Symptom Recovery and Return to Participation Timelines of Patients With Concussion at a Community Physiotherapy Clinic Based on Injury Mechanism

ObjectiveTo compare patient demographics, injury phase (IP; time-to-assessment), total symptom severity score (TSS) changes and return to participation (RTP; cognitive/physical) to mechanism of injury (MOI).BackgroundSecondary concussion prevention includes timely assessment and treatment to decrease TSS and maximize RTP.Design/MethodsOne community physiotherapy clinic. Retrospective chart review (September 1, 2016–August 8, 2018). Two hundred thirty-four patients with concussion (male: n = 85; female: n = 149) from various MOIs. Age groups (years): children 8–12, youth 13–17, young adult 18–29, adult 30–64, senior 65+. IP: acute (<72 hours), subacute (72 hours-2 weeks adults, 72 hours-4 weeks children/youth), persistent (2 weeks-3 months adults, 4 weeks-3 months children/youth), chronic (>3 months). Intervention: multimodal physiotherapy (cervico-vestibular, exertion, education), referral to specialist, psychology and/or neuropsychology. Outcome measures: treatment (number, timeframe) and weeks to recovery (WTR) vs MOI; TSS changes and RTP rates.ResultsAll acute IP had sport MOI, with WTR consistent with current literature. For all others, WTR was longer regardless of age or MOI. MVC and other MOIs were primarily patients in persistent or chronic IP (80% and 71%, respectively). MVC had the longest recovery (12.28 ± 8.21 treatments over 21.03 weeks 95% CI [17.05, 25.01], 44.94 WTR 95% CI [36.38, 53.51]); p < 0.05). Sport MOI received 5.50 ± 3.62 treatments over 7.49 (95% CI [5.59, 9.40]) weeks and 19.07 (95% CI [13.72, 24.42]) WTR. No significant statistical difference was observed between sport and other MOI recovery. TSS decreased in 85% of all patients. Full cognitive RTP was achieved by 75% of patients, and full physical RTP by 68%.ConclusionsConcussion patients experienced symptom and participation recovery, with IP and MOI related to WTR. Treatment/recovery timeframes were longer than previously reported for subacute, persistent, and chronic IPs. These results will inform secondary prevention strategies and knowledge translation underscoring the need for timely assessment and treatment. It also draws attention to RTP in MOIs other than sport.

Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up. Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

Omalizumab for the treatment of allergic rhinitis: a systematic review and meta-analysis

Background: Allergic rhinitis (AR), an IgE mediated inflammatory disease, significantly impacts quality of life of a considerable proportion of the general population. Omalizumab, a humanized monoclonal antibody against IgE, has been evaluated for both seasonal and perennial AR. We aimed to assess the efficacy and safety of omalizumab in randomized controlled trials (RCTs) in inadequately controlled AR. Methods: We conducted a systematic literature search of RCTs evaluating the safety and efficacy of omalizumab in AR. We synthesized evidence for clinical improvement of AR symptoms, quality of life, reduction of the use of rescue medication, and adverse events. Results: The systematic search returned 289 articles, of which 12 RCTs were eligible for data extraction and meta-analysis. Omalizumab reduced the Daily Nasal Symptom Severity Score (DNSSS) by a summary standardized mean difference of -0.41 points with large heterogeneity; omalizumab significantly reduced the DNSSS both in the 3 cedar pollen-induced AR trials by -0.97 points and to a lower extent in the remaining five non-cedar trials by -0.19 points. Omalizumab also improved the Daily Ocular Symptom Severity Score (DOSSS) by a summary standardized mean difference of -0.30 points with large heterogeneity; the Rhino-conjunctivitis Quality of Life Questionnaire by a summary standardized mean difference of -0.45 points with no heterogeneity and the mean daily consumption of rescue antihistamines by a summary standardized mean difference of -0.21 with large heterogeneity. No statistically significant difference in the occurrence of adverse events was observed between omalizumab and placebo. Conclusion: Our findings further support the efficacy and safety of omalizumab in the management of patients with allergic rhinitis inadequately controlled with a conventional treatment.

