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The biopsychosocial model, as well as a number of approaches and paradigms based on it (scientific, clinical, preventive, therapeutic), currently cause a lot of criticism up to the complete denial of its use in psychiatry possibilities. The aim of this paper is to propose a modern interpretation of the biopsychosocial model in psychiatry for the further studies of the mental disorders etiopathogenesis and for the research of new opportunities for their therapy and prevention. Progress in biological medicine and the emergence of new research technologies today open up new opportunities for the actual interpretation of the biopsychosocial model and its application for the modern biopsychosocial paradigm, which can be used both as a research strategy and for the relevant scientifically based methods of therapy and prevention. Thus, it is important to understand that the biopsychosocial model is not a competitor or antithesis of the biomedical model, but allows one to expand the biological boundaries beyond a simple description of the organs and systems functioning.

Inflammatory pseudotumors of the liver are rare entities, only few cases being reported so far, pathogenesis of these lesions being scarcely understood. However since now multiple mechanisms have been proposed in order to explain the development of these lesions, the knowledge of their pathogenesis being mandatory in order to further orientate the therapeutic strategy. The current paper is a literature review of the largest studies which aimed to discuss the etiopathogenesis of the inflammatory pseudotumors of the liver.

Despite extensive research in the field, the etiopathogenesis of endometriosis remains an unresolved enigma. The possible role of different enzymes of the extracellular matrix, in particular the role of the matrix metalloproteases or metalloproteinases (MMPs) in the etiopathogenesis and the mechanisms involved in the processes of benign dissemination of endometriosis have been widely investigated in recent years. Various members of the enzymatic system of the MMPs, as well as their inhibitors, termed tissue inhibitors of metalloproteinases (TIMPs) and their inducer, termed extracellular matrix metalloproteinase inducer (EMMPRIN), have been implicated in the mechanisms involved in endometriosis formation, progression, and maintenance. The aim of the present paper was to provide an overview and critical evaluation of existing experimental evidence on this issue. For this purpose the authors have conducted a systematic review of the literature and evaluated relevant papers regarding experimental animal models, in vitro experiments, and analyses in human samples and studies regarding genetic polymorphisms in humans. In conclusion, members of the system of matrix MMPs, their inhibitors and inducers could be useful as novel diagnostic and prognostic biomarkers in determining the severity of endometriosis and response to therapy. Furthermore, in depth knowledge in this field could possibly lead to the development of more efficient treatment modalities. Future research should focus on the systematic investigation of the entire MMPs system in endometriosis, as well as on the interaction between its members.

Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.

PurposeTo analyze the level of sex hormone in relation to keratoconus (KC).MethodsSixty-two eyes of 62 patients (12 females, 50 males) classified as KC and 120 eyes of 120 patients (21 females, 99 males) with mild to moderate myopia and astigmatism were analyzed. Plasma samples were collected and analyzed using a chemiluminescence immunoassay to determine the concentrations of estriol (E3), estradiol (E2), progesterone (P), and testosterone (T). Corneal morphological parameters, such as the central corneal thickness (CCT), thinnest corneal thickness (TCT), and maximum simulated keratometry (Kmax), were measured using Pentacam and Sirius.ResultsThe mean age was 23.73 ± 5.16 years for patients with KC and 23.68 ± 6.10 years for patients treated with laser vision correction (LVC). Among the patients with KC, 12 were female (19.35%) and 50 were male (80.65%). The majority of patients with KC were between 20 and 30 years old. In female patients, the concentration of T in the KC group was significantly lower than that in the LVC group (0.86 ± 0.33 vs. 1.18 ± 0.58 nmol/L; P = 0.044). There were positive correlations between T, CCT (r = 0.395, P = 0.023) and TCT (r = 0.378, P = 0.030) in female patients. In male patients, E2 was higher in the KC group than the LVC group (143.75 ± 34.82 vs. 124.80 ± 43.56 pmol/L; P = 0.013), while T was significantly lower (11.59 ± 2.85 vs. 13.58 ± 4.77 nmol/L; P = 0.026). A positive correlation was found between E2 and Kmax (r = 0.222, P = 0.007) in male patients.ConclusionsConclusively, our results showed that T level was reduced in both female and male KC plasma, while E2 was increased in male KC plasma. Different levels of sex hormones are correlated with KC, which, may provide the basis of a new technique for screening and diagnosing KC with or without the assistance of current imaging techniques. Moreover, the correlations between sex hormone alterations and KC provide compelling insight into KC etiopathogenesis.

Epidemics have not been new to India. Ayurveda being in the fore front of health care of those times, has recorded its valuable experiences of epidemics & termed them as Janapadodhwamsa or Maraka. It has vividly described their mechanism of Causation (Nidana), factors affecting severity and actions complicating illnesses their management and prevention. The present work uses the same model described in Samhitas which assert the superiority of host susceptibility (Nija) over External Agent/Virus (Agantuja) and uses the same principles in prevention; while adopting the Jwara model to explain and correlate with different stages of COVID – 19. It proposes management guidelines using Ahara (Nutritional Principles) and Oushadha (Medication) for different stages and subsets of patients along with their potential complications and drug interactions, utilizing the principles of host factor modification (Dosha hara) and potential broad spectrum Anti-viral (Prativisha) as envisaged by Rasa Shastra.

