Total Severity Score Research Articles

Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools.

Youth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide. To examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms. Secondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program. Thirteen public high schools during the 2021-2022 academic year. Sixty-two students diagnosed with concussion who reported symptoms to school personnel. The school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations. Symptom profile, accommodation type, and accommodation duration. A total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered. Students with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.

Abstract 4131815: The Prevalence of Normal Coronary Arteries as Determined by a Coronary Artery Calcium Score of Zero Amongst Subjects with Diabetes Mellitus

Background: The CDC reports that in 2021, 11.6% of the American population had diabetes mellitus (DM). Past literature has shown diabetes to be a significant risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). Research Question/Goal: Using data obtained through Computed Tomography Angiography (CTA), we aim to distinguish the risk factors associated with a coronary artery calcium (CAC) score of zero in subjects with DM and to identify the prevalence of non-calcified plaque in individuals with this score. Methods: We performed a retrospective study of patients with DM, who underwent CAC and CTA screenings from October 2004 to January 2024 at our center in Torrance, California to examine CTA outcomes in those with CAC Score of zero and greater than zero. Results: Among the cohort of 2,763 subjects with DM, the average age was 63.8±12.2 years, 62% male. Within this cohort, 465 (17%) subjects had a CAC Score of zero compared to 2,298 subjects with a CAC Score greater than zero with a median score of 428 (Interquartile range (IQR) 91-1267). DM subjects with CAC Score of zero were significantly younger (53.0±13.9 versus 66.0±10.6: p<0.001), were more likely to be female and had significantly lower rates of hypertension (57% versus 76%: p<0.001), and hyperlipidemia (63% versus 76%: p<0.001). In DM subjects with CAC Score of zero, 133 (29%) had a total plaque severity score of 1 or greater (median 1, IQR 1-2) while 332 (71%) had normal coronaries on CTA. Conclusions: A significant percentage of subjects with DM were determined to have a CAC score of zero. Subjects with normal coronary arteries were more likely to be younger, female, and/or absent of other chronic diseases such as hypertension and hyperlipidemia. Although age and sex are nonmodifiable risk factors of ASCVD, limiting the comorbid conditions associated with DM may be beneficial in preventing ASCVD in individuals with diabetes.

Efficacy and safety of balovaptan for posttraumatic stress disorder: A randomized, placebo-controlled trial.

Posttraumatic stress disorder (PTSD) has a significant impact on quality of life and affects more than 13 million individuals in the United States, with limited treatments available. EXUVIA (NCT05401565) was a Phase 2, randomized, placebo-controlled, double-blind trial, conducted across eight sites in the United States. The study aimed to assess the efficacy, safety, and pharmacokinetics of balovaptan, a highly selective vasopressin 1a receptor antagonist, in adults with PTSD. Between August 2022 and October 2023, a total of 57 adult participants (aged 18-60 years) were screened, and 29 participants were randomly allocated (1:1) to receive either balovaptan (13/29 [44.8%]) or placebo (16/29 [55.2%]). No meaningful differences were observed for balovaptan (-17.2 [± 10.7]) versus placebo (-15.6 [± 10.7]) as measured by the primary endpoint of change from baseline at Week 12 in Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition total symptom severity score. No meaningful differences for balovaptan versus placebo were observed at Week 12 for any secondary endpoints. Balovaptan was well tolerated with no new safety findings. The number of participants with at least one adverse event of any intensity was 9/13 (69.2%) in the balovaptan group and 7/16 (43.8%) in the placebo group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A cross-sectional study on distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity disorders in Indian context