Evaluation of the Fibromyalgia and Related Risk Factors in Patients with Advanced Kidney Failure Undergoing Hemodialysis

Background : Fibromyalgia syndrome (FMS) is defined as widespread and persistent pain in the musculoskeletal system. There are limited reports regarding the prevalence of fibromyalgia syndrome in patients with advanced kidney failure undergoing regular hemodialysis. Therefore, this study aimed to evaluate the prevalence of fibromyalgia syndrome and its risk factors in a large proportion of patients under the hemodialysis condition. Materials and Methods: In this cross-sectional study, 293 patients who were admitted to the hemodialysis ward were evaluated for fibromyalgia syndrome in an educational hospital. The questionnaire was designed according to symptom severity score (SS score) and widespread pain index (WPI) criteria. The correlation between FMS and various variables, including demographic, clinical, and biochemistry biomarkers, was also precisely calculated by logistic regression. Data were analyzed using SPSS v.17 statistics software. Results: The results showed that, of 293 hemodialysis patients, 130 patients (44.4%) had fibromyalgia, the mean age of patients with and without fibromyalgia was 61.09 ± 15.36 and 53.49 ± 15.38 years old, respectively (P = 0.001). Moreover, there was a significant difference in terms of gender among patients with fibromyalgia syndrome (P = 0.001). To note, there was no significant relationship between the kidney failure etiopathogenesis, duration of dialysis, body mass index (BMI), Kt/v index, history of peritoneal dialysis, and laboratory parameters with fibromyalgia in hemodialysis patients (P > 0.05). However, our findings revealed that both age and gender could be considered as the predictor variables associated with fibromyalgia in patients undergoing hemodialysis. Conclusion: Taken together, in this study, we found that age and gender would be the critical factors in terms of the fibromyalgia syndrome in patients undergoing hemodialysis.

A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of a Nutritional Supplement (ImmuActiveTM) for COVID-19 Patients

Background. SARS-CoV-2 has emerged as a global threat due to its infectivity and rapid transmission. We evaluated the safety and efficacy of herbal and mineral formulation (ImmuActive) as an adjunct therapy in COVID-19 patients. Methods. A randomized, double-blind, placebo-controlled study was conducted in 100 COVID-19 patients in three centers in Southern India, and 92 subjects completed the study. Subjects were followed up until they were discharged from the hospital or for a maximum of 28 days, whichever was earlier. The primary outcome parameters were the mean change and time required to change the ordinal scale of disease severity by one unit. The secondary outcomes were the time required to turn RT-PCR negative or get discharged from the hospital, change in modified Jackson’s Symptom Severity score, and COVID-19 quality of life questionnaire. Results. The ordinal scale at the end of the study was significantly lower in COVID-19 patients supplemented with ImmuActive (0.57) than placebo (1.0), with a p value of 0.0043. The ordinal scale decreased by one unit within 2.35 days in ImmuActive-supplemented patients, while it took 3.36 days in placebo-supplemented patients. Days of hospitalization and time required to turn RT-PCR negative were comparatively lower in the ImmuActive arm than the placebo arm. Change in modified Jackson’s Symptom Severity Score and COVID-19 QOL were significant from screening to the end of the study in both ImmuActive and placebo arms. There were no adverse events observed during the study period. Conclusion. The study results suggest that ImmuActive could be a beneficial and safe adjunct treatment for effectively managing COVID-19 infection symptoms.

The longitudinal use of EmPHasis-10 and CAMPHOR questionnaire health-related quality of life scores in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Background Health-related quality of life (HRQoL) is impaired in patients with pulmonary hypertension (PH). The EmPHasis-10 and CAMPHOR questionnaires are developed to evaluate HRQoL specifically in patients with PH. Data on the longitudinal use of both questionnaires are still limited. Purpose This paper will evaluate and compare the longitudinal value of two health-related quality of life questionnaires specific for patients with pulmonary hypertension (CAMPHOR and EmPHasis-10 questionnaires) using a broad spectrum of clinical anchor points. Furthermore we will establish minimal clinically important differences (MCID) for both questionnaires. Methods Sixty-one treatment naïve pulmonary arterial hypertension or chronic thromboembolic patients were prospectively included. Patients were treated according to the current ESC/ERS guidelines. We compared EmPHasis-10 and CAMPHOR scores between baseline, 6 and 12 months of follow-up and evaluated the correlation between these scores and a 5-scale symptom severity score, 5-scale overall health score, NYHA-classification, six minute walk test distance (6MWD), NT-proBNP and echocardiographic parameters. MCIDs were calculated using distribution and anchor based calculations. Results After one year of treatment a significant reduction in EmPHasis-10 score and CAMPHOR QoL and symptoms domain score was observed. Moderate to good correlations were observed between the questionnaires and the overall-health and symptom severity score and 6MWD. No relevant correlations were seen between the questionnaires and NT-pro-BNP and echocardiographic parameters. EmPHasis-10 scores showed strong correlations with all CAMPHOR domains. The MCID for the EmPHasis-10 questionnaire was −8. The MCIDs for the CAMPHOR domains were: activity −3, symptoms −4, QoL −3. Conclusion The EmPHasis-10 and CAMPHOR questionnaires are valid tools for the longitudinal measurement of HRQoL in patients with PH. The much shorter EmPHasis-10 correlates well with the CAMPHOR domain scores and with the clinical endpoints and it may be easier to use in daily practice. We established acceptable MCIDs. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): This research project was supported by an unrestricting grant by Actelion pharmaceuticals.