Acne is a common inflammatory condition of the skin worldwide. The skin is an endocrine organ and hormones are a key pathogenic factor in all types of acne with a particularly important role in adult female acne pathogenesis and management. In females, we have the unique opportunity to manipulate hormones systemically to successfully manage acne and, more recently with the approval of clascoterone 1% cream, we can target the hormones topically in both genders. The intent of this paper is to provide physicians with an up-to-date clinically relevant review of the role of hormones in acne, the impact of currently available contraceptives and therapies available to target hormones in acne., Competing Interests: Dr. Lipson has been a speaker, or advisory board member for, or received a grant, or an honorarium from AbbVie, Amgen, Bausch Health, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, L’Oréal, Galderma, Janssen, Leo, Lilly, Novartis, Pfizer, Sanofi, Sun Pharma and UCB.

Background: Middle ear cholesteatoma is characterized by hyper-proliferation of keratinocytes. Circular RNA (circRNA) plays an essential role in the pathogenesis of many proliferative diseases. However, the role of circRNA in the etiopathogenesis of middle ear cholesteatoma is rarely investigated so far. We aimed to investigate the differential expression profiling of circRNAs between acquired middle ear cholesteatoma and normal skin, and to identify potential circRNAs contributing to the etiopathogenesis of middle ear cholesteatoma. Microarray analysis and functional prediction were performed to investigate the circRNA expression profiling between middle ear cholesteatoma and normal skin. Validation of differentially expressed circRNAs was conducted by qRT-PCR. Prediction of m6A modification was also carried out.Results: Microarray analysis displayed that totally 93 up-regulated and 85 down-regulated circRNAs were identified in middle ear cholesteatoma. Through validation, expressions of hsa_circRNA_104327 and hsa_circRNA_404655 were significantly higher, while hsa_circRNA_000319 was significantly down-regulated in cholesteatoma. GO classification, KEGG pathway, and ceRNA network analyses suggested that these differentially expressed circRNAs might play important roles in the etiopathogenesis of middle ear cholesteatoma. Prediction of m6A modification exhibited that hsa_circRNA_000319 possessed 4 m6A sites with very high confidence, and hsa_circRNA_404655 had 3 m6A sites with high confidence.Conclusions: Our study revealed that these differentially expressed circRNAs might contribute to the etiopathogenesis of middle ear cholesteatoma. Further researches should be conducted to investigate the exact mechanism of these differentially expressed circRNAs in the etiopathogenesis of middle ear cholesteatoma. Targeting on these circRNAs may provide a new strategy for middle ear cholesteatoma therapy in the future. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is a common chronic tissue-specific autoimmune disease, resulting in hair loss, that affects up to 2% of the general population. The exact pathobiology of AA has still remained elusive, while the common theory is the collapse of the immune privilege of the hair follicle caused by immunological mechanism. Multiple genetic and environment factors contribute to the pathogenesis of AA. There are several clinical treatments for AA, varying from one or multiple well-defined patches to more diffuse or total hair loss of the scalp (alopecia totalis) or hair loss of the entire body (alopecia universalis). The available treatments for AA, such as corticosteroids and other immunomodulators, minoxidil, and contact immunotherapy, are of limited efficacy with a high risk of adverse effects and high recurrence rates, especially for patients with severe AA. Recent insights into the pathogenesis of AA have led to the development of new treatment strategies, such as Janus kinase (JAK) inhibitors, biologics, and several small molecular agents. In addition, modern therapies for AA, including antihistamines, platelet-rich plasma (PRP) injection, and other novel therapies have been well explored. In this review, we discussed the recent advances in the pathogenesis, diagnosis, and treatment of AA. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to analyze patients with chronic lower limb lymphedema (LE) clinically, diagnostically and etiopathogenetically. Patients and methods: This single-center, retrospective national epidemiological study included a total of 558 patients (161 males, 397 females; median age: 43 years; range, 10 days to 94 years) with chronic lower limb LE who were treated in our department between January 2005 and January 2020. Primary and secondary LE were classified clinically by stage and severity and lymphoscintigraphically. Body mass index was calculated for the detection and classification of obesity. Results: A total of 72.5% of the patients had unilateral lower limb LE, while 27.5% had bilateral LE including lipolymphedema. The rate of the patients with obesity and pre-obesity was 71.2%. Primary LE patients (54.1%) were more common than those with secondary LE. The rates of clinical, clinical severity, and lymphoscintigraphic staging were 11.1%, 38%, and 28%, respectively for Stage I, 55.2%, 30.9%, and 42%, respectively for Stage II, and 33.7%, 31.1%, and 17%, respectively for Stage III. Complications were elephantiasis (13.3%), elephantiasis nostras verrucosa (3.0%), cellulitis (22.1%), erysipelas (2.3%), ulcer (2.6%), onychomycosis (27.4%), and lymphangiosarcoma (0.2%). Conclusion: Chronic LE is a challenging problem with poor quality of life, negative psychosocial effects, and disabling consequences, and it is of vital importance to recognize the disease in its early stages with awareness, diagnosis, and multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Erosive pustular dermatosis (EPD) is a chronic inflammatory skin disorder that usually affects mature individuals. It predominantly affects the scalp and can lead to scarring alopecia. Risk factors include actinic damage and androgenetic alopecia. A traumatic insult to the skin is considered a vital trigger of the condition. EPD is a diagnosis of exclusion; thus, several neoplastic, infectious, vesiculobullous, and inflammatory conditions should be ruled out. Biopsy and clinicopathologic correlation are required to differentiate between EPD and these entities. A dysregulated, chronic immune response is considered central to the etiopathogenesis of EPD. We performed an evidence-based systematic review of the management options. There were predominantly studies with level IV and V evidence and only two with level III. Despite the responsiveness of EPD to potent topical steroids, such as clobetasol propionate, recurrence occurs after treatment withdrawal. With the available data, tacrolimus 0.1%, curettage-assisted aminolevulinic acid-photodynamic therapy, and systemic retinoids can be considered second-line options for EPD with a role in maintenance regimens. However, controlled data and more powerful studies are needed to make solid recommendations.

