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Introduction: Bipolar disorders (BD) are characterized by mood symptoms that can worsen medication side effects. We aimed to study the association between residual mood signs and self‐reported side effects in the euthymic phase of BD. Methods: We assessed residual mood signs using the Montgomery–Asberg Depression Rating scale (MADRS) and Young Mania Rating scale (YMRS) and self‐reported side effects using the Patient‐Rated Inventory of Side Effects (PRISE‐M) for 880 males and 1369 females with BD. We conducted a network analysis to test the associations between 52 items of the three scales for males and females separately. We then identified clusters of nodes that fit the networks well. Results: We report only positive associations between residual mood signs and side effects. An elevated mood (YMRS) in females and increased energy (YMRS) in males were central nodes, strongly influencing the development of additional mood symptoms and side effects. Furthermore, we identified three clusters of nodes in both sexes: (1) a "mood cluster", including most YMRS and MADRS items and the PRISE‐M items evaluating sedation, sleep, and restlessness, (2) a cluster of nonsexual side effects (mostly PRISE‐M items), and (3) a cluster of sexual side effects. In both sexes, we identified bridge nodes that may favor the communication between mood and side effects, namely palpitations (PRISE‐M) and agitation (PRISE‐M). Conclusions: The results justify the particular attention of practitioners to monitor elevated moods or increased energy to try to reduce self‐reported side effects and other residual mood symptoms in the euthymic phase of BD. Our findings suggest that clinicians could consider patient‐reported loss of energy, difficulty in falling asleep, and restlessness as mood symptoms rather than medications' side effects. Palpitations and agitation may contribute to the development of additional mood symptoms or somatic complaints. [ABSTRACT FROM AUTHOR]

Background: Lyme borreliosis is by far the most common vector-borne infection in Western Europe. The most severe manifestation of Lyme borreliosis is Lyme neuroborreliosis (LNB). In LNB symptoms vary from mild to severe and may include late complications that involve both physical and/or neurocognitive constraints. An estimated 25–28% of the LNB population suffers from late complications. This study investigates patient and relative perspectives on everyday life with LNB symptoms, diagnosis, and treatment to identify areas for improvement of healthcare. Methods: A focus group was conducted at Odense University Hospital, Denmark. The focus group comprised 16 participants, nine patients diagnosed with LNB who had been treated at the Clinical Center for Emerging and Vector-borne Infections, and seven relatives of the patients' choice. The focus group lasted 2 ½ hours and was audio recorded as well as documented in field notes. Results: Data analysis was grounded in the conceptual framework of critical psychology and resulted in three main themes: (1) Burden of LNB symptoms in everyday life, (2) A break in the conduct of everyday life caused by LNB and (3) Need for transparent pathways to specialist knowledge. Conclusions: Before diagnosis and treatment, each patient reported varying degrees of non-treatable pain, and cognitive and/or musculoskeletal symptoms. Visible physical symptoms were rare. All patients had experienced that their bodily symptoms remained unaddressed throughout numerous encounters with the healthcare system. The course of LNB comes with a break in patients' everyday lives and self-understandings affecting their ability to work and manage everyday activities. Patients and relatives strongly recommend a specialised LNB clinic. [ABSTRACT FROM AUTHOR]

Iatrogenic aneurysms of the splenic artery constitute a rare yet potentially severe complication arising from diverse medical or surgical interventions. The clinical complexity and challenging management strategies associated with these aneurysms pose significant difficulties for clinicians. This circumstance is exemplified in our case report, detailing an iatrogenic aneurysm of the splenic artery that emerged secondary to a pancreatic fistula following a median pancreatectomy performed for a Frantz tumor. The intricate clinical presentation of this case underscores the considerable management challenges posed by such iatrogenic complications. [ABSTRACT FROM AUTHOR]

Endometriosis is a common gynecological condition in women of reproductive age and has variable symptomology such as pelvic pain, menorrhagia, dysmenorrhea, dyspareunia, and infertility. Endometriomas are a form of endometriosis and are characterized by cystic masses most commonly found on the ovaries. This case discusses the management of a rare occurrence of a 25‐cm endometrioma in a patient without a prior diagnosis of endometriosis, who presented to the emergency room in an acute hypertensive emergency. It is believed that the large cyst caused a mass effect against renal vasculature precipitating renovascular hypertension that required immediate intervention. This case was approached with minimally invasive surgical removal of the cyst and lysis of adhesions without postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The risk factors for contralateral hip refracture after primary hip fracture are not fully understood; therefore, this study compared the clinical characteristics of patients with first and second hip fractures and explored and analyzed the risk factors for contralateral refracture after hip fracture in elderly individuals to provide a reference for the clinical prevention of postoperative refracture of hip fracture in elderly individuals. Methods: A retrospective study was conducted on 458 elderly patients with hip fractures who underwent surgical treatment and were discharged from our hospital from March 2016 to March 2019. The clinical data of the patients were analyzed retrospectively. Patients were divided into a case group (postoperative refracture) and a control group (no postoperative refracture) based on whether they experienced refracture within five years after surgery. The clinical data of the two groups were compared and analyzed via univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) regression analysis to identify the risk factors for refractures after hip fracture surgery in elderly patients. Results: Sixty-one patients experienced refracture, with an incidence rate of 13.3%. Age ≥ 80.5 years, female sex, poor knee joint function, FRAX score ≥ 15.5, anemia, visual impairment, osteoporosis, and Alzheimer's disease (AD) were identified as risk factors for refracture after hip fracture surgery in elderly individuals (P < 0.05). Conclusion: Elderly patients with hip fractures are susceptible to refracture after surgery because of factors such as advanced age, female sex, high FRAX score, poor knee joint function, anemia, osteoporosis, visual impairment, and AD. Targeted interventions should be implemented based on the above risk factors. [ABSTRACT FROM AUTHOR]

Background: Major Depressive Disorder (MDD) poses a significant global health challenge, with symptom presentation potentially varying between adolescents and adults. Adolescence is a critical period marked by heightened vulnerability to interpersonal stresses, yet the impact of these stresses on the structure of depressive symptoms is not well understood. Recognizing the cultural nuances in how depression manifests among adolescents is crucial. To this end, this paper employs a network analysis approach, utilizing a comprehensive symptom checklist from the Multidimensional Depression Assessment Scale (MDAS). Our study investigates the role of interpersonal symptoms within the broader cluster of emotional, cognitive, and somatic symptoms and explores variations in adolescent groups in four Asian and European regions. Methods: We recruited a diverse sample of 6,348 adolescents aged 12 to 18 from Hong Kong, Taiwan, the UK, China, and the Netherlands using the Qualtrics platform. Employing the Gaussian Graphical Model, we established a network model of depressive symptoms as measured by the MDAS, segregating the sample into Asian and European regions to examine the interconnections between them. The study focused on identifying central symptom nodes and comparing the network structures between the two groups. Results: The analysis identified feeling worthless, low energy, being a burden to others, and low mood as central symptoms of depression. Notably, there were significant differences in the connections between depressive symptoms among Asian (Hong Kong, China and Taiwan) and European (UK and the Netherlands) adolescents, highlighting cultural variations in how interpersonal symptoms interact with emotional, cognitive, and somatic symptoms. Conclusion: This study is pioneering in applying network analysis to include interpersonal symptoms in examining depression among a diverse adolescent population. It demonstrates that interpersonal symptoms are integral to the central features of depressive symptoms. Furthermore, our findings suggest that, compared to their UK and Dutch peers, interpersonal symptoms in Asian adolescents are uniquely connected to other symptom clusters, reflecting distinct cultural patterns. Limitations: The study engaged a broad community sample; however, future research could benefit from including a larger sample size to allow for a more detailed analysis of a greater number of symptom nodes. [ABSTRACT FROM AUTHOR]

