Investigation of Screen Time Inclination and the Accompanying Visual and Musculoskeletal Discomfort in Young Smartphone Users

The purpose of this study is to investigate the screen time inclination and its accompanying visual and musculoskeletal discomfort in young smartphone users. Thirty-one smartphone users aged between 20 - 30 years old were recruited through convenient sampling. The screen time patterns were recorded daily for a week and documented using Action Dash on Google Play Store according to the times of the day (morning, afternoon evening and night). Accompanying visual and musculoskeletal symptoms were examined through a self-reporting questionnaire survey. The questions used in the questionnaire were adapted and modified from the Asthenopia Questionnaire and Nordic Musculoskeletal Questionnaire. Results showed that young smartphone users spent approximately 30 % of their time on screen and were relatively similar for different times of the day. Daily screen time was approximately 7.36 ± 1.74 h. Most users engaged in WhatsApp (74 %), followed by YouTube (68 %), Instagram (65 %) and Twitter (39 %). Tired eyes were reported by all smartphone users. A positive correlation was only found between weekly screen time and eye strain (p < 0.05). All musculoskeletal symptoms were self-reported by young smartphone users in our study but anatomical locations varied in percentages. Neck pain was the most significant musculoskeletal symptom associated with screen time (OR = 4.80, 95 % CI: 0.95 - 24.14, p < 0.05). Every smartphone user reported at least 1 type of visual symptom. All smartphone users reported tired eyes. In conclusion, our results showed that smartphone users spent one third of their time daily on-screen and mostly on social media. Tired eyes and neck pain were the most common accompanying symptoms. Visuo-skeletal symptoms are common among young and healthy smartphone users. Our findings advocate that future strategic plans to address digital related health problems from the perspective of health education, promotion and protection should be inclusive of youth. HIGHLIGHTS Excessive screen time is a public health concern Adverse health implications have been linked to excessive electronic usage Smartphone users spend one-third of their time daily on-screen and mostly on social media Visuo-skeletal symptoms are common among young and healthy smartphone users Tired eyes and neck pain are the most common accompanying symptoms GRAPHICAL ABSTRACT

Purpura Fulminans in a 20-Year-Old Female

A previously healthy 20-year-old female presented with extensive retiform purpura located at the face, upper and lower limbs, one week after an episode of acute tonsillitis. Despite the exuberance of the cutaneous findings and progression to skin necrosis she had no accompanying symptoms. Laboratory investigation revealed a heterozygous protein C mutation (exon 9, c.1332G> C, p.Trp444Cys), accounting for a partial deficiency of this anticoagulant protein. The patient was started on broad spectrum antibiotics, anticoagulation and systemic corticosteroids, with no lesional progression and complete resolution of cutaneous ulceration within 6 months. This is a singular case of purpura fulminans, since two different causative factors precipitated the events. The previous tonsillitis reported by the patient is significant, because the serum concentration of protein S may also decrease after an infectious event - post-infectious purpura fulminans. This case illustrates that purpura fulminans due to autoantibodies against protein S, although rare, should be considered, especially in the absence of a severe acute infection. It also illustrates how in a given patient different independent factors can act simultaneously, triggering potentially devastating clinical scenarios.

History Taking in Non-Acute Vestibular Symptoms: A Four-Step Approach

History taking is crucial in the diagnostic process for vestibular disorders. To facilitate the process, systems such as TiTrATE, SO STONED, and DISCOHAT have been used to describe the different paradigms; together, they address the most important aspects of history taking, viz. time course, triggers, and accompanying symptoms. However, multiple (vestibular) disorders may co-occur in the same patient. This complicates history taking, since the time course, triggers, and accompanying symptoms can vary, depending on the disorder. History taking can, therefore, be improved by addressing the important aspects of each co-occurring vestibular disorder separately. The aim of this document is to describe a four-step approach for improving history taking in patients with non-acute vestibular symptoms, by guiding the clinician and the patient through the history taking process. It involves a systematic approach that explicitly identifies all co-occurring vestibular disorders in the same patient, and which addresses each of these vestibular disorders separately. The four steps are: (1) describing any attack(s) of vertigo and/or dizziness; (2) describing any chronic vestibular symptoms; (3) screening for functional, psychological, and psychiatric co-morbidity; (4) establishing a comprehensive diagnosis, including all possible co-occurring (vestibular) disorders. In addition, pearls and pitfalls will be discussed separately for each step.