Abstract Introduction: Conduct behaviors are frequently associated with disorders of inattention and hyperactivity. Many studies have been done in the Western population on predictors of those conduct behaviors among these children with inattention-hyperactivity. However, such studies are lacking in the Indian context. Thus, the current study examined the distinctive factors associated with conduct behaviors among children presenting with inattention-hyperactivity Disorders in the Indian setting. Materials and Methods: A cross-sectional study was done in a Medical College of Kolkata with two groups of children and adolescents each having 50 samples diagnosed as hyperkinetic conduct disorder (HKCD) and hyperkinetic disorder of attention and activity (HKD-AA) as per International Classification of Diseases-10th version. Comparison between the two groups was made with the abbreviated (10-item) Conners’ rating scale for parents (CPRS-HI) and a semi-structured socio-demographic pro forma to find out the distinctive factors associated with HKCD. Results: On comparison between the two groups, significant differences (P < 0.05) were found in items such as male sex, birth complications, inadequate social-skill development, paternal alcohol use disorders (AUD), and disturbed family ambience, which were significantly higher in HKCD. Among CPRS-HI items, impulsivity was the distinguishing feature of HKCD. However, the total severity scores of CPRS-HI were similar in both the groups. In our population, maternal substance abuse was not found, and mood and alcohol use disorders were more common than childhood externalizing disorders in the family history. Conclusion: Similar to the Western population, in our study male sex, birth complications, paternal-AUD, and disturbed family ambience are distinctively higher in conduct behaviors, but contrary to them, there is no maternal substance abuse, and severity of inattention-hyperactivity scores are similar in children with or without conduct behaviors.

Interdisciplinary Consensus in Evaluating the Severity Subscale of the Original and Revised Toronto Western Spasmodic Torticollis Rating Scale Through Video-Based Assessment: An Inter-Rater Reliability Study.

Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is widely employed for cervical dystonia (CD) evaluation. To assess the inter-rater reliability of the severity subscale of the original and revised TWSTRS using video recordings. Three raters, a PhD student with a nursing degree, a physiotherapist specialized in CD, and a neurologist-in-training independently rated all videos. The inter-rater reliability was assessed with the intra-class correlation coefficient (ICC). The total severity score of both tools demonstrated a good inter-rater reliability (ICC = 0.87 to 0.88). The inter-rater reliability of individual sub-items varied from poor (ICC = 0.29) to excellent (ICC = 0.9). The total severity score of both TWSTRS showed good inter-rater reliability in a multidisciplinary team, indicating their applicability for online patients' assessment. We recommend using the total subscale for outcome comparison. Furthermore, there is a need for more accurate definitions of duration factor and shoulder elevation.

The relationship between COMT, proline, and negative symptoms in clinical high risk and recent psychosis onset

Individuals at clinical high-risk (CHR) of developing psychosis, as well as patients with recent psychosis onset (RO), experience significant negative symptoms that detrimentally impact daily-life functioning and are associated with poor outcomes, even in those who do not convert to psychosis. Targeting negative symptoms may thus hold promise for the treatment of CHR and RO patients. Building from previous findings we examined whether the catechol-O-methyltransferase (COMT) Val158Met functional polymorphism and fasting peripheral proline concentration predicts the severity of negative symptoms experienced by adolescents and young adults at CHR or those with RO. As hypothesized, the interaction between fasting plasma proline and COMT predicted negative symptoms, as measured via the Scale for the Assessment of Negative Symptoms (SANS) total (n = 50, β = 0.066, adjusted p = 0.007) and global severity scores (n = 50, coefficient = 0.026, adjusted p = 0.003): Higher proline was beneficial for Val/Val subjects, but detrimental to those with the Met allele. In a secondary analysis, the COMT x proline interaction also predicted symptoms measured via the Clinical Assessment Interview for Negative Symptoms (CAINS) total scores (n = 50, β-coefficient = 0.035, adjusted p = 0.044), although this result did not reach the Benjamini-Hochberg’s threshold for significance. Further, there was a trend towards significance for an association with social and interpersonal function (Global Functioning-Social, coefficient = −0.005, adjusted p = 0.055). Negative symptoms are intractable and largely unaddressed by current medications. This study further supports a relationship between peripheral proline and COMT influencing negative symptoms such as anhedonia, in young CHR individuals and those with RO. That higher proline has converse effects on symptoms by COMT may have implications for the development of therapeutics to intervene early and specifically target the interaction pathway.