ABSTRACT Thymoma‐associated multiorgan autoimmunity (TAMA) is a rare paraneoplastic disorder that presents similarly to graft versus host disease (GVHD). We report a unique case of TAMA presenting as a GVHD‐like erythroderma in an elderly male with a history of benign thymoma. Cutaneous histopathological findings demonstrated vacuolar interface dermatitis with numerous dyskeratotic keratinocytes, exocytosis of lymphocytes, and a mildly acanthotic epidermis, which can be seen in several different disease processes. Thus, careful consideration of clinical presentation, historical information, laboratory testing, and histopathologic findings led to the correct diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background Objective Animals Methods Results Conclusion and Clinical Importance Limited information is available regarding the clinical features, treatment, and prognosis of neosporosis in adult dogs.Describe the clinical signs, laboratory findings, magnetic resonance imaging (MRI) findings, treatment and outcome in adult dogs (>6 months) diagnosed with neosporosis based on consistent clinical signs and positive serology (titer ≥1 : 800) at a referral hospital in Sydney, Australia.Twenty‐one client‐owned dogs.Retrospective case series of affected dogs between 2010 and 2023. Survival times were determined from onset of clinical signs to date of death or censoring.Clinical signs varied, and were indicative of generalized myopathy (6 dogs), multifocal intracranial disease (7 dogs), myelopathy (4 dogs), polyneuropathy (2 dogs) and single cases of focal myopathy and cerebellar disease. Serum creatine kinase activity was markedly increased (median, 3369 U/L) in most dogs. The most common MRI abnormalities were multifocal intracranial abnormalities (7/13 dogs) and muscle changes (5/13 dogs) whereas T2‐weighted cerebellar abnormalities (2/13 dogs) and cerebellar atrophy (1/13) were less common. Treatment response was complete (resolution to normal) in 8 dogs, incomplete (persistent neurological deficits) in 6 dogs, but there was minimal response in 7 dogs. Thirteen dogs (62%) were alive after 6 months and 12 dogs (57%) alive after 1 year. Relapse was common, with 4 dogs experiencing at least 1 relapse event during the follow‐up period.Adult‐onset neosporosis is uncommon and has variable clinical presentations. Treatment response also is variable, and relapse can occur, even among patients that respond completely to initial treatment. [ABSTRACT FROM AUTHOR]

Sport-related concussions (SRCs) are prevalent in high school (HS) sports, though the determinants of, and relationships between concussion symptoms in this population remain relatively unknown. We analysed SRC data captured within the HS RIO injury surveillance system during 2014/15-2018/19. We used Generalized Estimating Equations to simultaneously assess covariate predictors of symptom presentations and identify pairwise symptom associations and employed multivariable ordinal logistic regressions to determine symptom resolution time (SRT) predictors. Among the 8,969 concussions assessed, headaches (94.3%) and dizziness (73.3%) were the most prevalently reported symptoms. In 5,953 boys’ concussion assessed, class year, event type and injury mechanism emerged as determinants of various concussion symptoms, while in 3,016 girls’ concussions assessed, class year, event type, injury mechanism, and sport type emerged as significant symptom determinants. In both groups, difficulty concentrating, sensitivity to light, sensitivity to noise, and disorientation were symptoms with the strongest associations with other symptoms. Odds of longer SRT were higher with greater endorsement (i.e. counts) of the subset of symptoms with strongest cross-domain associations (ORadj. = 1.35; 95% CI = [1.30, 1.40]). Our findings provide valuable information for informing sideline and follow-up clinical concussion assessment algorithms in high school athletes. [ABSTRACT FROM AUTHOR]

AbstractIn February 2021, elongated grey lesions with reddish margin were observed on sudangrass (Sorghum × drummondii) leaves, in the municipality of Guasave, Sinaloa, Mexico. These symptoms resembled those of leaf blight caused by Bipolaris and Exserohilum on other grasses. Two fungal isolates were recovered from symptomatic leaves, and their identities were confirmed based on a polyphasic approach. The morphological and phylogenetic analysis of the actin gene (act) and internal transcribed spacer region (ITS) of both isolates revealed their identity as Exserohilum turcicum. A pathogenicity test with a representative isolate confirmed this fungus as the causal agent of leaf blight on sudangrass, as symptoms previously observed in the field were developed on the inoculated plants. The E. turcicum isolate was recovered from the diseased sudangrass plants, fulfilling Koch’s postulates. This is the first report of E. turcicum causing leaf blight on sudangrass in Mexico. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion Little is known about factors modulating pain and pain‐related functional impairment in isolated cervical dystonia (CD).The aim was to assess the prevalence and interrelationship between pain‐modulating factors and pain‐related determinants of functional impairment and quality of life in CD.We analyzed pain‐aggravating and pain‐relieving external factors, the degree of pain‐related functional impact on routine activities, and the relationship between these and pain severity, using cross‐sectional data collected using the Pain in Dystonia Scale (PIDS) from 85 participants with CD. Pairwise correlation analyses and age‐ and sex‐adjusted linear regression models estimated the relationship between pain‐modulating factors and pain severity, and the impact of pain severity, dystonia severity, and psychiatric symptoms on pain‐related functional impairment and disease‐specific quality of life (measured using the Craniocervical Dystonia Questionnaire‐24).Stress and prolonged fixed position were the most frequent and impacting pain triggers, with women reporting larger impact. The average impact of pain‐relieving factors was lower than that of pain triggers. Physical exercise and social gatherings were the most impacted activities by pain in CD. The intensity of external modulating factors was a predictor of pain severity. Severity of pain, CD, and psychiatric symptoms independently predicted pain‐related functional impairment, whereas quality of life was predicted by pain severity, pain‐related functional impairment, and psychiatric symptom severity, but not dystonia severity.The PIDS provides insight into external modulation and functional impact of pain in CD. The pattern of external modulation of pain in CD is in line with a multifactorial modulation and complex physiology. [ABSTRACT FROM AUTHOR]

Diffuse midline gliomas present a particularly intricate and challenging clinical scenario. This rare case involves a patient with comutant H3F3A and FGFR diffuse midline glioma with a clinical presentation of fulminant leptomeningitis. A 22‐year‐old male presented with fatal and fulminant diffuse leptomeningitis. Next‐generation sequencing of plasma and cerebrospinal circulating tumour DNA revealed diffuse midline gliomas with H3F3A and FGFR mutations. Methylome analysis of meningeal tissue collected during autopsy confirmed the diagnosis. Liquid biopsy plays a crucial role in the diagnosis of diffuse midline gliomas, mainly those with exclusively leptomeningeal presentations. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion In patients diagnosed with glioblastoma (GBM), minimal data exist on the pathway to presentation and the impact of symptoms on survival outcomes. This study aims to detail the symptoms that occur at time of initial presentation, the response to subsequent intervention, and the factors that predict survival in patients managed for GBM.A retrospective audit was performed from established prospective databases in patients managed consecutively with radiation therapy (RT) for GBM between 2016 and 2019. The major endpoint was median overall survival (mOS). Analysis was performed to determine associations with clinical factors including presenting symptom, performance status, tumour site and extent of resection. The level of carer support and objective perception of carer mastery was also assessed.Overall, 182 patients with GBM were eligible for analysis. The majority of patients presented directly to Emergency (52%), with the most common initial presenting symptom being personality change in 23% of patients. The primary symptoms resolved pre‐operatively in 47% of patients, with 9% having worse symptoms postoperatively. The mOS was 16.5 months (95% CI: 14.5–18.5). ECOG Scores 0–1 were associated with improved mOS at both initial ECOG (P < 0.001) and ECOG at 6 months (P = 0.006). Recognised Carer Mastery (P = 0.007) but not presence of carer (P = 0.35) was associated with improved mOS.In patients with GBM initial presenting symptoms, level of performance status and role of carer influence clinical outcomes and survival. These findings can assist to guide clinicians and supportive care services to optimise future patient care. [ABSTRACT FROM AUTHOR]

