contributes to the literature on MBSP in an Eastern context. It underscores the effectiveness of MBSP as a positive psychological, mindfulness-based intervention on college campuses for promoting well-being and mitigating mental health challenges among college students.

Clinical supervision based on video vs. verbal report: a randomized controlled trial

ABSTRACT Clinical supervision is considered important in psychotherapy training, but little is known about the efficacy of specific supervision methods. We investigate two such methods (video-based vs. verbal report-based supervision) in a randomized controlled trial. Seventy-three supervisees were trained in common cognitive-behavioral therapy methods (i.e. behavioral activation and cognitive restructuring) by means of written information and a modelling video demonstrating the techniques. Supervisees had to apply the techniques in role plays with standardized patients (presenting depressive patients). Subsequently, supervisees were randomized to supervision, based on the video, or supervision based on the verbal report of the supervisees. Subsequently and after a three-month follow-up period, supervisees had to demonstrate the therapeutic techniques again. Therapist competence, therapeutic alliance, empathy, and anxiety were assessed through various different perspectives (i.e. independent raters, standardized patients, and supervisees’ self-evaluation). Both supervision conditions lead to a significant improvement of therapeutic competences, therapeutic alliance, and empathy. No significant differences were found between the two supervision conditions. At three-month follow-up, training effects decreased on all perspectives except standardized patients. A training condition without supervision would be necessary to demonstrate that improvements are specific effects of the supervision conditions. Moreover, further supervision seems necessary to maintain training effects over time.

Efficacy of the Eat Breathe Thrive Recovery Protocol Delivered Virtually to Adults Recovering From Eating Disorders: A Randomized Controlled Trial.

Current treatments for eating disorders have limited effectiveness, leaving over half of patients unremitted. The evaluation of emerging interventions to support recovery is therefore critical. This study evaluated the efficacy and acceptability of an innovative, virtual intervention for eating disorders (Eat Breathe Thrive; EBT-R). Participants recovering from eating disorders from 27 different countries (N = 277) were randomly allocated to EBT-R or waitlist conditions. Assessments were completed at baseline, postintervention, and three-month follow-up. Primary outcomes were eating disorders and co-occurring psychopathology; secondary outcomes included measures of positive embodiment. Compared with controls, participants in EBT-R demonstrated significant improvements in eating disorders and associated psychopathology (i.e., depression, anxiety) than controls. Participants also reported increased appreciation for the body, interoception, interoceptive attunement, intuitive eating, emotion regulation, mindful self-care, and integrity. This study evaluated the efficacy of a brief, virtual, embodiment-focused intervention for eating disorders. The findings suggest that EBT-R may be an effective intervention to support recovery from eating disorders and development of positive embodiment.

Creating dementia-friendly communities: Challenging stigma and building understanding through public education

ABSTRACT Stigma is a well-documented barrier to community and social engagement for people living with dementia. Awareness raising and public education have been identified as essential for developing communities that are supportive of people living with dementia and enable their social inclusion. A public dementia education program, co-designed and delivered by people living with dementia and targeted to people working in public-facing service roles, was developed to increase awareness of dementia and challenge stigma. This quality improvement study evaluates this dementia-friendly community education program in terms of participants’ reactions to the program, knowledge acquisition, change in behavior, and impacts associated with the program. A survey methodology was used to assess immediate reactions to the workshop (N = 110), and at a three-month follow-up to assess longer-term impacts of the program (N = 36). The workshop was well received with >88% of respondents being satisfied with the topics covered, delivery format, and program materials; >65% of respondents reported being more knowledgeable in all workshop topic areas as a result of the program. At follow-up, >80% of respondents reported that they implemented dementia-friendly actions as outlined in the workshop but were able do so more frequently for individual-level actions, rather than organizational-level actions. Respondents valued hearing the experiences of a person with lived experience. The study findings highlight the value of practical education targeted to public service sector personnel and codesigned and delivered by people living with dementia as a strategy for fostering change towards more dementia-friendly communities. Targeting leadership and management may affect greater change at organizational levels.

