THE UNDERLYING PATHOPHYSIOLOGY AND CLINICAL APPEARANCE OF LSS, AND THE AVAILABLE DIAGNOSTIC AND THERAPEUTIC OPTIONS

The term lumbar spinal stenosis (LSS) refers to the narrowing of the spinal canal due to anatomical reasons, and it is linked to a variety of clinical symptoms.The onset of stenosis LSS can be unilateral or bilateral, monosegmental or multisegmental. The stenosis can be characterized as central, lateral, or foraminal anatomically.Neurogenic claudication is the most prevalent symptom of LSS, which is defined as limping or cramping lumbar pain that spreads into the legs primarily during walking.Typical patient symptoms include unilateral or bilateral (exertional) back and leg discomfort that develops over months, if not years.As people live longer and seek a better quality of life, as well as increased knowledge of the condition and the availability of improved imaging techniques, the number of people diagnosed with degenerative LSS has increased.

Emotional Blunting in Patients With Major Depressive Disorder: A Brief Non-systematic Review of Current Research

Emotional blunting is frequently reported by patients with major depressive disorder (MDD) and has been identified as one of the most prominent side effects of antidepressants leading to medication discontinuation. However, antidepressant-induced emotional blunting remains largely unexplored—there lacks a clinical definition of this condition, and no agreeing conclusion has been reached regarding its etiology. Current research suggests that the onset of diminished emotional response may be related to antidepressant dose, with higher doses being more likely to induce emotional blunting. Consequently, most clinicians either reduce the dose or switch to another drug when treating this symptom. Overall, more comprehensive clinical assessments or interviews specifically designed to evaluate antidepressant-induced emotional blunting in MDD patients are in need to elucidate the neuropsychological mechanisms behind this increasingly prevalent symptom.

Etiology, Assessment and Management of WDHA (Watery Diarrhea, Hypokalemia, and Achlorhydria) and VIPoma

The syndrome of watery diarrhoea, hypokalemia, and achlorhydria (WDHA syndrome) is an uncommon disorder marked by severe, watery diarrhoea caused by non–beta pancreatic islet cell oversecretion of vasoactive intestinal peptide (VIP). The onset of the disease is gradual, and diagnosis is often months or years later. Long-term dehydration, electrolyte and acid-base abnormalities, and chronic renal failure are all linked to morbidity. Pancreatic endocrine tumours are extremely rare, with less than 10 incidences per million people. VIPomas are uncommon tumours that affect between 0.05 and 2.0 percent of people. The most prevalent symptom is diarrhoea, which affects at least 89 percent of patients. VIPoma is treated with a combination of medicine and surgery The goal of first medical treatment is to reduce symptoms and restore fluids and electrolytes as quickly as possible

Persistence of Fatigue among COVID-19 Survivors in Bangladesh: A Two-month after Follow-up Study

Background: A limited number of studies have exclusively assessed fatigue among post-COVID patients. Our study aimed to assess the persistence and associations of fatigue among COVID-19 survivors after two months of recovery from their primary illness. Methods: During hospital admission from August to September, 2020, a total of 400 patients were diagnosed to be suffering from fatigue using Chalder fatigue scale. After obtaining informed written consent, patients were followed up two months later over telephone. A total of 332 participants participated in the interview (63 patients could not be traced and another 5 patient died within two months). Patients were asked to categorize their present fatigue condition based on a simplified questionnaire developed for telephone interview. Results: Among study participants, 62.9% (n=207) were found to be still suffering from fatigue two months after their hospital discharge. A significant association of fatigue was found with age (p=0.000), hypertension (RR: 1.51; CI: 1.15-1.99; p=0.002), diabetes mellitus (RR: 1.45; CI: 1.08-1.95; p=0.010), ischemic heart disease (RR: 2.04; CI: 1.15-3.64; p=0.011), on admission SpO2 (p=0.000), on admission serum ferritin (p=0.000), d-dimer (p=0.000), CRP (p=0.000), and Hb% (p=0.019). Binary logistic regression model revealed significant association of age and onadmission SpO2 with persistence of fatigue. Conclusions: Fatigue is a highly prevalent symptom among the COVID-19 survivors with significant association between fatigue and patients clinical and laboratory markers. Bangladesh J Medicine July 2022; 33(1) : 57-63

