Hasil untuk "Medicine (General)"

Eri Ohta, Eri Ohta, Etsuko Okada et al.

Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening inflammatory disease characterized by neutrophilic pustules and systemic inflammation. We report a case of severe GPP triggered by SARS-CoV-2 infection in a 46-year-old woman with a long history of psoriasis. Eleven days after recovery from COVID-19 pneumonia, she developed widespread pustules and fever. Histopathology revealed subcorneal spongiform pustules and dermal neutrophilic infiltration consistent with GPP. Systemic corticosteroids followed by etretinate and deucravacitinib achieved complete remission. A literature review identified 11 infection- and 10 vaccine-related GPP cases. Compared with vaccine-associated cases, infection-related flares showed longer latency and higher corticosteroid use. Mechanistically, both SARS-CoV-2 infection and vaccination may be associated with IL-36 axis activation, potentially via spike protein–driven, Toll-like receptor–mediated innate immune signaling. This case highlights that distinct immune kinetics may underlie infection- and vaccine-related GPP, while supporting a putative role of IL-36–driven inflammation in COVID-19–associated disease exacerbation.

Maria Rogalidou, Dimitrios Christodoulou

Celiac disease is a chronic immune-mediated disorder triggered by the ingestion of gluten in genetically susceptible individuals, primarily those carrying <i>HLA-DQ2</i> or <i>HLA-DQ8</i> and, in rare cases, <i>HLA DQ7</i> alleles. Although traditionally regarded as a gastrointestinal condition, celiac disease is now recognized as a multisystem disorder with a wide range of clinical presentations. It has been described as a “clinical chameleon” due to its variable manifestations, which may include non-specific symptoms, extraintestinal involvement, or even an asymptomatic course, often identified only through screening of high-risk groups. This narrative review provides a comprehensive overview of celiac disease, highlighting recent insights into its pathogenesis, including genetic predisposition, immune mechanisms, and the role of environmental and microbial factors. It emphasizes the importance of recognizing extraintestinal features, outlines current diagnostic approaches and their limitations, and discusses management strategies centered around the gluten-free diet. Furthermore, it explores emerging therapies aimed at improving patient outcomes and reducing dependence on dietary restriction. By synthesizing the latest developments, this review aims to present a fresh perspective on a condition with significant clinical relevance that is evolving.

Rayyah R. Alkhanjari, Maitha M. Alhajeri, Poorna Manasa Bhamidimarri et al.

Abstract Septins are GTP-binding cytoskeletal proteins primarily known to be involved in cell division, membrane remodeling, and cytoskeletal organization. In the nervous system, septins are suggested as key regulators of neural development, including neurite outgrowth, spine morphology, and axon initial segment formation. Septins are localized to specialized membrane domains, such as dendritic spines, axon initial segments, and synaptic terminals, where they function as scaffolding components and diffusion barriers. They are abundant in neurons, oligodendrocytes, Schwann cells, and astrocytes, regulating processes like myelination and synaptic organization. In neuronal cells, specific septin isoforms such as SEPT3, SEPT5, and SEPT7 contribute to dendritic spine formation, neurotransmitter vesicle trafficking, and axonal integrity. Alterations in septin expression or assembly can disrupt synaptic architecture and neuroplasticity, emphasizing their role in neuronal homeostasis. Dysregulation of septin expression and function has been implicated in a range of neurological disorders, including demyelinating diseases like Multiple Sclerosis and Hereditary Neuralgic Amyotrophy. Abnormal septin aggregation has been observed in neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Moreover, septins can modulate inflammatory responses, where antibodies for septins 5 and 7 were associated with autoimmune encephalitis conditions. This review will provide a comprehensive overview of the role of septins in the nervous system, focusing on their molecular mechanisms, cellular functions, and implications in neurological disorders.

Rui Han, Xiaoyu Deng, Hebing Liu et al.