Study protocol for a randomized controlled trial evaluating the effectiveness of a mother-child intervention model of neurogenic tremor as an add-on to treatment for emotional disorders in adolescents

BackgroundAdolescents exhibit a high prevalence of mental health disorders, with more than half of all cases emerging before the age of 14 years. Since the advent of the COVID-19 pandemic, there has been a marked upsurge in anxiety and depression among adolescents across several nations. Emotional disorders often lead to severe outcomes, including school absenteeism, self-harm, and suicidal tendencies. The suboptimal efficacy of pharmacotherapy, compounded by limited availability and substantial costs associated with individual psychotherapy, underscores the critical need for identifying simple yet efficacious psychotherapeutic interventions suitable for both individual and group settings. Tension and Trauma Release Exercise (TRE) is a mind-body therapeutic approach that efficiently alleviates symptoms of anxiety and depression. This randomized controlled trial (RCT) aims to evaluate the effectiveness of a mother-child intervention model using TRE in enhancing the clinical management of adolescent patients diagnosed with emotional disorders.Methods This study recruits 140 dyads of adolescents with emotional disorders and their mothers, randomly assigned to intervention or control groups. The intervention arm combines eight weeks of standard pharmacotherapy with an eight-week TRE group therapy, assessing at baseline, post-8-week treatment, and three-month follow-up. Initially, controls receive eight weeks of standard medication with parallel assessments, later transitioning to the same TRE intervention while maintaining continuous evaluation. The study further examines the influence of maternal emotional health on adolescent treatment response and investigates associated neurophysiological and psychological mechanisms.DiscussionThis research endeavors to identify a straightforward and potent body-oriented psychological intervention that could improve the clinical outcomes for adolescent patients with emotional disorders. Such findings would carry profound implications not only for the healthy development of teenagers but also for potentially mitigating the burden on families, educational institutions, and society as a whole.Trial registrationChiCTR2100044553, Registered March 24, 2021.

WITHDRAWN: Comparing the Effectiveness of In-Person and Telehealth Cognitive-Behavioral Therapy on Psychological Distress and Resilience in People Recovered from COVID-19: A Randomized Control Study

Background: In addition to the physical effects caused by coronavirus disease 2019 (COVID-19), the disease is also associated with various psychological problems that have required research and clinical attention. Objectives: The purpose of this study was to compare the effectiveness of in-person and telehealth cognitive-behavioral therapy (CBT) in people who have recovered from COVID-19. Methods: This study was a randomized controlled trial with a pre-post design, a control group, and a three-month follow-up. The statistical population consisted of patients who had recovered from COVID-19 in Tehran between 2022 and 2023. From this population, 45 patients were selected using a convenience sampling method and randomly divided into three groups: An in-person CBT group, a telehealth CBT group (15 patients in each), and a control group (15 patients). The in-person CBT group received 11 sessions, while the telehealth CBT group received 12 sessions. Research instruments included the Depression, Anxiety, and Stress Scale (DASS-21) and the Resilience Scale (RS). The data were analyzed using repeated measures analysis of variance. Results: The results showed that although both treatments led to improvements in psychological distress (P &lt; 0.01) and resilience (P &lt; 0.01), the effectiveness of in-person CBT was greater and statistically significant. The effect sizes for depression, anxiety, stress, and resilience were 0.37, 0.38, 0.44, and 0.64, respectively. Conclusions: The results indicate that both in-person and virtual CBT lead to improvements in psychological distress and resilience in patients with a history of COVID-19, compared to the control group. However, the improvement rate was higher for in-person CBT compared to the virtual group. In-person CBT led to significant improvements in both psychological distress and resilience.

