Search Results (128)

Background/Objectives: Management of prehepatic portal hypertension involves endoscopic and medical therapies with subsequent shunting if symptoms persist. Lately, surgical shunts, particularly the Meso-Rex shunt, are increasingly considered early in the disease course, offering benefits such as minimized hyperammonemia, improved somatic growth, and preservation of liver function. Our study evaluates post-operative outcomes after different surgical procedures in children with prehepatic portal hypertension. Methods: This single-centre retrospective case series included six children undergoing surgical shunting for prehepatic portal hypertension over a 5-year period. Medical records before and after surgery, followed for an average of 4.0 years, were analyzed. Results: Five patients underwent a Meso-Rex bypass, while one patient underwent a mesorenal shunt procedure. All cases showed clinically significant regression of esophageal varices six months post-surgery. Thrombocyte as well as leukocyte count significantly increased in five out of six patients during the long-term follow-up. Currently, five out of six surgically formed shunts (83%) continue to function normally. Conclusions: Our study supports early surgical intervention for improved long-term outcomes in managing portal hypertension, reducing complications like hypersplenism and variceal bleeding. Early consideration and ongoing monitoring are crucial for long-term success in children with portal hypertension. Full article

Psychological and motivational factors are implicated in various medical conditions, yet the link between physical health and life aspirations, as defined in Self-Determination Theory (SDT), remains underexplored. To address this gap and advance theory, we conducted a preliminary investigation of associations between aspirations and self-reported symptoms across five functional medical conditions—gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), headaches, sleep disturbances, and sexual dysfunction. We surveyed 392 Canadian medical patients (Mage = 42.8 years, SD = 12.7, 50.5% women, 82.1% white, 75.3% with higher education) to assess whether the relative importance, likelihood, and attainment of intrinsic (e.g., personal growth, relationships, community, health) and extrinsic (e.g., wealth, fame, image) aspirations were associated with symptoms. Consistent with hypotheses, greater relative prioritization of intrinsic goals was linked to fewer symptoms—especially sleep disturbance—while extrinsic aspirations were associated with increased symptoms, particularly GERD. Sociodemographic factors, such as age, gender, education, religiosity, and subjective financial status, also showed associations with goal orientations and symptom burden, broadly aligning with SDT predictions. Findings highlight the potential relevance of people’s personal goals in patient-centered care for functional conditions and underscore the need for further research exploring mechanisms and moderators of these effects. Full article

Background: The fibromyalgia syndrome (FMS) is classified as a functional somatic syndrome and is characterized primarily by chronic pain in multiple body regions and physical and/or mental fatigue. The German S3-guideline recommends a multimodal therapy for severe forms. Since research on non-pharmacologic complementary, naturopathic, and integrative therapy approaches shows positive and promising effects, integrative methods are firmly anchored in the S3 guideline. Objective/Methods: Aim of the present study was to investigate whether a multimodal integrative treatment program can be effective in reducing the primary symptoms of FMS (pain and fatigue) and improving psychological aspects such as quality of life (QoL), anxiety, depression, and perceived stress. Another aim of the study is to explore whether potential effects appear only in the short term (immediately after discharge) or persist long term (six months after discharge). The treatment concept is based on mind–body medicine and elements of classical European naturopathy (including fasting interventions) and focusses on stress reduction and lifestyle modification. Results: Of N = 134 originally included longstanding fibromyalgia patients (mean time since diagnosis 9.2 ± 8.5 years), 101 data sets could be analyzed. Results show a significant improvement in both short-term and long-term pain and fatigue intensity (about 12% improvement). Long-term reductions in pain intensity appear to be supported by medical fasting interventions. Regarding psychological aspects and quality of life, there are long-lasting reductions regarding anxiety, depression, perceived stress, and helplessness and a long-lasting increase in self-efficacy, quality of life and current working ability. Conclusions: The two-weeks inpatient stay therefore leads to significant improvements in all mentioned aspects. Therefore, the concept may be a promising component for integration into medical guidelines and thus in the care of FMS patients. Future research including randomized controlled trials is necessary to further evaluate the program. Full article