BackgroundAcute pancreatitis (AP) morbidity has been increasing in recent years. Patients with AP exhibit highly variable symptom patterns over time, posting challenges to traditional analytical methods. Dynamic Time Warping (DTW) effectively aligns temporal sequences of different rhythms, offering a novel approach to model these complex dynamics.ObjectiveThis study employs DTW technology to systematically analyze the individualized developmental trajectories of symptom clusters in patients with AP, delving into the heterogeneous characteristics during the process of time series changes.MethodsIn a longitudinal study of 155 patients with AP, 32 symptoms were assessed using the Memorial Symptom Assessment Scale at hospitalization and 1, 3, 6, 9, and 12 months post-discharge. DTW was used to analyze temporal dynamics, generating individual symptom distance matrices. At the group level, these matrices are integrated using Distatis analysis, followed by hierarchical clustering to identify symptom clusters and network analysis to determine central symptoms.ResultsEach patient had unique symptom manifestations and dynamic change patterns. Six major symptom clusters were identified: emotional disorder cluster, appetite disorder cluster, multi-system physical discomfort cluster, localized physiological perception abnormality cluster, functional decline cluster, and abdominal discomfort cluster. Centrality analysis revealed that the appetite domain exhibited high centrality, suggesting that its variation may influence multiple aspects of patient experience.ConclusionDynamic Time Warping provides a novel and effective approach for analyzing the temporal trajectories of symptoms both within and across individuals. The research results provide methodological support and empirical evidence for individualized symptom management, early intervention, and predictive model construction of AP progression.

Jay Lodhia, Mujaheed Suleman, Vanessa Poppe et al.

Abstract Background Mucoepidermoid carcinoma of the skin is an exceedingly rare neoplasm, with only a limited number of cases documented in the literature. Typically, mucoepidermoid carcinoma arises in the salivary glands, where it accounts for 30% of all malignant salivary gland tumors and generally presents as a low-grade malignancy with a low probability of metastasis. Case presentation We report a case of a 49-year-old female patient of African origin who presented to our tertiary center with a longstanding scalp lesion that had been present for approximately 10 years. Initially, the lesion was roughly the size of a tennis ball and remained stable until about 3 months prior to presentation, when it was excised at a peripheral primary health center. Unfortunately, no histological analysis or follow-up was conducted after the excision, and the lesion recurred, progressively increasing in size. The patient reported no cardinal B-symptoms or central nervous system symptoms at any point. Histopathological analysis of the recurrent mass confirmed a diagnosis of mucoepidermoid carcinoma, and a complete surgical excision was subsequently performed. Following surgery, the patient was referred to the national oncology center for radiotherapy as part of her comprehensive oncological management. She is currently 8 months post-excision, receiving radiotherapy, and exhibits no clinical signs of recurrence. Conclusion Mucoepidermoid carcinoma originating in cutaneous sites is particularly unusual and may stem from the embryonic development of ectopic salivary glands within the skin. In this case report, we describe a unique presentation of primary mucoepidermoid carcinoma on the scalp, which demonstrated aggressive characteristics with suspected metastasis to the vertebral body. This case highlights the importance of considering mucoepidermoid carcinoma in the differential diagnosis of scalp masses and underscores the need for further investigation into its pathogenesis and metastatic potential.

Shaukat Ali Jawaid, Masood Jawaid

There are numerous well-established parameters to judge and evaluate the standard of a medical journal like quality of its contents and geographic distribution of manuscripts, it attracts for publication, indexation and coverage in important indexes and databases like Medline, Web of Sciences by Clarivate known for its Impact Factor (IF), PubMed Central, Scopus etc., journal visibility and readership, timely regular publication. Impact Factor is one of the criteria and not the only criteria, which should be used to judge the standard of a journal. However, too much importance being given to the  Impact Factor by the regulatory bodies in Pakistan as well as by medical institutions, asking those doing PhD to publish their research work in Impact Factor journals has created a crisis like situation not only for the researchers but also made the life of the IF journal editors miserable. They are under tremendous pressure to accommodate more and more papers by the authors anxious for early publication to meet certain deadlines for the completion of their research project and award of degrees while the editors on their part are faced with a dilemma due to human resource and financial resource constraints. In an environment where political stability remains in short supply most of the time, law and order situation is unpredictable, not to forget the frequent breakdown of electricity and inefficient internet service, it is not possible to either increase the frequency of publications or plan some other measures which all call for additional investment. Finding trained human resource and then retaining those remains a constant problem.

