Total Score Of Patients Research Articles

Impact of Parkinson Medication on Neuropsychiatric and Neurocognitive Symptoms in Patients with Advanced Parkinson Disease Prior to Deep Brain Stimulation.

This study evaluates the impact of Parkinson disease (PD) medication in advanced PD on neuropsychological performance, psychiatric symptoms, impulsivity and the quality of life. In the 4-year period 27 patients with advanced PD, scheduled for deep brain stimulation (DBS) surgery (N=27, mean age: 58.9±7.1, disease duration: 10.0 years±4.2) were examined preoperatively. We hypothesized that a high dosage of PD medication or current use of dopamine agonists affect cognitive functioning and psychiatric wellbeing. We performed two subgroup analyses with low versus high levodopa-equivalent Dosage (LED) medication and without versus with dopaminagonistic medication. The neuropsychological testing revealed significant differences in the verbal learn- and memory-test (VLMT) during the learning passage (U=36.500, Z=- 2.475, p=0.012) and in the subtest of the semantic fluency of Regensburg verbal fluency test (RWT) (t(25)=- 2.066, p=0.049) with better results for patients without dopaminagonistic medication. Pearson correlation analyses of LED in correlation with the clinical and cognitive dependent variables showed a significant higher PANSS total score in patients with higher LED medication (r=0.491, p=0.009). In addition, lower LED treatment was associated with significant higher scores in the impulsivity perseverance subtest (r=- 0.509, p=0.008). In conclusion, we found lower LEDs to be correlated with a better perseverance in the impulsivity test and additional treatment with a dopamine agonist influenced some verbal learning tasks and the PANSS total score in patients with advanced PD. This should be considered prior to DBS surgery.

The Relationship between Fatalism and Hope Level in Surgical Cancer Patients: A Cross-Sectional Study

Aim: This study was conducted to determine the relationship between fatalism and level of hope in surgical cancer patients. Material and Methods: This descriptive study was conducted with the participation of 314 patients from the surgical clinics and oncology department of the Ondokuz Mayıs University Health Practice and Research Hospital between October 2021 and March 2023 in Turkey. All patients aged 18 and over who did not have communication problems, had cancer surgery, spread or radiation therapy, and did not agree to participate in the study were included in the study. Personal Information Form, Fatalism Tendency Scale, and Dispositional Hope Scale were used to collect data. Results: The mean age of participants was 59.45±10.16 (min-max:27-80). The mean Fatalism Tendency total score of patients was 82.8 ± 12.2, and the mean Dispositional Hope total score was 52.3 ± 7.2. It was determined that there was a significant difference between the Fatalism Tendency total score average, and the marital status, education level, place of residence, person living with, and seeing spirituality as important (p

Assessment of depression and anxiety and their relationship with functional status in patients with stroke

Aims: This study aimed to investigate the anxiety and depression levels and the relationship between functional status and depression, anxiety, pain, and quality of life in stroke patients. Methods: 65 stroke patients and 65 healthy controls were involved in the study. After recording the sociodemographic characteristics of all patients, anxiety, and depression levels were evaluated with the hospital anxiety depression (HAD) scale, and the quality of life with the Nottingham Health Profile (NHP) questionnaire. In stroke patients, functional status was evaluated with the functional ambulation categories (FAC), disease stages with the Brannstrom Staging system, and pain intensity with the visual analogue scale (VAS). Results: Anxiety levels were high in 33 patients (50.77%) in the stroke group and 16 patients (24.60%) in the control group. Depression levels were high in 35 patients (53.85%) in the stroke group and 25 patients (38,46%) in the control group. In the stroke group, the HAD anxiety, HAD depression, and HAD total scores of patients were statistically significantly higher compared to the control group (p:0.036, p:0.013, p: 0.010,respectively). When the quality of life of the patients was examined, the NHP energy level was statistically significantly lower in the stroke group (p:0.008). Examination of the stroke patients by their functional ambulation levels revealed statistically lower HAD anxiety, HAD depression, and HAD total scores with higher functional status (p:0.003, p:

