CLINICAL FEATURES OF ANXIETY DISORDER IN POST-COVID-19 SYNDROME AND FINDING OF ITS PREDICTORS

the article summarizes and describes clinical features of anxiety disorders in post-COVID-19 syndrome. Mental and neurological disorders occupy a leading place in the structure of post-COVID syndrome. Recent studies indicate an increase in the incidence of anxiety disorders in individuals with COVID-19. However, no clinical or laboratory features of the post-COVID anxiety disorders have been identified. Therefore, our study aimed to describe the clinical features of anxiety disorders in the post-COVID period and to develop a mathematical prognostic model to identify potential predictors of post-COVID anxiety disorder. We conducted a case-control clinical study, which included 145 males and females, which were divided into 2 groups, namely: group 1 - patients who became ill with COVID-19 during the last 6 months and group 2 - persons who were not ill with COVID-19 during the last 6 months. The clinical interview included the registration of symptoms of the debut and the time of the debut relative to the episode of COVID-19. The Beck anxiety inventory was used for the assessment of the overall level of anxiety. The State-trait anxiety inventory was used to assess state and trait anxiety. Statistical analysis of the data was performed using the program EZR Statistics 1.54. Anxiety disorders during the first 6 months after COVID-19 develop more often than those who have not had the disease in the last six months. Patients who had COVID-19 in the last 5-24 weeks have an increased risk of anxiety disorders during this period and therefore require close medical supervision and sufficient awareness of the likely symptoms. People with a post-COVID anxiety disorder reported the presence of autonomic symptoms, including excessive sweating and tachycardia, a feeling of inner emptiness, as well as circadian rhythm disorders in the form of difficulty falling asleep and waking up at the desired time. It should be noted that the overall frequency of detection of anxiety disorders in the post-COVID period is increasing. It has been established that the risk of developing post-COVID disorder decreases with knowledge of the fact of contact with an infected person before the COVID onset and increases with a heightened level of prior personal anxiety. Circadian rhythm disorders, in particular sleep phase shift and abnormal fatigue, may be predictors of post-COVID anxiety disorder.

Viscoelastic Polyurethane Foams for Use as Auxiliary Materials in Orthopedics

One of the essential factors in prostheses is their fitting. To assemble a prosthesis with the residual limb, so-called liners are used. Liners used currently are criticized by users for their lack of comfort, causing excessive sweating and skin irritation. The objective of the work was to develop viscoelastic polyurethane foams for use in limb prostheses. As part of the work, foams were produced with different isocyanate indexes (0.6–0.9) and water content (1, 2 and 3 php). The produced foams were characterized by scanning electron microscopy, computer microtomography, infrared spectroscopy, thermogravimetry and differential scanning calorimetry. Measurements also included apparent density, recovery time, rebound elasticity, permanent deformation, compressive stress value and sweat absorption. The results were discussed in the context of modifying the foam recipe. The performance properties of the foams, such as recovery time, hardness, resilience and sweat absorption, indicate that foams that will be suitable for prosthetic applications are foams with a water content of 2 php produced with an isocyanate index of 0.8 and 0.9.

Effects of Medical Drugs According to Sweating Localization in Primary Hyperhidrosis

Background: Primary hyperhidrosis is excessive sweating localized to different parts of the body, mostly on the hands. It is exact cause unknown, negatively affects the psychosocial structure of the person and a clinically important health problem. Aims: In the study, it was aimed to examine the effects of drugs used on primary hyperhidrosis. Study Design: The drugs used by the patients who applied to the thoracic surgery clinic with the complaint of sweating and their effects were analyzed retrospectively. Ersin Arslan Training and Research Hospital Thoracic Surgery Clinic between January 1, 2015, and September 30, 2021 (outcomes of seven years). Methodology: A total of 120 patients(45 female, 75 male and age range 8-67) with sweating complaints were identified. Age, gender, sweating localization and drugs used were examined. Statistically, data were analyzed with 95% confidence interval(CI) and Chi Square test. Results: A total of 120 patients were analyzed. 37.5% were female and 62.5% male.The mean age was 27.1±1.54 years.Patients were use 23.4% Aluminum hydrochloride cream),20.8% Bornaprine hydrochloride, 20% Hyoscine-N-butylbromide.According to sweating localizations;42.6% palmar only, 18.7% palmar and axilla, 18.7% palmar and craniofacial, 7.8% palmar and plantar, 5.9% diffuse, 4.5% cranial, 1.8% palmar and abdomen.It is more often between ages of 21-30 and in male.According to the complaints of patients with a history of using medical treatment; there were 34.5% partial response and 20.2% complete response, and no response to medical treatment in 45.3%. Conclusion: In the study; according to the localization of sweating;Aluminum hydrochloride cream reduces sweating on the palmar, and Hyoscine-N-butylbromide reduces axillary and palmar sweating. Bornaprine hydrochloride reduces sweating on all localizations except craniofacial and abdomen, and is related with a complete response on palmar sweating.According to sweating localizations; although there are localizations where all three drugs used are effective, it has been concluded that these drugs used in primary hyperhidrosis do not respond fully at a high rate.