Wallop of Symptoms and Co-morbidities on COVID-19 Outcome

Background: Fever, cough, fatigue, and myalgia are usually the original clinical picture of the COVID-19 pandemic, which appears non-specific and not exclusive. Objectives: To illustrate the clinical picture pattern and assess the prevalence of underlying co-morbidities and their correlation with the severity of COVID-19 infected patients. Methods: A cross-sectional online survey included 580 participants who were either suspected or confirmed with COVID-19 infection. Results: The severity of the disease significantly correlates with both age (p=.01) and the time lag of the diagnosis of COVID-19 (p=.03). Hypertension (p=.015) and diabetes mellitus (p<.01) were significantly associated with the duration of symptoms. A wide range of ages (21-60 years) seemed to be the only risk factor for the severity. When symptoms were tested, dyspnea appeared to be the most prevalent symptom, predicting a more severe disease (OR= .066, 95% CI: .022- .200), followed by diarrhea (OR= .285, 95% CI: .122-.663), then fever (OR= .339, 95% CI: .139-.824). During the examination of co-morbidities influences on the severity, the only major co-morbidity that predicted a more severe disease was IHD (OR= .218, 95% CI: .073- .648), p= .006. Conclusion: Special consideration is required for patients with COVID-19 with an associated longer gap between symptoms and diagnosis and associated co-morbidities including hypertension, diabetes, and established chronic kidney disease (CKD), for which this study proved its profound influence on the severity of the illness and duration of symptoms.

Facial expressions can detect Parkinson’s disease: preliminary evidence from videos collected online

A prevalent symptom of Parkinson’s disease (PD) is hypomimia — reduced facial expressions. In this paper, we present a method for diagnosing PD that utilizes the study of micro-expressions. We analyzed the facial action units (AU) from 1812 videos of 604 individuals (61 with PD and 543 without PD, with a mean age 63.9 y/o, sd. 7.8) collected online through a web-based tool (www.parktest.net). In these videos, participants were asked to make three facial expressions (a smiling, disgusted, and surprised face) followed by a neutral face. Using techniques from computer vision and machine learning, we objectively measured the variance of the facial muscle movements and used it to distinguish between individuals with and without PD. The prediction accuracy using the facial micro-expressions was comparable to methodologies that utilize motor symptoms. Logistic regression analysis revealed that participants with PD had less variance in AU6 (cheek raiser), AU12 (lip corner puller), and AU4 (brow lowerer) than non-PD individuals. An automated classifier using Support Vector Machine was trained on the variances and achieved 95.6% accuracy. Using facial expressions as a future digital biomarker for PD could be potentially transformative for patients in need of remote diagnoses due to physical separation (e.g., due to COVID) or immobility.

A home-based palliative care pilot project for the patients and families with incurable diseases in Bangladesh

Background: Home-based palliative care (HPC) is a community-based palliative care approach with various advantages over institutional care like comprehensive care at patient’s known comfortable environment. This study aims at describing a pilot HPC program. Methods: A 3-year pilot project was implemented by Centre for Palliative Care (CPC) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, supported by the Ministry of Education. At the end of the project period the team attempted a survey to capture a picture of HPC recipients, of their suffering and their needs and to assess as to what extent these needs can be met in the best possible way with the present strategy. A total of 34 patients and their caregivers were interviewed over telephone about receiving homecare. An attempt was taken to compare with the patients who used to get conventional care along with an access to the 24/7 telephone care service. Results: A total of 1634 home visits were made to 338 patients, mostly (79.3%) to 310 cancer patients and covered 0.807% of estimated population in need of palliative care in Dhaka City Corporation. Pain was the most prevalent symptom and opioid drugs were the most commonly prescribed medication. HPC helped them to remain at their own home where they wanted to be and assisted them taking into account individually tailoring care and enabled them to continue coping. Conclusions: HPC helped the patients of incurable diseases and their families to avail comprehensive care at home contributing to reduce hospital burden. Enhancement of the care infrastructure will ensure a sustainable provision of palliative care in the domestic environment. BIRDEM Med J 2021; 11(3): 202-211