Ocular metastasis is a rare type of distant metastasis of lung cancer. Limited information is available regarding ocular symptoms, diagnosis, treatment, and prognosis. We reported 16 patients diagnosed with ocular metastasis from lung cancer treated at our hospital from January 1988 to March 2024 and conducted a systematic review of 100 patients retrieved from the PubMed database from January 2014 to December 2023. A pooled analysis was performed using individual‐level patient data to generate the hazard ratio (HR) of the association between patient characteristics and overall survival. A total of 116 patients, 100 patients from the literature and 16 patients from our center, diagnosed with ocular metastasis from lung cancer were included in this study. Choroid metastasis was presented in 77 (66.4%) patients and was significantly associated with the onset of lung cancer with ocular symptoms and decreased vision; iris metastasis was significantly associated with small cell lung cancer (SCLC), high intraocular pressure, and ocular pain. Multivariate analyses revealed that males (HR, 2.488; 95% confidence interval [CI], 1.127–5.495), age ≥ 60 years (HR, 3.196; 95% CI, 1.391–7.341), and onset with ocular symptoms (HR, 4.312; 95% CI, 1.675–11.099) were significantly associated with overall survival. For non‐SCLC (NSCLC) patients, compared with chemotherapy, targeted therapy (HR, 0.238; 95% CI, 0.087–0.651) and combined therapy (HR, 0.133; 95% CI, 0.017–0.822) have greater therapeutic efficacy. Chemotherapy combined with immunotherapy and targeted therapy are more effective than chemotherapy alone for ocular metastatic NSCLC patients. For patients with targetable mutations, new‐generation tyrosine kinase inhibitors (TKIs) are preferred. [ABSTRACT FROM AUTHOR]

Background: To analyze the clinical manifestations, diagnostic and therapeutic processes of perinatal tuberculosis in children, providing reference for clinicians in the diagnosis and treatment of this disease. Methods: A retrospective analysis was conducted on the epidemiological history, clinical manifestations, laboratory and imaging findings, and treatment follow-up of 20 cases of perinatal tuberculosis diagnosed in the Second Department of Infectious Disease, Kunming Children's Hospital, from February 2014 to September 2021. Results: Of the 20 cases, 13 were male (65.0%) and 7 were female (35.0%). The average age at onset was 35.35 ± 23.03days, with an average time from onset to diagnosis of 24.75 ± 15.55days. Tuberculin skin test (TST) was positive in 1 out of 4 cases (25.0%). Gamma interferon release assays (IGRAs) were positive in 9 out of 17 cases (52.9%).acid-fast staining was positive in 7 out of 16 cases (43.7%), and Mycobacterium tuberculosis nucleic acid polymerase-chain-reaction(PCR) was positive in 14 out of 20 cases (70.0%). Chest CT showed miliary changes in 4 out of 19 cases (21.0%), multiple nodular and patchy opacities in 6 out of 19 cases (31.6%), and pulmonary consolidation and atelectasis in 10 out of 19 cases (52.6%). After anti-tuberculosis treatment, 16 out of 20 cases (80.0%) improved, and no recurrence of tuberculosis was observed during follow-up periods ranging from 9 months to 3 years. The growth and development of these children were similar to those of healthy children. Conclusion: The clinical manifestations and chest imaging features of perinatal tuberculosis are nonspecific. In suspected cases, it is crucial to investigate the mother's condition thoroughly and complete etiological examinations to achieve early diagnosis and timely treatment, which can improve prognosis. [ABSTRACT FROM AUTHOR]

The article discusses a case of Cushing disease presenting with hypertension in a 33-year-old woman. The patient had a history of easy bruising and a unilateral adrenal adenoma, leading to investigations for hypercortisolism. The diagnosis was confirmed as Cushing disease due to a pituitary microadenoma, which was successfully treated with transsphenoidal surgery. The article emphasizes the importance of accurate diagnosis and appropriate treatment for hypercortisolism and secondary hypertension, highlighting the impact of timely intervention on weight and metabolic health. [Extracted from the article]

Purpose: Blunt trauma often results in splenic injuries, with non-operative management (NOM) being the preferred approach for stable patients. Following NOM, splenic vascular injuries, such as pseudoaneurysms, may arise, prompting radiological follow-up. However, a consensus on optimal radiological follow-up strategies is lacking. This systematic review evaluates existing evidence on radiological follow-up post-NOM for traumatic splenic injuries. Methods: Conducting a systematic review following updated PRISMA guidelines, we searched MEDLINE, Embase, The Cochrane Library, and trial registries from January 2010 to March 2023. Inclusion criteria covered studies on radiological follow-up for blunt splenic injuries. Results: Out of 5794 studies, 17 were included involving 3392 patients. Various radiological modalities were used, with computed tomography (CT) being the most common. Vascular injuries occurred in 4.5% of patients, with most pseudoaneurysms diagnosed on day 2–6 post-trauma, and leading to intervention in 60% of these cases. Thirteen studies recommended routine follow-up, with six favouring CT, and seven supporting radiation-free modalities. Four studies proposed follow-up based on clinical indications, initial findings, or symptoms. Recommendations for specific timing of radiological follow-up ranged from 48 h to seven days post-injury. Regarding AAST grading, nine studies recommended follow-up for injury grade III and higher. Conclusion: Limited high-quality evidence exists on radiological follow-up in isolated blunt splenic injuries, causing uncertainty in clinical practice. However, our review suggests a reasonable need for follow-up, with contrast-enhanced ultrasound emerging as a promising alternative to CT. Specific timing and criteria for follow-up remain unresolved, highlighting the need for high-quality prospective studies to address these knowledge gaps. [ABSTRACT FROM AUTHOR]

The dermatological manifestations of the coronavirus cause severe acute respiratory syndrome. The current study investigates the morphological and histopathological relationship between the emergence of skin lesions and the severity of COVID‐19 across the course of the disease via a cross‐sectional study. There were skin lesions (maculopapular rash, vesiculobullous lesions, urticarial lesions, cutaneous thromboembolic "CT," and erythema multiforme‐like lesions "EM‐like") in confirmed COVID‐19 instances. A total of 150 patients of both sexes were evaluated morphologically and were classified as early (44% of the total) or late based on the emergence of respiratory symptoms (one week before or two weeks after, respectively). The early and late diagnostic groups represented 44% and 56% of the total patients, respectively. Patients with no skin lesion and one skin lesion showed a significant correlation with disease timeline early and late stages (X2 = 22.38, P < 0.001; X2 = 4.432, P < 0.001, respectively). CT and EM‐like were correlated with the disease severity, X2 = 50.51, P < 0.001; X2 = 19.186, P ≤ 0.001, respectively. In conclusion, our data suggested that the onset of dermatological lesions that developed during the COVID‐19 pandemic may be a useful diagnostic and prognostic tool for COVID‐19 severity. Therefore, a thorough examination of the skin may save time and bring physicians to an accurate diagnosis and, as a result, prompt treatment. [ABSTRACT FROM AUTHOR]

Background: Choriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy. Case presentation: A 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient's hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year. Conclusions: This case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Intolerance of uncertainty, the tendency to interpret and react negatively to uncertainty, is a transdiagnostic risk factor for anxiety, depression and eating‐related disorders. Given the high comorbidity between anxiety, depression and schizophrenia‐spectrum diagnoses (SSDs), there is potential for intolerance of uncertainty to play a role in modulating psychosis symptoms. To address this gap in our understanding, we conducted the first prospectively registered systematic review on intolerance of uncertainty and psychotic symptoms in both people with SSDs and in the general population.Four databases were searched (PsycINFO, Medline, Web of Science and PubMed), which identified ten studies with a total of 1503 participants that measured intolerance of uncertainty and psychosis symptoms.Key findings suggest the following: (1) Intolerance of uncertainty was associated with total negative psychotic symptoms with small–medium effect sizes; (2) intolerance of uncertainty was higher in individuals with an ‘at‐risk’ mental state for psychosis compared to controls; (3) higher intolerance of uncertainty was associated with more individual psychotic symptoms related to delusions and paranoia within clinical and nonclinical samples; and (4) there was mixed evidence for a relationship between intolerance of uncertainty and auditory hallucinations and intolerance of uncertainty and total positive symptoms in clinical samples.Overall, these findings highlight that intolerance of uncertainty may be an important transdiagnostic dimension and potential treatment target for psychotic symptoms such as delusions and paranoia in people with SSDs. [ABSTRACT FROM AUTHOR]

ABSTRACT Brucellosis is one of the most important zoonoses worldwide, primarily affecting livestock but also posing a serious threat to public health. The major Brucella species are known to cause a feverish disease in humans with various clinical signs. These classical Brucella species are (re‐)emerging, but also novel strains and species, some of them transmitted from rodents, can be associated with human infections. As a result of our review on rodent‐borne brucellosis, we emphasise the need for more comprehensive surveillance of Brucella and especially Brucella microti in rodent populations and call for further research targeting the ecological persistence of rodent‐associated Brucella species in the environment, their epizootic role in wild rodents and their virulence and pathogenicity for wildlife. [ABSTRACT FROM AUTHOR]

