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PURPOSE: Lymphedema is a specific type of edema with a chronic, progressive nature. The aim of the present study is to report clinical findings related to edema and its location in children with primary lymphedema. METHODS: Sixty-eight children with congenital primary lymphedema were evaluated at the Godoy Clinic in São Jose do Rio Preto, Brazil, between 2014 and 2017. A retrospective, cross-sectional study was conducted involving the analysis of clinical data on the location of edema in 68 children with congenital primary lymphedema. We evaluated the charts of all children with this condition in the period analyzed, recording the affected limbs and conditions associated with lymphedema. RESULTS: Sixty-eight children, 37 girls (54.41%) and 31 boys (45.58%), were evaluated. CONCLUSION: We found that congenital primary lymphedema predominantly affects the lower limbs and is more prevalent in girls than boys. [ABSTRACT FROM AUTHOR]

Objectives: Clinical variables were investigated in the 'treatment resistant depression (TRD)‐ III' sample to replicate earlier findings by the European research consortium 'Group for the Study of Resistant Depression' (GSRD) and enable cross‐sample prediction of treatment outcome in TRD. Experimental procedures: TRD was defined by a Montgomery and Åsberg Depression Rating Scale (MADRS) score ≥22 after at least two antidepressive trials. Response was defined by a decline in MADRS score by ≥50% and below a threshold of 22. Logistic regression was applied to replicate predictors for TRD among 16 clinical variables in 916 patients. Elastic net regression was applied for prediction of treatment outcome. Results: Symptom severity (odds ratio (OR) = 3.31), psychotic symptoms (OR = 2.52), suicidal risk (OR = 1.74), generalized anxiety disorder (OR = 1.68), inpatient status (OR = 1.65), higher number of antidepressants administered previously (OR = 1.23), and lifetime depressive episodes (OR = 1.15) as well as longer duration of the current episode (OR = 1.022) increased the risk of TRD. Prediction of TRD reached an accuracy of 0.86 in the independent validation set, TRD‐I. Conclusion: Symptom severity, suicidal risk, higher number of lifetime depressive episodes, and comorbid anxiety disorder were replicated as the most prominent risk factors for TRD. Significant predictors in TRD‐III enabled robust prediction of treatment outcome in TRD‐I. [ABSTRACT FROM AUTHOR]

In the first part of the article, the author summarizes the basic elements in the pathogenesis of lupus erythematosus, in the second part he presents the many possible clinical aspects, according to the current classifications, of the cutaneous and systemic manifestations of lupus erythematous and concludes with the currently validated treatment principles. [ABSTRACT FROM AUTHOR]

Objectives: To assess demographical and clinical data in a Middle‐European cohort of patients with Adamantiades–Behçet's disease (ABD), together with the use of medication in adherence to international guidelines. Methods: In a retrospective cohort study, in‐ and outpatients of an Austrian secondary and tertiary university hospital center were analyzed independent from the medical discipline involved. After ethics approval, screening for ABD‐patients in the clinical information system resulted in 1821 documents from 1997 to 2016. Patients fulfilling the International Criteria for Behçet's Disease were included, and ABD symptoms and signs together with medical interventions for immunosuppression, anticoagulation and pain management were identified by individual chart reviews and evaluated for conformity with international recommendations. Results: A total of 76 ABD patients were identified with 39.1% Austrian and 37.0% Turkish origin. Genital aphthae and skin manifestations were more frequent, neurological, gastrointestinal and vascular manifestations less frequent in ABD patients of Turkish origin living in Austria compared to those living in Turkey (each P < 0.05). The male‐to‐female ratio averaged 0.86 (0.39 in patients with Austrian and 1.43 with Turkish backgrounds), and was 3.3 in patients with venous manifestations. Out of 174 medical interventions, 55.2% fully matched the European League Against Rheumatism recommendations of 2008, and 93.7% were considered at least as equal to the recommendations. Indications for tumor necrosis factor inhibition were in line with the 2007 Sfikakis recommendations. Conclusions: In this Middle‐European ABD cohort clinical presentations between patients of Austrian and Turkish origin do not strongly vary, whereas Turkish patients from the non‐endemic Innsbruck cohort present differently compared to patients living in Turkey. The role of such cohort analyses will increase, from the epidemiological as well as the management perspective. [ABSTRACT FROM AUTHOR]

Objective: Evidence‐based guidance of clinical decision‐making for the management of Autism Spectrum Disorder (ASD) is lacking, particularly for co‐occurring psychiatric symptoms. This review evaluates treatment evidence for six common symptom targets in children/adolescents with ASD and provides a resource to facilitate application of the evidence to clinical practice. Method: A systematic search identified randomized controlled trials (RCTs) and high‐quality systematic reviews published between 2007 and 2016, focused on: social interaction/communication impairment, stereotypic/repetitive behaviours, irritability/agitation, attention‐deficit/hyperactivity disorder symptoms, mood or anxiety symptoms, and sleep difficulties. We then completed qualitative evaluation of high‐quality systematic reviews/meta‐analyses and quantitative evaluation of recently published RCTs not covered by prior comprehensive systematic reviews. Results: Recently published RCTs focused on social interaction and communication impairment (trials = 32) using psychosocial interventions. Interventions for irritability/agitation (trials = 16) were mainly pharmacological. Few RCTs focused on other symptom targets (trials = 2–5/target). Integration of these results with our qualitative review indicated that few established treatment modalities exist, and available evidence is limited by small studies with high risk of bias. Conclusion: Given the current evidence‐base, treatment targets must be clearly defined, and a systematic approach to intervention trials in children/adolescents with ASD must be undertaken with careful consideration of the limitations of safety/efficacy data. [ABSTRACT FROM AUTHOR]