The Functioning Assessment Short Test (FAST): Clinically meaningful response threshold in patients with major depressive disorder receiving antidepressant treatment

BackgroundFunctional impairment is common in patients with major depressive disorder (MDD). The Functioning Assessment Short Test (FAST) provides a detailed clinician-rated assessment of functioning across multiple aspects of daily life. This study aimed to establish clinically relevant response thresholds for the FAST in patients with MDD receiving antidepressant treatment. MethodsData were derived from three 8-week clinical trials of antidepressant therapy in patients with MDD that included assessment of functioning using the FAST as a pre-specified endpoint. The minimal clinically important difference (MCID) and threshold for response in terms of change in FAST total score were determined using anchor-based methods. ResultsAfter 8 weeks of antidepressant treatment, the mean reduction in FAST total score in patients considered clinically minimally improved (Clinical Global Impression–Improvement [CGI-I] score of 3) was 7–9 points (~20 % reduction). The threshold for functional response (reduction in FAST total score from baseline in patients with a CGI-I score of ≤2 at week 8) was 16–19 points (~50 % reduction). The threshold for functional response was higher in patients with MDD and comorbid generalized anxiety disorder than in those with MDD alone (mean reduction in FAST total score at 8 weeks: 26 points [63 %]). LimitationsShort-term studies. ConclusionsThese results provide further validation of the FAST for assessing functioning in patients with MDD. In patients with MDD, the suggested MCID for FAST total score is 7–9 points and the proposed threshold for response is a reduction from baseline of approximately 50 %.

Relationship between family resilience and dyadic coping in colorectal cancer patients and their spouses, based on the actor-partner interdependence model

PurposeTo explore the relationship between dyadic coping and family resistance in colorectal cancer patients and their spouses. Methods178 pairs of colorectal cancer patients and their spouses hospitalized in a three tertiary hospital in Changsha were selected from July 2021 to March 2022. The Family Resilience Assessment Scale and the Dyadic Coping Inventory were used to investigate, which relationship was analyzed by APIM. ResultsThe total score of patients' dyadic coping was 121.51 ± 16.8, and spouses' score was 123.72 ± 16.6. The total score of family resilience was 176.42 ± 16.0, and spouses' score was 182.72 ± 17.03. There was a significant positive relationship between dyadic coping and family resistance of colorectal cancer patients and their spouses (r > 0.7, P < 0.001). The positive dyadic coping of colorectal cancer patients and their spouses had a positive effect on their own and their spouses’ family resilience and the effect was the same. The negative dyadic coping of colorectal cancer patients and their spouses had a negative impact on their own family resilience, and the overall model showed a subject pattern. ConclusionsThe level of family resilience of colorectal cancer patients and their spouses was affected by the level of dyadic coping. Medical workers should regard patients and their spouses as a whole and formulate mutually supportive coping strategies with family as the center, so as to increase positive coping behavior and enhance their family's ability to cope with cancer.

THE RELATIONSHIP OF OBSESSIONS AND COMPULSIONS WITH AGGRESSION IN PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder that is frequently encountered in the clinic and affects the functionality of patients significantly. Patients with higher levels of aggression have lower treatment compliance and recovery rates for their current mental illnesses. In our study, the relationships between OCD and its subtypes and aggression were examined. A total of 87 patients with OCD were included in the study. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Buss-Perry Aggression Questionnaire (BPAQ) were applied to the patients. In this study, the relationship between Obsession subtypes and aggression total and subtypes was evaluated. Hostility (p=0.004), anger (p=0.034), verbal aggression (p=0.002) and total aggression scores (p=0.017) were significantly higher in patients with aggression obsessions. Hostility (p=0.021) and aggression total scores (p=0.043) were significantly higher in patients with contamination obsession. Anger total scores of patients with hoarding obsessions (p=0.025) and symmetry obsessions (p=0.023) were found to be significantly higher. Anger levels of patients with counting compulsions (p= 0.038) were significantly higher. Anger levels (p= 0.047) and verbal aggression levels (p= 0.018) were significantly higher in patients with hoarding compulsion. A positive and significant correlation was found between the levels of total obsession score and total aggression scores (p=0.038 r= 0.222). However there was no significant correlation between the total compulsion score and the total aggression score.

