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Journal of the Endocrine Society Sep 2018Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the... (Review)
Review
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
PubMed: 30187015
DOI: 10.1210/js.2017-00471 -
Journal of Pain Research 2023Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. is an emerging minimally... (Review)
Review
BACKGROUND
Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary.
OBJECTIVE
This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of
STUDY DESIGN
This is a narrative review.
SETTING
All included articles are clinic trials including analytic studies and descriptive studies.
METHODS
PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on.
RESULTS
According to the literature, for the procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of over epidural steroid injection.
LIMITATIONS
There is few high-quality literature in the review. Moreover, the long-term efficacy of cannot be revealed according to the current literature.
CONCLUSION
Based on the reviewed literature, is an effective and safe procedure. can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
PubMed: 37954472
DOI: 10.2147/JPR.S428112 -
Turk Psikiyatri Dergisi = Turkish... 2022In this review, it is aimed to discuss neuropsychiatric symptoms as prodromal symptoms of dementia syndromes, to define the concept of 'Mild Behavioral Impairment', and... (Review)
Review
In this review, it is aimed to discuss neuropsychiatric symptoms as prodromal symptoms of dementia syndromes, to define the concept of 'Mild Behavioral Impairment', and to introduce the 'Mild Behavioral Impairment Checklist'. Neuropsychiatric symptoms (NPS) represent non-cognitive symptoms and behaviors in dementia patients. The frequency of NPS accompanying dementia increases as the disease progresses. Studies reveal that NPS are seen in patients with dementia as well as in the elderly without cognitive complaints, individuals with subjective cognitive complaints, and individuals diagnosed with mild cognitive impairment. Based on these findings, identifying and detecting these symptoms were thought to be useful in predicting the development of dementia in cases where cognitive symptoms have not yet appeared. 'Mild Behavioral Impairment' was first defined by Taragano and Allegri, and it was introduced as a concept that includes neurobehavioral symptoms seen in elderly people for at least 6 months and that do not meet the diagnostic criteria of any other psychiatric syndrome. Mild Behavioral Impairment Checklist (MBI-C) has been developed recently which consists of 34 questions including apathy, mood, impulse dyscontrol, social inappropriateness, abnormal thinking, and perception. Studies on the neurobiological basis of these sub-domains and their relationship with biomarkers gained momentum with the definition of the concept and the development of MBI-C. However, the concept is still very new and it is possible for people to be over-diagnosed and to face the risk of stigmatization during the evaluation. Therefore, studies with large samples are needed. Demonstrating the validity of this concept will also serve the purpose of identifying the subjects with a neurodegenerative disease without any cognitive complaints yet at a very early stage in clinical studies. Keywords: Mild behavioral impairment, neuropsychiatric symptoms, prodromal dementia.
Topics: Humans; Aged; Dementia; Prodromal Symptoms; Neurodegenerative Diseases; Neuropsychological Tests; Cognitive Dysfunction
PubMed: 36592107
DOI: 10.5080/u26980 -
Dementia and Geriatric Cognitive... 2017To estimate a pooled association between hearing impairment and risk of mild cognitive impairment and dementia. (Review)
Review
BACKGROUND
To estimate a pooled association between hearing impairment and risk of mild cognitive impairment and dementia.
METHODS
PubMed, Embase, and Web of Science were searched for prospective cohort studies that examined the association between hearing impairment and risk of mild cognitive impairment and/or dementia. Random-effects models were fitted to estimate the summary risk ratios (RRs) and 95% confidence interval (CIs), which represents the pooled association between hearing impairment with risk of mild cognitive impairment and dementia, compared to subjects free of hearing impairment.
RESULTS
Four studies on hearing impairment with mild cognitive impairment and 7 studies on hearing impairment with dementia were included in the meta-analysis. A total of 15,521 subjects were studied with follow-up periods between 2 and 16.8 years. Hearing impairment was associated with a greater risk of mild cognitive impairment (RR = 1.30, 95% CI: 1.12, 1.51) and dementia (RR = 2.39, 95% CI: 1.58, 3.61).
CONCLUSIONS
The meta-analysis showed that hearing impairment is associated with a higher risk of mild cognitive impairment and dementia among older adults.
PubMed: 29430246
DOI: 10.1159/000485178 -
CMAJ : Canadian Medical Association... May 2008Mild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia in elderly... (Review)
Review
BACKGROUND
Mild cognitive impairment and cognitive impairment, no dementia, are emerging terms that encompass the clinical state between normal cognition and dementia in elderly people. Controversy surrounds their characterization, definition and application in clinical practice. In this article, we provide physicians with practical guidance on the definition, diagnosis and treatment of mild cognitive impairment and cognitive impairment, no dementia, based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006.
METHODS
We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that had mild cognitive impairment or cognitive impairment, no dementia, as the outcome. Subsequent to the conference, we searched for additional articles published between January 2006 and January 2008. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.
