METHODS: Patients with SLE enrolled in a prospective multinational cohort from March 2013 to December 2020 who were in LLDAS at least once were included. Visits that fulfilled both LLDAS and Definition of Remission in SLE (DORIS) criteria were excluded.
RESULTS: 2099 patients were included, with median follow-up of 3.5 (IQR 1.3-5.8) years. At 6150 visits, patients were in LLDAS but not DORIS criteria; of these 1280 (20.8%) had some clinical activity, 3102 (50.4%) visits had serological activity only and 1768 (28.8%) visits had neither clinical nor serological activity. Multivariable regression analysis showed that compared with non-LLDAS, all three subsets of LLDAS had a protective association with flares in the ensuing 6 months and damage accrual in the ensuing 36 months. LLDAS with no clinical or serological activity had a significantly stronger protective association with severe flares in the ensuing 6 months compared with LLDAS with clinical activity (HR 0.47, 95% CI (0.27 to 0.82), p=0.007).
CONCLUSIONS: LLDAS without any clinical activity accounted for almost 80% of LLDAS visits. This study confirms that all subsets of LLDAS are associated with reduced flare and damage accrual. However, LLDAS without any clinical or serological activity has the strongest protective association with severe flares.
METHODS: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.
FINDINGS: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]).
INTERPRETATION: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden.
FUNDING: Bill & Melinda Gates Foundation.
METHODS: We recruited PWE who received treatment at specialized medical facilities for epilepsy in Japan, Malaysia (Chinese, Malay), and Turkey from February to October 2023. The Epilepsy Self-Stigma Scales (ESSS), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Generalized Anxiety Disorder 7 (GAD-7) in local languages were used to assess self-stigma, depressive symptoms, and anxiety.
RESULTS: The ESSS total scores were significantly higher among the Turkish and Japanese cohorts (F [3, 406] = 6.57, p
METHODS: We report a case of 41-year-old diabetic, male army officer with warm, fluctuant left temporal swelling and reduced hearing. Otoscopy revealed an edematous external auditory canal (EAC) with posterior wall sagging and bulging tympanic membrane. Computed tomography revealed subperiosteal temporal abscess extending intracranially. The pus was drained surgically via an otological and a neurosurgical approach, and pus sent for culture grew paecilomyces. He showed clinical improvement after receiving oral antifungal treatment postoperatively. Retrospectively, his occupation as an army officer and his diabetic immunocompromised state may have predisposed him to the infection.
RESULTS: Paecilomyces middle ear infection leading to intracranial involvement of such magnitude is yet to be reported, and we showcase its successful management through a combined surgical neuro-otology approach and oral antifungal therapy. Fungal ear infections can lead to severe extracranial and intracranial complications if inadequately treated. Differentiating it from cholesteatoma also presents a diagnostic challenge clinically and radiologically. While both can lead to intracranial complications, our patient's brief history and lack of prior ear symptoms contrast with that of cholesteatoma.
CONCLUSION: The rarity of neuro-otological paecilomyces infections emphasizes the need for awareness and early identification. It is vital to recognize such infections, and prompt surgical management with appropriate antifungal drugs is warranted to prevent disastrous outcomes.
METHODS: Patients with AI on twice-daily hydrocortisone, who had low or moderate risk of adrenal crisis and intended to fast, were recruited. Patients were given prednisolone 2.5 mg once daily taken at sahur(predawn) and Ramadan education was given. Weight, sleep duration, physical activity, biochemical parameters and quality of life measurements (SF-36 questionnaire) were analysed at the end of Ramadan and compared against the patient's own baseline readings before the start of Ramadan.
RESULTS: A total of 16 patients (10 men, median age 60 [50.3, 68] years) were recruited. All patients were on 15-20 mg of hydrocortisone (in divided doses) before Ramadan, and intended to fast. Five of the participants had type 2 diabetes with low IDF-DAR risk category. 18.7% of the participants were unable to complete all 29 days of fasting. Up to 62.5% of the participants reported at least one adverse event. There was a statistically significant reduction in weight (median: -1.6 [-2.5, -0.3] kg, p
OBJECTIVE: The aim of this study therefore is to determine if improving sleep quality could improve executive functions in medical students with poor sleep quality by comparing cognitive behavioural therapy for insomnia (CBT-I) with sleep hygiene education (SHE) in a randomized controlled trial (RCT).
METHODS: A parallel group, RCT with a target sample of 120 medical students recruited from government-based medical universities in Malaysia. Eligible participants will be randomized to internet group CBT-I or internet group SHE in a 1:1 ratio. Assessments will be performed at baseline, post-intervention, 1 month, 3-months, and 6-months. The primary outcome is between-group differences in sleep quality and executive function post-baseline. The secondary outcomes include pre-sleep worry, attitude about sleep, sleep hygiene and sleep parameters.
RESULTS: This study received approval from the Research Ethics Committee in Universiti Putra Malaysia (JKEUPM-2023-1446) and Universiti Kebangsaan Malaysia (JEP-2024-669). The clinical trial was also registered in Australian New Zealand Clinical Trial Registry (ACTRN1264000243516). As of June 2024, the recruitment process is ongoing and a total of 48 and 49 students have been enrolled from the universities into the CBT-I and ISHE groups, respectively. All the participants provided signed and informed consent to participate in the study. Data collection has been completed for the baseline (pre-treatment assessment), and follow-up assessments for T1 and T2 for all the participants in both groups, while T3 and T4 assessments will be completed by July 2025. Data analysis will be performed by August 2025 and the research will be completed by December 2025.
CONCLUSIONS: This study is the first attempt to design a CBT intervention to ameliorate poor sleep quality and its related negative effects among medical students. This research is also the first large-scale exploring the relationship between health status and CBT-mediated sleep improvement among medical students.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12624000243516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387030.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59288.
METHODS: A retrospective cohort study was conducted with BD patients diagnosed according to ICD-10-CM codes F31.0 to F31.9 across 13 Asian countries or regions. Data were collected through an online system covering prescriptions for all psychotropic medications including LAIs. The Anatomical Therapeutic Chemical (ATC) Classification System was used to compare medication dosage patterns.
RESULTS: The study analyzed 2029 prescription records for BD, including 103 cases involving LAIs. The highest LAI prescription rates were found in Sri Lanka and Malaysia, with no reported use in Myanmar, India, and Japan. Patients receiving LAIs were younger, more often male, and had higher BMI and drug loads compared to those on oral medications. South Korea and Indonesia showed the highest LAIs drug load. South Korea, Pakistan, and China exhibited the highest total psychotropic drug loads, while Malaysia had the lowest.
CONCLUSIONS: This study is the first to examine LAIs use for BD across Asia. Cross-national differences in LAIs prescriptions and psychotropic drug load highlight variations in treatment practices and healthcare systems. These findings underscore the need for further research and the development of region-specific guidelines to improve BD treatment outcomes.