Background: Endometriosis is a chronic, estrogen-dependent inflammatory and immunological disease, with chronic pain being its predominant clinical manifestation. This condition significantly impairs quality of life and is frequently associated with depressive and anxiety symptoms, further exacerbating social and occupational dysfunction in affected women. The aim of this study was to assess the relationship between chronic pain in patients with endometriosis and the severity of depressive symptoms. Methods: A retrospective analysis was conducted on the medical records of 60 women of reproductive age treated at the Tomaszewski Medical Center in Białystok between 2023 and 2024. Pain intensity was evaluated using the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire, while depressive symptoms were assessed with the Beck Depression Inventory (BDI). Results: Statistical analyses included the Student t-test, Wilcoxon signed-rank test, chi-square test, and Shapiro–Wilk test, with significance set at p < 0.05. Pain intensity was significantly higher during menstruation (M = 7.23) compared to non-menstrual phases of the cycle (M = 4.55; p < 0.001). Accompanying symptoms included sleep disturbances, reduced activity, and gastrointestinal complaints. Depressive symptoms were also more severe during menstruation (M = 30.12) than during the rest of the cycle (M = 22.15; p < 0.001). A significant association between pain severity and depressive symptoms was observed during menstruation (χ²(4) = 12.89; p = 0.012), but not outside this phase. Conclusions: (1) Pain in endometriosis is chronic and cyclic in nature. (2) Depressive symptoms are common but may be masked by nonspecific somatic complaints. (3) Pain intensity strongly correlates with the severity of depressive disorders, particularly during menstruation. (4) The coexistence of depression significantly impairs patient functioning. (5) Effective management of endometriosis should integrate gynecological treatment with psychological support and psychiatric care when necessary. Full article

Introduction: The mental health of nursing professionals is an escalating global concern, particularly due to the inherently challenging work conditions they frequently encounter. This study aimed to investigate the prevalence of Minor Mental Disorders (MMD) and resilience levels among nursing professionals, analyzing the relationship between these constructs and identifying resilience’s potential protective role. Methods: This was a quantitative, descriptive, correlational, and cross-sectional study. The sample consisted of 203 nursing professionals (including nursing assistants, technicians, and nurses) from two healthcare institutions in the interior of São Paulo, Brazil. Data were collected between August and October 2019. Instruments utilized included a sociodemographic and professional questionnaire, the Self-Report Questionnaire (SRQ-20) for MMD screening, and the Wagnild & Young Resilience Scale. Results: The overall prevalence of MMD in the studied sample was 31.0%. Mean scores for the SRQ-20 domains were observed as follows: Depressive/Anxious Mood (1.33), Somatic Symptoms (1.63), Reduced Vital Energy (1.77), and Depressive Thoughts (0.39). A key finding indicated that resilience did not demonstrate a significant direct predictive role on MMDs when the effect of quality of life was controlled. However, resilience showed a significant positive correlation with Quality of Life (QoL) (coef. = 0.515; p < 0.001). Furthermore, QoL emerged as a robust and statistically significant negative association with all dimensions of MMD. Discussion: These findings suggest that resilience may function as an indirect moderator or precursor to QoL, with QoL, in turn, exerting a more direct and substantial influence on the reduction of MMDs. This integrated perspective aligns with the understanding that resilience contributes to a more adaptive assessment of stressors and, consequently, to better QoL, thereby minimizing the detrimental effects of stress on mental health. Conclusion: This study reaffirms the high prevalence of Minor Mental Disorders among nursing professionals, highlighting Quality of Life as a primary target for interventions aimed at promoting mental well-being. It also emphasizes resilience as a valuable individual resource that indirectly supports mental health by enhancing QoL. A holistic understanding of occupational stressors, psychosocial, and biological mechanisms is crucial for developing effective and targeted support strategies for these essential professionals. Full article