The role of childhood trauma in the development of borderline personality disorder (BPD) in young age has long been studied. The most accurate theoretical models are multifactorial, taking into account a range of factors, including early trauma, to explain evolutionary pathways of BPD. We reviewed studies published on PubMed in the last 20 years to evaluate whether different types of childhood trauma, like sexual and physical abuse and neglect, increase the risk and shape the clinical picture of BPD. BPD as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders). In such cases it tends to have a prolonged course, to be severe, and treatment-refractory. In comparison with subjects who suffer from other personality disorders, patients with BPD experience childhood abuse more frequently. Adverse childhood experiences affect different biological systems (HPA axis, neurotransmission mechanisms, endogenous opioid systems, gray matter volume, white matter connectivity), with changes persisting into adulthood. A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect).

The role of childhood trauma in the development of borderline personality disorder (BPD) in young age has long been studied. The most accurate theoretical models are multifactorial, taking into account a range of factors, including early trauma, to explain evolutionary pathways of BPD. We reviewed studies published on PubMed in the last 20 years to evaluate whether different types of childhood trauma, like sexual and physical abuse and neglect, increase the risk and shape the clinical picture of BPD. BPD as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders). In such cases it tends to have a prolonged course, to be severe, and treatment-refractory. In comparison with subjects who suffer from other personality disorders, patients with BPD experience childhood abuse more frequently. Adverse childhood experiences affect different biological systems (HPA axis, neurotransmission mechanisms, endogenous opioid systems, gray matter volume, white matter connectivity), with changes persisting into adulthood. A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect). [ABSTRACT FROM AUTHOR]

Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient's age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities. [ABSTRACT FROM AUTHOR]

Background and aim: This study analyzed peripheral blood lymphocyte subsets to determine their role in the etiopathogenesis of IGM. Materials and methods: This study includes 51 pathologically proven IGM patients (active disease: 26 and in remission: 25) and 28 healthy volunteers. The analyses of lymphocyte subsets were performed by flow cytometric immunophenotyping. Results: The percentage of T helper lymphocyte of all IGM patients were lower than control groups (p = 0.001). Absolute cytotoxic T lymphocyte count (p = 0.03), both percentage (p = 0.035) and absolute count (p = 0.002) of the natural killer cells, and both percentage (p = 0.038) and absolute count (p = 0.008) of natural killer T cells, were higher than the control group. The T helper lymphocyte percentage of the patients with active disease was lower than the control group (p = 0.0003). The absolute cytotoxic T lymphocyte (p = 0.029) and natural killer T cells (p = 0.012) of the patients with active disease were higher than the control group.Conclusion: Idiopathic granulomatous mastitis is defined as a localized form of granulomatous disorders. However, the observed changes in T cells, NK, and NKT cells suggest that there is systemic immune dysregulation in patients with IGM. [ABSTRACT FROM AUTHOR]

Background Context: Scoliosis is a 3D deformity of the spine in which vertebral rotation plays an important role. However, no treatment strategy currently exists that primarily applies a continuous rotational moment over a long period of time to the spine, while preserving its mobility. We developed a dynamic, torsional device that can be inserted with standard posterior instrumentation. The feasibility of this implant to rotate the spine and preserve motion was tested in growing mini-pigs.Purpose: To test the quality and feasibility of the torsional device to induce the typical axial rotation of scoliosis while maintaining growth and mobility of the spine.Study Design: Preclinical animal study with 14 male, 7 month old Gottingen mini-pigs. Comparison of two scoliosis induction methods, with and without the torsional device, with respect to 3D deformity and maintenance of the scoliosis after removal of the implants.Methods: Fourteen mini-pigs received either a unilateral tether-only (n=6) or a tether combined with a contralateral torsional device (n=8). X-rays and CT-scans were made post-operative, at 8 weeks and at 12 weeks. Flexibility of the spine was assessed at 12 weeks. In 3 mini-pigs per condition, the implants were removed and the animals were followed until no further correction was expected.Results: At 12 weeks the tether-only group yielded a coronal Cobb angle of 16.8±3.3°For the tether combined with the torsional device this was 22.0±4.0°. The most prominent difference at 12 weeks was the axial rotation with 3.6±2.8° for the tether-only group compared to 18.1±4.6° for the tether-torsion group. Spinal growth and flexibility remained normal and comparable for both groups. After removal of the devices, the induced scoliosis reduced by 41% in both groups. There were no adverse tissue reactions, implant complications or infections.Conclusion: The present study indicates the ability of the torsional device combined with a tether to induce a flexible idiopathic-like scoliosis in mini-pigs. The torsional device was necessary to induce the typical axial rotation found in human scoliosis.Clinical Significance: The investigated torsional device could induce apical rotation in a flexible and growing spine. Whether this may be used to reduce a scoliotic deformity remains to be investigated. [ABSTRACT FROM AUTHOR]