Identifying Parkinson’s disease subtypes with motor and non-motor symptoms via model-based multi-partition clustering

Identification of Parkinson’s disease subtypes may help understand underlying disease mechanisms and provide personalized management. Although clustering methods have been previously used for subtyping, they have reported generic subtypes of limited relevance in real life practice because patients do not always fit into a single category. The aim of this study was to identify new subtypes assuming that patients could be grouped differently according to certain sets of related symptoms. To this purpose, a novel model-based multi-partition clustering method was applied on data from an international, multi-center, cross-sectional study of 402 Parkinson’s disease patients. Both motor and non-motor symptoms were considered. As a result, eight sets of related symptoms were identified. Each of them provided a different way to group patients: impulse control issues, overall non-motor symptoms, presence of dyskinesias and pyschosis, fatigue, axial symptoms and motor fluctuations, autonomic dysfunction, depression, and excessive sweating. Each of these groups could be seen as a subtype of the disease. Significant differences between subtypes (P< 0.01) were found in sex, age, age of onset, disease duration, Hoehn & Yahr stage, and treatment. Independent confirmation of these results could have implications for the clinical management of Parkinson’s disease patients.

Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate. In this case report, we present a 52 years old male presented to ER with the complain of typical chest pain for more than 2 hours duration. Pain was in center of chest with radiation to back and left arm and associated with excessive sweating. Patient is a known smoker for past 10 years. At presentation Blood pressure was 110/70 mmHg and pulse rate of 55/min. Troponin I level was five times of upper normal limit. Basic investigations including ECG were done at presentation. ECG was showing typical changes of inferior wall myocardial infarction with infarction of right ventricle with hidden unique sign known as dead man sign commonly predict the location of obstruction and course of disease in the setting of acute coronary syndrome.

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.

A CLINICAL STUDY OF SHILAJEET VATI IN PRAMEHA PURVARUPA (PRE-DIABETIC STATE)

Introduction- The incidence of Prameha is increasing rapidly because of changes in dietetic habits and lifestyle. If the Prameha Purvarupa (Pre-diabetic) clinical features are treated by formulation Shilajeet is recommended in Ayurvedic Classics, proven efficacious and widely practised in the management of Prameha (Diabetes). Materi- als and methods- 30 patients from OPD and IPD of Govt. Ayurvedic College & Hospital, Balangir, fulfilling the Subjective and Objective Parameters were registered for the clinical trial. After diagnosis, they were under trial with Ayurvedic formulation Shilajeet Vati treated in a dose of 2 Vati (500mg each) twice daily empty stomach, for a period of 30 days with Ushna Jala. The assessment of subjective and objective parameters was evaluated on the 10th, 20th and 30th day from the day of initiation of trial up to 30 days in order to find the efficacy of the trial by statistical paired ‘t’ test. Observation and results- The average percentage of improvement in subjective parame- ter Prabhuta Mutrata (quantity) 71.43%, Prabhuta Mutrata (frequency) 77.78%, Pipasa (increased thirst) 72.73%, Kshudha (excessive appetite) 72.22%, Kara-pada Daha (burning sensation in hand and feet) 73.81%,Kara-pada Suptata (numbness of hand and feet) 80%, Sweda Pravritti (excessive sweating) 83.33%, Mukha Sho- sha (dry mouth) 79.17%, Mukha Madhurya (sweetness in mouth) 77.78%, Sheeta Priyata (liking for cold things) 80% and Madhura Shukla Mutrata (sweetness in urine) 100% and in objective Parameter fasting plasma glucose 68.89%, postprandial glucose 81.11%, HbA1c 73.33%. It has been observed that the trial drug patients are highly significant (p<0.001) to reduce both Subjective and Objective parameters after 30 days of treatment. Discussion and Conclusion- Prameha is a Kapha Pradhana Tridoshaja Vyadhi in which Meda is a Pradhana Dushya. The drug showed a potent Pramehahar effect which is evident from the reduction in the Subjective Parameter of Prameha and objective parameter of the levels of FBS, PPBS and HbA1c in patients. No side effect was noticed during the clinical study of Shilajeet Vati. Keywords: Prameha, Diabetes, Shilajeet Vati.

Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

Background Primary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH. Methods RLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months. Results Mean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed. Conclusions RLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

Abstract 1122‐000230: Unique Clinical Finding of Localized Bifacial Hyperhydrosis in a Patient with Basilar Artery Thrombosis

Introduction : Sweating abnormalities accompanied with other neurological deficits have been reported after cerebral infarcts involving the operculum, medulla and pons; however, these have always caused hyperhydrosis of the entire unilateral side of the body including the face, arms and legs. Methods : A 59 year old male who was found unresponsive to verbal and noxious stimuli after being admitted to our hospital for a vascular surgery procedure. He did not withdraw to pain in any of the extremities including to sternal rub. Pupils were bilaterally equal and reactive to light and the patient did not have any facial asymmetry. He did have intact brainstem reflexes initially in the first day. He was admitted to the Medical ICU and a brain MRI was obtained after initial head CT head was found to be unremarkable. MRI demonstrated a large bilateral pontine acute infarct, more prominent on the left side. There was also acute infarction in the left thalamus as well as some involvement of left midbrain. An MRA of Brain showed complete occlusion of the mid‐distal basilar artery. Results : The patient subsequently was found to have excessive sweating of both sides of his face, forehead and head from day 1 of the stroke onwards. This occurred independent of the patient’s body temperature (37C) and room temperature (28C).The patient remained afebrile for the next few days; however, profuse sweating continued for the next two weeks when he passed away. The patient continued to remain intubated and unresponsive off sedation during this time. Conclusions : Pure Bifacial hyperhydrosis might indicate bilateral pontine lesions. This appears to be due to disruption of a putative inhibitory pathway that controls sweating of the contralateral face and body. This pathway originates in the operculum and ends in the sympathetic sudomotor neurons in the contralateral thoracic spinal cord via the hypothalamus and brainstem. It is likely that in our patient, only the bulbar fibers of this pathway were disrupted making the face the only part with excessive sweating.

Farmers’ Knowledge, Attitudes, and Perceptions Regarding Carcinogenic Pesticides in Fez Meknes Region (Morocco)

Pesticides play an important role in the improvement of agricultural production, but their use may result in adverse effects on the environment, consumers, and farmers’ health. As there are limited data focusing on the factors influencing safety behavior toward pesticide use in Morocco, we conducted a cross-sectional survey in 15 rural communities of Morocco’s Fes Meknes region to assess the attitudes, knowledge, and practices regarding pesticide use. A structured questionnaire was completed, containing the data of the interviewed farmers, their behavior towards safety measures, the type of active ingredient used, as well as the perception of risks to their own health following exposure to pesticides by the existence of chronic, self-perceived symptoms. Non-probability (empirical) sampling with the quota method was carried out, which consists of constructing the sample. Results showed that most respondents have not been trained in the application of pesticides, with almost half of the farmers using a category of pesticides which are classified by the International Agency for Research on Cancer as probable human carcinogenic (i.e., Glyphosate, Malathion). In terms of pesticide storage, 40% of farmers said that they did not store pesticides in a separate room after purchasing or using them. The empty containers were buried or burnt by half of the responders, while the remainder were thrown at the edge of fields or in public dumps. Although the participants were aware of the negative effects on their own health and on the environment caused by the application of pesticides in use, the protection measures by individual equipment were insufficient. A canonical analysis indicates that these behaviors were influenced by the farming experience, the benefit of the agricultural council services, the follow-up of training, and the education level. These variables are important factors in explaining and understanding the dangers to both the environment and health caused by pesticides. The most recorded likely consequences of pesticide exposure were visual impairment (46%), followed by dizziness (44.3%), headache (39.4%), and excessive sweating (34.4%), and 30.2% of participants identified consequent respiratory problems. Extension services targeted at safety and protection measures should be developed and accompanied by educational programs to put farmers’ perceptions into practice and encourage them to adopt healthy and environmentally friendly behaviors.