Hina Niaz, Dure Nayab, Asaf Alam Khan

OBJECTIVES This study investigated the coexistence of adenomyosis and uterine fibroids in individuals diagnosed with endometriosis. This research seeks to contribute to understanding how these conditions interact, aiming to improve treatment strategies and enhance patient fertility outcomes. METHODOLOGY This study aims to evaluate 250 patients suspected of endometriosis with the help of clinical investigation and ultrasound (US). From the US study, we examined the existence of endometriosis with either uterine fibroid or adenomyosis based on patient age groups (less than 32 years, 33 to 42 years, and 43 and above). In addition, ovarian endometriosis and profoundly infiltrating endometriosis were evaluated. RESULTS US study diagnosed adenomyosis in 3.2% of cases, fibroids in 21.8%, and the coexistence of both fibroid and adenomyosis in 14.2% of the cases. Intranural fibroids were found at 11.4%,   submucous fibroids 1.6% and subserous at 8.1% of the total. Patients with an age of more than 33 years were more affected by adenomyosis, uterine fibroids, and both adenomyosis and uterine fibroid. There was no statistically significant correlation between uterine diseases and endometriosis. Additionally, no correlation was found between endometriosis and the patient’s age. CONCLUSION Our findings indicate that women over 32 are more likely to experience these comorbidities, complicating infertility outcomes. The significant association between adenomyosis and severe endometriosis reinforces the need for comprehensive diagnostic evaluation to inform tailored treatment plans. Future research should investigate the interactions between these conditions further to improve diagnostic and therapeutic approaches.

Lalan Prasad Rauniyar, Maya Rouniyar, Rashmi Jha et al.

Background: Globally, the burden of malnutrition, especially undernutrition, as well as the consequences of malnutrition is of the rise which is especially of significant concern for underdeveloped countries. Countries like Nepal are also facing a similar problem of malnutrition. In Madhesh province, among the under 5 children the incidence of chronic malnutrition is 29.3%. Our aim is to assess the malnourishment in the children of Madhesh province in Nepal. Methods: This cross-sectional quantitative study was carried out among 409 malnourished children who were admitted from July 17, 2018 to July 16, 2022 at NRH in Gajendra Narayan Singh Hospital. Collected data were fed into Microsoft-excel and analyzed using SPSS software, version-2016. As data were normally distributed, frequency, percentage, mean and standard deviation were calculated for descriptive analysis. To find out the association of categorical variables, the Chi-square test or Fisher’s Exact test was used where appropriate. P-value <0.05 was significant. Results: Out of 409 malnourished cases, 145 cases were SAM (SD<-3) and 264 cases were MAM (-2 to -3SD) at the time of admission. The mean increment in the weight was 1.14±0.44  kg.  The average length of stay was 19.82±8.73 days. There is a significant difference (p<0.001) in the length of stay among the SAM and MAM cases of our study and a difference in the increment of weight in comparison to mean weight gain (1.14±0.44  kg) with respect to the length of stay of the malnourished child who stayed for more than 28 days and less. Conclusions: There is significant weight gain in malnourished children after management at the Nutritional Rehabilitation Center. Keywords: Height; increment in weight; malnourished child; moderate acute malnutrition; nutritional rehabilitation home

Manuela J. Scherer, Sandra Kampe, Sandra Kampe et al.

IntroductionPrevalence and predisposing factors for the development of thoracic pain (TP) in patients with chronic interstitial lung disease (cILD) are largely unknown. Underestimation and insufficient therapy of pain can lead to worsened ventilatory function. Quantitative sensory testing is an established tool for characterization of chronic pain and its neuropathic components. We investigated frequency and intensity of TP in cILD patients and the potential association with lung function and quality of life.Materials and methodsWe prospectively investigated patients with chronic interstitial lung disease to analyze risk factors for the development of thoracic pain and quantify thoracic pain through quantitative sensory testing. In addition, we studied the relationship between pain sensitivity and lung function impairment.ResultsSeventy-eight patients with chronic interstitial lung disease and 36 healthy controls (HCs) were included. Thoracic pain occurred in 38 of 78 patients (49%), most frequently in 13 of 18 (72%, p = 0.02) patients with pulmonary sarcoidosis. The occurrence was mostly spontaneous and not related to thoracic surgical interventions (76%, p = 0.48). Patients with thoracic pain showed a significant impairment of mental well-being (p = 0.004). A higher sensitivity to pinprick stimulation during QST can be observed in patients with thoracic pain (p &lt; 0.001). Steroid treatment was associated with lower sensitivity within thermal (p = 0.034 and p = 0.032) and pressure pain testing (p = 0.046). We observed a significant correlation between total lung capacity and thermal (p = 0.019 and p = 0.03) or pressure pain sensitivity (p = 0.006 and p = 0.024).ConclusionThis study was performed to investigate prevalence, risk factors and thoracic pain in patients with chronic interstitial lung disease. Thoracic pain mostly occurs spontaneous as a frequent symptom, and seems to be an underestimated symptom in patients with chronic interstitial lung disease, especially those with pulmonary sarcoidosis. Timely identification of thoracic pain may allow starting symptomatic treatment at early stage, before impairment in quality of life occurs.Clinical Trial Registrationhttps://www.drks.de/drks_web/, Deutsches Register Klinischer Studien (DRKS) DRKS00022978.