• Literature has reported few cases of COVID-19 patients with Bell's palsy as the only major neurological manifestation. • Bell's Palsy may be caused by another virus i.e. SARS-CoV2. • Evidence of Bell's Palsy in COVID-19 patients signifies important clinical finding. • Robust research is needed to investigate their association. Bell's palsy is an acute idiopathic paralysis of the facial nerve. The disease is caused by many viruses like Herpes simplex virus-1, Varicella zoster, Epstein-bar virus, Cytomegalovirus, Usutu virus, Human immunodeficiency virus, etc. Literature has reported few cases of COVID-19 patients with Bell's palsy as the only major neurological manifestation indicating the possible role of another virus in the etiopathogenesis of Bell's Palsy. This paper aims to evaluate the reported cases of COVID-19 positive patients, presented with Bell's palsy as the only major neurological manifestation from March 2020 to December 2020, and to investigate the association of SARS-CoV2 and Bell's palsy. A systematic review of the published literature was performed using an electronic search in PubMed/Medline, Science Direct, Web of Science, Embase, J- STAGE, Google Scholar, China National Knowledge Infrastructure (CKNI) and Scopus databases, from March 2020 to Dec 2020 using keywords like 'COVID-19', 'SARS-CoV-2', 'Coronavirus', 'Bell's palsy', 'Facial nerve', 'First', 'Only',' Neurological', 'Manifestation'. The studies reviewed were case series and case reports regarding the subject. Search strategy revealed thirteen articles from March 2020 to Dec 2020 with a total of 20 cases of COVID-19 with Bell's palsy as the only major neurological manifestation. Evidence of Bell's palsy as the only major neurological manifestation in COVID-19 patients signifies an important clinical finding but robust research is needed to investigate their association and the exact mechanisms by which SARS-CoV2 causes Bell's Palsy. [ABSTRACT FROM AUTHOR]

Anxiety and depression disorders have a high prevalence in the population, sometimes generated by exceptional situations such as the Covid-19 pandemic. The prevalence of these mental disorders could be inferred with Google Trends, a tool that analyzes Internet search holdings by time ranges and geographic location. In order to study the relationship between search trends for the terms "Anxiety" and "Depression" and their prevalence in Spain during the Covid-19 pandemic, a selective search analysis was carried out based on geographic variables (Madrid, Andalusia, Catalonia) and temporary (weeks in 2020). The words "Anxiety", "Depression" and "Covid-19" were taken into account to make the estimates of search trends in Google Trends. The results showed significant differences between the autonomous communities in their interest in searching for information on depression, as well as a different temporal progression, both in anxiety and depression, which would reflect the fluctuations in the evolution of epidemiological data in each geographic region. Tools such as Google Trends would allow the health community to implement prevention strategies in the event of the detection of peaks of concern for certain mental disorders in specific regions and time periods. This is especially relevant if the prevalence of these disorders in the population can negatively interfere with the effectiveness of prevention and health containment policies in emergency situations. [ABSTRACT FROM AUTHOR]

Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. To identify Lindsay's nails and Terry's nails in patients with end stage renal disease (ESRD) on maintenance hemodialysis (HD) and to determine the common anamnestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examination took place during the dialysis session. Lindsay's nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proximal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry's nails were identified by a 0.5-3.0 mm wide distal band, pinkbrown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay's nails, and Terry's nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry's nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay's nails), and Terry's nails in patients with ESRD on HD. [ABSTRACT FROM AUTHOR]

Physiotherapists often use a postural biomechanical model of explanation to integrate in their clinical rationale the causes of various musculoskeletal conditions such as scoliosis. Scoliosis represents the most common spinal disorder in children, adolescent and adult population. It is believed that postural deviations, body asymmetries and pathomechanics are the predisposing and maintaining factors for many musculoskeletal conditions in general, scoliosis in particular. This model also plays an important role in clinical assessment and physiotherapeutic management, including the choice of manual techniques and the exercise prescribed. Existing literature presents various ways of clasification of scoliosis; in neither we find a type of weak or bad postural scoliosis. There is a widespread opinion that scoliosis is caused by pour posture, wearing a backpack on one shoulder, incorect sitting posture or asimetrical ergonomics. In reality, the majority of scoliosis patients have an idiopathic condition and biomechanics can be considered aggravating factors not causes. Yet understanding the assymetrical loading of the scoliotic patient is one of the key of a succesfull rehabilitation. Various theories about the reason of the majority of scoliosis were stated from heredity to gene modification, from level of melatonin to systemic disorders. None of these found the explanation to rule out the idiopathic from the diagnostic. [ABSTRACT FROM AUTHOR]

Correlations between alterations in the oral cavity and systemic conditions have been widely reported. A considerable number of gastrointestinal (GI) diseases of varied nature may produce lesions in the hard and soft oral tissues. Among the different types of manifestations of GI, oral lesions represent an important, if not a major component of the manifestation of these diseases. As a consequence, recognition and management of oral lesions accompanying the GI conditions, is mandatory for all clinicians, either gastroenterologists or dentists. The aim of this article is to underline useful data about the most common GI conditions (intestinal bowel diseases (IBD), gastroesophageal reflux, genetic diseases, malabsorption conditions, infections, metastatic tumors) and their link to oral pathology.