Critical Care Workers Have Lower Seroprevalence of SARS-CoV-2 IgG Compared with Non-patient Facing Staff in First Wave of COVID19

Introduction: In early 2020, at first surge of the coronavirus disease 2019 (COVID-19) pandemic, many health care workers (HCW) were re-deployed to critical care environments to support intensive care teams looking after patients with severe COVID-19. There was considerable anxiety of increased risk of COVID-19 for these staff. To determine whether critical care HCW were at increased risk of hospital acquired infection, we explored the relationship between workplace, patient facing role and evidence of immune exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a quaternary hospital providing a regional critical care response. Routine viral surveillance was not available at this time. Methods: We screened over 500 HCW (25% of the total workforce) for history of clinical symptoms of possible COVID19, assigning a symptom severity score, and quantified SARS-CoV-2 serum antibodies as evidence of immune exposure to the virus. Results: Whilst 45% of the cohort reported symptoms that they consider may have represented COVID-19, 14% had evidence of immune exposure. Staffs in patient facing critical care roles were least likely to be seropositive (9%) and staff working in non-patient facing roles most likely to be seropositive (22%). Anosmia and fever were the most discriminating symptoms for seropositive status. Older males presented with more severe symptoms. Of the 12 staff screened positive by nasal swab (10 symptomatic), 3 showed no evidence of seroconversion in convalescence. Conclusions: Patient facing staff working in critical care do not appear to be at increased risk of hospital acquired infection however the risk of nosocomial infection from non-patient facing staff may be more significant than previous recognised. Most symptoms ascribed to possible COVID-19 were found to have no evidence of immune exposure however seroprevalence may underrepresent infection frequency. Older male staff were at the greatest risk of more severe symptoms.

Validation of the Brazilian-Portuguese Version of the Clinician Administered Post Traumatic Stress Disorder Scale-5

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event.Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study.Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987–0.997), p &lt; 0.001]. Cohen's Kappa for individual items ranged between 0.759 and 1. Cronbach's alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance.Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835).

Title: Long-term health related quality of life following Uterine Fibroid Embolization 1 in a predominantly black African population: A retrospective Cohort study

Background: Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. Most of the studies have demonstrated an improvement in the quality of life over a short to intermediate period. We carried out this study to assess the long-term quality of life following uterine fibroid embolization in a predominantly black population. There are no identified studies locally or in Africa addressing this issue whereas studies done elsewhere indicate a probable increased fibroid disease burden among black women. Methods: This was a retrospective single cohort study that recruited patients who had UFE between 2009-2014. Study participants were sampled consecutively, invited to the study and asked to fill an online general demographic tool and the UFS-QOL. Wilcoxon signed rank tests were done to test for statistical significance between HRQOL scores. Pearson correlation analysis was carried out to evaluate possible association between various independent factors and specific outcomes of interest such as quality of life and symptom severity score. Results: Data was obtained from 77 participants. The median duration after the initial UFE was eight years. The median health related quality of life was 88.6 (62.9-98.3). This was statistically significant from baseline median scores of similar studies. The median symptom severity score decreased from a baseline score of 54.7 (43.8-65.6) to 21.9 (6.3-42.2). This decrease was statistically significant (p-value <0.001). Twenty-four participants (31.1%) reported follow up fibroid treatments after the initial UFE procedure. Eleven participants (14.3%) reported major repeat procedures (myomectomy, hysterectomy and UFE) .Seventeen participants (22%) reported a pregnancy after the UFE procedure with ten participants (13 %) reporting to have had children after the UFE procedure. Conclusion: UFE results in clinically sustained improvement in health related quality of life and symptom control among patients with uterine fibroids.

Digital Eye Strain During COVID-19 Lockdown in Jeddah, Saudi Arabia

Objectives: This study aimed to determine the prevalence of computer vision syndrome (CVS) and associated risk factors of prolonged use of electronics. Methods: This was an online non-interventional cross-sectional studyconducted over the period of COVID curfew in Jeddah city from April to June 2020, through a questionnaire. Participants were between 20 and 60 years of age and used electronic devices. Results: Total 1,227 participants were recruited between 20 and 60 years of age. The majority of them were females (69.9%). Almost 1,048 participants used smartphones or laptops. More than half (54.5%) of them used electronics for more than 4 hours daily. A high symptom severity score was found in 44% of the respondents. Taking breaks during electronics use <30 minutes (P=0.018), viewing computers at a distance less than arm length (P=0.001), and the use of screen protectors (p=0.014) were significant factors related to the symptom’s severity score. Conclusion: CVS was prevalent among the participants who used electronics for more than 4 hours daily. Taking breaks during electronics use, viewing computers at an appropriate distance, and the use of screen protectors were effective practices to relieve the eye symptoms severity score.