Leukoaraiosis is associated with clinical symptom severity,poor neurological function prognosis and stroke recurrence in mild intracerebral hemorrhage:a prospective multi-center cohort study

Leukoaraiosis(LA)results from ischemic injury in small cerebral vessels,which may be attributable to decreased vascular density,reduced cerebrovascular angiogenesis,decreased cerebral blood flow,or microcirculatory dysfunction in the brain.In this study,we enrolled 357 patients with mild intracerebral hemorrhage(ICH)from five hospitals in China and analyzed the relationships between LA and clinical symptom severity at admission,neurological function prognosis at 3 months,and 1-year stroke recurrence.Patients were divided into groups based on Fazekas scale scores:no LA(n=83),mild LA(n=64),moderate LA(n=98)and severe LA(n=112).More severe LA,larger hematoma volume,and higher blood glucose level at admission were associated with more severe neurological deficit.More severe LA,older age and larger hematoma volume were associated with worse neurological function prognosis at 3 months.In addition,moderate-to-severe LA,admission glucose and symptom-free cerebral infarction were associated with 1-year stroke recurrence.These findings suggest that LA severity may be a potential marker of individual ICH vulnerability,which can be characterized by poor tolerance to intracerebral attack or poor recovery ability after ICH.Evaluating LA severity in patients with mild ICH may help neurologists to optimize treatment protocols.This study was approved by the Ethics Committee of Ruijin Hospital Affiliated to Shanghai Jiao Tong University(approval No.12)on March 10,2011.

The epidemiology of anal incontinence and symptom severity scoring

For many patients,anal incontinence(AI)is a devastating condition that can lead to social isolation and loss of independence,contributing to a substantial economic health burden,not only for the individual but also for the allocation of healthcare resources.Its prevalence is underestimated because of poor patient reporting,with many unrecorded but symptomatic cases residing in nursing homes.Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery,most notably after fistula and hemorrhoid operations.The clinical scoring systems assessing the severity of AI are discussed in this review,along with their limitations.Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies.

Symptom severity,quality of sleep,and treatment adherence among patients suffering from schizophrenia and depression

Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.

Differences in dietary habits of people with vs without irritable bowel syndrome and their association with symptom and psychological status:A pilot study

BACKGROUND Previous studies have demonstrated that dietary factors are involved in irritable bowel syndrome(IBS),but the role of diet was evaluated mostly based on food frequency questionnaire.Whether food categories,quantity per time,and intake frequency are different between IBS patients and non-IBS individuals has not been clearly clarified.AIM To explore differences in dietary habits of people with vs without IBS and their correlation with symptom and psychological status.METHODS A total of 220 questionnaires were administered in a community population and the Rome IV criteria was applied to diagnose IBS.The dietary questionnaire used in this study was multidimensional from food categories,quantity per time,and intake frequency,in contrast to“yes or no”classification used in previous studies.Questionnaires including IBS symptom severity scale(IBS-SSS),IBS quality of life,visceral sensitivity index,hospital anxiety and depression score(HADS),and gastrointestinal symptom rating scale were used to assess the participants.Rank sum test was used to compare the quantity per time and intake frequency between IBS patients and non-IBS participants.The correlation between psychological factors and diet was evaluated by Spearman correlation analysis.Logistic regression analysis was used to assess the possible dietary risk factors for IBS.RESULTS In total,203 valid questionnaires were collected(response rate 92.3%).Twentyfive participants met the Rome IV criteria for IBS,including 15(60.0%)women and 10(40.0%)men.Compared with the non-IBS group,the quantity per time and intake frequency of soybean and its products,spicy food,and dry-fried nuts were statistically significant in IBS participants(P<0.05).They were positively associated with IBS-SSS and HADS anxiety and depression scores(P<0.05).Besides,seafood,soft drinks,vegetables,and fruits differed only in quantity per time.The intake frequencies of egg,barbecue,and coarse grain were statistically significant in IBS patients(P<0.05).We also found that the frequency of soybean and its products(≥7 times/week,odds ratio=11.613,95%confidence interval:2.145-62.855,P=0.004)was an independent risk factor for IBS.CONCLUSION Both quantity per time and intake frequency,especially soybean,differ between IBS patients and non-IBS participants.Dietary habits might play potential roles in the pathophysiology of IBS.

Association between Blood Type and Severity of Covid-19 Infection among Patients in Kaski District, Nepal

Novel Coronavirus (SARS-CoV-2) first broke out in China and speeded globally. With the considerable number of Covid-19 infections and deaths, the situation has brought up major public health and governance concerns. This research study is conducted to understand if there is any association between blood group and Covid-19 disease severity. Study is conducted in Life care diagnostic and research center, New road Pokhara. A total of 1050 people who underwent RT-PCR test at Life Care Diagnostic and identified positive are used as the sample to conduct this research study. Our findings reveal that Covid-19 severity is uncommon in people with blood group O and Rh negative whereas those with blood group AB and B types are found to be severely affected. We also have an impression that individuals with rhesus negative (Rh-negative) blood groups have higher resistance for Covid-19 infection and severity.

