Measuring symptoms severity in carpal tunnel syndrome: score agreement and responsiveness of the Atroshi-Lyrén 6-item symptoms scale and the Boston symptom severity scale

Purpose To assess score agreement between the Atroshi-Lyrén 6-item symptoms scale and the Boston 11-item symptom severity scale and compare their responsiveness in patients with carpal tunnel syndrome before and after carpal tunnel release surgery. Methods This prospective cohort study included 3 cohorts that completed the A-L and Boston scales (conventional score 1–5) on the same occasion: a preoperative and short-term postoperative cohort (212 patients), a mid-term postoperative cohort (101 patients), and a long-term postoperative cohort (124 patients). Agreement was assessed with Lin’s concordance correlation coefficient and Passing-Bablok regression analysis. Analyses using item response theory were conducted on responses from the preoperative/short-term postoperative cohort including testing of item infit/outfit. Reliability was assessed with Cronbach alpha. Overall and sex-specific effect sizes were calculated using Cohen’s d. Results Lin’s CCCs were high (0.81–0.91). Passing-Bablok analysis showed constant and proportional differences in all cohorts except preoperative to short-term postoperative change. Both scales showed high reliability (alpha, 0.88–0.93). The IRT-based analyses showed infit/outfit values within the desired range. With IRT-based scoring, the A-L scale had significantly higher responsiveness than the Boston scale, overall (d, 2.02 vs 1.59), in women (d, 2.22 vs 1.77) and in men (d, 1.74 vs 1.36). Conclusion The Atroshi-Lyrén 6-item symptoms scale and the Boston 11-item symptom severity scale show good agreement but are not equivalent in measuring CTS-related symptoms severity. When using IRT-based scoring, the Atroshi-Lyrén scale demonstrated significantly higher responsiveness.

Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as “delusional disorder, somatic type”. Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Dynamic Ultrasound Assessment of Median Nerve Mobility Changes Following Corticosteroid Injection and Carpal Tunnel Release in Patients With Carpal Tunnel Syndrome

Decreased median nerve (MN) mobility was found in patients with carpal tunnel syndrome (CTS) and was inversely associated with symptom severity. It is unclear whether MN mobility can be restored with interventions. This study compared the changes in MN mobility and clinical outcomes after interventions. Forty-six patients with CTS received an injection (n = 23) or surgery (n = 23). Clinical outcomes [Visual Analogue Scale; Boston Carpal Tunnel Questionnaire (BCTQ), which includes the Symptom Severity Scale and Functional Status Scale; median nerve cross-sectional area; and dynamic ultrasound MN mobility parameters (amplitude, and R2 value and curvature of the fitted curves of MN transverse sliding)] were assessed at baseline and 12 weeks after the interventions. At baseline, the BCTQ-Functional Status Scale and median nerve cross-sectional area showed significant inter-treatment differences. At 12 weeks, both treatments had significant improvements in BCTQ-Symptom Severity Scale and Visual Analogue Scale scores and median nerve cross-sectional area, but with greater improvements in BCTQ-Functional Status Scale scores observed in those who received surgery than in those who received injections. MN mobility was insignificantly affected by both treatments. The additional application of dynamic ultrasound evaluation may help to discriminate the severity of CTS initially; however, its prognostic value to predict clinical outcomes after interventions in patients with CTS is limited.

Regulation of serum microRNA expression by acupuncture in patients with diarrhea-predominant irritable bowel syndrome