Aim: To determine if there are ethnic differences in the prevalence of antiphospholipid syndrome (APS), clinical presentation and autoantibody profile between Roma and Caucasian patients with systemic lupus erythematosus (SLE). Method: A cross‐sectional study was conducted including data from Roma and Caucasian SLE patients consecutively attending six hospitals in Spain. Socio‐demographic characteristics, prevalence of APS, clinical and analytical features of SLE and APS were compared between ethnic groups. Results: Data from 52 Roma and 98 Caucasian SLE patients were included. Roma SLE patients had a higher risk (odds ratio 2.56, 95% CI 1.02–6.39) and prevalence of APS (28.8% vs. 13.3%, P = 0.027). Furthermore, Roma SLE patients had a statistically significant higher prevalence of abortions (23.5% vs. 10.2%, P = 0.049). In relation to other APS diagnostic criteria, Roma SLE patients had a non‐statistically significant higher prevalence of fetal deaths (14.3% vs. 5.1%, P = 0.106) and thrombotic events (21.1% vs. 12.2%, P = 0.160). In relation to SLE clinical features, Roma patients had a significantly higher prevalence of arthritis (75% vs. 57.1%, P = 0.034) and non‐significant higher prevalence of serositis (44.2% vs. 29.6%, P = 0.104), discoid lesions (11.5% vs. 5.1%, P = 0.191), oral ulcers (46.1% vs. 34.7%, P = 0.218) and livedo reticularis (21.1% vs. 15.3%, P = 0.374). No statistically significant differences were found in the Systemic Lupus International Collaborating Clinics Damage Index or the autoimmune serological profile. Conclusion: Prevalence and risk of APS were significantly higher in Roma SLE patients. Furthermore, Roma patients had a significantly higher prevalence of abortions and a non‐significant higher prevalence of fetal deaths and thrombotic events. [ABSTRACT FROM AUTHOR]

Abstract: Background: Food allergy significantly impairs health‐related quality of life (HRQL). Currently, it is still unknown whether diagnostic interventions for food allergy improve HRQL. We aim to assess the impact of diagnostic interventions for food allergy on HRQL. Methods: A systematic search was performed in MEDLINE, Embase, Cochrane Library, and CINAHL focused on patients with a (suspected) food allergy who underwent diagnostic interventions (ie, skin prick test, specific IgE, or oral food challenges [OFC]) and in whom HRQL was assessed. The mean difference between HRQL before and after the diagnostic intervention was calculated. A minimal clinically important difference of 0.5 was considered clinically relevant for the food allergy quality of life questionnaire. Results: Seven of 1465 original identified publications were included in which the impact of an OFC on HRQL was investigated (total patients n = 1370). No other diagnostic interventions were investigated. Food allergy‐specific parent‐reported HRQL improved significantly after an OFC irrespective of the outcome in children with a suspected food allergy in two publications. The change was considered clinically relevant in one of two publications. In addition, parent‐reported HRQL improved after an OFC to assess the eliciting dose in children with a confirmed food allergy. The parental burden was significantly reduced after an OFC to assess resolution of food allergy. A meta‐analysis could not be performed due to the limited numbers of, and considerable heterogeneity between, eligible publications. Conclusion: An OFC is associated with an improved food allergy‐specific HRQL and a reduced parental burden of food allergy. [ABSTRACT FROM AUTHOR]

Aim: To determine the motor phenotype and outcome in a clinically ascertained group of patients with motor neuron disease (MND) and frontotemporal dementia (FTD). Methods: This is an observational retrospective clinical study of patients fulfilling the clinical criteria for MND-FTD. A contemporary series of patients with amyotrophic lateral sclerosis (ALS) without dementia were included for comparison. Demographic, clinical, genetic, and neuropathological data were collected. A descriptive and comparative data analysis was performed. Results: We identified 22 patients with MND-FTD. Selective distal upper limb muscle weakness and atrophy with non-significant lower limb weakness during follow-up was the most frequent motor pattern, present in 18 patients – in 15 of them associated with severe dysphagia. Aspiration pneumonia was the most common cause of death (12/19; 63%) despite gastrostomy. One-third of the patients did not develop upper motor neuron dysfunction. When compared to classic ALS without dementia (n = 162), these features were significantly different. A neuro­pathological examination was performed on 7 patients, and it confirmed the presence of MND with TDP43 protein aggregates in all patients. Conclusions: The MND-FTD patients frequently displayed a distinctive motor pattern characterized by weakness and atrophy in distal upper limb muscles and dysphagia, with no or little spreading to other regions. These features may help to define specific subgroups of patients, which is important with regard to clinical management, outcome, and research. [ABSTRACT FROM AUTHOR]