RESULTS
We identified 2483 articles, of which 314 were considered to be relevant and of good or fair quality. From a synthesis of the evidence in these studies, we made 16 recommendations. In brief, family physicians should be aware that most types of dementia are preceded by a recognizable phase of mild cognitive decline. They should be familiar with the concepts of mild cognitive impairment and of cognitive impairment, no dementia. Patients with these conditions should be closely monitored because of their increased risk for dementia. Leisure activities, cognitive stimulation and physical activity could be promoted as part of a healthy lifestyle in elderly people and those with mild cognitive impairment. Vascular risk factors should be treated optimally. No other specific therapies can yet be recommended.
INTERPRETATION
Physicians will increasingly see elderly patients with mild memory loss, and learning an approach to diagnosing states such as mild cognitive impairment is now warranted. Close monitoring for progression to dementia, promotion of a healthy lifestyle and treatment of vascular risk factors are recommended for the management of patients with mild cognitive impairment.
Topics: Cognition Disorders; Dementia; Diagnosis, Differential; Disease Progression; Evidence-Based Medicine; Humans; Neuropsychological Tests; Risk Factors
PubMed: 18458258
DOI: 10.1503/cmaj.070797 -
PloS One 2023During mild moxibustion treatment, uncertainties are involved in the operating parameters, such as the moxa-burning temperature, the moxa stick sizes, the stick-to-skin...
During mild moxibustion treatment, uncertainties are involved in the operating parameters, such as the moxa-burning temperature, the moxa stick sizes, the stick-to-skin distance, and the skin moisture content. It results in fluctuations in skin surface temperature during mild moxibustion. Existing mild moxibustion treatments almost ignore the uncertainty of operating parameters. The uncertainties lead to excessive skin surface temperature causing intense pain, or over-low temperature reducing efficacy. Therefore, the interval model was employed to measure the uncertainty of the operation parameters in mild moxibustion, and the uncertainty optimization design was performed for the operation parameters. It aimed to provide the maximum thermal penetration of mild moxibustion to enhance efficacy while meeting the surface temperature requirements. The interval uncertainty optimization can fully consider the operating parameter uncertainties to ensure optimal thermal penetration and avoid patient discomfort caused by excessive skin surface temperature. To reduce the computational burden of the optimization solution, a high-precision surrogate model was established through a radial basis neural network (RBNN), and a nonlinear interval model for mild moxibustion treatment was formulated. By introducing the reliability-based possibility degree of interval (RPDI), the interval uncertainty optimization was transformed into a deterministic optimization problem, solved by the genetic algorithm. The results showed that this method could significantly improve the thermal penetration of mild moxibustion while meeting the skin surface temperature requirements, thereby enhancing efficacy.
Topics: Humans; Moxibustion; Reproducibility of Results; Uncertainty; Skin; Skin Temperature
PubMed: 37068075
DOI: 10.1371/journal.pone.0282355 -
Neural Regeneration Research Feb 2022There is increasing evidence that infants with mild neonatal encephalopathy (NE) have significant risks of mortality, brain injury and adverse neurodevelopmental... (Review)
Review
There is increasing evidence that infants with mild neonatal encephalopathy (NE) have significant risks of mortality, brain injury and adverse neurodevelopmental outcomes. In the era of therapeutic hypothermia, infants need to be diagnosed within 6 hours of birth, corresponding with the window of opportunity for treatment of moderate to severe NE, compared to the retrospective grading over 2 to 3 days, typically with imaging and formal electroencephalographic assessment in the pre-hypothermia era. This shift in diagnosis may have increased the apparent prevalence of brain damage and poor neurological outcomes seen in infants with mild NE in the era of hypothermia. Abnormal short term outcomes observed in infants with mild NE include seizures, abnormal neurologic examination at discharge, abnormal brain magnetic resonance imaging and difficulty feeding. At 2 to 3 years of age, mild NE has been associated with an increased risk of autism, language and cognitive deficits. There are no approved treatment strategies for these infants as they were not included in the initial randomized controlled trials for therapeutic hypothermia. However, there is already therapeutic creep, with many centers treating infants with mild NE despite the limited evidence for its safety and efficacy. The optimal duration of treatment and therapeutic window of opportunity for effective treatment need to be specifically established for mild NE as the evolution of injury is likely to be slower, based on preclinical data. Randomized controlled trials of therapeutic hypothermia for infants with mild NE are urgently required to establish the safety and efficacy of treatment. This review will examine the evidence for adverse outcomes after mild NE and dissect some of the challenges in developing therapeutic strategies for mild NE, before analyzing the evidence for therapeutic hypothermia and other strategies for treatment of these infants.