Predictors of Chest CT Total Severity Score InCovid-19 Infected Patients In Rwanda

Background: Over 5.54 million COVID-19 deaths occurred worldwide by the January 2021 and COVID-19 pneumonia remains the commonest cause of death. The current study was conducted to investigate predictors of total severity score in patients with COVID-19 pneumonia who underwent chest CT and in turn be used in setting with limited resource to predict TSS as well as prognosis Materials and Methods: The current study retrospectively evaluated the CT findings in COVID-19 patients with clinical severity using a 25-point visual quantitative assessment and total severity score predictors were determined. A sample of 384 COVID-19 patients was used and Statistical analysis was done using SPSS 25.0. Results: The findings of the current study indicate that age (p < 0.001), vaccination status (p = 0.006), and disease status (p < 0.001) are significant predictors of the total severity score on chest CT scans in patients with COVID-19 pneumonia. Specifically, as age increases, the odds of having a higher total severity score also increase. Conversely, individuals who are vaccinated tend to have lower severity scores, suggesting that COVID-19 vaccination is associated with a reduced likelihood of experiencing severe disease. Additionally, patients with severe COVID-19 pneumonia are more likely to exhibit higher severity scores on Chest CT. Conclusion: Chest CT scan total severity score can be predicted with age, immunization status and disease status classified as mild, moderate, severe and critical covid-19 pneumonia and this score can be used to predict clinical outcome. Recommendation: A large multicenter study can be used to validate current study findings and these clinical predictors can be used in resource limited settings where CT scan accessibility is not ensured.

Practical Assessment of Neuropsychiatric Symptoms: Updated Reliability, Validity, and Cutoffs for the Neuropsychiatric Inventory Questionnaire

ObjectivesTo improve assessment of neuropsychiatric symptoms (NPS) by expanding the measurement properties of the Neuropsychiatric Inventory Questionnaire (NPI-Q). DesignMulticenter, longitudinal observational study. SettingSeveral Alzheimer's Disease Research Centers (ADRCs). ParticipantsIndividuals who presented to an ADRC with a collateral and completed the NPI-Q. MeasurementsThe NPI-Q total severity score, four NPI-Q subscales, dementia stage, expert NPS rating, consensus rating of dementia syndrome, global cognitive screening, collateral rating of daily functioning, and self-rating of depression. ResultsThere was strong evidence of criterion validity with both dementia stage and expert NPS rating for the NPI-Q total severity index, which informed cutoffs and interpretive ranges. Furthermore, subscales had adequate classification of dementia syndromes and appropriate convergent relationships with cognition, daily functioning, and mood. There was good-to-excellent evidence of reliability for the NPI-Q total severity index over several years, and subscales had adequate-to-good reliability. ConclusionsThis is the first study to provide empirically established cutoffs, interpretive ranges, and evidence of reliability over a period longer than a month on the NPI-Q and its subscales. This will improve assessment of NPS in clinical and research contexts. Article SummaryNeuropsychiatric symptoms of neurodegeneration are increasingly understood as early disease markers with tremendous functional impact later in disease, but are often missed or misdiagnosed. The most common measure of these symptoms, the Neuropsychiatric Inventory Questionnaire (NPI-Q), does not have clinically actionable guidance, which this article provided. We established cutscores for several conditions and test-retest reliability over longer periods for the total score and subscales using a multicenter database.

Symptom Burden in Patients on Maintenance Hemodialysis: Prevalence and Severity 17 Years Apart.