Summary: Waldenström macroglobulinaemia (WM) is a rare, indolent B‐cell lymphoproliferative disorder characterized by cellular involvement in bone marrow and monoclonal IgM production. Symptoms can be related to cytopenias, tumoural involvement, or IgM‐related disorders. Somatic mutations in the MYD88 gene have been described in the majority of WM cases. The mutation is responsible for a gain‐of‐function and induces activation of nuclear factor‐κB, for DNA transcription and cell survival. It seems that MYD88 mutation is associated with better prognosis and better response to some treatment. Treatments are started when WM is symptomatic, following systematic biological and morphological assessments. Therapeutic choice depends on age, frailty and urgent efficacy need. In first line, the majority of patients are treated with monoclonal anti‐CD20 antibody‐based regimens combined with cytotoxic chemotherapy. Rituximab, cyclophosphamide and dexamethasone remain the most commonly used regimen with good safety. Nevertheless, increasing numbers of new drugs are becoming available or are in development. Proteasome inhibitors, such as bortezomib or carfilzmib, showed good and rapid responses. Bruton tyrosine kinase (BTK) inhibitor demonstrated excellent results and is now available for relapse/refractory disease or as first line for some patients. This review highlights the diagnostic procedures and therapeutic approaches in WM. [ABSTRACT FROM AUTHOR]

It is estimated that between 1.7 and 2.6 million people have had intermittent explosive disorder (IED) during their life in the United States alone. Co-occurring psychiatric disorders are very common in IED, being major depressive disorder arguably the most common. The objective of this study was to examine the clinical correlates of IED and depressive manifestations in 74 treatment-seeking subjects. After controlling for confounders, there were associations between major depressive disorder and severity of depressive symptoms, and (a) higher assault scores, (b) more severe hostile behavior and (c) worse social adjustment. Management of depressive symptoms may be an important for IED treatment. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to evaluate whether PD1.1 (c.‐606G>A), PD1 (c.627 + 252C>T), PD1.5 (c.804C>T), and PD1.9 (c.644C>T) single nucleotide polymorphisms of PDCD1 gene influence the risk, clinicopathological aspects, and survival of cutaneous melanoma (CM). Individuals with phototype I or II and PD1 CC genotype were under 5.89‐fold increased risk of developing CM. PD1.5 TT genotype increased PDCD1 expression (2.49 versus 1.28 arbitrary units, p = .03) and PD1.5 CT or TT genotype and allele T increased PD1 expression in TCD4+ lymphocytes (16.6 versus 12.5%, p = .01; 17.0 versus 13.1%, p = .006). At 60 months of follow‐up, short recurrence‐free survival was seen in patients with PD1.1 AA genotype (33.3 versus 71.8%, p = .03). Patients with PD1.1 AA and PD1.5 CC genotype had 4.21 and 2.62 more chances of presenting relapse and evolving death by disease in Cox analyses, respectively. Our data provide preliminary evidence that abnormalities in regulation of T lymphocyte alter CM risk, clinical aspects, and prognosis. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess the beliefs and knowledge of gout management in new medical graduates. Method: A survey on gout management was sent to new medical graduates during their orientation week, New South Wales, Australia. Results: Of 15 hospital networks, 11 agreed to participate. From these, 168 graduates responded (23.7% response rate). Most (81.1%) felt that gout was a serious disease, 51.2% answered that they had been taught adequately to manage acute gout, only 37.2% for chronic gout. In an acute gout flare, 63.4% answered they would continue urate lowering therapy and 67.2% were aware of first‐line pharmacological management options; 28% answered the correct dosing regimen for colchicine. Chronic management was answered poorly. Only 42.0% stated they would titrate allopurinol dosing to a target urate level; 23.5% would check the urate level monthly. More than half, 56.8%, were aware that medical prophylaxis is indicated when initiating urate lowering therapy. Of this subgroup, 46.7% (25.9% overall) knew that non‐steroidal anti‐inflammatory drugs and colchicine were recommended and 28.4% (15.4% overall) answered the correct timeframe of use. Close to one‐third (35.0%), were aware of febuxostat, probenecid and benzbromarone as second‐line urate lowering therapy. Conclusion: The findings of this study suggest that new graduates’ knowledge of gout management, especially chronic management, is suboptimal. Many felt their teaching on gout management inadequate; this is a potential target for intervention. Up to date university education which covers chronic management may lead to better clinical outcomes for this burdensome disease. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To describe the treatment regimens, duration of therapy and reasons for disease‐modifying antirheumatic drug (DMARD) cessation in a large psoriatic arthritis (PsA) cohort. Methods: A retrospective non‐interventional multi‐centre study using Audit4 electronic medical records, with de‐identified, routinely collected clinical data from rheumatology practices in the OPAL consortium (Optimising Patient outcomes in Australian rheumatoLogy) during November 2015. Baseline characteristics, type and duration of conventional and biologic DMARDs (cDMARD and bDMARD, respectively), disease activity (Disease Activity Score of 28 joints C‐reactive protein [DAS28‐CRP]), and reasons for treatment cessation were recorded. Results: A total of 3422 rheumatologist‐diagnosed PsA patients were included: 60% female, mean age 54 years and disease duration 10 years. Of patients with treatment recorded (n = 2948), 46% were on cDMARD monotherapy, 19% bDMARD monotherapy, 13% combination bDMARD and cDMARDs, 11% combination cDMARDs and 10% no DMARDs. Of those with DAS28‐CRP results (n = 494), the highest mean DAS28‐CRP was 3.32 on combination cDMARDs, and the lowest was 2.19 on bDMARD monotherapy. Median duration on cDMARD monotherapy was 33.5 months (n = 2232), on bDMARD monotherapy 110.1 months (n = 751), on combination bDMARD and cDMARDs 68.5 months (n = 559). The most common reasons for cessation of cDMARD monotherapy was adverse reactions (41%), for bDMARD monotherapy lack of efficacy (26%), and for combination bDMARD and cDMARDs treatment completed or no longer required (37%). Conclusion: Most PsA patients were prescribed DMARD therapies with a large proportion receiving cDMARDs. Patients on combination cDMARD therapies had the highest DAS28‐CRP results. Adverse reactions were the most common reason for cessation of cDMARD monotherapy, whereas for bDMARD monotherapy it was lack of efficacy. [ABSTRACT FROM AUTHOR]