Transplant recipients who are seronegative for Toxoplasma and receive an organ from a seropositive donor are at high risk for donor‐derived toxoplasmosis in the absence of prophylaxis. While the risk in cardiac transplant recipients is well known, this infection is often underrecognized in noncardiac transplant recipients. Toxoplasmosis in transplant patients is associated with high mortality, and diagnosis is challenging as the presentation is nonspecific. Recommendations for prophylaxis in cardiac transplant recipients are well‐defined, but the optimal prophylactic strategy in noncardiac transplant recipients, especially those with sulfa allergies, is unknown. We report a case of donor‐derived disseminated toxoplasmosis in a liver transplant recipient who did not receive prophylaxis due to documented sulfa allergy. The patient subsequently underwent a challenge with trimethoprim/sulfamethoxazole and was successfully treated with this therapy. This case underscores the variable clinical presentation of donor‐derived toxoplasmosis as well as the critical importance of accurate allergy evaluation pretransplant. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dementia is increasing worldwide and many people with the condition require some level of palliative care. However, the trajectories of function and symptom burden in palliative care services at the end of life remain unclear. This study aimed to describe and compare the longitudinal trajectories of function and symptom burden among patients with dementia between hospital versus palliative community care services in the last two weeks of life. Methods: A retrospective cohort study used data from the Australian Palliative Care Outcomes Collaboration. Patients with dementia who died between 1 January 2013 and 31 December 2020 from the Australian Palliative Care Outcomes Collaboration. Four validated clinical instruments were used to collect outcomes on each individual's function and symptom distress and severity. Multilevel models were used to estimate the differences in clinical trajectories between hospital and community-based palliative care in the last two weeks of life. Results: Patients with dementia tended to have low levels of distress for most symptoms but increasing levels of functional impairment. There were no or only marginally significant differences in the symptom trajectories between the community and hospital groups (OR ranged from 0.57 to 1.97). Although clinical trajectories of function were relatively similar between two groups, statistically higher functional indicators were observed for people when admitted to community palliative care services (OR = 0.42 and 2.27, respectively). Conclusions: Our findings suggest that community-based palliative care services can be as effective as hospital-based care for many patients with dementia nearing the end of life. With appropriate support for families, community-based care could serve as a viable alternative to hospital-based care for some patients in the final stages of dementia. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion In patients with frequent premature ventricular contractions (PVCs), palpitations may not always be directly caused by PVCs, and therefore, it is essential to establish symptom‐rhythm correlations to determine the appropriate treatment. This study aims to analyze the palpitations and related factors in patients with frequent PVCs.The study enrolled patients with frequent PVCs who were not combined with other arrhythmias or structural heart disease. Through face‐to‐face consultation, patients were divided into symptomatic and asymptomatic groups. For symptomatic patients, the correlation between palpitations and PVC was further evaluated based on the temporal consistency of symptom onset and PVC occurrence. The demographic, clinical, and electrocardiogram features of the patients in each group were compared.Of the 214 patients enrolled, 124(57.9%) experienced palpitations. Compared to the asymptomatic group, the symptomatic group had a higher proportion of females (63.7% vs. 47.8%; p = .020) and a higher proportion of subjects with anxiety (44.4% vs.14.4%; p = .000). Within the symptomatic patients, 72 (33.60%) who had palpitations that were clearly correlated with PVCs were classified as the PVC‐relevant group. In this group, the PVC CI ratios were significantly lower (55% [52% −60%] vs. 62% [55% −67%]; p = .001) and the Post‐PVC CI were longer (1170 [1027–1270] vs. 1083 [960–1180] ms; p = .018) than in the PVC‐irrelevant group.A direct relationship between palpitations and PVCs could be established only in a minority of patients with frequent PVCs. PVCs with a relatively short PVC CI and a long post‐PVC CI were more likely to cause palpitations, whereas palpitations lasting only a few seconds were more likely to be directly relevant to PVCs. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Prader–Willi syndrome (PWS) is a genetic disorder characterised by hyperphagia, intellectual disability and increased propensity to a range of medical disorders. To better characterise the clinical presentation of PWS across the lifespan, this study reports on the demographics and clinical diagnosis of individuals with PWS hospitalised in the United States.The National Inpatient Sample, an all‐payor administrative claims database of hospitalisations in the United States, was queried for patients with a coded diagnosis of PWS from October 2019 through December 2021. Hospitalisations for patients with PWS were matched to five non‐PWS hospitalisations based on age, sex, year and hospital characteristics.There were 4400 (95% CI: 3,885 to 4,915) PWS hospitalisations, with a median age of 24. Compared to controls, PWS hospitalisations had longer hospital stays (median 5 vs. 3 days) and higher in‐hospital mortality (2.2% vs. 1.3%). Infectious (19.0%) and respiratory (16.2%) diagnoses were most common for PWS patients. Codes for overweight or obesity were present in 38.1% of PWS hospitalisations, with Hispanic ethnicity was associated with a higher odds of overweight/obesity in PWS patients (aOR 1.73; 95% CI: 1.11–2.71).PWS hospitalisations are characterised by higher healthcare utilisation and complexity compared to matched controls. The high prevalence of obesity and significant rates of infectious and respiratory conditions highlight specific health challenges for PWS patients. Validation of the Q87.11 administrative claims code is an essential step for ongoing health services research in this condition. [ABSTRACT FROM AUTHOR]

Summary Background Study design Objectives Methods Results Main limitations Conclusions Dentigerous cysts are well‐known congenital defects in horses, and the literature on this condition is extensive. Recently, a third type of dentigerous cyst, associated with an exostosis arising from the temporal bone, has been described. Today, computed tomography (CT) is often available and provides detailed information about the exact location and extent of dentigerous cysts, allowing for the description of new findings.This is a case series outlining the clinical, radiographic and computed tomographic features of dentigerous cysts in seven horses presented to the Equine Clinic at the Vetsuisse Faculty, University of Zurich, Switzerland.The aim of this case series was to describe the radiographic and computed tomographic findings, and the occurrence of exostoses arising from the temporal bone, in horses with dentigerous cysts.The medical records of the Equine Hospital at the University of Zurich were reviewed for horses admitted with dentigerous cysts between 2007 and 2023. Data collected and analysed included patient signalment, clinical history, clinical signs and their duration prior to referral, diagnostic imaging results, treatment and outcomes.The most common location for the cysts was the base of the ear, although in one case, the maxillary sinus was involved. Of the seven cases, four were Icelandic horses. CT proved superior to standard radiography for determining the extent and precise location of the cysts, as well as for identifying dental material and exostoses in the temporal region. CT also facilitated detailed surgical planning. All cysts were surgically removed with good long‐term outcomes.Overall, the incidence of dentigerous cysts in horses was low. The relatively high occurrence of dentigerous cysts in Icelandic horses in this study is an interesting finding, though the small sample size calls for further research.Two of the cases in this series were similar to a recently described variant of a ‘temporal dentigerous cyst associated with an exostosis in the temporal region’ and were closely connected to the bony structure and draining tract. [ABSTRACT FROM AUTHOR]

Evidence from a number of paradigms suggests that methamphetamine use is associated with increased risk for the development of Parkinson's disease and parkinsonism, and that it may be associated with the premature development of Parkinson's disease. Prevalence of Parkinson's disease and parkinsonism is greater in both methamphetamine users and people who previously used methamphetamine, and evidence from animal studies provides a plausible mechanism for this observation. Despite this increased risk, Parkinson's disease is rarely diagnosed in methamphetamine users. Reasons for this may include under‐detection, premature mortality, and individual and substance use characteristics which moderate the risk, including higher rates of smoking. Clinicians should be vigilant to signs and symptoms of Parkinson's disease and parkinsonism in methamphetamine users. [ABSTRACT FROM AUTHOR]

The article discusses a multicentre study on the impact of cigarette smoking on Behcet's disease outcomes. The study included 445 Behcet's disease patients and found that smoking was associated with higher disease severity and visual impairment. Despite no significant difference in disease activity or remission rates between smokers and non-smokers, smokers had more severe damage. The study highlights the importance of considering smoking as a factor in managing Behcet's disease. [Extracted from the article]