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Correlation Between Initial Lung Involvement on CT Scan, Assessed by Total Severity Score, and Pulmonary Outcomes After Three Months in Patients with Severe COVID-19

Background: Patients with severe COVID-19 experience various respiratory complications, which can have potential long-term effects. Objectives: This study investigates the long-term pulmonary consequences of severe COVID-19 and their relationship with the severity of lung involvement. Methods: All patients who survived severe COVID-19 in the ICU were selected for the study. A radiologist reviewed the chest CT scans, and patients were categorized based on their total severity score (TSS) into two groups: Group A (TSS ≤ 7) and Group B (TSS > 7). Patients were followed up after three months with a chest CT scan, spirometry, SpO2 measurement, and a dyspnea score assessment. Results: The mean age was 54.69 ± 12.51 for Group A and 55.31 ± 12.73 for Group B. Groups A and B had 23 (46.9%) and 39 (39.4%) female patients, respectively. Patients in Group B had significantly lower SpO2 and a prolonged length of hospitalization. Group B also experienced more severe dyspnea and reduced lung function, as observed in spirometry during the three-month follow-up. The total severity score decreased significantly after three months in all patients (from 14.42 ± 5.90 to 6.68 ± 4.79; P < 0.001). After logistic regression analysis, non-invasive ventilation was independently associated with a higher TSS (OR = 0.45 when comparing Group A to Group B; P = 0.028). Conclusions: The lungs are the most affected organ by COVID-19, making it crucial to investigate the effects of the virus on pulmonary function. Our study showed that patients with higher TSS experienced greater reductions in lung function during the three-month follow-up. Additionally, the use of non-invasive ventilation was independently associated with a higher TSS in severe COVID-19 cases.

Post‐intubation hypotension risk factors in patients with COVID‐19 undergoing endotracheal intubation in the emergency department: A prospective observational study

AbstractIntroductionAcute respiratory distress syndrome, a severe manifestation of COVID‐19, prompts the critical intervention of endotracheal intubation (ETI). However, ETI is associated with complications, notably post‐intubation hypotension (PIH), linked to an increased adverse prognosis. Our purpose was to investigate risk factors for PIH in COVID‐19 patients in the emergency department (ED).MethodsThis observational study was conducted at the Afzalipour Hospital, Iran. Adult COVID‐19 patients undergoing ETI were included, with data collected on demographic variables, medical history, and hemodynamic parameters. PIH was defined as the occurrence of any of the following: reduction of systolic blood pressure (SBP) to 90 mmHg or less; reduction of mean arterial pressure (MAP) to 65 mmHg or less; reduction of SBP by at least 20% of the initial value; or the need for vasopressor support during the 30 min after intubation.ResultsAmong 145 patients, the mortality rate was 82.7%, and PIH occured in 22.7%. Univariate analysis revealed associations between PIH and initial SBP (SBP‐0) and initial MAP. Multivariable regression revealed that each 1 mmHg decrease in SBP‐0 increased the risk of PIH by 5%. Patients with SBP‐0 of less than 116 mmHg had a PIH odds ratio of 4.1. A history of hypertension (HTN) or ischemic heart disease (IHD) increased the likelihood of PIH sixfold. The receiver operating characteristic curves for SBP‐0 had an area under the curve (AUC) of 0.67 (95% CI: 0.54–0.79), lower than the AUC of 0.77 (95% CI: 0.64–0.86) for the model incorporating SBP‐0, history of HTN or IHD, and total severity score. Despite this, the Z score comparing the AUCs of SBP‐0 and the multivariable model did not indicate a statistically significant difference.ConclusionsHistory of HTN or IHD, as well as low SBP‐0, are independently associated with an increased risk of PIH in COVID‐19 patients.