Within-person relationships between catastrophizing and pain intensity during a mind-body intervention to prevent persistent pain and disability after acute traumatic orthopedic injury

Interventions aimed at preventing chronic pain after acute traumatic injury have significant potential to reduce healthcare expenditures and improve quality of life for millions of individuals. Given recent development of such interventions, limited research has examined mechanisms of change using repeated measures (e.g., session-by-session assessments). This study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention for individuals with acute traumatic orthopedic injury (N = 76, T = 445). Random intercept cross-lagged panel models were used to examine within-person autoregressive, contemporaneous, and cross-lagged effects between pain catastrophizing and pain intensity, after accounting for stable between-person differences. Our primary hypothesis that improvements in catastrophizing would be associated with subsequent reductions in pain intensity was partially supported by a significant within-person cross-lagged effect between catastrophizing at post-test and pain with activity reported at three-month follow-up (β = 0.421, SE = 0.099, p < .001). Improvement in catastrophizing was also associated with same-session improvement in pain intensity midway through the intervention. Importantly, bidirectional within-person analyses allowed us to rule out the possibility that improvements in pain were responsible for subsequent improvements in catastrophizing, but not vice versa. Together, these findings suggest improvements in catastrophizing during psychosocial intervention may prevent transition from acute to chronic pain after injury. Future research with larger between-person sample sizes, more frequent within-person assessment, and comparable control group data is necessary to facilitate greater understanding of psychosocial mechanisms for preventing chronic pain after injury. PerspectiveThis study examines within-person relationships between pain catastrophizing and intensity during and after a four-session mind-body intervention to prevent persistent pain after acute traumatic orthopedic injury. Improved catastrophizing at post-test was associated with reduced pain with activity at three-month follow-up. Within-person analyses enhance understanding of psychosocial mechanisms for preventing chronic pain after injury.

Effectiveness of Acceptance and Commitment Therapy (ACT) on disease acceptance for breast cancer patients: Study protocol of a randomized controlled trial.

Breast cancer patients face significant psychological challenges, including difficulties in accepting the diagnosis, treatment, and long-term impact of the disease. Acceptance and Commitment Therapy (ACT) has shown promise in enhancing acceptance and psychological flexibility in various populations. This study aims to investigate the effectiveness of ACT in promoting disease acceptance among breast cancer patients through a randomized controlled trial. This study will recruit 90 breast cancer patients and randomly allocate them to an ACT intervention or control group. The ACT intervention, focusing on acceptance, mindfulness, value clarification, and committed action, will be delivered over 4 weeks. Meanwhile, the control group will receive standard care with non-therapeutic intervention. The study's primary outcome is disease acceptance, while secondary outcomes include depression, anxiety, social support, quality of life (QoL), and psychological inflexibility. Data will be collected at three points: baseline, post-intervention, and three-month follow-up. Statistical analysis will compare outcomes between groups to evaluate the effectiveness and mechanism of this intervention using covariance and mediation analysis. This study evaluates the effectiveness of ACT in promoting disease acceptance among breast cancer patients. It hypothesizes that the ACT group will show higher disease acceptance and improvements in social support, QoL, and psychological flexibility compared to the control group. The findings will contribute to research on psychological interventions and demonstrate ACT's effectiveness in enhancing disease acceptance. The research project is registered in the ClinicalTrials (NCT05327153).

An Uncommon Occurrence of Posterior Fossa Ependymoma in Elderly Patient: A Case Report

Cerebellar ependymomas are rare neoplasms, even more so in elderly patients. In this case report, a 75-year-old male patient admitted with a one-year history of progressive general decline, urinary retention, left-sided weakness, memory loss, and insomnia was presented. Physical examination revealed left-sided hemiparesis and mild confusion. Cranial magnetic resonance imaging (MRI) showed a heterogeneously enhancing lesion measuring 22x15x20 mm originating from the fourth ventricle, with signs of hydrocephalus. The patient underwent tumor resection and placement of a ventriculoperitoneal (VP) shunt to address hydrocephalus. Postoperative MRI revealed no residual tumor, and the patient experienced gradual clinical improvement. Hemiparesis showed partial recovery, the overall condition stabilized, and he was subsequently discharged. Pathological examination confirmed a diagnosis of World Health Organization (WHO) grade II ependymoma. The patient is currently on a three-month follow-up.

Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice

BackgroundSudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice. ObjectiveThis study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains. MethodsThe study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood. ResultsSeventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints. ConclusionsApproximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.

