An Overview of Disease and Health Research Vol. 3

A Critical Review on Functional Neurological Disorders and Psychogenic Nonepileptic Seizures: Neurologic Disease NOT a ‘Functional Aetiology’

2025-06-30T07:22:17+00:00

Neurologic symptoms deemed inconsistent, incongruent, or incompatible with recognised neurologic disease will likely garner a functional (formerly psychogenic) diagnosis, or Conversion Disorder in modern nomenclature. Functional neurological disorders (FND) embody a broad phenomenological spectrum, encompassing psychogenic nonepileptic seizures (PNES), abnormal movements, gait abnormalities, and sensorimotor deficits. The theory underlying the functional diagnosis presumes that in the absence of organic findings, the neurologic symptom must have a psychological aetiology and thus, symptom remission rests on psychological intervention. In fact, it is the absence of organic (neurologic) findings that distinguishes a functional disorder from ordinary neurologic disease. This paper explored the history that underlies the FND diagnosis and the modern clinical findings to assess whether the data supports or refutes the FND diagnosis. To generate and support the analysis, a wide sampling of articles on the relevant populations (FND patients and those with symptoms labelled ordinary neurologic disease) was reviewed. The results show that every premise of the psychogenic theory has been debunked by the empirical data. Studies show pervasive organic (neurologic) disease in FND and PNES patient populations; that in many FND and PNES patients, there is no discernible psychological factor that could be responsible for the ‘psychogenic’ symptom.; that physical therapies, not psychotherapy, have emerged as highly effective treatments for movement disorders labelled functional; that, like a substantial proportion of untreated epilepsy patients, many PNES patients show spontaneous remission of symptoms without any psychotherapy at all. The findings starkly expose the inherent flaws of the diagnostic practice promoted in the FND and PNES literature. The diagnosis of PNES relies on the scalp vEEG, a ‘gold standard’ that fails to capture a substantial proportion of epileptiform discharges, particularly those of a frontal lobe origin. The ‘positive signs’ underlying the diagnosis of functional movement disorders are fallible, have been observed in neurologic conditions, and label atypical presentations, and likely early-stage disease, as inconsistent with classic neurologic disorders. Despite compelling evidence that these patients indeed suffer from ordinary neurologic disease and epilepsy, FND and PNES investigators remain highly invested in the ‘functional’ aetiology and show confirmation bias in their interpretation of the empirical data. The ongoing misdiagnosis of neurologic disease and epilepsy as FND and PNES is the real crisis in neurology.

Impact of Emerging Pandemics on Cardiovascular Health and Psychological Stress: A Systematic Review

2025-06-30T07:25:20+00:00

Introduction: Every epidemic that breaks out could cause confusion and fear in society. Little is known regarding behavioural changes and health condition responses, despite the dramatic warning in the media. There is an extremely strong correlation between the onset of cardiovascular disease and the pandemic.

Aim: The goal of the study was to find out how the pandemic's stress affected the heart's regular physiological processes.

Methodology: Information about the potential effects of psychological stress brought on by the pandemic on cardiac physiological function was gathered from several databases. Using the various databases, studies that examined the relationship between stress on CVDs or the emergence of the pandemic and the cardiovascular system were found. A total of 37 studies were chosen for full assessment out of the more than 200 abstracts that were screened to ascertain whether all inclusion requirements were satisfied. Among these studies, one focused on evaluating the stress levels of front-line medical staff in China, particularly those working at a provincial hospital during the coronavirus outbreak and severe acute respiratory syndrome (SARS).

Discussion: As a result, a study revealed that medical staff members experienced significantly higher levels of moderate and severe anxiety than their administrative counterparts. Prior research on severe acute respiratory syndrome emphasised the importance of increasing awareness of mitigating strategies. Because a larger perceived danger of infection was more likely to result in an increase in cautionary events in contrast to contamination, this strategy was taken into consideration with the underlying insights of risk and anxiety. The implementation of control measures raises the stress level, which may cause CVD to develop.

Conclusion: There is adequate evidence that illustrates the physiological manifestation of the respiratory system and obstruction of the blood flow that might lead to the development of CVD. If not properly controlled might lead to death due to a heart attack.

