Factors perpetuating functional cognitive symptoms after mild traumatic brain injury

INTRODUCTION

Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI.

METHODS

A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group.

RESULTS

Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group.

CONCLUSIONS

This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.

Mental distress and virtual mental health resource use amid the COVID-19 pandemic: Findings from a cross-sectional study in Canada

Objective

This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress.

Methods

Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults (N  =  3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use.

Results

Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons.

Conclusions

This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources.

The frequency of non-alcoholic fatty liver disease in non-obese young medical professionals

This cross-sectional study was conducted in Mayo Hospital, Lahore, from July 16, 2018 to January 15, 2019 to observe the frequency of occurrence of non-alcoholic fatty liver disease in non-obese young medical professionals. One hundred and fifty-three subjects were selected using Simple Random Sampling Technique. SPSS version 25.0 was used to analyse the data. Out of a total of 153 medical professionals, 67 (43.8%) were males and 86 (56.2%) were females, median age was 23 years (inter-quartile range of 5 years), mean BMI was 22.79 ± 1.57 kg/m2, 122 (79.7%) subjects had normal texture of liver on ultrasonography and normal ALT levels, 21 (13.7%) had fatty liver with normal ALT levels, and 10 (6.5%) had fatty liver and elevated ALT levels (NASH). NAFLD and NASH are common ultrasonographic findings in seemingly healthy young adults with normal BMI. Awareness programmes should be carried out at the national level to educate the general public about the prevention and treatment of this disease through lifestyle and dietary modifications.

Predictors of Disease Severity in Adult Covid-19 Patients Admitted in Mayo Hospital, Lahore, Pakistan

OBJECTIVE

To assess disease severity, based on clinical presentation and laboratory investigations.

STUDY DESIGN

 Observational study.

PLACE AND DURATION OF STUDY

COVID-19 Isolation Unit of Mayo Hospital, Lahore from 15th March to 31st May, 2020.

METHODOLOGY

Four hundred and forty-five COVID-19 RT-PCR positive patients of either gender in age group of 18-80 years, admitted in isolation wards, high dependency units (HDUs) and intensive care units (ICUs) of the Hospital, were selected for the study via simple random sampling. Clinical presentations and laboratory investigations were recorded for all patients. Kruskal-Wallis test, Pearson Chi-square test, boxplots and ROC curve were used to analyse the data. A p-value ≤0.05 was considered statistically significant.

RESULTS

Out of the 445 cases, a male predominance 286 (64.3%) was observed with majority of patients 324 (72.8%) having mild disease, 73 (16.4%) moderate, 25 (5.6%) severe and 23 (5.2%) having critical disease. D-dimer was considered to be the best discriminatory marker to assess disease severity with an overall accuracy of 92.1%.

CONCLUSION

Fever, sore throat, shortness of breath, body aches, abdominal pain, anosmia and aguesia were the predominant symptoms in majority of patients belonging to different categories based on disease severity. Inflammatory markers like D-dimers and ferritin levels determined the overall disease severity with a high accuracy. Key Words: Disease severity, Clinical presentation, Laboratory investigations, RT-PCR.

The frequency of occurrence of Hepatocellular Carcinoma after direct antiviral therapy in Hepatitis C virus patients

Objective

To study the frequency of occurrence of hepatocellular carcinoma (HCC) in hepatitis C virus patients treated with direct acting antiviral (DAA) agents.

Methods

This hospital based cross-sectional study was conducted in Mayo Hospital, Lahore from June, 2016 to January, 2018. Total 300 patients with HCV genotype 3, selected via Non-Probability Purposive Sampling technique, without prior or concurrent history of HCC, were given DAA agents and were followed up for 6 months after completion of therapy. Results were based on Quantitative PCR to assess Sustained Virological Response (SVR) and Ultrasound Abdomen to look for the appearance of any new lesion. Data was presented as mean ±SD, frequency and percentages and was analyzed using SPSS Version 24.0.

Results

Out of 300 patients, 179 (59.7%) were males and 121(40.3%) were females. Mean age of the patients was 55.08 ± 5.602 years. 214(71.3%) patients had compensated cirrhosis at the start of treatment and 86(28.7%) had decompensated cirrhosis. SVR was achieved in 200(93.4%) out of 214 patients with compensated cirrhosis and in 76(88.3%) out of 86 patients with decompensated cirrhosis. At six months post- treatment, 10(3.33%) patients developed HCC,2(0.7%) in the compensated group and 8(2.7%) in the decompensated group, out of which 5(6.6%) patients had achieved SVR.