The efficacy of autologous serum therapy in chronic spontaneous urticaria: A systematic literature review and meta-analysis

Chronic spontaneous urticaria (CSU) is an autoimmune disease characterised by urtica lesions and/or angioedema accompanying an itching sensation, recurring for at least six weeks without any specific trigger. Autologous serum therapy (AST) is an adjuvant therapy for CSU that is resistant to H1 antihistamines. This therapy is an economical option in developing countries. There were a few studies discussing the role of AST in CSU. This systematic review and meta-analysis were conducted to evaluate the efficacy of AST based on urticaria activity scores (UAS or UAS7) and urticaria total severity scores (TSS) so that clinicians can consider them. Data were searched systematically in Cochrane, PubMed, Google Scholar, Willey, and EMBASE from 2000 to March 2023. Data analysis using Excel 2010 (Microsoft Corp) and MedCalc version 20.218. There were 14 studies: 4 randomised controlled trials (RCT), 9 prospective, and 1 cross-sectional. The average improvement in UAS and TSS scores at the end of therapy was 42.24% and 41.24%. Results of subgroup analysis of AST administration in the group autologous serum skin test (ASST) positive and ASST negative based on the end of therapy UAS score (p=0.18). Results of subgroup analysis of AST administration in the positive ASST and negative ASST groups based on the TSS score at the end of therapy (p=<0.001). Results of subgroup analysis of AST administration versus placebo based on TSS score (p=0.861). Based on subgroup analysis, autologous serum therapy improves TSS scores in CSU patients (ASST positive). However, AST is not significantly different from placebo.

The revised Clinician-Administered PTSD scale for DSM-5 (CAPS-5-R): Initial psychometric evaluation in a trauma-exposed community sample.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a widely used, well-validated structured interview for posttraumatic stress disorder (PTSD). It was recently revised to improve various aspects of administration and scoring. We conducted a psychometric evaluation of the revised version, known as the CAPS-5-R. Participants were 73 community residents with mixed trauma exposure (e.g., sexual assault, physical assault, transportation accident, the unnatural death of a loved one). CAPS-5-R PTSD diagnosis demonstrated good test-retest reliability, кs =.73-.79; excellent interrater reliability, кs =.86-.93; and good-to-excellent alternate forms reliability with the CAPS-5, кs =.79-.93. In addition, the CAPS-5-R total PTSD severity score demonstrated excellent test-retest reliability, intraclass correlation coefficient (ICC) =.86; interrater reliability, ICC =.98; and alternate forms reliability with the CAPS-5, r =.95. Further, the CAPS-5-R demonstrated good convergent validity with other measures of PTSD and good discriminant validity with measures of other constructs (e.g., depression, anxiety, alcohol problems, somatic concerns, mania). Given its strong psychometric performance in this study, as well as its improvements in administration and scoring, the CAPS-5-R appears to be a valuable update of the current CAPS-5.

Topical Nasal Steroids for Allergic Rhinitis in Children. Is One Better Than the Others? Protocol for a Systematic Review and Network Meta-analysis.

Background The present protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO under de ID code CRD42023476313, and adheres the PRISMA-P 2015 statement. The complete checklist can be consulted in the extended data section. Allergic Rhinitis (AR) is the most common chronic disease in children worldwide. According to many guidelines topical nasal steroids (TNS) are the first-line treatment for moderate/severe AR in children, nevertheless there is no conclusive evidence about which of them is superior in terms of efficacy and safety, including their impact on child’s growth. Methods We will conduct a systematic review of randomized controlled trials evaluating TNS in the treatment of children with moderate/severe AR. The primary outcome is the efficacy measured with the Total Nasal Symptom Severity Score (TNSS). Secondary outcomes are quality of life, adverse events (AE), and growth velocity. We will search Medline, Embase, CENTRAL, LILACS, clinicaltrials.gov, WHO trials database and grey literature resources. Two reviewers will independently screen titles and abstracts, review full texts, extract information, and assess the risk of bias and the confidence in the estimate (with the grading of recommendations, assessment, development, and evaluation [GRADE] approach). We will conduct a random-effects NMA to combine the pooled direct and indirect treatment effect estimates for each outcome if adequate data is available and transitivity and coherence assumptions are considered justifiable. Subgroup and sensitivity analyses are planned to evaluate the impact of some potential effect modifiers such as doses, co-intervention with oral antihistamines, the type of AR (intermittent or persistent), sponsorship of the study, the time of outcomes measurement and the risk of bias. We will use GRADE approach to draw conclusions from NMA. Discussion This systematic review and network meta-analysis aims to determine the relative efficacy and safety of the TNS for treatment of children with moderate/severe AR. The results will provide valuable information to assist clinicians, guideline developers, patients, and policy makers about the management of these patients, based on the best available evidence. Systematic review registration: PROSPERO number: CRD42023476313.