Aim Methods Results Conclusion To explore the optimal dose of blonanserin transdermal patch (BNS‐P) based on baseline psychiatric symptomatic characteristics during acute schizophrenia.A post hoc cluster analysis was conducted using data from a 6‐week randomized, double‐blind, placebo‐controlled study of BNS‐P (40 or 80 mg/day) in acute schizophrenia. We classified patients into three clusters based on baseline psychiatric symptoms. Efficacy was assessed using the change from baseline to week 6 in the PANSS total score. Safety was assessed by the incidence of adverse events.Among 577 patients, three clusters were identified, characterized by severe psychiatric (Cluster‐S; n = 122), predominant negative (Cluster‐N; n = 191), and predominant positive (Cluster‐P; n = 264) symptoms. In Cluster‐P, both BNS‐P 40 and 80 mg/day reduced PANSS total score significantly more than placebo (p = 0.036, effect size = 0.342; p < 0.001, effect size = 0.687, respectively). In Cluster‐S and ‐N, only BNS‐P 80 mg/day reduced PANSS total score significantly more than placebo (p = 0.045, effect size = 0.497; p = 0.034, effect size = 0.393, respectively). The effect size was greater at 80 mg/day than at 40 mg/day across all clusters. The most common treatment‐emergent adverse events were akathisia and skin‐related adverse events in all clusters.BNS‐P exhibited a dose‐dependent antipsychotic effect in all clusters, particularly highlighting its efficacy in patients with predominant positive symptoms, even at lower doses. These findings provide novel and valuable insights for determining BNS‐P dose tailoring to individual symptomatic characteristics in real‐world practice. [ABSTRACT FROM AUTHOR]

Background: Dysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD. Case presentation: An 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot's spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings. Conclusion: Dysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism. [ABSTRACT FROM AUTHOR]

Acromegaly due to ectopic secretion of growth hormone-releasing hormone (GHRH) is a rare disorder. The signs and symptoms of ectopic acromegaly are indistinguishable from acromegaly due to a somatotroph adenoma. A 35-yearold female presented with secondary amenorrhea for 10 years, intermittent headache, and reduced vision in both eyes for 4 years, which worsened over 4 months before presentation. Additionally, she was diagnosed with uncontrolled diabetes mellitus. On examination, she had coarse facial features, a fleshy nose, and acral enlargement. She had diminished visual acuity (left>right) and bitemporal hemianopia on perimetry. Biochemical investigations revealed elevated IGF-1 [588 ng/ml, reference range (RR) 100--242], markedly elevated basal growth hormone (>80 ng/ml; RR, 0.12--9.88), and hyperprolactinemia in the tumoral range (832 ng/ml; RR, 5--25). MRI sella demonstrated a 22x30x34mm sellar-suprasellar mass with T2 hypointensity. Chest imaging revealed a 75x87x106mm left lung mass, which was found to be a welldifferentiated neuroendocrine tumor (NET) on biopsy. Plasma GHRH levels were elevated [38,088 ng/l; RR, <250--300], and a diagnosis of ectopic acromegaly secondary to lung neuroendocrine tumor was considered. During workup, the patient developed in-hospital pituitary apoplexy, which improved with medical management. After a left pneumonectomy, her clinical features of acromegaly improved, her diabetes underwent remission, and there was a marked reduction in plasma GHRH and pituitary size. Histopathology was suggestive of a neuroendocrine tumor, with immunohistochemistry positive for GHRH and negative for prolactin. Her final diagnosis was ectopic acromegaly due to GHRH secreting a lung NET with pituitary somatotroph and lactotroph pituitary hyperplasia and apoplexy in the hyperplastic pituitary. [ABSTRACT FROM AUTHOR]

Self-criticism is a transdiagnostic factor of significant clinical relevance. Research has studied its detrimental role on mental health without discriminating how this differs based on individual psychological functioning. Furthermore, little research has considered the lack of emotional awareness as an essential competence that contributes to dysfunctional self-critical processes and, consequently, to psychopathological outcomes. The objective of the study was to investigate how different forms of self-criticism are associated with specific symptoms, considering social anxiety, obsessive-compulsive, and eating disorder symptoms. Furthermore, we wanted to explore the role of alexithymia in this relationship. The sample comprised 564 subjects (M = 35.12, SD = 12.8), 389 females and 175 males. Participants completed online questionnaires to investigate levels of self-criticism, alexithymia, and specific symptoms. Hierarchical regression and path analyses showed that aspects of self-criticism have different importance in psychopathological features. Furthermore, the subscales of alexithymia differently mediate the relationship between self-criticism and symptomatological features, depending on the type of feature considered (social anxiety, eating or obsessive-compulsive). In light of the results, since self-criticism is a contributing factor to the onset and maintenance of many mental disorders, it becomes important to distinguish its specific characteristics and how they are linked to the disorders. A better understanding of these processes would help to prepare more targeted interventions. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHPT) due to ectopic parathyroid adenoma is a rare case of hypercalcemia in the pediatric population. Herein, a rare case of PHPT due to ectopic intrathymic parathyroid adenoma was described in an asymptomatic 15-year-old girl who had incidental diagnosis based on laboratory abnormalities but experienced a 3-month postoperative course of persistently elevated parathyroid hormone (PTH) and hypercalcemia following the initial unsuccessful parathyroidectomy operation carried out in a non-parathyroid expert center. The curative surgical treatment was accomplished only after the patientwas reoperated with video-assisted thoracoscopic surgery (VATS) thymectomy by the surgeon experienced in parathyroid surgery with implementation of the combined imaging modalities for accurate localization of ectopic adenoma including 99mTc sestamibi (MIBI) plus neck and thoracic computed tomography (CT) and the appropriate surgical strategies including intraoperative intact PTH monitoring and frozen section diagnosis. Before the reoperation (VATS thymectomy), laboratory findings showed elevated PTH (1,171 ng/L; reference range: 21.80 ng/L-87.5 ng/L) and hypercalcemia (13.4 mg/dL; reference range: 8.4 mg/dL-10.2 mg/dL). The preoperative PTH levels were 94 ng/L at 5 min after thymectomy and 78 ng/L at 10 min. The PTH and calcium levels were 54.3 ng/L and 8.47 mg/dL, respectively, on postoperative day 1 and were 34.2 ng/L and 8.1 mg/dL on postoperative day 2. The patient was discharged on postoperative day 2 without any complications. In conclusion, our findings indicate the likelihood of isolated primary hyperparathyroidism to be incidentally diagnosed based solely on laboratory abnormalities with no specific clinical manifestations in the pediatric age. In addition, using combined imaging modalities (such as MIBI and CT) in accurate localization of ectopic parathyroid adenoma and implementation of surgery by experienced surgeons along with intraoperative intact PTH monitoring and frozen section diagnosis seem crucial to ensure the curative surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause diverse clinical manifestations in multiple organ systems. Child-onset SLE (cSLE) is associated with significantly higher morbidity and mortality than adult-onset SLE. The traditional treatments for SLE (glucocorticoids, antimalarials, conventional and biological diseasemodifying antirheumatic drugs) often have significant adverse effects and may not fully control disease activity. Tofacitinib is an oral Janus kinase (JAK) inhibitor that inhibits the JAK-STAT pathway and has the potential to reduce SLE severity. Methods: cSLE patients who received tofacitinib and had at least one follow-up visit were retrospectively examined. Case histories, laboratory test results, and treatment regimens were analyzed at disease onset, initiation of tofacitinib treatment, and 1, 3, 6, 9, 12, 18, and 24 months after starting tofacitinib. Results: We examined 9 patients with refractory cSLE. All patients were female and the average age at diagnosis was 10.67 years. At initiation of tofacitinib, the average age was 13.28 years and the average disease duration was 2.62 years. Four patients experienced alleviation of symptoms and reduced their daily prednisone dosages; one of them also discontinued cyclosporine A and two of them also discontinued belimumab. The other 5 patients experienced no apparent benefit. Conclusion: Tofacitinib may provide clinical benefits for some patients with refractory cSLE, and can also allow reduction in the glucocorticoid dosage. Tofacitinib has the potential as an adjunctive treatment for some patients with cSLE. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19, triggered by the SARS-CoV-2 virus, has varied clinical manifestations, ranging from mild cases to severe forms such as fatal pneumonia and acute respiratory distress syndrome (ARDS). Disease severity is influenced by an exacerbated immune response, characterized by high proinflammatory cytokine levels. Inhibition of AKT can potentially suppress pathological inflammation, cytokine storm and platelet activation associated with COVID-19. In this study, we aimed to investigate the rs2494746 and rs1130214 variants in the AKT1 gene associated with severe COVID-19 outcomes. Methods: Peripheral blood samples and sociodemographic data from 508 individuals with COVID-19, measuring plasma cytokine concentrations using ELISA and genotyped the AKT1 variants. Results: The rs2494746-C allele was associated with severity, ICU admission, and death from COVID-19. The C allele at rs1130214 was linked to increased TNF and D-dimer levels. Moreover, both variants exhibited an increased cumulative risk of disease severity, ICU admission, and mortality caused by COVID-19. In the predictive analysis, the rs2494746 obtained an accuracy of 71%, suggesting a high probability of the test determining the severity of the disease. Discussion: Our findings contribute to understanding the influence of the AKT1 gene variants on the immunological damage in individuals infected with SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Objective: This study aims to analyze the clinical features, Radiological findings and diagnostic characteristics (tissue biopsy, flow cytometry and cerebrospinal fluid cytology) of primary central nervous system lymphoma (PCNSL). To improve the diagnosis of the disease. Methods: A total of 19 patients with primary central nervous system lymphoma admitted to the Second Hospital of Hebei Medical University from 2014 to 2023 were selected. The clinical data of the patients were retrospectively analyzed. Combined with the relevant literature, the clinical characteristics of PCNSL patients were analyzed to assist the diagnosis. Result: Most of the patients were middle-aged and elderly patients (65 years old), and the main clinical manifestations showed no obvious specificity, including headache, dizziness and limb weakness. Radiological findings showed that common site of currence were located in the brain parenchyma. The PCNSL subtype of 19 patients was all diffuse large B cell subtype by cytology, flow cytometry or histopathology. Six cases were diagnosed by biopsy pathology and 11 cases were diagnosed by flow cytometry of cerebrospinal fluid. In all patients diagnosed with PCNSL by clinical cytology (CSF cytology and flow cytometry), abnormal cells were found on CSF examination. Conclusion: The pathological type of primary central nervous system lymphoma was diffuse large B-cell subtype, with diverse clinical manifestations and multiple. Both tissue directed biopsy and flow cytometry could effectively assist clinical diagnosis. Early and timely diagnosis and intervention are of great significance for delaying the disease process and reducing the economic burden of patients and families. [ABSTRACT FROM AUTHOR]