Conclusion

The frequency of HCC following DAA agents is significant (3.3%) even after achieving SVR. Caution must be exercised in prescribing DAA agents to HCV patients keeping this complication of HCC in mind.

Myeloid-Derived Suppressor Cells Ameliorate Cyclosporine A-Induced Hypertension in Mice

The calcineurin inhibitor cyclosporine A (CsA) suppresses the immune system but promotes hypertension, vascular dysfunction, and renal damage. CsA decreases regulatory T cells and this contributes to the development of hypertension. However, CsA's effects on another important regulatory immune cell subset, myeloid-derived suppressor cells (MDSCs), is unknown. We hypothesized that augmenting MDSCs would ameliorate the CsA-induced hypertension and vascular and renal injury and dysfunction and that CsA reduces MDSCs in mice. Daily interleukin-33 treatment, which increased MDSC levels, completely prevented CsA-induced hypertension and vascular and renal toxicity. Adoptive transfer of MDSCs from control mice into CsA-treated mice after hypertension was established dose-dependently reduced blood pressure and vascular and glomerular injury. CsA treatment of aortas and kidneys isolated from control mice for 24 hours decreased relaxation responses and increased inflammation, respectively, and these effects were prevented by the presence of MDSCs. MDSCs also prevented the CsA-induced increase in fibronectin in microvascular and glomerular endothelial cells. Last, CsA dose-dependently reduced the number of MDSCs by inhibiting calcineurin and preventing cell proliferation, as other direct calcineurin signaling pathway inhibitors had the same dose-dependent effect. These data suggest that augmenting MDSCs can reduce the cardiovascular and renal toxicity and hypertension caused by CsA.

Frequency of atrial fibrillation in Mitral Stenosis and its correlation with left atrial size

Introduction: Chronic rheumatic heart disease is much the commonest cause of mitral stenosis. Incidence of rheumatic MS parallels that of acute rheumatic fever. Atrial fibrillation usually develops in the presence of pre-existing ECG evidence of left atrial enlargement and is related to the size of the chamber, the extend of fibrosis of the left atrial myocardium, the duration of the atriomegaly and the age of the patient. Study Design: Descriptive Setting: Mayo Hospital, Lahore and Punjab Institute of Cardiology, Lahore Type of sampling: Convenient No. of cases: 129 consecutive cases of predominant mitral stenosis. 112 cases included in the final workup. Results: The frequency of AF in MS in this study was calculated as 25.9%. The correlation between AF and left atrial size was significant (p = 0.000). This was plotted on the scattergram (Figure No. 1), which shows a steep rise in the frequency of AF beyond a left atrial size of 70 mm. Conclusions: Frequency of AF in patients with MS is 25.9%. The correlation between AF in MS and left atrial size is significant (p = 0.000).

Atrial Fibrillation in Mitral Stenosis and its correlation with age, sex & clinical symptoms

Objective: The objective of the study was to calculate the frequency of atrial fibrillation of MS and its correlation with age, sex and clinical symptoms. Design: A prospective descriptive study. Place: Mayo Hospital & Punjab Institute of Cardiology, Lahore. Patients and methods: 112 patients of mitral stenosis were investigated with an ECG and an echocardiography to confirm mitral stenosis and to measure anteroposterior left atrial dimensions on M-mode. All patients who were suffering from AF due to causes other than mitral stenosis were excluded. The significance of findings were tested through standard "t"test. Results: Atrial fibrillation is more in female patient and has a linear correlation with age. More common symptoms of shortness of breath followed by palpitation.