Mortality due to infectious diseases continues to rise globally, despite advances in antimicrobial therapy and supportive care. This is evident with the occurrence of coronavirus disease 2019 (COVID-19) pandemic, instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Saudi Arabia, an eminent country within the Arab region, has had significant impact during global pandemics, concomitant with the fact that millions of Muslims travel to Saudi Arabia for pilgrimages every year. Herein, we discuss the significance of SARS-CoV-1, SARS-CoV-2, as well as the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia with particular reference to global transmission and/or emergence of new variants due to genetic mixing of different strains. Furthermore, we also discuss the role of Saudi Arabia with reference to novel emerging infectious diseases and re-emerging infections, such as Ebola, zika, and monkeypox, as well as in the context on coinfections. Future strategies to limit the spread of viral infections and the pivotal role of Saudi Arabia, are deliberated upon. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the clinical, laboratory, and anthropometric profile of a sample of Brazilian patients with glycogen storage disease type I managed at an outpatient referral clinic for inborn errors of metabolism. Methods: This was a cross‐sectional outpatient study based on a convenience sampling strategy. Data on diagnosis, management, anthropometric parameters, and follow‐up were assessed. Results: Twenty‐one patients were included (median age 10 years, range 1–25 years), all using uncooked cornstarch therapy. Median age at diagnosis was 7 months (range, 1–132 months), and 19 patients underwent liver biopsy for diagnostic confirmation. Overweight, short stature, hepatomegaly, and liver nodules were present in 16 of 21, four of 21, nine of 14, and three of 14 patients, respectively. A correlation was found between height‐for‐age and BMI‐for‐age Z‐scores (r = 0.561; p = 0.008). Conclusions: Diagnosis of glycogen storage disease type I is delayed in Brazil. Most patients undergo liver biopsy for diagnostic confirmation, even though the combination of a characteristic clinical presentation and molecular methods can provide a definitive diagnosis in a less invasive manner. Obesity is a side effect of cornstarch therapy, and appears to be associated with growth in these patients.

Borrelioza Lyme (BL) este cea mai frecventă infecţie transmisă de căpuşe din genul Ixodes, atât în Statele Unite ale Americii (SUA), cât şi în Europa. Obiectivele studiului au constat în monitorizarea incidenţei şi a manifestărilor clinice ale bolii în judeţul Mureș. Material şi metodă. Studiul s-a efectuat pe o perioadă de 2 ani, 1 ianuarie 2010 - 31 decembrie 2011, pe un număr de 120 pacienţi. Diagnosticul cert sau probabil al BL s-a stabilit pe baza criteriilorCenters for Diseases Control and Prevention (CDC, Atlanta, SUA) şi European Union Concerted Action on Lyme Borreliosis (EUCALB) şi anume epidemiologice, clinice şi serologice. Pentru identificarea anticorpilor antiBb IgM, IgG din ser şi LCR s-au utilizat tehnicile ELISA şi Western-Blot. Rezultate. În anul 2010 s-au înregistrat 44 cazuri, iar în anul 2011, 76 cazuri. Conform definiţiei de caz, 106 cazuri au fost confirmate, 14 probabile. BL a fost evidenţiată cu o frecvenţă mai ridicată la copii, adulţi tineri şi adulţi, comparativ cu grupa de vârstă peste 60 ani. Incidenţa afecţiunii a fost mai ridicată la sexul feminin, 68 pacienţi (56,66%) faţă de sexul masculin 52 pacienţi (43,33%), cu o pondere, mai crescută la persoanele din mediul urban, 78 pacienţi (65,0%), comparativ cu cele din mediul rural 42 pacienţi (35,0%). Manifestările clinice au fost acute de tipul eritemului migrator (EM) la 64,16 din pacienţi, neurologice la 22,50% pacienţi, articulare la 1,66% pacienţi şi cardiace la 0,83% din cazuri. Concluzii. În judetul Mureș s-a constatat o incidenţă în creştere a bolii în anul 2011 comparativ cu anul 2010. Manifestările clinice predominante au fost cele acute dermatologice, neurologice.