Objective: To screen for differentially expressed serum microRNAs (miRNAs) in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) compared with healthy participants and explore the mechanism of acupuncture in the treatment of IBS-D based on miRNAs. Methods: IBS-D patients that met the Rome III diagnostic criteria and age- and sex-matched healthy participants were enrolled between April 2017 and December 2017. Serum miRNA levels were initially determined using a TaqMan low-density array (TLDA) in pooled samples. Markedly altered miRNAs in IBS-D patients were subsequently validated using quantitative real-time polymerase chain reaction (qRT-PCR) on individual samples. All IBS-D patients accepted the acupuncture therapy for 6 weeks. The disease severity was assessed using the IBS symptom severity scale (IBS-SSS) questionnaire before and after treatment. After acupuncture, the patients’ serum was re-analyzed for altered expression of the miRNAs by qRT-PCR. Results: TLDA and qRT-PCR analysis revealed six upregulated miRNAs (miR-1305, miR-575, miR-149-5p, miR-190a-5p, miR-135a-5p, and miR-148a-3p; P < 0.05) and two downregulated miRNAs (miR-194-5p, miR-127-5p; P < 0.05) in IBS-D patients compared with healthy controls. Post acupuncture treatment, total IBS-SSS scores, severity of abdominal pain, duration of abdominal pain, severity of abdominal distention, dissatisfaction with bowel habits and disruption in quality of life decreased significantly ( P < 0.001). Furthermore, the upregulated miR-148a-3p levels in IBS-D patients also decreased significantly after acupuncture ( P < 0.05). Conclusions: The over-expression or reduced expression of several miRNAs may contribute to IBS-D pathogenesis. Acupuncture might downregulate miR-148a-3p through multiple pathways to alleviate or relieve IBS-D symptoms. Trial registration number: ChiCTR-IOR-17010860 (Chinese Clinical Trials Registry)

Probiotic therapy in patients with irritable bowel syndrome: does it have a real role?

Background Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders (FGIDs). There is good evidence that microbiota plays a predominant role in the IBS pathophysiology. The aim of the study is to evaluate the role of probiotics in improvement of IBS symptoms via IBS-symptom severity scale (IBS-SSS Arabic version) and improvement of quality of life via irritable bowel syndrome-quality of life survey (IBS-QOL). Results This double-armed comparative trial was conducted on IBS patients, who fulfill ROME IV criteria and the IBS diagnostic questionnaire between August and December 2019. Ninety patients were followed up for 4 weeks from the first visit. The first group was prescribed probiotics (10 billion colony of Lactobacillus delbruekii and Lactobacillus fermentum) and itopride hcl 50 mg three times daily, while the second group received only itopride hcl 50 mg by the same dose for 4 weeks. There was a highly significant improvement in the IBS-SSS score in group 1 after 4 weeks of treatment than in group 2 (137.56±67.53 vs 258.44±34.18) (p=0.001). Also, there was a highly significant improvement in the overall QOL terms in group 1 in comparison with baseline QOL score [with overall mean score (60.64±7.77) at baseline vs (81.54±7.87) at 4 weeks (p value <0.001)]. Conclusion Probiotics are useful for the improvement of IBS symptoms and quality of life of the studied patients. Larger multicenter studies are needed in the future.

COMT rs4680 single nucleotide polymorphism, ethnicity, and age are associated with fibromyalgia in women

To investigate the influence of the catechol-O-methyltransferase enzyme (COMT) single nucleotide polymorphism (SNP) rs4680 (G/A) on fibromyalgia in women. In this observational study of case-control type 29 women with a diagnosis of FM (cases) and 31 healthy non-fibromyalgia women (controls). Sociodemographic and anthropometric data were collected, as well as data relating to Symptom Severity Scale and Generalized Pain Index and peripheral blood samples for DNA extraction; genotypic analyzes were performed by PCR-SSP. We observed that rs4680 AA genotype was more frequently observed in fibromyalgia than controls (p=0.02). The A allele was also more often present in the fibromyalgia participants than in their control peers (p = 0.03). There was a statistically significant association between race and FM sufferers, showing that those of white ethnicity had a 2.05 times greater chance of developing the syndrome than non-white individuals (p=0.03; CI 95% 0.93 – 4.53). A statistically significant correlation between age and FM was observed (rS=0.812, p=0.01). This study demonstrates that white women above the age of 45, who have the AA genotype or A-allele, presents a higher risk of developing FM, showing that this polymorphism of the COMT gene may be one of the risk factors for the fibromyalgia.