Dizziness In A Tertiary Neurological Department： A Retrospective Study

Background Dizziness is a common and challenging condition among population. There is little published study which surveys the characteristics of dizziness of inpatients in the department of neurology. Objective This study was to investigate the inpatients with dizziness as the chief complaint in a neurology department. Materials and Methods We conducted a retrospective study of inpatients with dizziness attending a tertiary neurological department in Beijing. We audited 211 patients with dizziness as the chief complaint from 1841 patients discharged from our tertiary neurological department. Results The inpatients with dizziness as the chief complaint accounted for 11.5% of all inpatients. Dizziness was more common in women than in men (p=0.004). There were more patients presenting with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walk unsteadily (13.3%) and ear symptoms (12.8%) were the most common accompanying symptoms. Hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease were the most common diseases in past medical history. Dix-Hallpike test (24.6%) and Romberg’s sign (11.4%) were positive in dizziness patients. Nystagmus (2.4%), vision changes (1.4%) and hearing disorders (8.5%) were relatively rare symptoms. MRI (60.2%), CT (31.8%), carotid duplex ultrasound (30.8%), echocardiography (28.0%) were common auxiliary examination. Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were common causes of dizziness. 97.2% of inpatients with dizziness can be improving after treatment. Conclusion Dizziness was a common and challenging condition. Vertigo and light-headedness were the most common dizziness types. Benign paroxysmal positional vertigo and stroke/transient ischemic attack were the common dizziness disorders. The prognosis of most patients with dizziness was good.

A Case Report on 14 Patients with Palpitations Treated with Gami-ondam-tang

Objectives: This study examined cases of patients with palpitations treated with Gami-ondam-tang.Methods: The patients were treated with Gami-ondam-tang and changes in their symptoms were assessed using a self-reported numeral rating scale (NRS) score.Results: Following treatment, the patients’ palpitations and accompanying symptoms (e.g., insomnia, hot flushes, dyspepsia, and depression) improved. The study investigated 14 first occurrences and 10 subsequent recurrences. In the subsequent recurrent cases, compared to the first occurrence cases, the symptoms according to the NRS score were not severe, and the treatment period was shorter.Conclusions: The results showed that Gami-ondam-tang is effective for treating palpitations and accompanying symptoms.

A Randomized, Double-Blind, Placebo-Controlled Phase III Trial On The Efficacy and Safety of Tocilizumab in Patients With Colchicine-Resistant or -Intolerant Familial Mediterranean Fever

Objective To evaluate the efficacy and safety of tocilizumab (TCZ), an interleukin 6 receptor monoclonal antibody, in patients with familial Mediterranean fever (FMF). Methods We performed a double-blind, randomized, parallel-group trial, followed by an open-label extension trial, in patients with colchicine-resistant or -intolerant FMF (crFMF). Patients were randomly assigned (1:1) to receive TCZ (162 mg every week) or placebo, administered subcutaneously, for 24 weeks. Rescue treatment was allowed if the rescue criteria were met. The primary endpoint was the number of fever attacks over the 24 weeks of treatment. Secondary endpoints included the frequency of accompanying symptoms during attacks, serum CRP and SAA values, and adverse events (AEs). The open-label extension study evaluated the long-term safety and efficacy of TCZ in patients who had completed the preceding study. Results We randomly assigned 23 patients to either TCZ (n = 11) or placebo (n = 12). The TCZ–placebo rate ratios were 0.691 (95% confidence intervals (CI), 0.189–2.531; P = 0.577) for the fever attacks, based on the group rates per week. The recurrence of attacks was significantly lower in the TCZ group (hazard ratio = 0.457; 95% CI, 0.240–0.869). Fever attacks, accompanying symptoms, serum CRP and SAA values were controlled in most of the patients who received long-term TCZ. In these trials, the numbers and severity of AEs did not differ between groups. Conclusion Although a primary endpoint was not met in the preceding trial, long-term administration of TCZ showed stable efficacy and safety for patients with crFMF.

Impact of Repeated Lidocaine Injections, Exercise, and Mindfulness on Fibromyalgia Symptoms in a Clinical Population

Fibromyalgia (FM) patients usually are resistant to conventional single mode therapy. Therefore, the efficacy of combined pharmacological and nonpharmacological treatments for the management of FM symptoms in a clinical population was assessed. Participants were injected with 4x5 mL 1% lidocaine HCl solution and given education materials and support on increasing their daily steps walked and to engage in mindfulness techniques to reduce their overall pain and accompanying symptoms of their condition. Participants self-reported pain intensity, unpleasantness, anxiety, fatigue, and depression three days prior to and after each injection. Overall ratings of pain intensity and unpleasantness showed statistically significant reductions of 34.7 and 47.2 percent respectively with the combined use of treatments. Additionally, fatigue levels had a significant decrease but depression and anxiety ratings were not significantly modified by this treatment modality. Patients who had a greater adherence to their protocol had an improved pain relief when compared to others. These results suggest that the use of a combination treatment method for FM in a clinical setting and when used in combination is effective. This pilot study can be used as a model for future randomized controlled studies on comprehensive treatments for FM.