Background/Objective: Insomnia is a clinically important symptom in Long COVID; however, few studies have addressed the presentation and course of insomnia symptoms in patients with Long COVID. Methods: The Insomnia Severity Index (ISI) was administered as part of a comprehensive baseline neuropsychological evaluation (Time 1) for patients with Long COVID at an Academic Medical Center (AMC). Data were gathered on 172 consecutively referred patients between the dates of November 2020 and May 2022. The mean age of patients at Time 1 was 49 years (range: 18 to 78), with a mean of 15 years of education. Patients were 70% female and 30% male and identified as White/Caucasian (78%), Black/African American (21%), or American Indian (1%). Patients’ severity of COVID-19 infection and self-reported emotional, somatic, cognitive, and fatigue symptoms were also gathered to identify concomitant risk factors for insomnia in Long COVID. Patients were then followed to observe the natural trajectory of insomnia complaints in Long COVID, with the Time 2 evaluation a mean of 9 months after the Time 1 evaluation. Results: Seventy-eight percent of Long COVID patients reported insomnia symptoms at Time 1, with 30% reporting Subthreshold Insomnia symptoms (ISI Score = 8–14), 30% reporting Moderate Insomnia symptoms (ISI Score = 15–21), and 18% reporting Severe Clinical Insomnia (ISI Score = 22–28). Severity of acute COVID-19 infection was not correlated with severity of insomnia in Long COVID; however, being non-white (r = 0.24, n = 172, p < 0.01) and having higher self-reported levels of anxiety (r = 0.41, n = 172, p < 0.01), depression (r = 0.52, n = 172, p < 0.01), perceived stress (r = 0.38, n = 172, p < 0.01), somatic symptoms (r = 0.51, n = 172, p < 0.01), cognitive failures, and fatigue were significantly correlated with insomnia symptoms. Insomnia was also significantly correlated with lower global cognitive function (r = 0.51, n = 172, p < 0.01) and lower cognitive flexibility (r = −0.17, n = 172, p < 0.05). There was a statistically significant decrease in reported ISI scores from Time 1 to Time 2 (t = −3.04; p = 0.003); however, ISI mean scores at both Time 1 (ISI Score = 14) and Time 2 (ISI Score = 12) remained in the Subthreshold Insomnia range (ISI score 8–14). Conclusions: Findings suggest that a large majority of Long COVID patients experience insomnia symptoms. Additionally, insomnia symptoms did not dissipate over time in a clinically meaningful way and were highly correlated with reduced global cognitive function, reduced cognitive flexibility, and higher levels of reported mood symptoms, fatigue, somatic symptoms, and experience of cognitive failures. Thus, there is a pressing need for intervention strategies to treat insomnia in Long COVID patients. Full article

Background: Functional Neurological Disorder (FND) encompasses conditions with neurological symptoms inconsistent with structural pathology, arising instead from complex interactions between psychological, biological, and social factors. Despite growing research, the etiological and risk factor landscape remains only partially understood, complicating diagnosis and treatment. Objective: This systematic review maps risk factors for major FND subtypes such as functional seizures (psychogenic non-epileptic seizures or PNES), functional cognitive disorder (FCD), functional movement disorders (FMD), functional weakness and sensory disturbances, functional visual symptoms, and functional gait abnormalities by categorizing predisposing, precipitating, and perpetuating influences. Methods: A systematic search of PubMed, PsycINFO, Scopus, and Web of Science initially identified 245 records. After removal of 64 duplicates, 181 studies were screened by title and abstract. Of these, 96 full texts were examined in detail, and finally 23 studies met the predefined inclusion criteria. Data were extracted and analyzed thematically within a biopsychosocial framework, with results summarized in subtype-specific profiles. Results: Childhood adversity, especially emotional, physical, or sexual abuse, emerged as a robust and consistent predisposing factor across PNES cohorts. Psychiatric history (notably anxiety, depression, and PTSD), neurodevelopmental traits (more frequent in FCD), and personality patterns such as alexithymia and somatization also contributed to vulnerability. Precipitating influences included acute psychological stress, intrapersonal conflict, or concurrent medical illness. Perpetuating factors comprise maladaptive illness beliefs, avoidance behaviors, insufficient explanation or validation by healthcare providers, and secondary gains related to disability. While several risk factors were shared across subtypes, others appeared subtype-specific (trauma was especially associated with PNES, whereas neurodevelopmental traits were more characteristic of FCD). Conclusions: FND arises from a dynamic interplay of predisposing, precipitating, and perpetuating factors, with both shared and subtype-specific influences. Recognizing this heterogeneity can enhance diagnostic precision, guide tailored intervention, and inform future research into the neurobiological and psychosocial mechanisms underlying FND. Full article