#42: COVID-19 in Pediatric Hemato-Oncology Patients from Three Hispaniola Hospitals

Background In late 2019, a novel coronavirus, SARS-CoV-2, was reported in China, which rapidly spread across the globe. The WHO declared a pandemic of coronavirus disease (COVID-19) in early 2020. In March, both the Dominican Republic and Haiti reported their first cases. The three pediatric oncology units (POUs) that make up the St. Jude Global Infectious Diseases Hispaniola Project began to see COVID-19 among patients in Santo Domingo in March and in both Santiago and Port-au-Prince in June. We report the experience of managing pediatric hemato-oncology patients with COVID-19 in these three POUs. Methods We added COVID-19 data to our ongoing healthcare-associated infection surveillance in the POUs of the Hispaniola Project. The population studied included all patients tested for SARS-CoV-2 by PCR and/or serological methods. Patient data was recorded on a basic line listing. Cases were categorized using a published clinical symptom severity scale and case definition criteria from the WHO and the US Centers for Disease Control and Prevention (CDC). Results In total, 31 pediatric oncology patients met either the WHO and/or CDC case definition for COVID-19. The average age was 8 years (range: 5 months to 15 years). Just over half (17, 55%) of cases were female. The most common oncology diagnosis was acute lymphoblastic leukemia in 17 of the cases, followed by acute myeloid leukemia (5) and solid tumor (4). Five (16%) cases were in the consolidation phase, 7 (23%) in induction, and 11 (35%) in maintenance. Using the symptom severity scale, 13 (32%) cases were asymptomatic; symptoms were considered mild in 14 (45%) cases, moderate in 3 (10%), severe in 0 (0%), and critical in 1 (3%). Three deaths were attributed to COVID-19. Eighteen cases met the WHO criteria, 13 (72%) of which were confirmed, 1 probable, and 4 suspected. Twenty-six cases met the CDC criteria, 13 (50%) of which were confirmed and 13 (50%) were suspected; there were 0 probable cases. Conclusions Our findings about COVID-19 in pediatric oncology patients are consistent with data reported globally that disease presentation is mostly asymptomatic or mild but with increased mortality. The high contagiousness and unpredictable clinical response of children with cancer call for rigorous measures to prevent infections in this population. In low resource settings, the scarcity of antiviral, immunologic, and supportive medications further underscores this need. Additionally, we observed differences in our data depending on which COVID-19 case criteria were used (WHO versus CDC); this highlights the importance of standardized definitions that can be used at all resource levels to promote reliable measurement of disease burden.

Method to Convert an 8-item PCL-5 Score to a Total PCL-5 Score: A Scaled Equation Analysis

The repeated assessment of PTSD symptom severity is a critical component of research and evidence-based interventions. PTSD is composed of 20 symptoms across four clusters. However, 20-item measures can be burdensome to administer frequently, especially in ecological momentary assessment (EMA) where multiple assessments are conducted per day. An abbreviated 8-item version of the PCL-5 was developed to obtain information about PTSD symptoms at reduced effort to the participant. However, the symptom severity scale by which symptoms can range between the abbreviated (0–32) and full (0–80) scales differ, which limits the interpretability of the abbreviated scale. The current study evaluated three different methods (a proportional, linear regression, and genetic programming model) to convert scores from the abbreviated measure to that of the full PCL. These equations were then compared across two testing samples to assess their accuracy and bias. The genetic programming and linear regression equation were superior to a proportional equation in both measures of accuracy and bias, with the genetic programming equation demonstrating less bias overall than the linear regression. Furthermore, the diagnostic utility of each method was found to be similar. These results provide a method to convert abbreviated PCL scores to that of the full scale, which increases the utility of this abbreviated scale.