Eagle syndrome is defined as an elongated styloid process (ESP) that compresses nearby vasculo-nervous structures. The vascular variant of Eagle syndrome can lead to neurological symptoms including syncope, transient ischemic attack, or stroke; however, it has also been associated with other atypical presentations, making its diagnosis challenging. This review aimed to depict the characteristics of patients with the symptomatic vascular variant of Eagle syndrome. The literature search identified 56 reported cases of vascular variants of Eagle syndrome, with a mean age at onset of 51 years (range: 15-85 years), and the male-to-female ratio was 2:4. The ESP was bilateral in 63% of the cases, and the mean length was 48 mm (range: 31-77 mm). Vascular complications were mostly represented by internal jugular vein (IVJ) stenosis (n = 28), followed by internal carotid artery (ICA) dissection (n = 15). Additionally, eight cases of ICA thrombosis and two cases of severe chronic stenosis of the ICA > 90% were reported. Vascular complications may lead to cerebral ischemia due to either a thromboembolic mechanism or, less frequently, reduced blood flow. Laminar cortical necrosis, as a cerebral complication of ICA compression, was exceptionally described in one case, and such an atypical clinical presentation may be regarded as a diagnostic pitfall. [ABSTRACT FROM AUTHOR]

Introduction: Patients with spontaneous intracranial hypotension (SIH) frequently present with several symptoms and impaired mental health. This study systematically investigates the somatic and mental symptom burden of SIH and the effect of surgical treatment. Methods: In this single-center retrospective study, patients with surgical closure of a spinal cerebrospinal fluid leak between September 2022 and July 2023 completed the Somatic Symptom Scale (SSS-8), the Somatic Symptom Disorder - B Criteria Scale (SSD-12), and the Patient Health Questionnaire (PHQ-8) preoperatively and three and 6 months postoperatively. Results: Fifty-seven patients were included. All three scores showed clearly pathological values before surgery (SSS-8: 12 [IQR 6.5-16], SSD-12: 26 [IQR 19.5-33.5], PHQ-8: 11 [IQR 6.5-15]) representing a high somatic symptom burden and relevant current depression. After surgery, there was a significant and sustainable improvement (SSS-8: 8 [IQR 3-11.75], SSD-12: 12.5 [IQR 5-21.75], PHQ-8: 4.5 [IQR 2-9], p < 0.001, respectively) that exceeded the minimal clinically important difference for every score. Conclusion: SIH presents with high somatic and mental symptom burden. Surgical treatment leads to a relevant improvement of somatic and depressive symptoms. However, even after surgical success some patients still exhibit elevated depressive scores. Depressive symptoms might be added to the typical symptomatology of SIH. [ABSTRACT FROM AUTHOR]

Background: Evidence on long COVID symptom clustering patterns among patients with COVID-19 is limited. We summarized long COVID symptoms in clusters defined by number of symptoms co-occurring together, and we assessed Health-Related Quality of Life (HQRoL), Work Productivity and Activity Impairment (WPAI) outcomes across these clusters over time. We assessed associations between the clusters and BNT162b2 vaccination status. Methods: A prospective longitudinal patient-reported outcomes (PRO) study recruited laboratory-confirmed symptomatic COVID-19 patients seeking testing from a national retail pharmacy. Long COVID-19 symptoms were self-reported by participants at 4-week, 3-month and 6-month surveys. Patient classes identified via latent class analysis (LCA) with long COVID-19 symptoms were simplified into clusters based on number of symptoms. HRQoL and WPAI outcomes were collected using EQ-ED-5L and WPAI: GH questionnaires. Mixed models for repeated measures analyses were conducted to examine associations between exposure groups and outcomes. Results: The study included 328 participants that were segmented into three groups of long COVID-19 symptoms based on LCA and then simplified by the number of symptoms (Cluster 1 low, <2; Cluster 2 moderate, 2–6; and Cluster 3 high, >6 symptoms). The number of long COVID-19 symptoms was negatively associated with HRQoL and WPAI, whereby participants with high symptom burden (>6 symptoms) had the lowest HRQoL and WPAI scores assessed by absenteeism, presenteeism, work productivity loss, activity impairment, and hours worked metrics. Compared with those unvaccinated and not up-to-date with COVID-19 vaccination, subjects boosted with BNT162b2 consistently reported less symptom burden during the follow-up, regardless of their symptom-based cluster. Conclusion: Three distinct patient clusters based on frequency of long COVID symptoms experienced different HRQoL and WPAI outcomes over 6 months. The cluster with more concomitant symptoms experienced greater burden than the others. Participants up-to-date with BNT162b2 reported lower symptom burden across all clusters and timeframes. Clinical trial registration: Clinicaltrials.gov NCT05160636. [ABSTRACT FROM AUTHOR]

Introduction: In spite of rapid advances in evidence-based treatments for attention deficit hyperactivity disorder (ADHD), community access to rigorous gold-standard diagnostic assessments has lagged far behind due to barriers such as the costs and limited availability of comprehensive diagnostic evaluations. Digital assessment of attention and behavior has the potential to lead to scalable approaches that could be used to screen large numbers of children and/or increase access to highquality, scalable diagnostic evaluations, especially if designed using user-centered participatory and ability-based frameworks. Current research on assessment has begun to take a user-centered approach by actively involving participants to ensure the development of assessments that meet the needs of users (e.g., clinicians, teachers, patients). Methods: The objective of this mapping review was to identify and categorize digital mental health assessments designed to aid in the initial diagnosis of ADHD as well as ongoing monitoring of symptoms following diagnosis. Results: Results suggested that the assessment tools currently described in the literature target both cognition and motor behaviors. These assessments were conducted using a variety of technological platforms, including telemedicine, wearables/sensors, the web, virtual reality, serious games, robots, and computer applications/software. Discussion: Although it is evident that there is growing interest in the design of digital assessment tools, research involving tools with the potential for widespread deployment is still in the early stages of development. As these and other tools are developed and evaluated, it is critical that researchers engage patients and key stakeholders early in the design process. [ABSTRACT FROM AUTHOR]