A Review of Key Considerations for Rice (Oryza sativa) Fortification with Essential Micronutrients in Public Health Intervention

2025-06-30T07:28:38+00:00

Rice (Oryza sativa L.) is the most popular staple food grain and an important source of fibre, energy, minerals, vitamins, and other biomolecules. Fortification of staple foods and commonly used condiments with vitamins and minerals has been considered one of the most cost-effective interventions to prevent and control micronutrient deficiencies. Because of its wide local consumption, acceptability, reach, and quantum of consumption, rice (Oryza sativa) far exceeds the requirements of a staple food vehicle that can be considered for fortification purposes at a population-level intervention. The World Health Organisation (WHO) has the mandate to develop evidence-informed guidelines for the fortification of staple foods as a public health intervention, including rice fortification with micronutrients. The WHO, in collaboration with the Global Alliance for Improved Nutrition (GAIN), convened a consultation on “Technical Considerations for Rice Fortification in Public Health” in Geneva, Switzerland, in 2012 to provide technical inputs to the guideline development process, particularly concerning feasibility and implementability. The objective of this study is to review the industrial and regulatory technical considerations in rice fortification, as well as the considerations for implementing it as a public health strategy and assuring equitable access and universal coverage. Key challenges, including micronutrient stability, regional cooking preferences, economic feasibility, and policy integration, are discussed, along with research priorities to support effective scale-up. Overall, rice fortification is a promising strategy for countries in which rice is a food staple. Decisions regarding which nutrients to add and in which amounts must be guided by the nutritional needs of the population, the rice consumption profile of the target groups, existing nutrition programs and their coverage (supplementation, fortification, and others), and available delivery platforms.

An Overview of Therapeutic Options between Proton Pump Inhibitors (PPI) and Fundoplication in Gastroesophageal Reflux Disease (GERD) Management

2025-06-30T07:32:23+00:00

Introduction: Gastroesophageal reflux disease (GERD) is a prevalent, chronic condition characterised by the retrograde flow of gastric contents into the oesophagus, resulting in symptoms such as heartburn, regurgitation, and chest discomfort. The disease imposes a substantial burden on healthcare systems and significantly affects patients’ quality of life. First-line therapy for GERD typically includes lifestyle modifications and acid suppression with proton pump inhibitors (PPIs). While PPIs are effective in the majority of patients, a significant proportion report persistent symptoms or develop concerns about long-term use, including risks of nutrient malabsorption, renal complications, and infections. Surgical options, particularly laparoscopic Nissen fundoplication, provide symptomatic relief but carry the potential for adverse outcomes such as dysphagia, gas bloat, and surgical failure over time.

Aim: This review aimed to clarify the role of Stretta, transoral incisionless fundoplication (TIF), endoscopic full-thickness plication (EFTP), LINX® magnetic sphincter augmentation system, laparoscopic electrical stimulation (EndoStim®), and the RefluxStop™ implant in modern GERD management and define their potential in bridging the gap between conservative and surgical therapies.

Methods: This review evaluated current data on the emerging therapies, as well as techniques such as endoscopic mucosal resection and ablation seek to augment the anti-reflux barrier through mucosal remodelling.

Results: Evidence from multiple clinical studies and meta-analyses supports Stretta’s role in improving GERD-related quality of life, reducing oesophageal acid exposure, and, in many cases, lowering dependence on proton pump inhibitors. Moreover, both TIF and EFTP offer significant benefits as less invasive alternatives to traditional GERD surgery, with the potential for improved patient outcomes and quicker recovery times. While TIF is less invasive and focuses on reshaping the gastroesophageal junction to restore LES function, EFTP offers a more robust structural intervention, which may be preferable in patients with more severe GERD. As these therapies continue to evolve, understanding their efficacy, safety, and appropriate indications is critical. Minimally invasive and endoscopic therapies represent a significant advancement in the treatment of GERD, offering alternatives to conventional pharmacologic and surgical strategies. While data supporting these interventions are promising, particularly in terms of symptom relief and reduced acid exposure, most studies to date are limited by short follow-up periods, heterogeneity in study design, and variability in patient selection. Stretta, TIF, and EFTP show utility in enhancing lower oesophagal sphincter function with a favourable safety profile, particularly in patients with mild to moderate disease. Similarly, device-based interventions such as LINX® and EndoStim® offer innovative mechanisms of action with growing clinical support. More recently, anatomical solutions like the RefluxStop™ implant and endoscopic mucosal remodelling have opened new avenues for intervention, though they remain in earlier stages of evaluation.