Effects of Respiratory Training on Pulmonary Function, Cough, and Functional Independence in Patients with Amyotrophic Lateral Sclerosis.

Respiratory complications in patients with amyotrophic lateral sclerosis (ALS), due to the involvement of respiratory muscles, are the leading cause of death, and respiratory physiotherapy (RP) focuses on addressing these complications. The objective was to evaluate the effectiveness of an RP intervention that combines the four specific techniques (inspiratory muscle training, lung volume recruitment, manually assisted coughing, and diaphragmatic breathing training) in patients with ALS. A quasi-experimental study was carried out, and a specific RP programme was implemented in 15 patients with ALS (12 sessions, 30 min/session, one session/week, duration of three months), based on directed ventilation techniques, lung volume recruitment, manually assisted coughing, and the use of incentive spirometry and a cough assist device, along with a daily home exercise programme. Respiratory functions were assessed (pre- and post-intervention, with follow-up at three months) using Forced Vital Capacity (FVC) and Peak Expiratory Cough Flow (PECF); functionality was assessed using the Revised ALS Functional Rating Scale (ALSFRS-R) and the Modified Barthel Index by Granger. FVC experienced an increase after three months of the intervention initiation (p = 0.30), which was not sustained at the three-month follow-up after the intervention ended. All other variables remained practically constant after treatment, with their values decreasing at follow-up. A specific RP intervention could have beneficial effects on respiratory functions, potentially preventing pulmonary infections and hospitalisations in patients with ALS. It may improve FVC and help stabilize the patient's functional decline. Considering the progressive and degenerative nature of the disease, this finding could support the usefulness of these techniques in maintaining respiratory function.

Causal mediation analysis of factors influencing physical activity and community access among people with mild to moderate Parkinson's disease

ObjectiveTo examine how known causal factors (exercise self-efficacy, balance, walking capacity) affect outcomes (moderate intensity physical activity, community access) in people with Parkinson's disease (PD): through a direct pathway, indirectly through potential mediators (non-motor impairments), or through combined direct and mediated paths. DesignCausal mediation analyses using baseline and three-month data from pooled treatment groups in a randomized controlled trial. SettingData were collected at two university clinical research centers. ParticipantsOne hundred thirty-eight people with PD. InterventionsHome and community-based walking and strength exercise program. Main Outcome Measure(s)Exposures were exercise self-efficacy, walking ability, and balance. Potential mediators included pain, fatigue, mood (anxiety, depression, affect, apathy), stigma, and cognition (executive function and cognitive flexibility). Outcomes were physical activity and community access behaviour at three-month follow-up. Separate models were developed for each causal factor-mediator-outcome combination. To minimise bias, all models were adjusted for known confounders (comorbidities, freezing of gait, severity of motor impairments, and/or age) and baseline values of the outcomes. ResultsSelf-efficacy of walking duration had a causal relationship with moderate intensity physical activity through direct and combined paths (p<.001). Walking capacity had a causal relationship with community access through direct (p=.03-.04) and combined (p=.02-.03) paths. Balance did not affect community access (p>.05). There were no significant mediation effects through indirect pathways for either outcome. ConclusionsThe effect of known causal factors on physical activity and community access was not mediated by non-motor impairments. Walking self-efficacy and walking capacity remain the primary intervention targets for improving physical activity and community access, respectively, in people with PD.

Influence of the Brain-Derived Neurotrophic Factor Gene Polymorphism on Weight Loss Following Intragastric Balloon Intervention: A Cross-Sectional Study.