Comparative efficacy of different types of exercise modalities on psychiatric symptomatology in patients with schizophrenia: a systematic review with network meta-analysis

This network meta-analysis investigated the effects of 8 types of physical exercises on treating positive symptoms, negative symptoms, general psychopathology, and the Positive And Negative Syndrome Scale (PANSS) total score in patients with schizophrenia. The methods adhered to PRISMA guidelines and used the Cochrane risk of bias tool for quality assessment, and Stata software for data analysis. Data were sourced from PubMed, Embase, Web of Science, and the Cochrane database up to August 15, 2023, following PICOS principles. A total of 25 studies including 1441 participants were analyzed. Results showed that resistance exercise seems to be effective for improving positive symptoms, while Yoga was more effective for negative symptoms. Low-intensity aerobic exercise was optimal for general psychopathology, and Yoga was effective in improving the PANSS total score. The study concluded that yoga and aerobic exercise demonstrated superior performance, but the impact of exercise on patients with schizophrenia is also influenced by individual factors and intervention dosages. Therefore, a pre-assessment of patients considering factors such as interests, hobbies, and physical capabilities is crucial for selecting appropriate exercise modalities.

Association of empathy with clinical symptoms and cognitive function in chronic schizophrenia patients with and without suicide attempts.

Cognitive impairment is recognized as a risk factor for suicide in schizophrenia (SZ) patients. Despite empathy being an important aspect of social cognition, the association between suicidal behavior and empathy has received little attention. We aimed to compare empathy and neurocognition in SZ patients with and without suicide attempts (SAs), and to explore the relationship between empathy, neurocognition, and clinical symptoms in SZ patients with and without SAs. Data on SAs and socio-demographic characteristics were collected from 628 chronic SZ patients. The patients' symptomatology was measured by the Positive and Negative Syndrome Scale (PANSS). Empathy and neurocognition were assessed with the Interpersonal Reactivity Index (IRI) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Patients with SAs performed better on all IRI domains (except for Perspective Taking) and total scores. Regression results showed that negative symptoms, positive symptoms, and duration of illness were independently associated with IRI total score in patients without SAs (adjusted R2 = 0.048). In patients without SAs, negative symptoms, general psychopathology, education, age, and sex were independently associated with RBANS total score (adjusted R2 = 0.265), while in patients with SAs, education, PANSS total score, and age at onset were independently associated with RBANS total score (adjusted R2 = 0.456). Our results show that SZ patients with SAs may have better empathic performance than patients without SAs. In chronic SZ patients, negative and positive symptoms may have different effects on cognition in the SAs and non-SAs groups.

Cost-effective prognostic evaluation of breast cancer: using a STAR nomogram model based on routine blood tests.