This review article aims to summarize the major causes of thrombocytopenia and characterize the main general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases and may be triggered by different systems. Trigger investigation and recognition might be important and sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP. Taking a detailed history and a thorough physical examination can give clues concerning possible underlying illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For instance, it might be difficult to differentiate inherited thrombocytopenia (without a family history) from immune thrombocytopenia (ITP); in this example, intravenous immunoglobulin infusion will likely have no effect in inherited thrombocytopenia, however, will generally be useful in ITP. [ABSTRACT FROM AUTHOR]

During the last 10 years, clinical trials formally demonstrated that about 50% of patients with chronic phase ( CP) chronic myeloid leukaemia ( CML) who achieve and maintain deep molecular responses for a prolonged period of time during treatment with imatinib or new generation tyrosine kinase inhibitors ( TKIs) may successfully stop their anti-leukaemic therapy. Based on the accumulated knowledge from abundant clinical trial experience, TKI discontinuation is becoming an important goal to achieve and is about to enter clinical practice. This review focuses on relapse definition, laboratory tests to identify relapse and relapse management after TKI discontinuation. [ABSTRACT FROM AUTHOR]

Abstract: We report here on four cases of patients with strongly positive anti‐citrullinated cyclic peptides (anti‐CCP) antibodies and clinical features of seronegative spondyloarthritis (SpA) and reactive arthritis. The four patients had various clinical presentations: one had an initial diagnosis of seropositive rheumatoid arthritis (RA) with involvement of the sacroiliac joints (similar to previous reports of the association of two diseases); one had a clinical picture of reactive arthritis following an episode of an Escherichia coli positive urinary tract infection; and two had asymmetrical sacroiliitis (SII), but no evidence of peripheral joint involvement (never reported before). In all cases, high titers of anti‐CCP antibodies were found. We present a comparison of the clinical manifestations, radiographic features and treatment regimens of these cases. Our report supports previous literature data of possible overlap existing between RA and SpA, but also presents for the first time the association of high titers of anti‐CCP antibodies with SII and reactive arthritis in patients with no peripheral small joint involvement. [ABSTRACT FROM AUTHOR]

Background: Vitamin B12 cannot be synthesized in the body and it is essential for growth and development in humans. Objectives: To evaluate the vitamin B12 levels between the mothers and their infants who presented to the Pediatric Hematology outpatients department due to the symptoms of vitamin B12 deficiency. We also compared the effects of low B12 levels in both the mother and the child, compared to the effects of normal B12 levels in the mother and low levels in the child. Methods: We enrolled 303 children aged 2 - 18 months between January 2013 and September 2015. Patients with a vitamin B12 level < 200 pg/mL in both the mother and the child and patients with a B12 level that was low in the child and normal in the mother were compared. Results: The birth weight of the children was low in the group where the B12 level of both the mother and the child (n = 163) was low and presentation to the clinic with neurologic signs and symptoms such as tremor, restlessness, seizure, hypotonia, and macrocephaly not related to another etiologic reason was common (P < 0.05). A remarkable finding was the simultaneous low levels of vitamin B12 in the mother in 55 of the 69 children who presented with neurological symptoms (P < 0.05). A generalized or focal epileptic pathology was found in the EEGs and MR images including retardation in myelination, demyelination, atrophic findings or ventricular dilatation in children whose mothers have B12 deficiency simultaneously. Conclusions: It is difficult to explain such complicated clinical pictures due to malnutrition especially in developing countries. Detecting and treating vitamin B12 deficiency early in mother and child is very important in prevention of potential irreversible neurological problems. [ABSTRACT FROM AUTHOR]

There are an estimated 400 million chronic carriers of HBV worldwide; between 15 and 20 million have serological evidence of exposure to HDV. Traditionally, regions with high rates of endemicity are central and northern Africa, the Amazon Basin, eastern Europe and the Mediterranean, the Middle East and parts of Asia. There are two types of HDV/HBV infection which are differentiated by the previous status infection by HBV for the individual. Individuals with acute HBV infection contaminated by HDV is an HDV/HBV co-infection, while individuals with chronic HBV infection contaminated by HDV represent an HDV/HBV super-infection. The appropriate treatment for chronic hepatitis delta is still widely discussed since it does not have an effective drug. Alpha interferon is currently the only licensed therapy for the treatment of chronic hepatitis D. The most widely used drug is pegylated interferon but only approximately 25% of patients maintain a sustained viral response after 1 year of treatment. The best marker of therapeutic success would be the clearance of HBsAg, but this data is rare in clinical practice. Therefore, the best way to predict a sustained virologic response is the maintenance of undetectable HDV RNA levels. [ABSTRACT FROM AUTHOR]