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that develops from vascular endothelial cells. It has been reported to occur many sites of body, but the most common EHE presentations are soft tissue (limbs), bone, liver and lung. Compared with other pulmonary tumors, pulmonary epithelioid hemangioendothelioma (P-EHE) is relatively rare. According to a literature review, more than 100 cases have been described all over the world. Due to the low incidence of P-EHE, lack of specificity in clinical symptoms and radiological findings, it is often misdiagnosed. Meanwhile, many patients do not receive appropriate treatment, resulting in poor prognosis in some cases. Histology and immunohistochemical methods are essential for diagnosis. However, there is no established standard treatment for P-EHE, because of the rarity of the disease. When the lesions are small and limited in number, surgical is the best treatment, achieving the purpose of diagnosis and treatment at the same time. This article tries to present the etiopathogenesis, clinical manifestations, diagnosis, treatment and prognosis of P-EHE.

Age-related macular degeneration (AMD) showed several processes and risk factors in common with neurodegenerative disorders (NDDs). The present work explored the existence of genetic determinants associated with AMD, which may provide insightful clues concerning its relationship with NDDs and their possible application into the clinical practice. In this study, 400 AMD patients were subjected to the genotyping analysis of 120 genetic variants by OpenArray technology. As the reference group, 503 samples representative of the European general population were utilized. Statistical analysis revealed the association of 23 single-nucleotide polymorphisms (SNPs) with AMD risk. The analysis of epistatic effects revealed that ARMS2, IL6, APOE, and IL2RA could contribute to AMD and neurodegenerative processes by synergistic modulation of the expression of disease-relevant genes. In addition, the bioinformatic analysis of the associated miRNA variants highlighted miR-196a, miR-6796, miR-6499, miR-6810, miR-499, and miR-7854 as potential candidates for counteracting AMD and neurodegenerative processes. Finally, this work highlighted the existence of shared disease mechanisms (oxidative stress, immune-inflammatory response, mitochondrial dysfunction, axonal guidance pathway, and synaptogenesis) between AMD and NDDs and described the associated SNPs as candidate biomarkers for developing novel strategies for early diagnosis, monitoring, and treatment of such disorders in a progressive aging population.

Background: The oral lymphoepithelial cyst (LEC) is a rare, soft-tissue, developmental cyst, initially presented by Gold in 1962 as a "branchial cleft cyst". It may occur in the pancreas, tongue, neck, and other regions of the oral cavity. No study has been reported in Pakistan and Karachi reporting a case of lymphoepithelial cyst in the submandibular region. This rare case of LEC has been reported to help the clinicians to bring LEC into their differential diagnosis for lesions affecting the submandibular region. Case presentation: We report a case of 57 years old female reported to the Maxillofacial OPD of a tertiary care hospital with the complaint of swelling on the right side of the neck for 3 weeks which was rapidly increasing in size. She was having difficulty in mastication. On extra-oral examination, there was swelling on the right side in the submandibular area. The overlying skin is normal with no evidence of pus and discharge. On palpation, the swelling was soft, non-tender, non-fluctuant, non-displaceable into the submandibular area. Lymph nodes were impalpable. Excision of the lesion performed under general anesthesia and biopsy revealed lymphoepithelial cyst associated with submandibular gland. Here we present an attention-grabbing case of swelling in the right submandibular region which was provisionally diagnosed as a malignant submandibular lymph node however later evidence histopathologically as a lymphoepithelial cyst of the submandibular gland. Conclusion: An unusual cause of swelling in the neck is lymphoepithelial cysts. Submandibular gland appearance is not usual and can prove to be a clinical problem. [ABSTRACT FROM AUTHOR]