Breast cancer (BC) is the most common and prominent deadly disease among women. Predicting BC survival mainly relies on TNM staging, molecular profiling and imaging, hampered by subjectivity and expenses. This study aimed to establish an economical and reliable model using the most common preoperative routine blood tests (RT) data for survival and surveillance strategy management. We examined 2863 BC patients, dividing them into training and validation cohorts (7:3). We collected demographic features, pathomics characteristics and preoperative 24-item RT data. BC risk factors were identified through Cox regression, and a predictive nomogram was established. Its performance was assessed using C-index, area under curves (AUC), calibration curve and decision curve analysis. Kaplan-Meier curves stratified patients into different risk groups. We further compared the STAR model (utilizing HE and RT methodologies) with alternative nomograms grounded in molecular profiling (employing second-generation short-read sequencing methodologies) and imaging (utilizing PET-CT methodologies). The STAR nomogram, incorporating subtype, TNM stage, age and preoperative RT data (LYM, LYM%, EOSO%, RDW-SD, P-LCR), achieved a C-index of 0.828 in the training cohort and impressive AUCs (0.847, 0.823 and 0.780) for 3-, 5- and 7-year OS rates, outperforming other nomograms. The validation cohort showed similar impressive results. The nomogram calculates a patient's total score by assigning values to each risk factor, higher scores indicating a poor prognosis. STAR promises potential cost savings by enabling less intensive surveillance in around 90% of BC patients. Compared to nomograms based on molecular profiling and imaging, STAR presents a more cost-effective, with potential savings of approximately $700-800 per breast cancer patient. Combining appropriate RT parameters, STAR nomogram could help in the detection of patient anemia, coagulation function, inflammation and immune status. Practical implementation of the STAR nomogram in a clinical setting is feasible, and its potential clinical impact lies in its ability to provide an early, economical and reliable tool for survival prediction and surveillance strategy management. However, our model still has limitations and requires external data validation. In subsequent studies, we plan to mitigate the potential impact on model robustness by further updating and adjusting the data and model.

Reappraisal of prognostic factors used in the European Pediatric Soft Tissue Sarcoma Study Group RMS 2005 study for localized rhabdomyosarcoma to optimize risk stratification and generate a prognostic nomogram.

The objective of this study was to investigate the role of clinical factors together with FOXO1 fusion status in patients with nonmetastatic rhabdomyosarcoma (RMS) to develop a predictive model for event-free survival and provide a rationale for risk stratification in future trials. The authors used data from patients enrolled in the European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) RMS 2005 study (EpSSG RMS 2005; EudraCT number 2005-000217-35). The following baseline variables were considered for the multivariable model: age at diagnosis, sex, histology, primary tumor site, Intergroup Rhabdomyosarcoma Studies group, tumor size, nodal status, and FOXO1 fusion status. Main effects and significant second-order interactions of candidate predictors were included in a multiple Cox proportional hazards regression model. A nomogram was generated for predicting 5-year event-free survival (EFS) probabilities. The EFS and overall survival rates at 5years were 70.9% (95% confidence interval, 68.6%-73.1%) and 81.0% (95% confidence interval, 78.9%-82.8%), respectively. The multivariable model retained five prognostic factors, including ageat diagnosis interacting with tumor size, tumor primary site, Intergroup Rhabdomyosarcoma Studies clinical group, and FOXO1 fusion status. Based on each patient's total score in the nomogram, patients were stratified into four groups. The 5-year EFS rates were 94.1%, 78.4%, 65.2%, and 52.1% in the low-risk, intermediate-risk, high-risk, and very-high-risk groups, respectively, and the corresponding 5-year overall survival rates were 97.2%, 91.5%, 74.3%, and 60.8%, respectively. The results presented here provide the rationale to modify the EpSSG stratification, with the most significant change represented by the replacement of histology with fusion status. This classification was adopted in the new international trial launched by the EpSSG.

Estimating meaningful change thresholds for Skin Pain-Numeric Rating Scale, Sleep-Numeric Rating Scale and Dermatology Life Quality Index in patients with prurigo nodularis.