Rhinovirus ( RV) known as the common cold virus generally only causes a mild upper respiratory infection, but severe lower respiratory symptoms have been associated with RV infections especially in asthmatic individuals. Wheezing is a symptom of airway obstruction, and preschool children wheezing with RV have been associated with increased risk of asthma at school age. There are, however, conflicting opinions as to whether there are differences in response to RV infection or whether wheezing with RV reveals a preexisting impairment that promotes asthma mainly in predisposed children. The advent of molecular diagnostics to detect respiratory viruses has led to new insights into the role of RV infections. This review will discuss recent information concerning the role of RV as an important respiratory pathogen related to early onset wheeze and exacerbation of established asthma in preschool children. [ABSTRACT FROM AUTHOR]

Aim Currently there are no national recommendation guidelines for the management of rheumatoid arthritis ( RA) in Saudi Arabia, which has led to a lack of standard of care. The aim of this study is to explore RA management strategies in practicing rheumatologists in Saudi Arabia. Methods A 38 questions survey was designed using an electronic website. The survey was distributed through the official email of the Saudi Society for Rheumatology. Rheumatologists with at least 1 year of experience were included. Descriptive analysis was used to report demographics and participants' answers. Chi-square and Fischer's exact test were used to evaluate the relation between the characteristics of participants and their answers. Results Out of 120 registered practicing adult rheumatologists, 54 (45%) completed the survey. The majority were male 31 (57.4%) and Saudis 36 (66.7%). Forty-two participants (77.8%) use clinical outcome measures in daily clinical practice to guide treatment decisions with the majority using the Disease Activity Score of 28 joints (61.1%). Quality of life measures were used by 22 (40.7%) participants with statistically significant male predominance ( P = 0.043). Time consumption was the most important cause for not using any outcome measures. Thirteen (24.1%) and 17 (31.5%) participants do not use parenteral methotrexate and leflunomide, respectively, because of unavailability in the hospital formulary. Nine (16.7%) and 38 (70.37%) participants do not see a role for tofacitinib and biosimilars, respectively, in the management of RA. Conclusion This survey has highlighted many areas of improvement in the practice of rheumatologists in Saudi Arabia and should be the focus of future educational activities. [ABSTRACT FROM AUTHOR]

Borderline Personality (BPD) and Bipolar (BP) disorders stimulate an academic debate between their distinction and the inclusion of Borderline in the Bipolar spectrum. Opponents to this inclusion attribute the important differences and possible diagnostic incomprehension to overlapping symptoms. We tested 248 Borderline and 113 Bipolar patients, consecutively admitted to the Psychiatric Unit, through DSM-IV Axis I and II Disorders (SCID-I/II), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS) and Borderline Personality Disorder Severity Index-IV (BPDSI-IV). All the tests statistically discriminated the disorders (p < 0.0001). Overlapping symptoms resulted significantly different (impulsivity = 5.32 in BPD vs 1.55 in BP, p < 0.0001; emotional instability = 7.11 in BPD vs 0.55 in BP, p < 0.0001) and the range of their scores gives the opportunity for an even more precise discrimination. Distinctive traits (e.g. irritability or sexual arousal) are also discussed in order to try to qualify the core of these disorders to a higher degree. Comorbidity proves to be extremely small (3.6%). However, Borderline patients with manic features offer a privileged point of view for a deeper analysis. This allows for the possibility of a more precise examination of the nature and load of each symptom. Borderline Personality and Bipolar Disorders can be distinguished with high precision using common and time-sparing tests. The importance of discriminating these clinical features may benefit from this evidence. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of insomnia in adults with Attention-deficit hyperactivity disorder ( ADHD) and its association with clinical subtypes, current ADHD symptoms, and stimulant treatment. Method We obtained diagnostic information, symptom rating scales and treatment history from clinically ascertained adult ADHD patients diagnosed according to DSM- IV criteria ( n = 268, mean age 38.1 years) and randomly selected population controls ( n = 202, mean age 36.5 years). The Bergen Insomnia Scale ( BIS) was used to measure insomnia. ADHD symptom domains were self-rated using the Adult ADHD Self-Rating Scale. Results Insomnia was far more frequent among adults with ADHD (66.8%) than in the population controls (28.8%) ( P < 0.001). Insomnia was more common in adults with the combined subtype than in those with the inattentive subtype (79.7% and 55.6%, respectively) ( P = 0.003). For self-reported current ADHD symptoms, inattention was strongly correlated to insomnia. Patients currently using stimulant treatment for ADHD reported a lower total insomnia score compared to patients without medication ( P < 0.05). Conclusion Insomnia was highly prevalent among adults with ADHD. The lower insomnia score in patients on current stimulant treatment suggests that stimulant treatment is not associated with worsening of insomnia symptoms in adult ADHD patients. [ABSTRACT FROM AUTHOR]

Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD patients recruited in the United States (U.S.) and Brazil. Our sample consisted of 1187 adult, treatment-seeking OCD outpatients from the U.S. ( n =236) and Brazil ( n =951). With regards to the demographics, U.S. participants with OCD were older, more likely to identify as Caucasian, had achieved a higher educational level, and were less likely to be partnered when compared to Brazilians. Concerning the clinical variables, after controlling for demographics the two samples presented largely similar profiles. Brazilian participants with OCD, however, endorsed significantly greater rates of generalized anxiety disorder and post-traumatic stress disorder, whereas U.S. subjects were significantly more likely to endorse a lifetime history of addiction (alcohol-use and substance-use disorders). This is the largest direct cross-cultural comparison to date in the OCD field. Our results provide much needed insight regarding the development of culture-sensitive treatments. [ABSTRACT FROM AUTHOR]

Background and aims: Gambling disorder (GD) may have its onset in a wide range of ages, from adolescents to old adults. In addition, individuals with GD tend to seek treatment at different moments in their lives. As a result of these characteristics (variable age at onset and variable age at treatment seeking), we find subjects with diverse duration of illness (DOI) in clinical practice. DOI is an important but relatively understudied factor in GD. Our objective was to investigate clinical and neurocognitive characteristics associated with different DOI. Methods: This study evaluated 448 adults diagnosed with GD. All assessments were completed prior to treatments being commenced. Results: Our main results were: (a) there is a negative correlation between DOI and lag between first gambling and onset of GD; (b) lifetime history of alcohol use disorder (AUD) is associated with a longer duration of GD; (c) the presence of a firstdegree relative with history of AUD is associated with a more extended course of GD; and (d) there is a negative correlation between DOI and quality of life. Discussion: This study suggests that some important variables are associated with different DOI. Increasing treatment-seeking behavior, providing customized psychological interventions, and effectively managing AUD may decrease the high levels of chronicity in GD. Furthermore, research on GD such as phenomenological studies and clinical trials may consider the duration of GD in their methodology. DOI might be an important variable when analyzing treatment outcome and avoiding confounders. [ABSTRACT FROM AUTHOR]

Aim This study aims to discuss risk factors associated with cervical spine involvement ( CSI) in patients with rheumatoid arthritis ( RA). Methods A literature search was performed in Medline, EMBASE, Web of Science and CBMdisc databases for potential studies published before October 2016. The clinical and laboratory data were extracted, and a meta-analysis was performed to evaluate the risk factors for CSI in RA patients. Results Twelve studies involving a total of 2750 cases with RA and 733 CSI (26.65%) were eligible and included in this meta-analysis. The results showed that risk factors for CSI were female (odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.079-1.74), positive rheumatoid factor (RF) (OR = 1.351, 95% CI: 1.084-1.683), long-term corticosteroids treatment (OR = 2.208, 95% CI: 1.732-2.815), erosion in hands or feet (OR = 2.559, 95% CI: 1.985-3.299), age (weighted mean difference [WMD] = −2.464 years, 95% CI: −3.688 to −1.240), RA duration (WMD = 1.495 years, 95% CI: 0.870-2.121), erythrocyte sedimentation rate (ESR) level (standard mean difference [SMD] = 0.288, 95% CI: 0.161-0.41), C-reactive protein (CRP) level (SMD = 0.288, 95% CI: 0.161-0.415), Disease Activity Score of 28 joints (SMD = 0.5, 95% CI: 0.303-0.697). Conclusion The significant risk factors for CSI in RA were female gender, positive RF, long-term corticosteroids treatment, peripheral joints erosions, younger age, long RA duration, markers of higher disease activity (ESR, CRP and Disease Activity Score). [ABSTRACT FROM AUTHOR]

Aim: To evaluate the potential role of age, sex, body mass index (BMI), radiographic features and pain in knee osteoarthritis (OA) case ascertainment. Methods: A cross-sectional study was performed using information from the EPIPorto cohort; social, demographic, behavioral and clinical data was obtained. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Knee radiographs were classified using the Kellgren-Lawrence scale (0-4). Path analysis was used to assess the plausibility of the causal assumptions and a classification tree to identify characteristics that could improve the identification of patients with radiographic OA. Results: Higher age and higher BMI were associated with higher radiographic score, but sex had no statistical association. Females, higher age, higher BMI and higher radiographic score were statistically associated with higher pain scores. For both genders, the classification tree estimated age as the first variable to identify individuals with knee radiographic features. In females older than 56 years, pain frequency score is the second discriminator characteristic, followed by age (> 65 years) and (BMI > 30 kg/m2). Higher pain frequency and BMI > 29 kg/m2 were relevant for identifying OA in men with ages between 43.5 and 55.5 years. Conclusions: Age, BMI and pain frequency are independently associated with radiographic OA and the use of information on these characteristics can improve the identification of patients with knee OA. Beyond age, pain complaints are particularly relevant but the level of pain is different by sex. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is classified into five stages with kidney failure being the most severe stage (stage G5). CKD conveys a high risk for coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Cardiovascular complications are the most common causes of death in patients with kidney failure (stage G5) who are maintained on regular dialysis treatment. Because of the high death rate attributable to cardiovascular (CV) disease, most patients with progressive CKD die before reaching kidney failure. Classical risk factors implicated in CV disease are involved in the early stages of CKD. In intermediate and late stages, non-traditional risk factors, including iso-osmotic and non-osmotic sodium retention, volume expansion, anaemia, inflammation, malnutrition, sympathetic overactivity, mineral bone disorders, accumulation of a class of endogenous compounds called 'uremic toxins', and a variety of hormonal disorders are the main factors that accelerate the progression of CV disease in these patients. Arterial disease in CKD patients is characterized by an almost unique propensity to calcification and vascular stiffness. Left ventricular hypertrophy, a major risk factor for heart failure, occurs early in CKD and reaches a prevalence of 70-80% in patients with kidney failure. Recent clinical trials have shown the potential benefits of hypoxia-inducible factor prolyl hydroxylase inhibitors, especially as an oral agent in CKD patients. Likewise, the value of proactively administered intravenous iron for safely treating anaemia in dialysis patients has been shown. Sodium/glucose cotransporter-2 inhibitors are now fully emerged as a class of drugs that substantially reduces the risk for CV complications in patients who are already being treated with adequate doses of inhibitors of the renin-angiotensin system. Concerted efforts are being made by major scientific societies to advance basic and clinical research on CV disease in patients with CKD, a research area that remains insufficiently explored., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The article offers information on the role of Grading cardiac response in Primary light chain amyloidosis (AL). It mentions AL as progressive disorder caused by clonal immunoglobulin light chain tissue deposition; and highlights the poorest prognosis of patients with symptomatic heart failure depending on the presenting N-terminal pro-B type natriuretic peptide cells.