Background: Functional Neurological Disorder (FND) encompasses a spectrum of symptoms—including motor, cognitive, and seizure-like manifestations—that are not fully explained by structural neurological disease. Accumulating evidence suggests that comorbid psychiatric and somatic conditions significantly influence the clinical course, diagnostic complexity, and treatment response in FND. Objective: This study systematically explores psychiatric and medical comorbidities across major FND subtypes—Functional Cognitive Disorder (FCD), Functional Movement Disorder (FMD), and Psychogenic Non-Epileptic Seizures (PNES)—with an emphasis on subtype-specific patterns and shared vulnerabilities. Methods: We conducted a narrative review of the published literature, guided by systematic principles for transparency, covering both foundational and contemporary sources to examine comorbid conditions in patients with FCD, FMD, PNES, PPPD and general (mixed) FND populations. Relevant studies were identified through structured research and included based on methodological rigor and detailed reporting of comorbidities (PRISMA). Extracted data were organized by subtype and comorbidity type (psychiatric or medical/somatic). Results: Across all FND subtypes, high rates of psychiatric comorbidities were observed, particularly depression, anxiety, PTSD, and dissociative symptoms. FCD was predominantly associated with internalizing symptoms, affective misattribution, and heightened cognitive self-monitoring. FMD demonstrated strong links with trauma, emotional dysregulation, and personality vulnerabilities. PNES was characterized by the highest burden of psychiatric illness, with complex trauma histories and dissociation frequently reported. Somatic comorbidities—such as fibromyalgia, chronic pain, irritable bowel syndrome, and fatigue—were also prevalent across all subtypes, reflecting overlapping mechanisms involving interoception, central sensitization, and functional symptom migration. Conclusions: Comorbid psychiatric and medical conditions are integral to understanding the presentation and management of FND. Subtype-specific patterns underscore the need for individualized diagnostic and therapeutic approaches, while the shared biopsychosocial mechanisms suggest benefits of integrated care models across the FND spectrum. Full article

Background: Fibromyalgia (FM) is a chronic condition characterized by widespread pain, fatigue, cognitive difficulties, and psychological symptoms. Patients often present distinct personality traits and psychopathological patterns associated with symptom severity. Objective: To examine psychopathological profiles in FM patients based on functional, physical–somatic, and emotional impairment domains, as well as on cumulative disease severity. Materials and Methods: A cross-sectional study was conducted with 70 women clinically diagnosed with FM at a specialized Fibromyalgia Unit. Psychological functioning was assessed using the Personality Assessment Inventory, and disease impact was measured with the Fibromyalgia Impact Questionnaire. Hierarchical cluster analyses were used to classify participants into mild and severe clusters across FIQ domains, and psychological profiles were compared. Results: Patients with severe functional impairment had more affective dysregulation (76.43 vs. 70.20, p < 0.01) and somatic complaints (85.57 vs. 79.76, p < 0.05) than those with mild impairment. The severe–physical cluster showed greater mood instability, somatization, and suicidal ideation (60.94 vs. 53.61, p < 0.05). The severe–emotional cluster had higher rates of major depression (85.71% vs. 64.28%) and persistent depressive disorder (76.19% vs. 70.61%, p < 0.05). Severe showed more emotional instability and somatization, distinguishing it from mild. Greater cumulative severity intensified depressive and somatic disorders. Discussion: Findings support FM’s biopsychosocial profile, where emotional distress may relate to psychological and physical symptoms, reinforcing the need for personalized, multidisciplinary care and comprehensive assessment. Full article