Aim: Beside the intention of early detection and optimal treatment of deep venous thrombosis (DVT), the aim of this study was to investigate the influence of chronobiological rhythms on the etiopathogenesis of unprovoked deep vein thrombosis of the lower limbs with monitoring of seasonal variations in biochemical parameters. Patients and methodology: The prospective clinical trial included all consecutive hospitalized patients and outpatients diagnosed with DVT at the Vascular Surgery Clinic of the Clinical Center in Niš, starting from January 2013 to December 2014. Results: There was no statistically significant difference in correlation between the distribution of the incidence of DVT of the lower limbs (p = 0.582), sex (p = 0.350), age (p = 0.385) and localization (p = 0.886) and the seasons. Creatinine levels were significantly higher in patients who developed DVT in spring than in those who developed DVT in winter (p < 0.05), while LDL cholesterol levels were significantly higher in patients diagnosed with DVT in winter than in those diagnosed with DVT in autumn (p < 0.05). Conclusion: According to the results of the study, it can be concluded that in the territory of South Serbia, the seasons are not significantly related to the incidence, sex, age and localization of unprovoked DVT of the lower limbs. Creatinine levels were significantly higher in patients who developed DVT in spring than in those who developed DVT in winter, while LDL cholesterol levels were significantly higher in patients during winter than during autumn. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) showed several processes and risk factors in common with neurodegenerative disorders (NDDs). The present work explored the existence of genetic determinants associated with AMD, which may provide insightful clues concerning its relationship with NDDs and their possible application into the clinical practice. In this study, 400 AMD patients were subjected to the genotyping analysis of 120 genetic variants by OpenArray technology. As the reference group, 503 samples representative of the European general population were utilized. Statistical analysis revealed the association of 23 single-nucleotide polymorphisms (SNPs) with AMD risk. The analysis of epistatic effects revealed that ARMS2, IL6, APOE , and IL2RA could contribute to AMD and neurodegenerative processes by synergistic modulation of the expression of disease-relevant genes. In addition, the bioinformatic analysis of the associated miRNA variants highlighted miR-196a, miR-6796, miR-6499, miR-6810, miR-499, and miR-7854 as potential candidates for counteracting AMD and neurodegenerative processes. Finally, this work highlighted the existence of shared disease mechanisms (oxidative stress, immune-inflammatory response, mitochondrial dysfunction, axonal guidance pathway, and synaptogenesis) between AMD and NDDs and described the associated SNPs as candidate biomarkers for developing novel strategies for early diagnosis, monitoring, and treatment of such disorders in a progressive aging population. [ABSTRACT FROM AUTHOR]

Aim: Parapsoriasis is a rare skin disorder characterized by erythematous, squamous, atrophic patchy lesions. Its etiopathogenesis and trigger factors still remain unclear. Parapsoriasis cases carry an increased risk of transformation into cutaneous T cell lymphoma. In the literature, there is no data about Helicobacter pylori (H. pylori) frequency in parapsoriasis. This study aims to evaluate the relationship between H. pylori infection and parapsoriasis. Materials and Methods: The study included thirty patients with parapsoriasis who had no dispeptic complaint and thirty healthy individuals. The patient group was divided into two groups as patients with small plaque parapsoriasis (SPP) and those with large plaque parapsoriasis (LPP) based on clinical examination. Carbon 14 urea breath test was performed to evaluate presence of H. pylori in both patient and control groups. Results: Parapsoriasis cases had a signifcantly higher rate (18/30, 60.0%) of H. pylori positivity than controls (9/30, 30.0%) (p=0.020). Whereas patients with SPP and patients with LPP had similar rates of H. pylori positivity (55.6% vs 44.4%, p=0.279). Comparison of H. pylori status according to gender it was found that majority of H. pylori positive individuals were men, indicating a signifcant difference (p=0.014). Conclusion: Our results revealed that H. pylori infection is increased in patients with parapsoriasis. Therefore, it was thought that H. pylori may be associated with parapsoriasis and this agent may play a role in the etiopathogenesis of the disease. [ABSTRACT FROM AUTHOR]

Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning "crown." It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations. [ABSTRACT FROM AUTHOR]

The contemporary clinical idea of bipolar affective disorder (BD) has been shaped as an aftermath of Emil Kraepelin's thought named "manisch-depressives Irresein", put forward in 1899, with essential modifications during the last half-century. A current paradigm for the etiopathogenesis of BD postulates the emergence of the illness as a result of an interaction between genetic and epigenetic factors with environmental influences. The most important for the molecular genetics of BD were the analyses of so-called candidate genes and genome-wide association studies (GWAS). The genetic BD profile includes many genes predisposing to other psychiatric disorders. Epigenetic disturbances constitute a mediating mechanism for the influence of environmental factors in the early period of life. Some neurobiological concepts of BD have a pharmacological origin, resulting from the mechanisms of the drugs used in the illness. They include catecholamine, cation transport, and purinergic theories. Such concepts as the neuroplasticity disturbances, "inflammatory" theory, and stress axis dysfunction resulted as an extrapolation of the initial pathogenetic hypotheses of depression. New pathogenetic theories of BD include the disturbances of biological rhythms and mitochondrial and oxidative stress dysfunctions. In BD there are abnormalities of the functions of the brain structures, in particular, the so-called anterior limbic system. Pathogenetic environmental influences include factors operating in pregnancy, early childhood trauma, stressful events in later life as well as seasonal and climatic factors. Both the pathogenesis and the course of BD are presently perceived in a developmental context, reflected by the staging concepts of the illness. [ABSTRACT FROM AUTHOR]

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Etiological agent of progressive multifocal leukoencephalopathy (PML) is polyomavirus JCV (John Cunnigham virus). PML occurs in immunosuppressed patients including MS patients treated with disease-modifying drugs. Activation of JCV in the nervous system and PML development is the result of dysregulation of genetic and immune cell mechanisms. The implementation of the safety treatment algorithm based on the length of treatment previous immunosuppressive drug treatment and positivity of the JCV antibody index is beneficial in natalizumab treated patients from the clinical point of view. Simultaneously with the use of MRI, the diagnosis of PML can be made in the preclinical phase of the disease and the prognosis of the disease can be improved. [ABSTRACT FROM AUTHOR]

Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by an intraoral burning sensation and an absence of oral mucosal lesions and disturbances in laboratory findings. Burning symptoms usually affect the anterior two-thirds of the tongue, its lateral borders, hard palate and labial mucosa, but other oral cavity sites may also be affected. Taste alterations and a decrease in the salivary flow rate frequently accompany the burning symptoms. This condition mostly affects peri- and postmenopausal women. To date, the etiology of BMS remains unclear. This unknown etiology means that no appropriate treatment is currently available. A large number of the treatments and medications have been tried for BMS, but treatment management remains unsatisfactory in some patients. The purpose of this article is to present current knowledge on the treatment of BMS. [ABSTRACT FROM AUTHOR]

Etiopathogenesis and diagnosis of sepsis is one of the controversial sections of combustiology, due to the difficult diagnosis and the possibility of developing severe complications such as multiple organ failure. Currently, there is no common view on the etiology, pathogenesis and diagnosis of burn sepsis. In this article, the authors have undertaken to summarize the experience in the diagnosis of burn sepsis. The opinions of various authors on the etiopathogenesis and diagnosis of this pathology are presented. [ABSTRACT FROM AUTHOR]

In December 2019, Wuhan city in the Hubei province of China reported for the first time a cluster of patients infected with a novel coronavirus, since then there has been an outburst of this disease across the globe affecting millions of human inhabitants. Severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2), is a member of beta coronavirus family which upon exposure caused a highly infectious disease called novel coronavirus disease-2019 (COVID-19). COVID-19, a probably bat originated disease was declared by World Health Organization (WHO) as a global pandemic in March 2020. Since then, despite rigorous global containment and quarantine efforts, the disease has affected nearly 56,261,952 laboratory confirmed human population and caused deaths of over 1,349,506 lives worldwide. Virus passes in majority through respiratory droplets and then enters lung epithelial cells by binding to angiotensin converting enzyme 2 (ACE2) receptor and there it undergoes replication and targeting host cells causing severe pathogenesis. Majority of human population exposed to SARS-CoV-2 having fully functional immune system undergo asymptomatic infection while 5–10% are symptomatic and only 1–2% are critically affected and requires ventilation support. Older people or people with co-morbidities are severely affected by COVID-19. These categories of patients also display cytokine storm due to dysfunctional immune response which brutally destroys the affected organs and may lead to death in some. Real time PCR is still considered as standard method of diagnosis along with other serology, radiological and biochemical investigations. Till date, no specific validated medication is available for the treatment of COVID-19 patients. Thus, this review provides detailed knowledge about the different landscapes of disease incidence, etiopathogenesis, involvement of various organs, diagnostic criteria's and treatment guidelines followed for management of COVID-19 infection since its inception. In conclusion, extensive research to recognize novel pathways and their cross talk to combat this virus in precarious settings is our future positive hope. [ABSTRACT FROM AUTHOR]

Background: Type B insulin resistance syndrome is a rare form of diabetes due to the presence of anti-insulin receptor antibodies [1, 2], which causes glycemic decompensation and antidiabetic therapy failure and instead responds to immunosuppressive therapy., Case Report: A 67-year-old patient was admitted to the hospital due to autoimmune hemolytic anemia and glycemic decompensation. We first prescribed subcutaneous basal-bolus insulin and then intravenous insulin without improvement in blood sugar levels (between 300 and 500 mg/dL). Considering the non-response to therapy and the autoimmune diathesis of the patient (hemolytic anemia and mixed connective tissue disease), we suspected an autoimmune etiopathogenesis of glycemic decompensation; we excluded type 1 diabetes mellitus (specific antibodies were negative), and we considered the anti-insulin-antibodies-(-assayed and negative) and anti-insulin receptor antibodies (not assayed due to the lack of a center specialized in this assay in the area). Therefore, we decided to start Rituximab. After 2 weeks from the infusion, the patient improved glycemic compensation, reducing insulin requirement. Further, 2 months after the first infusion, the patient stopped insulin, returning to oral therapy with Metformin. To date, the patient has completed 3 cycles of Rituximab with the benefit of glycemic control (HbA1c 6.7%)., Conclusion: The brilliant response to Rituximab supports the hypothesis of an autoimmune pathogenesis. The anti-insulin receptor antibodies (in the type B insulin resistance syndrome) affect mostly middle-aged adults, especially women, in the context of other autoimmune diseases. Hence, it is necessary to consider the diagnosis of this rare disease in order to perform timely and effective treatment., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global health crisis with significant neurological implications. While initially characterized by respiratory symptoms, COVID-19 has been increasingly recognized for its diverse neurological manifestations, including encephalopathy, stroke, peripheral neuropathies, and neuropsychiatric disorders. Understanding the neurological landscape of COVID-19 is essential for elucidating its pathophysiology, optimizing clinical management, and improving patient outcomes. This comprehensive review provides insights into the etiopathogenesis, clinical manifestations, diagnostic approaches, management strategies, and prognostic implications of neurological involvement in COVID-19. Mechanistic insights highlight the multifactorial nature of neurological complications involving direct viral invasion, immune-mediated mechanisms, and thrombotic events. Diagnostic challenges underscore the importance of a multidisciplinary approach to patient care, while management strategies emphasize early recognition and appropriate intervention. Long-term neurological sequelae and prognostic factors are also examined, emphasizing the need for comprehensive follow-up and rehabilitation services. Finally, recommendations for future research prioritize efforts to elucidate underlying mechanisms, identify biomarkers, and evaluate rehabilitative interventions. By addressing these challenges, we can better understand and mitigate the neurological consequences of the ongoing COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Chavhan et al.)