Accidents caused by snakes, especially in tropical and subtropical countries, still constitute a serious public health problem due to the lack of knowledge of health professionals and the precariousness of health systems in the regions where most accidents occur. Snake venoms contain a range of molecules that may provoke local swelling, pain, renal and respiratory insufficiencies. The study of the effects of each molecule on humans can help the development of complementary therapy. Similarly, the knowledge of clinical aspects of envenomations provides a better identification and implementation of appropriate treatment. In addition, to understand Bothrops envenomations and improve the therapeutic strategy, it is necessary to understand and study the role of important inflammatory mediators, particularly nitric oxide (NO), cytokines and the complement system.

INTRODUCTION: This study analyses the cases of all bites (including dry bites) caused by Bothropoides jararaca attended at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil. METHODS: A retrospective study was conducted of patients bitten by Bothropoides jararaca (n=792) from January 1990 to December 2004. The characteristics of the snake specimen, data related to the accident and clinical manifestations on admission were obtained from patient medical records. RESULTS: The majority of the cases in this study were caused by female and juvenile snakes. No stomach contents were found in 93.4% of the snake specimens after dissection. No statistical difference was observed between the occurrence of dry bites and the maturity or sex of the snake. The median SVL of snakes in mild and moderate cases was 40.5cm and in severe cases, SVL increased to 99cm. Necrosis was more common in the digits of the feet and hands (4.8%) compared to the other body regions (1.8%). A significant difference was verified between severity and a time interval greater than six hours from the bite to hospital admission. A significant association was verified between gingival bleeding and abnormal blood coagulability. In accidents caused by adult snakes, necrosis was more frequent (7.2%) compared to accidents caused by juvenile snakes (1%). CONCLUSIONS: In this work, the association between certain epidemiological data and the evolution of biological parameters in the clinical course of Bothrops sensu latu accidents were highlighted, contributing to the improvement of snake bite assistance.INTRODUÇÃO: Neste estudo, analisou-se todos os casos de picadas (incluindo picadas secas) causadas por Bothropoides jararaca atendidos no Hospital Vital Brazil do Instituto Butantan, São Paulo, Brasil. MÉTODOS: Estudo retrospectivo em que foram incluídos pacientes atendidos no Hospital Vital Brazil do Instituto Butantan, picados por serpentes da espécie Bothropoides jararaca (nº=792) entre 1990 a 2004. Os dados foram obtidos através de prontuários médicos. RESULTADOS: No presente estudo, a maioria dos acidentes foi causada por serpentes fêmeas e filhotes. Não havia presença de conteúdo estomacal em 93,4% das serpentes dissecadas. Não houve diferença estatística entre a ocorrência de picada seca e o sexo da serpente. O comprimento rostro cloacal das serpentes nos casos leves e moderados foram 40,5cm e nos casos severos 99cm. Necrose foi mais comum nos dedos dos pés e das mãos (4,8%) em comparação com outras regiões do corpo (1,8%). Houve diferença estatística entre a gravidade e o intervalo de tempo entre a picada e a admissão hospitalar superior a seis horas. Encontramos uma associação significativa entre gengivorragia e incoagulabilidade sanguínea. Nos acidentes causados por serpentes adultas, a necrose foi mais frequente (7,2%) quando comparado aos acidentes causados por serpentes filhotes (1%). CONCLUSÕES: Neste estudo, destaca-se a associação entre os dados epidemiológicos e biológicos em relação à evolução do quadro clínico nos acidentes botrópicos, contribuindo para a melhoria da assistência nos acidentes ofídicos.

The literature on hallucinations is reviewed, including its occurrence in different psychiatric disorders, neurological disorders and normal persons. The diagnostic significance of hallucinations is also discussed. Reports of hallucinations in normal people are reviewed. The different modes of the management of hallucinations are briefly discussed.