Conclusion: In conclusion, while emerging GERD therapies do not yet replace conventional treatment, they significantly expand the therapeutic toolkit. Collaboration between gastroenterologists, surgeons, and patients is essential to select the most appropriate treatment strategy, balancing innovation with evidence-based care. With ongoing refinement and validation, these approaches have the potential to address unmet needs and reshape the standard of care for GERD. Future directions should focus on long-term outcomes, head-to-head comparative trials, and defining patient subgroups most likely to benefit from each therapy. Importantly, successful GERD management increasingly depends on a multidisciplinary approach that incorporates patient-specific factors such as motility patterns, anatomical features, symptom phenotype, and treatment preferences.

Esthetic and Functional Outcomes of Zirconia and Metal-Ceramic Fixed Partial Dentures in the Maxillary Anterior Region: A Clinical Perspective

2025-06-30T07:36:05+00:00

Metal ceramic restorations were long-time considered as gold standard for fixed dental prostheses. The evolution in material science and patients’ aesthetic requests led to the introduction of new materials for frameworks, which are ceramics. The absence of anterior maxillary teeth as a result of congenital anomalies, or their loss due to extensive carious lesions, or trauma, may lead to serious esthetic and functional problems. Therefore, the anterior esthetic and functional rehabilitation is a common practice in fixed prosthodontics. This paper presents the case of a 55-year-old male patient. In this case report, the intraoral examination showed a favourable occlusion. The edentulous ridge seemed to be satisfactory. The coronal height of teeth to be supporting the FPD was also examined, which was judged as favourable. After decision-making, teeth preparations were made. The intraoral examination showed an extrusion in tooth #21 with a slight deviation of the midline. A gingival recession was also clearly revealed in all anterior teeth. Thus, the whole patient’s smile was remade while replacing the missing teeth using a Fixed Partial Denture (FPD). Intraoral examination showed a favourable occlusion, which is necessary for the ceramic FPD integration. The study concluded that the zirconia-based FPD is a suitable solution to replace anterior teeth, restore esthetics, and respect the biological and mechanical context of the restoration.

Homozygous Mutation of the AP4E1 Gene as a Cause of Autosomal Recessive Spastic Paraplegia Type 51 (SPG51) in a 17-Years-Old Boy

2025-06-30T07:44:32+00:00

Autosomal recessive spastic paraplegia-51 (SPG51) is a rare neurodevelopmental disorder caused by a homozygous mutation in the AP4E1 gene, located on chromosome 15q21. SPG51 is characterized by neonatal hypotonia that progresses to hypertonia and spasticity. This is an often underdiagnosed condition in childhood, frequently presenting with clinical inconsistencies that can lead to misdiagnosis. Due to clinical overlap with conditions like cerebral palsy and other hereditary spastic paraplegias (e.g., SPG47, SPG50, SPG52), SPG51 is frequently underdiagnosed. Mutations in the AP-4E1 gene on chromosome 15q21.2 can lead to SPG51. Different mutations in this gene have been identified in affected individuals, leading to disruption of the AP4 complex and vesicular trafficking processes. The specific characteristics of SPG51 are, due to only a few cases, not well understood, due to limited reports of affected families. Affected individuals also have global developmental delay with impaired intellectual development and poor or absent speech. They typically present with hypotonia in the neonatal period, which progresses to muscular hypertonia, especially in the lower limbs. They may also exhibit contractures, talipes equinovarus, decreased muscle mass, short stature, and microcephaly. Severe mental retardation, absent speech, and dysmorphic facial features are common. Some patients may experience seizures. Neurological examination often reveals spastic paraplegia of the lower limbs, and brain imaging may show atrophy of the cerebellar vermis and cortical atrophy.

This study presents an extremely rare case of a 17 years-old boy with autosomal recessive spastic paraplegia type 51. A compound heterozygous mutation in the AP4E1 gene was found in genetic analysis. The most disruptive symptoms were severe episodes of restlessness and aggression, particularly triggered by unfamiliar people and environments, including within the home. This case highlights the phenotypic variability of SPG51 and the importance of genetic testing and careful clinical evaluation in suspected cases of hereditary spastic paraplegia for accurate diagnosis.

Prevalence of Intermittent Allergic Rhinitis to Pollen among Students of the Polydisciplinary Faculty of Beni Mellal, Morocco

2025-06-30T07:47:29+00:00

Background: The frequency of respiratory allergy, including asthma and allergic rhinitis due to pollen, is increasing in the young and urban dwellers in developed countries. Allergic rhinitis negatively affects academic performance and quality of life. A better understanding of the prevalence and characteristics of allergy can help guide to strategy of management against the development of allergic rhinitis, asthma and anaphylaxis within and outside academic institutions in order to reduce the risk of morbidity and mortality.