Clinical effectiveness of adding probiotics to a low FODMAP diet:Randomized double-blind placebo-controlled study

BACKGROUND There are various studies showing the relationship between irritable bowel syndrome(IBS)and diet,and some dietary adjustments are recommended to reduce symptoms.In recent years,there is a growing number of studies that show a 4-8 wk low fermentable oligo,di-and mono-saccharides and polyols(FODMAP)diet has a 50%-80%significant effect on symptoms in IBS patients.There is strong evidence suggesting that changes in fecal microbiota have an impact on IBS pathogenesis.Based on this argument,probiotics have been used in IBS treatment for a long time.As is seen,the FODMAP diet and probiotics are used separately in IBS treatment.AIM To evaluate the effectiveness of adding probiotics to a low FODMAP diet to control the symptoms in patients with IBS.METHODS The patients who were admitted to the Gastroenterology Clinic of Dokuz Eylul University Hospital and diagnosed with IBS according to Rome IV criteria were enrolled into the study.They were randomized into 2 groups each of which consisted of 50 patients.All patients were referred to a dietitian to receive dietary recommendations for the low FODMAP diet with a daily intake of 9 g.The patients were asked to keep a diary of foods and beverages they consumed.The patients in Group 1 were given supplementary food containing probiotics(2 g)once a day in addition to their low FODMAP diet,while the patients in Group 2 were given a placebo once a day in addition to their low FODMAP diet.Visual analogue scale(VAS),the Bristol Stool Scale and IBS Symptom Severity Scale(IBSSSS)scores were evaluated before and after the 21 d treatment.RESULTS The rate of adherence of 85 patients,who completed the study,to the FODMAP restricted diet was 92%,being 90%in Group 1 and 94%in Group 2.The mean scores of VAS and IBS-SSS of the patients in Group 1 before treatment were 4.6±2.7 and 310.0±78.4,respectively,and these scores decreased to 2.0±1.9 and 172.0±93.0 after treatment(both P<0.001).The mean VAS and IBS-SSS scores of the patients in Group 2 before treatment were 4.7±2.7 and 317.0±87.5,respectively,and these scores decreased to 1.8±2.0 and 175.0±97.7 after treatment(both P<0.001).The IBS-SSS score of 37 patients(86.04%)in Group 1 and 36 patients(85.71%)in Group 2 decreased by more than 50 points.Group 1 and Group 2 were similar in terms of differences in VAS and IBS-SSS scores before and after treatment.When changes in stool shape after treatment were compared using the Bristol Stool Scale,both groups showed significant change.CONCLUSION This study is the randomized controlled study to examine the efficiency of probiotic supplementation to a low FODMAP diet in all subtypes of IBS.The low FODMAP diet has highly positive effects on symptoms of all subtypes of IBS.It was seen that adding probiotics to a low FODMAP diet does not make an additional contribution to symptom response and adherence to the diet.

Clinical Response to Treatment of Central Nervous System Tuberculosis in Non-Human Immunodeficiency Virus-Infected Adolescents and Adults

Introduction: More than half of patients with central nervous system tuberculosis (CNS TB) die or are left with severe neurological deficits despite receiving anti-TB treatment. Aims of the study: This study examined risk factors associated with poor response to initial treatment with four anti-TB drug regimens or three drug regimens with steroids as adjuvant therapy. Methods: This study analyzed medical records from two tertiary hospitals in Busan, Korea, between January 2009 and March 2012. The subjects were non-human immunodeficiency virus (HIV)-infected patients aged ≥16 years with clinical CNS TB. The subjects were divided into two groups according to response to treatment. Results: In totally, 52 patients with CNS TB were included. Of these, 14 (26%) and 38 (73%) showed poor and good responses, respectively. Of the patients with poor response, nine had stage III disease (64.3%) according to the British Medical Research Council (BMRC) staging system. A significantly higher proportion was seen in the good response group (p < 0.05). Patients with positive cerebrospinal fluid (CSF) acid-fast bacillus (AFB) culture, positive sputum AFB culture, positive CSF TB polymerase chain reaction (PCR) results, and brain tuberculoma had poorer responses (p < 0.05). Multivariate analysis to determine risk factors associated with poor response to anti-TB therapy revealed that a poor response was associated with stage III clinical signs upon diagnosis (odds ratio [OR] 32.122;95% confidence interval [CI] 2.221 - 464.605), positive sputum AFB culture (OR 13.624;95% CI 1.066 - 174.149), and tuberculoma on brain images (OR 45.714;95% CI 1.893 - 1104.018). Conclusions: The results demonstrate the importance of identifying the severity of CNS TB and promptly administering anti-TB drugs. It is necessary to perform drug susceptibility testing for anti-TB drugs. Further studies are needed to confirm the correlations between risk factors associated with poor response and anti-TB drug resistance and the other risk factors.