Prurigo nodularis (PN) is characterized by intensely itchy nodules/lesions and skin pain, which can have a substantial impact on health-related quality of life (HRQoL). Treatment benefits on such symptoms and impacts are best assessed in trials using patient-reported outcome (PROs) instruments such as Skin Pain Numerical Rating Scale (NRS), Sleep-NRS and Dermatology Life Quality Index (DLQI). However, no guidance exists for interpreting meaningful changes in scores using these PROs in patients with PN. The main objective was to derive within-patient (responder definition) and between-group improvement thresholds for interpreting Skin Pain-NRS, Sleep-NRS and DLQI total scores in patients with PN. The measurement properties of the three PROs were also evaluated. Intention-to-treat (ITT), blinded and pooled data were used from the Phase 3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN. Anchor- and distribution-based methods were applied to derive responder definition and between-group thresholds for Skin Pain-NRS, Sleep-NRS and DLQI. Data were additionally used to examine the instrument measurement properties, including reliability, validity and responsiveness. A total of 311 patients (mean age 49.5 years, 65.3% female) were included in the pooled ITT population. The within-patient improvement threshold for Skin Pain-NRS was estimated as 4.0 points, 2.0 points for Sleep-NRS and 9.0 points for DLQI total score. A 1.5-point improvement in Skin Pain-NRS scores, 1.0-point in Sleep-NRS and 4.0-point in DLQI indicated a between-group meaningful change. Adequate to good psychometric properties were demonstrated for all three instruments. The results of this study can aid interpretation of Skin Pain-NRS, Sleep-NRS and DLQI scores in patients with PN in both clinical trials and clinical practice to better understand and treat PN-related skin pain and the impact of PN on sleep quality and HRQoL.

The neutrophil-to-Lymphocyte ratio is associated with clinical symptoms in first-episode medication-naïve patients with schizophrenia

Innate immunity has been shown to be associated with schizophrenia (Sch). This study explored the relationship between symptoms and neutrophil-to-lymphocyte ratio (NLR) (a marker of innate immunity) in patients with Sch. Ninety-seven first-episode medication-naïve (FEMN) patients with Sch and 65 healthy controls were recruited in this study. We measured the complete blood count and assessed the clinical symptoms using the PANSS scales. We found higher NEU counts and NLR in patients with Sch compared with control subjects. Male patients showed a higher NEU count than female patients. In addition, FEMN patients with higher NLR and NEU values showed higher PANSS-p, PANSS-g, and PANSS-total scores (all p < 0.05). Regression analysis revealed that NLR was a predictor for PANSS total scores in patients with Sch. Higher NLR value was observed in patients with Sch and the significant associations between NLR and psychotic symptoms indicate that an imbalance in inflammation and innate immune system may be involved in the pathophysiology of Sch.

Orthodontic patient’s perspectives, attitudes, and readiness toward teleorthodontics

Abstract Aim: To evaluate the perspective, attitude, and readiness of orthodontic patients toward teleorthodontics. Materials and Methods: This prospective study was conducted at an orthodontic specialist clinic, Kulliyyah of Dentistry, Kuantan Pahang, Malaysia, involving all 46 orthodontic patients requiring active orthodontic treatment from February to July 2021. Patients were offered four options of online consultation: telephone call, virtual meeting, WhatsApp messaging, and a combination of all three methods. An online survey was distributed after the online consultations to assess patients’ perspectives, attitudes, and readiness toward teleorthodontics. Descriptive statistics were used to summarize the demographic data. Mann–Whitney U test and Kruskal–Wallis test were used to compare the patient’s perspectives, attitudes, and readiness toward teleorthodontics based on their demographic background. A Spearman’s correlation coefficient looked at the linear relationship between the perspective, attitude, and readiness toward teleorthodontics practice. Results: About 82.4% agreed that teleorthodontics was convenient. About 82% agreed that teleorthodontics should be practiced during the pandemic and 72% agreed that it should be practiced after the pandemic. About 89.1% agreed that teleorthodontics bring benefits during the pandemic, and 74% agreed that teleorthodontics might bring benefits after the pandemic. No significant difference was found between sociodemographic background with the total scores of patients’ perspectives, readiness, and attitude toward teleorthodontics. Conclusions: The majority of the patients showed good perspective, attitude, and readiness toward teleorthodontics. Teleorthodontics on certain clinical procedures can be implemented postpandemic to reduce in-office orthodontic visits.

Association of P50 with social function, but not with cognition in patients with first-episode schizophrenia.