Background: Post-concussion syndrome (PCS) and Functional Neurological Disorder (FND), including Functional Cognitive Disorder (FCD), are two frequently encountered but diagnostically complex conditions. While PCS is conceptualized as a sequela of mild traumatic brain injury (mTBI), FND/FCD encompasses symptoms incompatible with recognized neurological disease, often arising in the absence of structural brain damage. Yet, both conditions exhibit considerable clinical overlap—particularly in the domains of cognitive dysfunction, emotional dysregulation, and symptom persistence despite negative investigations. Objective: This review critically examines the shared and divergent features of PCS and FND/FCD. We explore their respective epidemiology, diagnostic criteria, and risk factors—including personality traits and trauma exposure—as well as emerging insights from neuroimaging and biomarkers. We propose the “Functional Overlay Model” as a clinical tool for navigating diagnostic ambiguity in patients with persistent post-injury symptoms. Results: PCS and FND/FCD frequently share features such as subjective cognitive complaints, fatigue, anxiety, and heightened somatic vigilance. High neuroticism, maladaptive coping, prior psychiatric history, and trauma exposure emerge as common risk factors. Neuroimaging studies show persistent network dysfunction in both PCS and FND, with overlapping disruption in fronto-limbic and default mode systems. The Functional Overlay Model helps to identify cases where functional symptomatology coexists with or replaces an initial organic insult—particularly in patients with incongruent symptoms and normal objective testing. Conclusions: PCS and FND/FCD should be conceptualized along a continuum of brain dysfunction, shaped by injury, psychology, and contextual factors. Early recognition of functional overlays and stratified psychological interventions may improve outcomes for patients with persistent, medically unexplained symptoms after head trauma. This review introduces the Functional Overlay Model as a novel framework to enhance diagnostic clarity and therapeutic planning in patients presenting with persistent post-injury symptoms. Full article

Background: Between 40 and 70% of the population with autism have been found to suffer from functional gastrointestinal disorders (FGIDs). The emergence of FGIDs is related to lower quality of life and greater medical resources, somatization and emotional instability. There is a paucity of research available that examines gastrointestinal symptoms and sensory responses in individuals with autism in different countries and cultures. The aim of the present study is to compare the possible differences between gastrointestinal symptoms and sensory reactivity between two samples of individuals with autism from Spain and Colombia. Methods. Differences in gastrointestinal symptoms and sensory response were analysed between individuals with autism from Spain (n = 65; mean age = 8.91, SD = 4.02) and Colombia (n = 62; mean age = 10.16, SD = 5.31). Results. No differences were found as a function of age, sex and autism severity between Spanish and Colombian participants. More severe functional nausea and vomiting was reported by the Colombian sample when compared with the Spanish sample (p < 0.00, d = 0.42). Similarly, greater sensory reactivity emerged in Colombian individuals with autism relative to Spanish individuals with autism. Conclusions. Due to methodological limitations, sample size and other factors that could not be analysed in this research, it is not possible to draw conclusions about the influences of cultural or biological factors on gastrointestinal symptomatology and sensory reactivity among both autistic populations. This work could encourage more rigorous cross-cultural research in the future. Full article

Caprine arthritis and encephalitis (CAE), caused by small ruminant lentivirus (SRLV), is a key disease of goats, with chronic inflammation of joints and brain symptoms leading to losses in milk production and animal trade. In this study, we analyzed gene expressions in the milk somatic cells (MSCs) of seropositive (SRLV-SP) and seronegative (SRLV-SN) goats to identify transcriptomic changes using a non-invasive sampling method. Materials and Methods: This study was conducted on goats of two Polish breeds (Polish Improved White and Polish Improved Fawn), which were kept at the Institute of Genetics and Animal Biotechnology, Polish Academy of Sciences, during their first lactation. MSCs were isolated from milk, and gene expression was analyzed using the Goat Gene Expression Microarray. The results were verified by RT-qPCR for five genes (DUSP26, PRLR, SCARA3, APBB2, OR4F4). Statistical analysis was performed in GeneSpring 12 software. Results: Microarrays showed reduced expression of DUSP26, PRLR, SCARA3, APBB2, and OR4F4 genes in SRLV-SP goats. RT-qPCR confirmed changes for DUSP26, SCARA3, and APBB2. Functional analysis indicated associations with immune processes and HIV-like pathways. Discussion: The results suggest that SRLV induces transcriptomic perturbations, especially in immunity-related genes. MSCs are an effective model for non-invasive studies, and further studies may support strategies for combating CAE. Full article