Elaine C. Khoong, Alicia Fernández

Ahmed Jubayer, Md. Hafizul Islam, Md. Moniruzzaman Nayan

Objectives: This study aimed to outline water, sanitation, and hygiene (WASH) practices for children under 5 years of age among the households of St. Martin’s Island as well as examine the role of water, sanitation, and hygiene on child nutritional outcomes. Methods: A total of 256 children under 5 years of age were anthropometrically measured, and multiple linear regression was performed to understand the relationship between combined water, sanitation, and hygiene score and child nutritional outcomes: height-for-age, weight-for-age, weight-for-height z -scores. Results: The majority of the sampled households had improved drinking water facilities. Over one-third of the participants (36.5%) did not have access to better sanitation, and 12.4% reported defecating in open places. Just over one-third of those surveyed reported washing their hands with soap or detergents after defecation, with more than 22% of people not having access to a handwashing station on their premises. Stunting, wasting, and underweight were found to be prevalent in 34.4%, 17.6%, and 18.9% of the sampled children, respectively. Height-for-age (0.08 SDs) and weight-for-age (0.014 SDs) were greater on average in children from households with improved water, sanitation, and hygiene conditions, but weight-for-height did not significantly differ from those from WASH-unimproved households. Conclusion: Certain aspects of WASH, particularly, sanitation facilities and hygiene practices were not up to the mark in St. Martin’s Island, and consistent with findings from other studies, our study findings underlined the potential benefits of improved water, sanitation, and hygiene practices in addressing child undernutrition.

Paul Carrillo-Mora, Yesenia Lugo Rodríguez, Kenia F. Franyutti-Prado et al.

It is increasingly common for healthy people to seek means to improve their alertness, or to try to get better their performance in some cognitive functions; this with the aim of increasing their performance and productivity in the academic or work environment. Several stimulant drugs have been used for many decades and have recently become very popular especially among young people. However, general practitioners and even specialists are rarely informed of their real benefits or potential adverse effects. This review provides an updated overview of the effects (positive and adverse) of some stimulant drugs that have been used to maintain alertness or improve cognitive performance in healthy subjects. For stimulant drugs, the positive effects improving the subjective symptoms of sleep deprivation are well established. However, the cognitive effects of stimulant drugs are still highly variable and inconsistent, since there are few studies that have been carried out with adequate methodological design. In addition, there are several adverse effects, from mild to severe that can be observed and there is a concern of potential addiction effect to some of them. Some stimulant drugs can improve alertness, but their positive effects improving cognition are not yet fully proven.

Wei Sha, Timothy Bertram, Deepak Jain et al.

Abstract Background Selected renal cells (SRC) are in Phase II clinical trials as a kidney-sourced, autologous, tubular epithelial cell-enriched cell-based therapy for chronic kidney disease (CKD). In preclinical studies with rodent models of CKD, SRC have been shown to positively modulate key renal biomarkers associated with development of the chronic disease condition. Methods A comparative bioinformatic analysis of transcripts specifically enriched or depleted in SRC component sub-populations relative to the initial, biopsy-derived cell source was conducted. Results Outcomes associated with therapeutically relevant bioactivity from a systematic, genome-wide transcriptomic profiling of rodent SRC are reported. Key transcriptomic networks and concomitant signaling pathways that may underlie SRC mechanism of action as manifested by reparative, restorative, and regenerative bioactivity in rodent models of chronic kidney disease are identified. These include genes and gene networks associated with cell cycle control, transcriptional control, inflammation, ECM–receptor interaction, immune response, actin polymerization, regeneration, cell adhesion, and morphogenesis. Conclusions These data indicate that gene networks associated with development of the kidney are also leveraged for SRC regenerative bioactivity, providing evidence of potential mechanisms of action.

Xinting Liu, Yanli Wang, Xiaoxiao Ying et al.