Functional deficits including cognitive impairment and social dysfunction are the core symptoms of schizophrenia (SCZ), and sensory gating (SG) deficits may be involved in the pathological mechanism of functional deficits in SCZ. This study was to investigate the relationship between defective P50 inhibition and functional deficits in first-episode drug naïve (FEDN) SCZ patients. A total of 95 FEDN SCZ patients and 53 healthy controls (HC) were recruited. The Chinese version of UCSD Performance-Based Skills (UPSA), MATRICS Consensus Cognitive Battery (MCCB), and EEG system were used to assess the social function, cognitive performance, and P50 inhibition, respectively. The MCCB total score and eight domain scores were significantly lower in patients with FEDN SCZ than those in HC (all p < 0.05). The UPSA total score and financial skills scores were also significantly lower in SCZ patients than that in the HC (all p < 0.05). Compared with HC, patients with FEDF SCZ had a higher P50 ratio (all p < 0.05). There was no correlation between P50 components and MCCB scores in patients with FEDF SCZ. However, there was only a correlation between the P50 ratio and UPSA financial skills, communication skills, or total score in patients (all p < 0.05). Defective P50 inhibition in FEDN SCZ patients may be associated with social dysfunction but not cognitive impairment, suggesting that the social dysfunction and cognitive impairment of patients with FEDN SCZ may have different pathogenic mechanisms.

A randomized, prospective, active-controlled study comparing intramuscular long-acting paliperidone palmitate versus oral antipsychotics in patients with schizophrenia at risk of violent behavior

ObjectivePaliperidone palmitate (PP) is an effective long-acting antipsychotic injection, but its impact on the behavior of schizophrenia patients with dangerous tendencies requires further investigation. This study aims to explore the effects of long-term antipsychotic treatment on this population in the community. MethodsThis 49-week, randomized controlled trial was conducted across 21 communities in Wuhan and enrolled 134 schizophrenia patients at risk for violent behavior. With a fixed block size of 10, participants were randomly assigned to receive either intramuscular PP 1-month formulation (PP1M) or oral antipsychotic medication (OAP) at a 1:1 ratio. Changes in patients' risk for violent/aggressive behavior, family burden, social, and cognitive functioning were measured using VRAPP, MOAS, PANSS, FBS, PSP, and RBANS scales from baseline to endpoint. Longitudinal data from multiple repeated measures were analyzed using linear mixed-effects models. ResultsThe study protocol was completed by 77.6% of the patients overall. Significant improvements were observed in the risk assessment scores, MOAS total score, PANSS total score, PSP total score, and FBS total score of patients in the PP1M group from baseline to the end of treatment (all P < 0.05). Importantly, compared to patients in the OAP group, the improvements in these measures were also significantly greater in the PP1M group. Commonly observed AEs, such as hyperprolactinemia (70.3% vs. 62.65%) and muscle tension (45.3% vs. 57.8%), were considered to be the PP-related AEs. Nonetheless, the differences between the two groups did not reach statistical significance, and no new safety concerns emerged. ConclusionsOur study suggests that PP long-acting injection (LAI) is a safe and effective treatment option for community-dwelling schizophrenia patients with impulsive violence and risky behaviors.

Altered prefrontal beta oscillatory activity during removal of information from working memory in obsessive-compulsive disorder

BackgroundObsessive-compulsive disorder (OCD) is related to working memory impairment. Since patients with OCD have difficulty controlling their obsessive thoughts, removal of irrelevant information might be important in the pathophysiology of OCD. However, little is known about brain activity during the removal of information from working memory in patients with OCD. Our goal was to explore potential deficits in inhibitory function related to working memory processes in patients with OCD.MethodsSixteen OCD patients and 20 healthy controls (HCs) were recruited. We compared in prefrontal alpha and beta band activity derived from magnetoencephalography (MEG) between patients with OCD and HCs during multiple phases of information processing associated with working memory, especially in post-trial period of the visuospatial working memory task (the delayed matching-to‐sample task), which is presumed to be related to the information removal process of working memory.ResultsPrefrontal post-trial beta power change (presumed to occur at high levels during the post-trial period) exhibited significant reductions in patients with OCD compared to HCs. In addition, the post-trial beta power change was negatively correlated with Obsessive-Compulsive Inventory–Revised total scores in patients with OCD.ConclusionsThese findings suggest that impairment in the removal of information from working memory might be a key mechanism underlying the inability of OCD patients to rid themselves of their obsessions.