Early temporal changes on CT chest in patients with COVID-19 pneumonia

Introduction: Computed tomography (CT) scan of the chest helps in the evaluation, prognostication, and follow-up of patients with Corona virus disease-19 (COVID-19) pneumonia.Objectives: To study the early temporal evolution of findings on CT chest in patients with COVID-19 pneumonia at 6 weeks follow up.Material and methods: A retrospective analysis was performed on 40 patients with confirmed COVID-19 pneumonia who underwent baseline chest CT scans followed by a repeat scan at six weeks. Patients were quantitatively assessed using an objective CT severity score and qualitatively assessed using imaging parameters like consolidation, ground glass opacities (GGOs), parenchymal bands, septal thickening, nodules and crazy paving pattern.Results: Mean age of our study population was 58.5 ± 10.2 years with 80% being males. The baseline CT scan revealed a total median CT severity score interquartile range (IQR) of 16/25 (range: 14-20) while the follow-up scan after six weeks revealed a median score (IQR) of 14/25 (range: 8-19). This difference was statistically significant (p=0.04). The difference in CT severity scores of bilateral upper lobes was statistically significant (p=0.04 on right side and p=0.009 on left side); however, the difference in scores of bilateral lower lobes was not statistically significant (p>0.05). The common imaging patterns on baseline imaging were GGO (97.5%), con-solidation (85%), septal thickening (85%), parenchymal bands (60%) and nodules (32.5%), which showed an interval resolution in the follow-up CT scan.Conclusion: Most of the patients with COVID-19 pneumonia showed interval resolution of lung findings seen on short-term follow-up CT scan.

Efficacy and Safety of Lurasidone vs. Quetiapine XR in Acutely Psychotic Patients With Schizophrenia in Korea: A Randomized, Double-Blind, Active-Controlled Trial.

This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35-4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Pain prevalence, intensity, and association with neuropsychiatric symptoms of dementia in immigrant and non-immigrant aged care residents in Australia

Pain recognition for culturally diverse people is complex as pain experience is subjective and influenced by cultural background. We compared the prevalence, intensity, and association of pain with neuropsychiatric symptoms (NPS) between immigrants and non-immigrants living with dementia in residential aged care homes (RACHs) who were referred to two Dementia Support Australia programs. Immigrant status was defined by the documented country of birth. Pain and NPS were assessed using PainChek® and the Neuropsychiatric Inventory, respectively. Subgroup analyses were also completed for English-speaking and non-English-speaking immigrants. A total of 17,637 referrals [immigrants, n = 6340; non-immigrants, n = 11,297] from 2792 RACHs were included. There were no significant differences for the prevalence of pain across all groups. Immigrants were slightly more likely to have moderate pain or severe pain than non-immigrants. Non-English-speaking immigrants had 0.5 points higher total pain scores on average (Cohen’s d = 0.10 [0.05, 0.15], p < 0.001) than non-immigrants. Total pain score had a significant effect on total NPS severity scores in all groups. While pain prevalence is similar across groups, higher pain intensities are more common among immigrants living with dementia. Increased care staff awareness, education, and training about the potential effect of culture on pain expression is needed.