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Dysphagia is a highly prevalent symptom in Amyotrophic Lateral Sclerosis (ALS), and the implantation of a percutaneous endoscopic gastrostomy (PEG) is a very frequent event. The aim of this study was to evaluate the influence of PEG implantation on survival and complications in ALS. An interhospital registry of patients with ALS of six hospitals in the Castilla-León region (Spain) was created between January 2015 and December 2017. The data were compared for those in whom a PEG was implanted and those who it was not. A total of 93 patients were analyzed. The mean age of the patients was 64.63 (17.67) years. A total of 38 patients (38.8%) had a PEG implantation. An improvement in the anthropometric parameters was observed among patients who had a PEG from the beginning of nutritional follow-up compared to those who did not, both in BMI (kg/m2) (PEG: 0 months, 22.06; 6 months, 23.04; p < 0.01; NoPEG: 0 months, 24.59–23.87; p > 0.05). Among the deceased patients, 38 (40.4%) those who had an implanted PEG (20 patients (52.6%) had a longer survival time (PEG: 23 (15–35.5) months; NoPEG 11 (4.75–18.5) months; p = 0.01). A PEG showed a survival benefit among ALS patients. Early implantation of a PEG produced a reduction in admissions associated with complications derived from it.

Clinical patterns, recovery time and prolonged impact of COVID-19 illness in international athletes: the UK experience

ObjectivesTo report COVID-19 illness pattern, symptom duration and time loss in UK elite athletes.MethodsObservational, clinical and database review of athletes with symptomatic COVID-19 illness managed within the UK Sports Institutes. Athletes were classified as confirmed (positive SARS-CoV-2 PCR or antibody tests) or probable (consistent clinical features) COVID-19. Clinical presentation was characterised by the predominant symptom focus (eg, upper or lower respiratory illness). Time loss was defined as days unavailable for full sport participation and comparison was made with a 2016–2019 respiratory illness dataset from the same surveillance system.ResultsBetween 24 February 2020 and 18 January 2021, 147 athletes (25 Paralympic (17%)) with mean (SD) age 24.7 (5.2) years, 37% female, were diagnosed with COVID-19 (76 probable, 71 confirmed). Fatigue was the most prevalent symptom (57%), followed by dry cough (50%) and headache (46%). The median (IQR) symptom duration was 10 (6–17) days but 14% reported symptoms >28 days. Median time loss was 18 (12–30) days, with 27% not fully available >28 days from initial date of infection. This was greater than our historical non-COVID respiratory illness comparator; 6 days, 0–7 days (p<0.001) and 4% unavailable at 28 days. A lower respiratory phenotype (ie, including dyspnoea±chest pain±cough±fever) was present in 18% and associated with a higher relative risk of prolonged symptoms risk ratio 3.0 (95% CI: 1.4 to 6.5) and time loss 2.1 (95% CI: 1.2 to 3.5).ConclusionsIn this cohort, COVID-19 largely resulted in a mild, self-limiting illness. The presence of lower respiratory tract features was associated with prolonged illness and a delayed return to sport.

Summary of TCM Treatment of Anal Swelling

People have become more sensitive to the local discomfort of the anus in recent years as their quality of life has improved. Anal bulge, which is related to Chinese medicine’s “post-heavy,” is a prevalent symptom in the anorectal department. The causes of disease are complicated, involving both objective and subjective elements. There is currently no precise plan for diagnosing and treating anal swelling. In the last ten years, Chinese medicine has briefly described the treatment of anal swelling.