An Investigation of Alexithymia, Type D Personality Traits, and Childhood Traumas in Patients with Fibromyalgia

Although not completely understood, fibromyalgia is characterized by intense physical complaints with psychiatric factors involved in its etiopathogenesis. The present study aimed to investigate alexithymia, type D personality, and childhood traumas that might accompany fibromyalgia in those patients. The study enrolled 44 healthy controls and 44 patients with fibromyalgia. Sociodemographic and Clinical Data Form, Type D Personality Scale (DS-14), Toronto Alexithymia Scale (TAS), and Childhood Trauma Questionnaire (CTQ-28) were used for the purposes of collecting data from all the participants. The group including patients diagnosed with fibromyalgia had significantly higher type D personality traits compared to the control group (p=.015). Furthermore, there was a significant intergroup difference by the TAS scale (p&lt;0.05). CTQ-28 total and emotional, physical neglect, and emotional abuse subscales were higher in the patient group compared to the control group (p&lt;0.05). Upon intragroup comparison of DS-14 subscale and CTQ-28 subscale scores in the patient group, patients with negative affection were significantly more emotionally neglected (p=.009). There was a moderate positive correlation between the CTQ-28 total scores and the TTS total score of patients with fibromyalgia (r=.54, p=.01). Individuals with fibromyalgia have a history of childhood trauma, difficulty in expressing their emotions, and distressed personality structures. Psychological assessment and psychosocial support therapies would prove to be beneficial in the treatment of fibromyalgia, a psychosomatic disease.

The Efficacy of Corticosteroids in the Management of Tietze Syndrome: A Randomized Controlled Trial

Abstract Background So far there are no clinical trials in the literature discussing the methods of treatment of Tietze‟s syndrome. Particularly, conservative methods of treatment are used, which include pain management using analgesics and nonsteroidal anti-inflammatory drugs. Oral corticosteroids offer a safe and effective treatment modality that is proven to be useful in a significant number of chest wall syndromes such as Sternoclavicular arthritis, Painful xiphoid syndrome, Costovertebral arthritis, and Slipping rib syndrome as well as conditions arising from ligament and tendon diathesis. Objective To use oral Corticosteroids in management of patients with Tietze syndrome at Ain shams university hospitals‟ cardiothoracic department and measuring the outcome randomly compared with the conventional NSAIDs to achieve the best outcome and quality of life. Methods This study included 40 patients who were diagnosed clinically as Tietze Syndrome at Ain Shams University Hospitals-cardiothoracic department in the duration between August 2020 till March 2022 with age ranging from 14 to 45 years and were sorted randomly. Two groups of patients were chosen and matched randomly as „Control arm‟ and „Interventional arm‟. The control group received the conventional NSAIDs (in the form of 50 mg of diclofenac potassium as „cataflam‟ twice daily) and the Interventional group received oral corticosteroids (in the form of 20 mg of prednisolone as „solupred‟ twice daily). Results Our study suggested that in patients with moderate to severe chondritis diagnosed clinically as Tietze syndrome, a 3 week course of oral 40 mg prednisolone is superior to the conventional oral NSAIDs in alleviating pain and improving the quality of life which is evidenced by the decline in EQ-5D total score of patients receiving oral steroids at the end of the treatment course as well as during each week throughout the trial timeframe. A highly significant reduction in pain score demonstrated via NRS was evident in the steroid-treated group compared to the NSAIDs-treated group at the same time point. Conclusion Oral corticosteroids are effective and safe in non-responding, obstinate Tietze syndrome. The results were unexpectedly good, obtaining significant relief and an outstanding refinement in quality of life reported by patients receiving oral steoids. There is no widely accepted protocol for oral steroid usage in Tietze syndrome and similar chest wall pain syndromes. Some other studies propose surgery in such patients. We think that surgery is a troublesome intervention for the patient and his doctor as well.