Chest Computed Tomography Severity Score to Predict Outcome of Patients with COVID 19

Abstract Background The coronavirus disease 2019 (COVID-19) is an acute infectious pneumonia caused by a severe acute respiratory syndrome-coronavirus-2. Some studies have suggested that C-reactive protein, lymphocyte count, and features from CT scoring as predictors of severity and prognosis of COVID-19. Non-contrast chest computed tomography (CT) scan was found to be a useful diagnostic instrument for screening COVID-19 pneumonia. This score uses lung opacification as a surrogate for extension of the disease in the lungs. Aim To assess the prognostic value of chest CT severity score (CSS) to predict the severity of symptoms and outcomes among patients with typical CT findings. Subject and Methods This Prospective Observational study was conducted at Radiology department, faculty of medicine, Ain Shams University on 94 patients. Results There is a significant difference between the groups regarding symptoms severity. there is no significant difference between the groups regarding CT findings. left lung severity scores and total severity score were significantly higher among poor prognosis patients compared to good prognosis patients. mortality rate was significantly higher among poor prognosis patients compared to good prognosis patients. severity score was significantly higher among severe symptoms patients compared to mild symptoms patients in good prognosis patients. Conclusion The current study showed that CT images and CT-severity scores can predict ICU admission and mortality in patients with COVID-19 pneumonia. Clinicians and radiologists can use the CT-severity score as a measure of disease severity and an indicator of poor prognosis, including the need for mechanical ventilation. Also, our findings showed the superiority of CT findings over other clinical information and co-morbidities in predicting the short-term outcome.

Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery in Collegiate Student-Athletes.

Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear. To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden. Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at <6 hours, 24 to 48 hours, time of asymptomatic and start of return-to-play protocol, unrestricted return-to-play, and 6 months after injury. Injured athletes were categorized into 4 groups based on BSI-18 scores: (1) B-ANX, elevated anxiety symptoms only; (2) B-DEP, elevated depression symptoms only; (3) B-ANX&DEP, elevated anxiety and depression symptoms; and (4) B-NEITHER, no elevated anxiety or depression symptoms. Relationship between age, sex, BSI-18 group, SCAT3 total symptom and severity scores, and time to asymptomatic status and return-to-play was assessed with Pearson's chi-squared test and robust analysis of variance. Level 3. Among 1329 athletes with 1352 concussions, no respondents had a self-reported premorbid diagnosis of anxiety/depression. There was no difference in time until asymptomatic or time until return-to-play between BSI-18 groups (P = 0.15 and P = 0.11, respectively). B-ANX, B-DEP, and B-ANX&DEP groups did not have higher total symptom or severity scores postinjury compared with the B-NEITHER group. Baseline anxiety/depression symptoms in collegiate student-athletes without a mental health diagnosis are not associated with longer recovery times until asymptomatic, longer time to return-to-play, or higher postconcussion total symptom and severity scores compared with athletes without baseline symptoms. Anxiety and depression symptoms without a clear mental health diagnosis should be considered differently from other comorbidities when discussing prolonged recovery in collegiate student-athletes.

Symptom Exacerbation and Adverse Events during a Randomized Trial of Early-stage Concussion Rehabilitation.

Few studies utilize randomized clinical trials (RCT) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster Randomized Controlled Trial (XXX). Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age=20 years; female n=48) across 28 sites from New Zealand professional rugby (n=31), Canadian professional football (n=52), United States (U.S.)/Canadian colleges (n=128) and U.S. high schools (n=40). Two medically supervised interventions: 1) Enhanced Graded Exertion (EGE): international return to sport strategy and sport specific activities only (EGE-only n=119) and 2) Multidimensional Rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR+EGE n=132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with a Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n=1437) were the primary analysis unit. Frequencies, proportions, medians, and Interquartile Ranges (IQRs) were calculated for outcomes by treatment group. The 251 post-injury participants completed 1437 (MDR+EGE=819, EGE-only=618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR+EGE and EGE-only arms respectively. Intrasession symptom exacerbations were equivilantly low in MDR+EGE and EGE-only arms (MDR+EGE: 16.7%, 95% CI:14.1%,19.1%; EGE-only: 15.7%, 95% CI: 12.8%,18.6%). In total, 9/819 MDR+EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a pre- to post-session symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR+EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.