Objective: This study was carried out to characterise pollen allergy and its relation with the environment at a university institution in order to propose a strategy of management against this disease.

Methods: The study was conducted at the Polydiscipline Faculty of Beni Mellal. For this study, 529 students (female 316 and male 213) were selected randomly from a set of about 7000 students from the institution. To support the descriptive analysis, a survey was administered to collect relevant data.

Results: The percentage of students allergic to pollen surveyed in the FPBM was 39%. This percentage was within the confidence interval of all students in the allergic FPBM [35%; 44%], estimated 5% error risk. The results proved that the selected sample was representative. The most common symptoms of pollen allergy among the students were the nasal symptoms (sneezing and nasal itching). These symptoms characterise allergic rhinitis. This study also revealed that the olive tree was the main allergen causing pollen allergy in the region. Moreover, most students experienced allergic reactions during the spring season; this could be explained by the pollination of the olive tree in this period. The majority of surveyed students were allergic to one or two types of plants, and the cross-reactivity between pollen and food was the most dominant.

Conclusion: This study is particularly significant, as no prior studies have documented a high prevalence of pollen allergy in the Beni Mellal-Khenifra region. The olive tree was the main allergen; this can be explained by the richness of the region of Beni-Mellal-Khénifra with this plant. These results are unexpected; normally, these youngsters must present a resistance to the pollen present in the region because they are native and have an adaptation to the environment. However, nearly a quarter of the young people surveyed in the area present an allergy. These findings highlight the need for further investigation into environmental factors and their role in the growing prevalence of pollen allergies.

Influence of Homozygous Sickle Cell Disease on the Outcome of P. falciparum Malaria Infections in Indian Patients

2025-06-30T07:50:32+00:00

Sickle cell disease includes a variety of conditions, including the homozygous state of the disease, which is commonly known as sickle cell anaemia. India has a high frequency of the sickle haemoglobin allele, like many other countries. The common geographical distribution of sickle cell haemoglobin (HbS) and P. falciparum malaria in Africa has led to the hypothesis that HbS provides partial protection against P. falciparum malaria. While the heterozygous state of the disease (HbAS) is known to provide protection against P. falciparum malaria, less is known about the role of the homozygous state (HbSS). P. falciparum infection possibly worsens the clinical condition of HbSS subjects because of their lower baseline haemoglobin level and with a hypofunctional spleen. India has the second largest population of sickle cell disease births after Nigeria. The disease is found predominantly in the malaria-endemic areas of central India. However, the clinical presentation of HbSS subjects seems far more benign in India than in Africa, with fewer complications in childhood and a higher longevity. The clinical consequence of P. falciparum infection in Indian HbSS subjects is not clearly known. It is also not known whether the homozygous (HbSS) state in India provides similar protection as that of the heterozygous (HbAS) state against P. falciparum malaria, considering their benign clinical presentation, particularly in childhood. A cohort study recruiting HbS infants from P. falciparum malaria endemic areas in India will help in understanding the interaction of disease-modifying factors as well as the impact of P. falciparum infection on the severity of the disease, and whether antimalarial prophylaxis is indicated.

Health Care Seeking Behaviour Among Pregnant Women in Rural Western India: A Qualitative Study

2025-06-30T07:52:49+00:00

Background: One of the most important aspects of maternal health services is antenatal care (ANC).

Aim of the Study: The perceptions and care-seeking behaviour of pregnant women living in rural Western India are examined in this study, as is their knowledge of pregnancy-related complications.

Methods: A qualitative descriptive study was carried out in 2022 with 74 pregnant women who were randomly selected from the ANC register and were in their third trimester. Using a pretested guide that covered eight thematic areas, data were collected through in-depth interviews. Thematic coding was used to analyse the transcriptions of the interviews.

Results: The majority of women understood the value of regular ANC visits. However, little was known about specific complications like pre-eclampsia or gestational diabetes. Although transportation obstacles and reliance on spouses for decision-making were observed, government health services were favoured because they were accessible and reasonably priced. Families provided support, and there was little dependence on traditional healers. A few participants voiced concerns about the results of deliveries, especially caesarean sections.

Conclusions: The study draws attention to the disparity in general ANC awareness and specialised knowledge regarding pregnancy complications. Maternal outcomes can be improved in rural Western India with sustained community involvement and education provided by primary healthcare systems.