Problematic internet use and sleep quality in adolescents with major depressive disorder

ABSTRACT This study aims to compare adolescents newly diagnosed with major depressive disorder (MDD) and healthy controls in terms of problematic internet use (PIU) and sleep quality. The study sample consisted of 50 newly diagnosed MDD patients aged 12–18 years and 50 healthy controls. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was administered to all cases by a child psychiatrist and sociodemographic data were collected. Children’s Depression Inventory (CDI), Pittsburgh Sleep Quality Index (PSQI), and Internet Addiction Test (IAT) were administered to all participants. Data of the MDD and control groups were compared using Student’s t-test or Mann-Whitney U test and the total scores of the IAT (z = −6.23, p < 0.001) and PSQI (t =–11.42, p < 0.001) scales were found to be significantly higher in MDD cases compared to the control group. The results of analysis of covariance demonstrated that there was a significant positive correlation between CDI and IAT, as well as CDI and PSQI total scores in patients with MDD. While no correlation was observed between the total scores of the IAT and PSQI scales in the MDD group, a significant positive correlation was found between the total scores of the IAT and PSQI scales in the healthy control group. Furthermore, there was a significant difference between the PSQI habitual sleep efficiency subscale score and the IAT total score (r = 0.36, p = 0.009), and the IAT responsibility (r = 0.34, p = 0.015), relationship (r = 0.36, p = 0.01), and mood subscale scores (r = 0.30, p = 0.03). A significant positive correlation was also found between the IAT duration subscale score and PSQI sleep disorder subscale score (r = 0.35, p = 0.013). In addition, binary logistic regression analysis showed that PSQI total score (B = 0.79, p < 0.001) and IAT total scores (B = 0.08, p = 0.001) could be significant predictors of MDD. The findings of this study indicate that the prevalence of PIU and poor sleep quality is higher in adolescents with newly diagnosed MDD compared to healthy controls. The results of our study indicated that the severity of depression, PIU, and sleep quality were significantly correlated in adolescents with newly diagnosed MDD, while PIU and sleep quality were correlated in adolescents without any psychiatric disorders. In addition, this study suggests that poor sleep quality and PIU may be risk factors for MDD.

Correlation of callosal angle at the splenium with gait and cognition in normal pressure hydrocephalus.

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventricular enlargement that deforms the corpus callosum, making the callosal angle (CA) small. The authors aimed to evaluate the clinical usefulness of the CA in different planes in iNPH. Forty patients with iNPH were included in the study. As a control group, 241 patients with other neurological diseases and 50 healthy controls were included. The subjects had been seen at the authors' institutions from 2010 to 2020. The Timed Up and Go (TUG) test total time and Mini-Mental State Examination (MMSE) total score were evaluated. CAs were measured in the axial plane at the splenium and genu and in the coronal plane at the anterior commissure and posterior commissure by using 3-dimensional T1-weighted MR images. As other hydrocephalus parameters, the Evans index, frontal-occipital horn ratio, and third ventricular width were also measured in patients with iNPH. Associations between each CA or hydrocephalus parameter and clinical parameters were evaluated. The classification efficacy of each CA in differentiating between iNPH and other neurological diseases and healthy controls was evaluated. The CA at the splenium, but no other hydrocephalus parameters, was correlated with TUG total time or MMSE total score in patients with iNPH. Receiver operating characteristic analysis showed that a CA of 71.1° at the splenium has 90.0% sensitivity and 89.0% specificity in discriminating iNPH from other neurological diseases and healthy controls. Probabilistic tractography analysis showed that neuronal fibers via the splenium connect the superior parietal lobules, temporal lobes, and occipital lobes. The study results suggest that interhemispheric disconnections at the splenium are, at least in part, responsible for gait and cognitive disturbance in iNPH. The CA at the splenium is a unique morphological feature that correlates with gait and cognition in iNPH, and it is useful for discriminating iNPH from other neurological diseases and healthy controls.