There is noticeable heterogeneity in weight loss outcomes following intragastric balloon (IGB) treatment, with average weight loss ranging between 11% to 15% of total body weight. Genetic variations associated with obesity have been found to influence weight loss response, however such variations are limited. Therefore, the aim of this study is to investigate the impact of the obesity associated brain-derived neurotrophic factor (BDNF) gene polymorphism rs11030104 with weight loss outcomes following IGB treatment. In this cross-sectional study, BDNF rs11030104 was analysed in 106 individuals who underwent intragastric balloon treatment. Weight loss metrics were evaluated at the three-month follow-up: percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of body mass index loss (%EBMIL). The effects of additive and dominant genetic models were evaluated. Both linear and logistic regression were applied to assess associations between rs11030104 genotypes and weight loss metrics. A total of 71 participants completed the 3-month follow-up assessment (loss to follow-up: 33%). This study found a significant association between the BDNF rs11030104 polymorphism and weight loss. A-allele carriers showed a better response to IGB treatment. Individuals carrying the AA genotype were found to have a greater %TWL than those carrying the GG genotype at 3 months post-IGB treatment (11.05% vs 5.09%, p=0.003). Our results suggest that BDNF rs11030104 influences the response to weight loss after IGB treatment and therefore could be added to the growing list of genetic variants that predict greater weight loss response.

Comparison of Visual Performance Between Mix-and-Match and Bilateral Implantation of Rotationally Asymmetric Multifocal Intraocular Lenses.

To evaluate and compare the clinical outcomes of rotationally asymmetric multifocal intraocular lenses (IOLs) in a mix-and-match approach or bilateral implantation. In this prospective study, patients were split into two groups based on the types of IOLs implanted. The mix group received mix-and-match implantation of a LENTIS Mplus LS-313 +1.50D IOL in the dominant eye and a LENTIS Mplus LS-313 +3.0D IOL in the fellow eye. The bilateral group received bilateral implantation of LENTIS Mplus LS-313 +3.00D IOLs. A three-month follow-up was performed after the surgery. Binocular visual acuity at various distances, subjective refraction and defocus curves were assessed. Subjective questionnaires included the overall satisfaction, a self-assessment of visual quality, spectacle independence, and presence of photic phenomena were completed. The study was completed by 52 patients in total (25 mix-and-match, 27 bilateral). The mean binocular uncorrected intermediate visual acuity in the mix group and the bilateral group were 0.10 ± 0.12 logMAR and 0.23 ± 0.14 logMAR, respectively, demonstrating a significant difference (P = 0.005). The mix group performed better in intermediate vision (range: -1.00 to -2.00 D) than the bilateral group (all P< 0.05), according to binocular defocus curves. About 92.0% of patients in the mix group did not need spectacles for intermediate distance vision compared to 59.26% in the bilateral group (P = 0.0001). The mix-and-match implantation of the +1.50D and +3.00D rotationally asymmetric multifocal IOLs provided good binocular visual outcomes and resulted in better intermediate vision than bilateral implantation of +3.00D IOLs.

022. From Challenge to Favorable Outcome: Resection of Progressive and Regrowing Neurofibroma in A Male 18-Year-Old Patient: A Case Report

Background: Neurofibromas are benign tumors originating from peripheral nervous system. While generally asymptomatic, they can cause significant morbidity, stigmatizing, and cosmetic concerns, requiring surgical intervention. This case report presents an interesting case of progressively enlarged and regrowing neurofibroma, which provides insights into the clinical aspect and treatment options in unusual cases. Case: An 18-year-old male patient presented with a progressively enlarging mass on his left dorsal pedis that had been present for eight years. The mass was soft, solitary, painless, accompanied by numbness, tingling, and a heavy sensation, occasionally causing difficult ambulatory. He was diagnosed with a neurofibroma and underwent wide surgical excision at another hospital. Physical examination revealed a well-defined mass measuring 12 x 7 x 5 cm, with hyperpigmentation and intact skin. Additional cutaneous lesions and café-au-lait spots suggested multiple neurofibromas, raising suspicion of Von Recklinghausen disease (neurofibromatosis type 1). Intraoperative findings confirmed a well-circumscribed, encapsulated tumor, which was completely removed by wide excision. A histopathological examination confirmed the diagnosis. The patient recovered well postoperatively, and a three-month follow-up showed no recurrence or neurological deficits. Conclusion: Neurofibromatosis type 1 can cause various manifestations, including progressive and regrowing large neurofibromas. Early detection and prompt surgical intervention are essential for preventing complications.