ObjectiveTo evaluate the contrast sensitivity function (CSF), chorioretinal thickness and vascular density as well as their relationships in subjects with simple early-stage high myopia.MethodsEighty-one young subjects were enrolled in this study. They were categorized into the simple high myopia group (sHM, n = 51) and the low-moderate myopia group (control group, n = 30). Monocular CSF under best correction was measured with the qCSF method. Retinal superficial and deep vascular density, inner and outer retinal thickness and choroidal thickness were measured using optical coherence tomography angiography.ResultsThe area under log CSF (AULCSF) and cutoff spatial frequency (Cutoff SF) of the sHM group were significantly reduced compared to those of the control group (P = 0.003 and P &lt; 0.001, respectively). The parafoveal and perifoveal retinal thickness, deep vascular density and choroidal thickness were also significantly reduced in the sHM group (all P &lt; 0.05). Multiple regression analysis revealed that AULCSF was significantly correlated with retinal deep vascular density, outer retinal thickness in the parafoveal and perifoveal areas (all P &lt; 0.05).ConclusionCompared to low to moderate myopic eyes, patients with simple high myopia have thinner retinal and choroidal thickness, lower retinal vascular density, and reduced contrast sensitivity. Moreover, the CSF was correlated with the measures of chorioretinal structure and vasculature. The results suggest that the CSF is a sensitive functional endpoint in simple early-stage high myopia.

S. Khatana, P. Groeneveld

(COVID-19) Pandemic in the USA Sameed Ahmed M. Khatana, MD, MPH and Peter W. Groeneveld, MD, MS Division ofCardiovascularMedicine, Perelman School ofMedicine, University of Pennsylvania Philadelphia, PA, USA; The LeonardDavis Instituteof Health Economics, University of PennsylvaniaPhiladelphia, PA, USA; Division of General Internal Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA.

Nicole Veltri, Prameet Sheth, Nicole Le Saux

Mucor circinelloides is a filamentous fungus that causes rare but devastating human infections. It is also a known human colonizer and laboratory contaminant which is tough to grow in blood culture. We present a case of a 48-year-old male presenting with fever, confusion, and hemodynamic instability, ultimately drug-related, complicated by transient M. circinelloides fungemia. Blood cultures drawn on separate occasions grew M. circinelloides following clinical improvement, likely from intravenous drug use versus nasal septal fracture with the colonization of nasal turbinates. No infectious focus was identified. He received 4 days of liposomal amphotericin B and was discharged home after prolonged observation. This case is a reminder that diagnosis of Zygomycetes infection is based on evidence of tissue invasion and that its growth in blood cultures should be taken seriously, however, it is a poor predictor of the true infection.

Bond, Diana M, Hammond, Jeremy, Shand, Antonia W et al.

BackgroundTraditional data collection methods using paper and email are increasingly being replaced by data collection using mobile phones, although there is limited evidence evaluating the impact of mobile phone technology as part of an automated research management system on data collection and health outcomes. ObjectiveThe aim of this study is to compare a web-based mobile phone automated system (MPAS) with a more traditional delivery and data collection system combining paper and email data collection (PEDC) in a cohort of breastfeeding women. MethodsWe conducted a substudy of a randomized controlled trial in Sydney, Australia, which included women with uncomplicated term births who intended to breastfeed. Women were recruited within 72 hours of giving birth. A quasi-randomized number of women were recruited using the PEDC system, and the remainder were recruited using the MPAS. The outcomes assessed included the effectiveness of data collection, impact on study outcomes, response rate, acceptability, and cost analysis between the MPAS and PEDC methods. ResultsWomen were recruited between April 2015 and December 2016. The analysis included 555 women: 471 using the MPAS and 84 using the PEDC. There were no differences in clinical outcomes between the 2 groups. At the end of the 8-week treatment phase, the MPAS group showed an increased response rate compared with the PEDC group (56% vs 37%; P<.001), which was also seen at the 2-, 6-, and 12-month follow-ups. At the 2-month follow-up, the MPAS participants also showed an increased rate of self-reported treatment compliance (70% vs 56%; P<.001) and a higher recommendation rate for future use (95% vs 64%; P<.001) as compared with the PEDC group. The cost analysis between the 2 groups was comparable. ConclusionsMPAS is an effective and acceptable method for improving the overall management, treatment compliance, and methodological quality of clinical research to ensure the validity and reliability of findings.

Joel Figueroa-Quiñones, Juan Ipanaqué-Neyra