PubMed: 34269188
DOI: 10.4103/1673-5374.317963 -
Neurology India 2021Traumatic brain injury (TBI) leads to various sequelae that affect the day-to-day functioning of patients. However, there is a dearth of studies investigating these...
BACKGROUND
Traumatic brain injury (TBI) leads to various sequelae that affect the day-to-day functioning of patients. However, there is a dearth of studies investigating these sequelae in complicated mild TBI and moderate TBI patients.
OBJECTIVE
The prime objective of the present study was to present the neurocognitive and affective profile of complicated mild and moderate TBI patients along with to compare the neurocognitive and affective sequelae in patients with complicated mild and moderate TBI.
MATERIALS AND METHODS
Twenty-two patients with complicated mild TBI and 17 patients with Moderate TBI, each with an intracranial lesion were recruited from level 1 trauma center in Varanasi. All patients were assessed with neurocognitive measures, Rivermead Post Concussive Symptoms Questionnaire, and Hospital Anxiety and Depression Scale. The patients' profiles were presented as clinical series using descriptive analysis. Further, comparison was done by using the Chi-square test and Fisher's exact test.
RESULTS
Findings revealed that complicated mild TBI patients reported significantly higher psychological distress and post head injury symptoms in comparison to patients with moderate TBI. Further, the complicated mild TBI and moderate TBI groups showed differences with respect to verbal fluency, mental speed, and flexibility tasks.
CONCLUSIONS
Complicated mild TBI and moderate TBI groups have not differed significantly on most of the cognitive tasks. Furthermore, affective symptoms were found more prominent in complicated mild TBI group as compared to the moderate TBI group.
Topics: Brain Concussion; Brain Injuries, Traumatic; Humans; Neuropsychological Tests
PubMed: 33642271
DOI: 10.4103/0028-3886.310110 -
Fertility and Sterility Oct 2017It has been proven that the use of high gonadotropin dose does not necessarily improve the final outcome of IVF. Mild ovarian stimulation is based on the principle of... (Review)
Review
It has been proven that the use of high gonadotropin dose does not necessarily improve the final outcome of IVF. Mild ovarian stimulation is based on the principle of optimal utilization of competent oocytes/embryos and endometrial receptivity. There is growing evidence that the pregnancy or live birth rates with mild-stimulation protocols are comparable to those with conventional IVF; the cumulative pregnancy outcome has been shown to be no different, despite having fewer numbers of oocytes or embryos available with milder ovarian stimulation. Although equally effective, mild-stimulation IVF is associated with a greater safety profile, in terms of the incidence of ovarian hyperstimulation syndrome and venous thromboembolism. It is also found to be better tolerated by patients and less expensive. Emerging research evidence may lead to widespread acceptance of mild IVF, by both patients and IVF providers, and make IVF more accessible to women and couples worldwide.
Topics: Birth Weight; Female; Fertilization in Vitro; Humans; Infant, Newborn; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Rate
PubMed: 28965549
DOI: 10.1016/j.fertnstert.2017.08.022 -
Emerging Microbes & Infections Dec 2023Little is known about alternation and difference in gut microbiota between patients with mild and severe hand, foot, and mouth disease (HFMD). We investigated the...
Little is known about alternation and difference in gut microbiota between patients with mild and severe hand, foot, and mouth disease (HFMD). We investigated the differences in gut and oropharynx microbiota between mild and severe HFMD in young children and changes in bacterial profiles as the disease progresses from acute to convalescent phase. Forty-two patients with confirmed HFMD were studied, among which 32 had severe HFMD and 10 had mild HFMD. First rectal swabs were collected from all patients at an average of 2 days (acute phase) after the onset of symptoms, and second rectal swabs were collected from 8 severe patients at day 9 (convalescent phase) after the onset. Oropharyngeal swabs were obtained from 10 patients in the acute phase and 6 in the convalescent phase. 16S rRNA sequencing was performed for all 70 samples. Compared with mild HFMD, severe HFMD exhibited significantly decreased diversity and richness of gut microbiota. Gut microbiota bacterial profiles observed in the acute and convalescent phases resembled each other but differed from those in mild cases. Additionally, 50% of patients with severe HFMD in the acute phase harboured a dominant pathobiontic bacterial genus. However, none of the patients with mild HFMD had such bacteria. Similar bacterial compositions in oropharynx microbiota were detected between mild and severe cases. Our findings indicate that severe HFMD exhibits significantly impaired diversity of gut microbiota and frequent gut and oropharyngeal inflammation-inducing bacteria. However, the results should be interpreted with caution as the number of subjects was limited.
Topics: Humans; Child; Infant; Child, Preschool; Hand, Foot and Mouth Disease; RNA, Ribosomal, 16S; Inflammation; Gastrointestinal Microbiome; Bacteria; Oropharynx; China
PubMed: 36927539
DOI: 10.1080/22221751.2023.2192819