Salivary CGRP can monitor the different migraine phases: CGRP (in)dependent attacks

Background CGRP plays a key role in the transmission and modulation of nociceptive signals and is a critical component in the pathogenesis of migraine. Objective To assess saliva as a substrate to measure CGRP by comparing interictal levels in patients with episodic migraine and controls; and to evaluate CGRP’s temporal profile during migraine attacks. Methods This prospective observational pilot study included young women with episodic migraine and healthy controls. We monitored salivary CGRP-like immunoreactivity (CGRP-LI) during 30 consecutive days and during migraine attacks. We considered six timepoints for the analysis: interictal (72h headache free), preictal (PRE-24h before the attack), ictal (headache onset, after 2h, after 8h), postictal (POST-24h after the attack). CGRP levels were quantified by ELISA. Results 44 women (22 with episodic migraine, 22 healthy controls) were recruited. Differences in interictal salivary levels of CGRP between patients and controls (Me [IQR]: 98.0 [80.3] (95% CI 56.6, 124.0) vs. 54.3 [44.0] (95% CI 42.2, 70.1) pg/mL, p = 0.034) were found. An increase in CGRP levels during migraine attacks was detected (pre:169.0 [95% CI 104.2–234.0]; headache onset: 247.0 [181.9–312.0]; after 2h: 143.0 [77.6–208.0]; after 8h: 169.0 [103.5–234.0], post: 173.0 [107.8–238.0]). Patients were classified as having CGRP-dependent (79.6%) and non-CGRP dependent migraine attacks (20.4%) according to the magnitude of change between preictal and ictal phase. Accompanying symptoms such as photophobia and phonophobia were significantly associated to the first group. Conclusions Salivary CGRP-LI levels, which interictally are elevated in episodic migraine patients, usually increase during a migraine attack in the majority of patients. However, not every attack is CGRP-dependent, which in turn, might explain different underlying pathophysiology and response to treatment.

Identifying Chinese Medicine Patterns of Tension-Type Headache and Understanding Its Subgroups

Tension-type headache (TTH) is common among adults. Individualized management strategies are limited due to lack of understanding of subtypes of TTH. Chinese medicine (CM) uses the pattern differentiation approach to subtype all health conditions. There is, however, a lack of evidence-based information on CM patterns of TTH. This study aimed to identity common CM patterns of TTH. TTH sufferers were invited for a survey, consisting of a validated Chinese Medicine Headache Questionnaire (CMHQ), Migraine Disability Assessment Test, and Perceived Stress Scale. The CMHQ consisted of information about headache, aggravating and relieving factors, and accompanying symptoms. Principal component analysis was used for factor extraction and TwoStep cluster analyses for identifying clusters. ANOVA was used to compare cluster groups with disability and stress. In total, 170 eligible participants took part in the survey. The commonest headache features were continuous pain (64%); fixed location (74%); aggravated by overwork (74%), stress (74%), or mental strain (70%); and relieved by sleeping (78%). The commonest nonpain symptoms were fatigue (71%) and neck stiffness (70%). Four clusters, differing in their key signs and symptoms, could be assigned to three different CM patterns including ascendant hyperactivity of liver yang (cluster 1), dual qi and blood deficiency (cluster 2), liver depression forming fire (cluster 3), and an unlabelled group (cluster 4). Additionally, over 75% participants in clusters 1 and 2 have episodic TTH, over one-third participants in cluster 3 have chronic TTH, and a majority of participants in cluster 4 have infrequent TTH. The three patterns identified also differed in levels of disability and some elements of coping as measured with PSS. The three CM patterns identified are common clinical presentations of TTH. The new information will contribute to further understanding of the subtypes of TTH and guide the development of targeted intervention combinations for clinical practice and research.

Neuropathic Pain: Biomolecular Intervention and Imaging via Targeting Microglia Activation

Many diseases, including cancer, can lead to neuropathic pain (NP). NP is one of the accompanying symptoms of suffering in many conditions and the life quality of NP patient is seriously affected. Due to complex causes, the effects of clinical treatments have been very unsatisfactory. Many experts have found that neuron-microglia interaction plays an essential role in NP occurrence and development. Therefore, the activation of microglia, related inflammatory mediators and molecular and cellular signaling pathways have become the focus of NP research. With the help of modern functional imaging technology, advanced pre-and clinical studies have been carried out and NP interventions have been attempted by using the different pharmaceuticals and the extracted active components of various traditional herbal medicines. In this communication, we review the mechanism of microglia on NP formation and treatment and molecular imaging technology’s role in the clinical diagnosis and evaluation of NP therapies.