Background/Objectives: Temporomandibular disorders (TMDs) are the most common cause of non-dental pain in the orofacial region. Due to the complex and multifactorial nature of TMD, a multidisciplinary approach is often required. The objective of this narrative review is to evaluate the effectiveness of multimodal therapies in the management of TMD. Methods: A literature search was performed using a combination of keywords: “TMD”, “TMJ”, “disorders”, “manual therapy”, “physical therapy”, “dry needling”, “botulinum toxin”, “Botox”, “splint”, and “psychotherapy”. The search was conducted in the PubMed, Google Scholar, and Scopus databases, focusing on studies involving human subjects. Results: The included studies reported that the use of multimodal approaches—such as physiotherapy, botulinum toxin injections, occlusal splints, and/or psychotherapy—led to symptom improvement or complete resolution in patients with TMD. Conclusions: Temporomandibular disorders are complex conditions with a multifactorial etiology involving both somatic and psychological components. Given the wide range of symptoms and the functional connections of the temporomandibular joint with the nervous, muscular, and skeletal systems—including the cervical spine—effective treatment of TMD requires a multidisciplinary strategy. Full article

Background: Toxic oil syndrome (TOS) was a major food-borne epidemic that occurred in Spain in May 1981, caused by the ingestion of rapeseed oil adulterated with aniline. While the somatic sequelae of TOS have been well documented, its long-term cognitive consequences remain poorly understood more than four decades after exposure. Methods: In this case-control study, 50 individuals with clinically confirmed TOS were compared to 50 healthy controls matched for age, sex, and education. All participants completed a comprehensive neuropsychological assessment, along with questionnaires evaluating fatigue, anxiety, depression, and health-related quality of life. Multivariate regression models were adjusted for demographic and vascular risk factors, as well as for mood symptoms, fatigue, and use of central nervous system-acting medications. Structural equation modeling was used to explore the potential mediating effects of affective and fatigue symptoms on cognitive performance. Results: TOS survivors showed significantly poorer performance than controls in attention, executive function, processing speed, and global cognition after adjusting for demographic and vascular risk factors. However, these differences were no longer statistically significant after additional adjustment for fatigue, depression, anxiety, and central nervous system-acting medications. Structural equation modeling analyses revealed that affective symptoms—particularly fatigue—substantially mediated the relationship between TOS and cognitive performance. Conclusions: The cognitive profile observed mirrors that of disorders characterized by subcortical dysfunction and impaired neural connectivity, such as multiple sclerosis and vascular cognitive impairment. Although early postmortem studies in TOS did not demonstrate overt white matter lesions, our findings raise the possibility of long-lasting alterations involving both white and gray matter networks. These results emphasize the need to consider mood and fatigue symptoms when evaluating cognition in TOS survivors and point to the potential for widespread, enduring neurobiological effects stemming from the original toxic exposure. Full article

Background: Postoperative pain is an unpleasant experience for the patient and impairs postoperative functional outcomes. The current literature on the influence of preoperative predictors on postoperative pain outcomes remains limited. This study aimed to identify sociodemographic, clinical, psychological, and temperamental predictors of postoperative pain in patients undergoing surgery for degenerative disc disease (DDD). Methods: Eighty-one adults with DDD, qualified for neurosurgical intervention, were enrolled. All patients underwent neurological and psychiatric evaluations, as well as preoperative pain assessments using the Visual Analogue Scale (VAS) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychological assessments included the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Somatic Symptom Scale, temperament, and personality inventories (e.g., FCB-TI, NEO-FFI), and cognitive tests (Trail Making Test, Digit Span Test). Postoperative pain was re-evaluated with the VAS 12 weeks after surgery. Data were analyzed using univariate and multivariate statistical methods. Results: Univariate analyses revealed significant differences between the defined groups regarding lack of improvement of pain 12 weeks after surgery compared to preoperative VAS, systolic blood pressure, and four scales from the WHYMPI. However, stepwise logistic regression identified only preoperative VAS score as an independent predictor of postoperative pain improvement. Receiver Operating Characteristic analysis and Youden’s index indicated a preoperative VAS cut-off score of 6 as the most predictive. Conclusions: A VAS score of 6 or more before surgery independently predicts the absence of chronic pain 12 weeks postoperatively for patients without neurological deficits. Moreover, given the complexity of this topic, further prospective, randomized controlled research is essential. Full article