Objective: To compare Transforming growth factor beta-1 (TGF-β1) expression in patients with and without adenomyosis., Methods: A prospective design was performed including 49 patients submitted to hysterectomy. Immunohistochemistry was performed on anatomopathological samples staged in paraffin blocks from patients with and without adenomyosis. The sample contained 28 adenomyosis cases and 21 controls. Student's t -test and multivariate logistic regression tests were used for statistical analysis. Associations were considered significant at p < 0.05., Results: We found no significant association between adenomyosis and: smoking ( p = 0.75), miscarriage ( p = 0.29), number of previous pregnancies ( p = 0.85), curettage ( p = 0.81), pelvic pain ( p = 0.72) and myoma ( p = 0.15). However, we did find a relationship between adenomyosis and abnormal uterine bleeding (AUB) ( p = 0.02) and previous cesarean section ( p = 0.02). The mean TGF-β1 intensity (mean ± SD) in the ectopic endometrium of women with adenomyosis showed no significant association (184.17 ± 9.4 vs.184.66 ± 16.08, p = 0.86) from the topic endometrium of women without adenomyosis., Conclusion: TGF-β1 expression was not increased in the ectopic endometrium of women with adenomyosis., Competing Interests: Conflicts to interest: none to declare., (© 2023. Federação Brasileira de Ginecologia e Obstetrícia. All rights reserved.)

Rheumatoid arthritis and spondyloarthropathy are the most common inflammatory rheumatic diseases. As the human microbiome is involved in the immune homeostasis, it has the potential to be a key factor in the development of autoimmune diseases and rheumatic diseases. In this article, we review the role of various human microbiota on the pathogenesis of rheumatic diseases, focusing on spondylarthritis and rheumatoid arthritis.

Multiple Sclerosis (MS) is an immune-mediated neurological disorder, characterized by central nervous system (CNS) inflammation, oligodendrocyte loss, demyelination, and axonal degeneration. Although autoimmunity, inflammatory demyelination and neurodegeneration underlie MS, the initiating event has yet to be clarified. Effective disease modifying therapies need to both regulate the immune system and promote restoration of neuronal function, including remyelination. The challenge in developing an effective long-lived therapy for MS requires that three disease-associated targets be addressed: (1) self-tolerance must be re-established to specifically inhibit the underlying myelin-directed autoimmune pathogenic mechanisms; (2) neurons must be protected from inflammatory injury and degeneration; (3) myelin repair must be engendered by stimulating oligodendrocyte progenitors to remyelinate CNS neuronal axons. The combined use of chronic and relapsing remitting experimental autoimmune encephalomyelitis (C-EAE, R-EAE) (“outside-in”) as well as progressive diphtheria toxin A chain (DTA) and cuprizone autoimmune encephalitis (CAE) (“inside-out”) mouse models allow for the investigation and specific targeting of all three of these MS-associated disease parameters. The “outside-in” EAE models initiated by myelin-specific autoreactive CD4+ T cells allow for the evaluation of both myelin-specific tolerance in the absence or presence of neuroprotective and/or remyelinating agents. The “inside-out” mouse models of secondary inflammatory demyelination are triggered by toxin-induced oligodendrocyte loss or subtle myelin damage, which allows evaluation of novel therapeutics that could promote remyelination and neuroprotection in the CNS. Overall, utilizing these complementary pre-clinical MS models will open new avenues for developing therapeutic interventions, tackling MS from the “outside-in” and/or “inside-out”.

Warty Dyskeratoma (WD) is a rare condition consisting in single or multiple papular or nodular lesions of the skin or of the oral mucosamucosa. Histologically, a cupshaped epidermal invagination centred by a plug of epidermal hyperparakeratosis with suprabasal acantholysis and dyskeratosis is typically observed. A case of post-inflammatory WD, which was also observed by dermoscopy, is described. Dermoscopy showed an eight-shape whitish collarette surrounded by light brown pigmentation. A central white structureless area with an adjacent rosette were observed. Some small rust-coloured blood crusts were also observed in the centre of the lesion; no prominent vascular pattern was detected. The etiopathogenesis of this benign neoplasm could be multifactorial. Dermoscopy of WD is not specific but may help to ruling out other skin tumors.

Peripheral facial palsy in children is very rare in comparison to adults. The most common cause is idiopathic. Another rare cause of peripheral facial palsy in children is trauma. It occurs after head trauma, mostly due to temporal bone fracture as an early onset paralysis after trauma. Early onset facial palsy is usually due to direct damage to the facial nerve whereas there is some controversy about the etiology of late onset facial palsy. In this article, a child patient whose peripheral facial palsy developed six days after a head injury is presented, and the etiopathogenesis and the treatment of delayed traumatic facial palsy after temporal bone fracture is discussed.