Radioligand therapies such as [177Lu] Lu-PSMA-617 have gained significant momentum in cancer treatment after clinical trials and multicenter studies demonstrated their safety and efficacy. As these innovative treatments become more widespread, rare and unique clinical manifestations are expected to be observed. In this report, we describe a case with metastatic castration-resistant prostate cancer (mCRPC) and peripancreatic lymph node metastases who developed acute pancreatitis following [177Lu] Lu-PSMA-617 therapy. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, with a date restriction from 2012 to April 2024, but without language limitations. The review included studies conducted in high-income countries on antibiotic therapy in children over 3 months of age diagnosed with mild-moderate CAP. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. Amoxicillin is the first-line treatment if the child is at least immunized against Haemophilus influenzae type b (low/very low quality of evidence, strong recommendations), while amoxicillin-clavulanate or second- or third-generation cephalosporins should be prescribed for those unimmunized or with incomplete immunization coverage for both H. influenzae type b and Streptococcus pneumoniae (low/very low quality of evidence, strong recommendations). Macrolides should be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 h of therapy (low/very low quality of evidence, strong recommendations). The dosage of amoxicillin is 90 mg/kg/day divided in three doses, although two doses could be considered to improve compliance (moderate quality of evidence, weak recommendations). A five-day duration of therapy is recommended, with clinical monitoring and re-assessment approximately 72 h after the start of antibiotic treatment to evaluate symptom resolution (moderate quality of evidence, strong recommendations). To improve the management of CAP in pediatric patients, we have developed this consensus based on a thorough review of the best available evidence and extensive discussions with an expert panel. However, further efforts are needed. Future research should focus on enhancing diagnostic accuracy, optimizing antibiotic utilization, comparing the efficacy of different antibiotic regimens, and determining the optimal dosage and duration of treatment in different setting. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is currently considered the most common bone disease in the world and is characterized by low bone mass, deterioration of the bone tissue microstructure, and decreased bone strength. With the increasing popularity of smartphones and short videos, many patients search for various types of health information through social media, such as short videos. As one of China's short video giants, TikTok has played a significant role in spreading health information. We found that there are many videos about osteoporosis on TikTok; however, the quality of these short videos has not yet been evaluated. Objective: The purpose of this study was to evaluate the information quality of osteoporosis videos on the domestic TikTok platform. Methods: We retrieved and screened 100 videos about osteoporosis from TikTok, extracted the basic information, encoded the video content, and recorded the source of each video. Two independent raters evaluated the information quality of each video via the DISCERN rating scale. Result: The videos were divided into three groups according to their source: medical personnel, science communicators, and news media, with medical personnel posting the most videos. The content of the video is divided into 7 groups, namely, disease prevention, disease diagnosis, disease symptoms, disease overview, life-style, drug knowledge, and drug treatment, with the most videos related to disease overview. The average DISCERN score of the videos is 37.69 (SD = 6.78), mainly within the 'poor' (54/100, 54%) and 'appropriate' (43/100, 43%) rating ranges, with overall quality being low. Further analysis revealed a positive correlation between the number of shares, comments, likes, and favorites, and a positive correlation between the DISCERN score and the number of shares and favorites. Conclusion: The overall quality of videos concerning osteoporosis on TikTok is lower, but the quality of videos varies significantly across different sources. We should be selective and cautious when watching videos about osteoporosis on TikTok. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), and Neisseria meningitidis (N. meningitidis) are leading causes of childhood bacterial meningitis and preventable by vaccines. The aim of this hospital-based sentinel surveillance is to describe the epidemiological characteristics of pneumococcal meningitis, including disease burden, and to provide baseline data on pneumococcal serotype distribution to support decision making for pneumococcal conjugate vaccine (PCV) introduction in Vietnam. Methods: Surveillance for probable bacterial meningitis in children 1–59 months of age is conducted in three tertiary level pediatric hospitals: one in Hanoi and two in Ho Chi Minh City. Cerebrospinal fluid (CSF) specimens were collected via lumbar puncture from children with suspected meningitis. Specimens were transferred immediately to the laboratory department of the respective hospital for cytology, biochemistry, and microbiology testing, including culture. PCR testing was conducted on CSF specimens for bacterial detection (S. pneumoniae, H. influenzae, and N. meningitidis) and pneumococcal serotyping. Results: During 2015–2018, a total of 1,803 children with probable bacterial meningitis were detected; 1,780 had CSF specimens available for testing. Of 245 laboratory-confirmed positive cases, the majority were caused by S. pneumoniae (229,93.5%). Of those with S. pneumoniae detected, over 70% were caused by serotypes included in currently available PCV products; serotypes 6 A/6B (27.1%), 14 (19.7%), and 23 F (16.2%) were the most common serotypes. Children with laboratory-confirmed pneumococcal meningitis were more likely to live in Hanoi (p < 0.0001) and children 12–23 months of age were at greater odds (OR = 1.65, 95% CI: 1.11, 2.43; p = 0.006) of having confirmed pneumococcal meningitis compared to children < 12 months of age when compared to those without laboratory-confirmed bacterial meningitis. Additionally, children with confirmed pneumococcal meningitis were more likely to exhibit signs and symptoms consistent with clinical meningitis compared to negative laboratory-confirmed meningitis cases (p < 0.0001) and had a greater odds of death (OR = 6.18, 95% CI: 2.98, 12.86; p < 0.0001). Conclusions: Pneumococcal meningitis contributes to a large burden of bacterial meningitis in Vietnamese children. A large proportion are caused by serotypes covered by PCVs currently available. Introduction of PCV into the routine immunization program could reduce the burden of pneumococcal meningitis in Viet Nam. [ABSTRACT FROM AUTHOR]

Background: Diagnosing neurodevelopmental disorders can sometimes be challenging, especially when the clinical presentation is different from what is normally observed. Evaluating executive functions can provide valuable information about children's and adolescents' mental states. There is no available executive function rating scale for Azerbaijani. From this perspective, there is great utility in translating and validating the Barkley Deficits in Executive Functioning Scale – Children and Adolescents (BDEF-CA). For this research, we decided to use the short form of the BDEF-CA. The rating scale was translated into the Azerbaijani by a bilingual clinical psychologist and by a professional translator. After performing backward translation, the final version was prepared, read and approved by two professors in the psychology department at the university. The study population included 148 parents of children aged 6-17 years (78 males and 70 females). Results: The findings of this research support the validity and reliability of the Azerbaijani translation of the BDEF-CA short version (Cronbach's alpha and McDonald's omega coefficient were both greater than 0.9, and Confirmatory Factor Analysis (CFA) results indicated an adequate fit). Conclusion: The short version of the Azerbaijani translation of the BDEF-CA could be used for assessing executive functioning deficits in children and adolescents. [ABSTRACT FROM AUTHOR]

The efficacy and safety of revision microscopic microvascular decompression (microscopic MVD) for treating residual or recurrent hemifacial spasm (HFS) remain uncertain. We conducted a systematic review and meta-analysis to evaluate the benefits and risks associated with this reoperation, focusing primarily on spasm relief, facial palsy, and hearing impairment. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We performed a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library for eligible articles from their inception through June 2024. A total of 17 studies involving 719 patients were included in this meta-analysis. Among these patients, 668 experienced overall symptom relief following reoperation, resulting in a relief rate of 94% (95% CI: 92–96%). Complete relief was achieved in 603 patients, corresponding to a rate of 87% (95% CI: 80–93%). Transient facial palsy developed in 4% (95% CI: 1–8%) of patients, while persistent facial palsy was observed in 5% (95% CI: 2–8%) of patients following reoperation. Transient hearing impairment occurred in 1% (95% CI: 0–3%) of patients, while persistent hearing impairment was reported in 4% (95% CI: 1–7%) of patients. Patients with recurrent HFS have significantly lower overall and complete relief rates after reoperation compared to those with residual HFS and are at higher risk of long-term hearing loss. Our study suggests that reoperation for residual or recurrent HFS after microscopic MVD could be considered a safe and effective treatment option. Early reoperation may be indicated in specific cases, and the timing should be tailored to each patient's specific circumstances to optimize outcomes. [ABSTRACT FROM AUTHOR]