Abstract P183: Myeloid-Derived Suppressor Cells Prevent Cyclosporine A-Induced Hypertension, Endothelial Dysfunction, and Renal Injury in Mice

Cyclosporine A (CsA) is an immunosuppressive drug used to treat focal segmental glomerulosclerosis, reduce autoimmune diseases, and prevent allograft rejection; however a limitation of CsA is that it can induce vascular and renal injury as well as hypertension. Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature granulocytes, macrophages, and dendritic cells that suppress pro-inflammatory immune responses by secreting anti-inflammatory cytokines, inhibiting innate and adaptive immune cells, and inducing regulatory T cells (Tregs). We hypothesized that adoptive transfer of MDSCs would prevent CsA-induced vascular and renal injury and hypertension. Daily treatment of male C57BL6/J mice for 1 week with CsA (50 mg/kg/day, i.p. injection) significantly increased systolic blood pressure (Day 7 SBP in mmHg: Con=97±2 vs. CsA=145±3, p<0.05 vs. Con), decreased aortic endothelium-dependent relaxation responses, increased aortic fibronectin levels, increased renal glomerular mesangial expansion, increased renal fibronectin levels, and decreased splenic Treg levels. Adoptive transfer of 1 million MDSCs by i.p. injection on days 1, 4, and 7 partially prevented the CsA-induced rise in systolic blood pressure (CsA+1M MDSCs=120±3 mmHg) and the detrimental vascular and renal effects. However, adoptive transfer of 2 million MDSCs fully prevented the CsA-induced hypertension (CsA+2M MDSCs=105±1 mmHg) and vascular and renal effects. The anti-hypertensive and vascular and renal protective effects of 2 million MDSCs were independent of Treg induction as splenic Treg levels remained significantly decreased. These data suggest that MDSCs can prevent the hypertension and toxicity caused by CsA independent of Tregs and may be a therapeutic target for CsA-treated patients.

Bashyr Aziz replies

I accept that my assumptions about the likelycontent of the IPPR report were mistaken. As Gavin Kelly, research director of IPPR states, the report was critical of some aspects of thegovernment's approach towards PPP. That this was a surprise to many is evident, even inthe article from which Gavin quotes, where itsays: 'Although it was financed by firms like Norwich Union, KMG and Nomura which havea vested interest in the outcome, it is arefreshingly non-partisan document.' [myitalics].

Developing good policies for the health of pregnant workers

It is inevitable that health and safety regulations for the protection of expectant or new mothers will have a major impact on nursing, a profession in which over 80% of the workforce is female. This article examines some of the ways in which this will happen.

Prealbumin rather than albumin is a more sensitive indicator of acute liver disease

The changes in serum prealbumin (transthyretin) and serum albumin in acute and chronic liver diseases were investigated. Albumin has long been used as a useful indicator of liver function but serum prealbumin has recently been noted for its clinical significance in acute liver diseases. Serum prealbumin concentrations and liver function tests (albumin, bilirubin, alanine aminotransferase) were determined on blood obtained from normal donors (n = 148) and from patients suffering from liver diseases (n = 78) such as acute viral hepatitis, chronic active hepatitis, cirrhosis and hepatoma. The mean serum prealbumin concentration in normal subjects was 29.6 +/- 4.82 mg/dl while the mean serum prealbumin concentration in patients with liver disease was greatly reduced (acute viral hepatitis = 15.3 +/- 7.4mg/dl; chronic active hepatitis = 10.2 +/- 6.6mg/dl; cirrhosis = 9.9 +/- 6.4mg/dl and hepatoma = 10.7 +/- 4.2). Albumin concentrations dropped slightly (13% compared to control) in acute viral hepatitis but dropped markedly (28% compared to control) in chronic liver diseases. The study suggests that serum prealbumin concentration might be a more sensitive indicator than albumin in assessing liver dysfunction in acute liver diseases.

Occupational health. Manual handling: proposed regulations

Injuries associated with manual handling operations account for most workplace injuries reported to the Health and Safety Executive and local authorities. In the health care services, they account for almost 50 per cent of all injuries reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RlDDOR) of 1985 (1). This article examines how proposed legislation may be applied to make the industry safer, drawing on work being carried out by some health authorities and organisations such as the Back Pain Association and WING (The Work-Injured Nurses Group of the Royal College of Nursing). The author draws on EC directives, and on consultative documents on the proposed regulations issued by the Health and Safety Executive (2), as well as draft guidance issued by the Working Party of the Health and Safety Commission's Health Services Advisory Committee (1).

The effective management of occupational health and safety: the requirement for accreditation for quality in the Health Services

It is becoming increasingly important for providers of health care to manage the health and safety of their workforce effectively. In the competitive world of health care, organizations seeking accreditation for quality are having to allot greater importance to health and safety than in the past. The manager of occupational health services for West Birmingham Health District, which has recently applied for Trust status, explores some of the reasons for this.