Artificial Intelligence based personalized diet: A pilot clinical study for IBS

Background and aimsCertain diets often used to manage functional gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). Personalized diet-induced microbiome modulation is being preferred method for symptom improvement in IBS. Although personalized nutritional therapies targeting gut microbiota using artificial intelligence (AI) promises a great potential, this approach has not been studied in patients with IBS. Therefore, in this study we investigated the efficacy of AI-based personalized microbiome diet in patients with IBS-Mix (M).MethodsThis study was designed as a pilot, open-labelled study. We enrolled consecutive IBS-M patients (n=25, 19 females, 46.06 ± 13.11 years) according to Rome IV criteria. Fecal samples were obtained from all patients twice (pre- and post-intervention) and high-througput 16S rRNA sequencing was performed. Patients were divided into two groups based on age, gender and microbiome matched. Six weeks of AI-based microbiome diet (n=14) for group 1 and standard IBS diet (Control group, n=11) for group 2 were followed. AI-based diet was designed based on optimizing a personalized nutritional strategy by an algorithm regarding individual gut microbiome features. An algorithm assessing an IBS index score using microbiome composition attempted to design the optimized diets based on modulating microbiome towards the healthy scores. Baseline and post-intervention IBS-SSS (symptom severity scale) scores and fecal microbiome analyses were compared.ResultsThe IBS-SSS evaluation for both pre- and post-intervention exhibited significant improvement (p<0.02 and p<0.001 for the control and intervention groups, respectively). While the IBS-SSS evaluation changed to moderate from severe in 82% (14 out of 17) of the intervention group, no such change was observed in the control group. After 6-weeks of intervention, a major shift in microbiota profiles in terms of alfa- or beta-diversity was not observed in both groups. A trend of decrease in Ruminococcaceae family for the intervention group was observed (p=0.17). A statistically significant increase in Faecalibacterium genus was observed in the intervention group (p = 0.04). Bacteroides and putatively probiotic genus Propionibacterium were increased in the intervention group, however Prevotella was increased in the control group. The change (delta) values in IBS-SSS scores (before-after) intervention and control groups are significantly higher in the intervention group.ConclusionAI-based personalized microbiome modulation through diet significantly improves IBS-related symptoms in patients with IBS-M. Further large scale, randomized placebo-controlled trials with long-term follow-up (durability) are needed.

Retinaculotomía endoscópica de doble portal en el síndrome del túnel carpiano

Objetivo: Evaluar los resultados de la retinaculotomía endoscópica para tratar el síndrome del túnel carpiano mediante la técnica de doble portal de Chow, entre enero de 2006 y diciembre de 2015. Materiales y Métodos: Estudio de 179 pacientes (edad promedio 48.2 años [rango 32-68]), con 217 casos de síndrome del túnel carpiano idiopático y un seguimiento promedio de 97.9 meses. Los pacientes eran 145 mujeres (81%) (31 bilaterales) y 34 hombres (19%) (7 bilaterales) y fueron evaluados con la Symptom Severity Scale (SSS) y la Functional Status Scale (FSS) del Boston Carpal Tunnel Questionnaire (BCTQ). Resultados: El puntaje medio de la SSS-BCTQ fue de 3,20 + 0,26 antes de la cirugía, mejoró a 1,30 + 0,12 a los 6 meses y se mantuvo en 1,25+ 0,11 a largo plazo. El puntaje medio de la FSS-BCTQ fue de 2,57 + 0,29 antes de la cirugía, mejoró a 1,28 + 0,18 a los 6 meses y se mantuvo en 1,20 + 0,09 a largo plazo. Hubo 7 casos (3,2%) de neuropraxia posquirúrgica transitoria. No hubo conversiones a técnica abierta. Conclusión: La liberación endoscópica del túnel carpiano con la técnica de Chow es un método quirúrgico eficaz y seguro para tratar el síndrome del túnel carpiano idiopático. Palabras clave: Síndrome del túnel carpiano; técnica de doble portal de Chow; liberación endoscópica; compresión neural; nervio mediano. Nivel de Evidencia: III