Background: This study investigated for a possible contributing role of hippocampus in the different clinical phenotypic manifestations of migraine aura. Methods: Herein, patients were categorized as those with pure visual aura (MwAv), those who reported additional somatosensory and dysphasic symptoms (MwAvsd), and healthy controls (HCs). Neuroimaging data obtained using FreeSurfer-based segmentation of hippocampal subfields were compared between HCs and patients with migraine with aura, as well as between HCs and those with MwAv and MwAvsd. The average migraine aura complexity score (MACS) was calculated for each patient to investigate the correlation between hippocampal subfield volume and migraine aura complexity. Results: Herein, 46 patients with migraine with aura (28 MwAvsd and 18 MwAv) and 31 HCs were included. There were no significant differences in the hippocampal subfields between HCs and patients with migraine with aura. The average MACS negatively correlated with the volumes of the left and right hippocampi, Cornu Ammonis (CA) 1, CA3, CA4, molecular layer, left granule cell layer of the dentate gyrus, hippocampal fissure, and hippocampus-amygdala transition area. The MwAvsd subgroup had significantly smaller whole hippocampal volumes in both hemispheres, as well as in both subicula, compared with the MwAv subgroup and HCs. In addition, the left molecular layer, right CA1, and hippocampal fissures were significantly smaller in the MwAvsd group than in the MwAv subgroup and HCs. Conclusions: Smaller left and right hippocampal volumes, particularly of the subiculum/CA1 area, may play an important role in the pathophysiology of somatosensory and dysphasic symptoms in migraine with aura. [ABSTRACT FROM AUTHOR]

Abstract\nHIGHLIGHTSMesoporous bioactive glass, with its versatile characteristics and morphology, holds significant potential as an ideal hemostatic material. However, limited data is available regarding its toxicity levels. Consequently, this research intends to assess the acute and repeated dose dermal toxicity of Mesoporous antibacterial bioactive glass microsphere impregnated nonwoven surgical cotton gauze (MABGmscg) dressing in albino Wistar rats, following the standards set by the Organization for Economic Cooperation and Development. In the acute dermal toxicity study, the impact of MABG (@2000mg/kg BW) mscg dressing was assessed following a single dermal application in both male and female Wistar rats (n = 10). Mortality, clinical signs, body weight fluctuations and gross observations were consistently monitored over a14 day period following the single dose. The results indicated that, MABG (@2000mg/kg BW) mscg dressing upon dermal exposure did not cause any adverse effect in acute dermal toxicity study in Wistar rats compared to control group. Given that 2000 mg/kg BW of MABG was deemed a nontoxic dose, a repeated dose dermal toxicity study of MABGmscg dressing was subsequently conducted at three dose levels (@200, 500, 1000 mg/kg BW) over 28 consecutive days in Wistar rats. During the study period, no unscheduled deaths occurred, and there were no clinical signs associated with treatment, body weight variations or abnormal gross findings at necropsy in any groups. The analysis concluded that, MABGmscg dressing is safe to be considered as a hemostatic dressing at the various tested dose levels in Wistar rats.A dressing composed of mesoporous antibacterial bioactive glass impregnated into nonwoven surgical cotton gauze (MABGmscg) has been developed to serve as an effective hemostatic material.The acute and repeated dose dermal toxicity study of MABGmscg dressing has been performed in Wistar ratsNo visible changes or systemic effects were observed after applying the MABGmscg dressing at different doses for 28 consecutive days in Wistar rats.Therefore, the MABGmscg dressing is considered safe for use as a hemostatic gauze.A dressing composed of mesoporous antibacterial bioactive glass impregnated into nonwoven surgical cotton gauze (MABGmscg) has been developed to serve as an effective hemostatic material.The acute and repeated dose dermal toxicity study of MABGmscg dressing has been performed in Wistar ratsNo visible changes or systemic effects were observed after applying the MABGmscg dressing at different doses for 28 consecutive days in Wistar rats.Therefore, the MABGmscg dressing is considered safe for use as a hemostatic gauze. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionThis study aimed to analyze the demographic characteristics, symptoms, and treatment outcomes of patients diagnosed with May-Thurner syndrome (MTS) using computed tomography venography (CTV).Medical records of patients diagnosed with MTS through CTV at Hebei General Hospital of China between April 1, 2017, and May 31, 2022, were reviewed. The data collected included: (1) gender, age, body mass index (BMI), and smoking and drinking habits; (2) time of onset and symptoms of MTS, as well as other accompanying symptoms; (3) additional diagnoses, length of hospital stay (days), treatment methods, treatment success, and the occurrence of post-treatment bleeding or recurrence. Descriptive statistics were used, with mean ± standard deviation and median values reported. The t-test/u-test and Chi-square test (including the exact probability method) were used to compare means and rates, respectively, with a significance level set at α = 0.05.Out of 402 patients (233 males, 169 females), 118 (29.4%) were diagnosed with MTS, with 47 (21.1%) males and 71 (39.7%) females. The incidence of MTS was significantly higher in females than males (χ2 proportion = 16.545, χ2 composition = 9.763, p < 0.05). The average ages of male and female MTS patients were 56.4 and 59.9 years, respectively, with mean BMIs of 27.05 and 27.09 kg/m2. Among male patients, 27.7% (13) were smokers, and 17.0% (8) consumed alcohol. Inferior vena cava (IVC) thrombosis was notable in 59.3% of MTS patients, with a significantly higher proportion in females (70.4%) than in males (42.6%) (χ2 = 9.102, p < 0.05). Lower limb swelling without pain was reported by 70.3% of patients, with 53.4% (44.7% male, 59.2% female) experiencing swelling on the left side only, which was significantly more common than swelling on the right side only or both sides (χ2 = 44.554, p < 0.05). Additionally, 12.7% of patients reported both swelling and pain, with left-side symptoms being more prevalent than right-side or both sides. The average ages at symptom onset were 51.3 ± 17.1 years in males and 57.1 ± 13.2 years in females. All treatments for MTS were successful without bleeding or recurrence. The most common treatment method was balloon dilation combined with stent placement (57.6%).CTV is highly effective in detecting and facilitating the successful treatment of MTS. It should be fully utilized to promote early diagnosis and treatment of MTS. Female MTS patients need more medical resources for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Cutaneous reactions to povidone (PVP)‐iodine are widely reported; however, distinction between allergic and irritant reactions can be challenging. Free iodine is responsible for irritant reactions and is released when PVP‐iodine is in a liquid state. The aim of this study was to review the clinical presentation and results of patch testing in patients with PVP‐iodine contact dermatitis. A systematic review was conducted by searching Pubmed, MEDLINE, and Google Scholar databases for reports of contact dermatitis secondary to PVP‐iodine. Data were collated including study design, patient age and gender identity, iodine exposure, skin biopsy findings, and patch test methodology and results. The search revealed 187 reports with 38 eligible studies; 30 case reports/case series and 8 retrospective cohort studies. Overall, there were 223 patients with PVP‐iodine contact dermatitis. The commonest reaction was irritant contact dermatitis (51%), followed by allergic contact dermatitis (40%) and contact dermatitis not further specified (9%). Irritant reactions were characterised by burn‐like morphology and, when due to surgical skin disinfectant, were often distant from the surgical incision site. Patch testing was most often performed with a 10% PVP‐iodine aqueous solution; however, irritant reactions in controls occur. Various testing methods including iodine in petrolatum, ethanol, dried powder, and open application testing were described. Most reactions to PVP‐iodine are irritant and patch testing using a closed‐chamber method yields inconsistent results due to risk of irritation from free iodine release over the 2‐day occlusion time. Surgeons should be aware of the risk of prolonged skin contact with wet iodine solution. [ABSTRACT FROM AUTHOR]