Generalized morphea profunda following COVID-19 messenger ribonucleic acid vaccination.

Bilateral Stereotactic Thalamotomy for Bilateral Musician's Hand Dystonia

To examine clinical preoperative and postoperative symptoms and changes in exotropia according to constancy and age. A survey was conducted of 50 patients on the day before and 1 month after exotropia surgery. Survey results were analyzed by type of exotropia at presentation and age. Changes in subjective symptoms from preoperatively to postoperatively were examined for stereopsis (5 items), asthenopia (5 items), and appearance (5 items). Each item was rated on a 5-point scale ranging from 0 to 4. The mean age of the 50 patients was 10.6 ± 7.75 years, and there were 21 (41.2%) males and 29 (56.9%) females. Thirty-two patients with intermittent exotropia had no significant improvement in the stereopsis or asthenopia symptoms. However, they showed significant (P < .05) improvement in the appearance symptoms of squint and out of focus. Eighteen patients with constant exotropia showed significant improvements in the symptoms of tripping over objects or running into a wall in stereopsis and of squint and out of focus in appearance (P < .05). Postoperatively, all patients had significant improvement in appearance-related symptoms regardless of age (P < .05). Patients with constant exotropia had improved symptoms in stereopsis, asthenopia, and appearance after surgery. Appearance was improved regardless of the type of exotropia or age.

Older women with fecal incontinence (FI) who underwent diet modification intervention (DMI) showed significant improvement in FI symptoms. It is unclear whether improvement in symptoms was associated with objective changes in dietary intake quality. The primary aim was to determine if improvement in overall dietary intake quality was associated with improvement in FI symptoms. Our secondary aim was to evaluate whether individual food group consumption changes were associated with changes in FI symptoms. This was an ancillary analysis of a prospective cohort study of women aged 65 years and older with FI who underwent DMI. Seven-day diet-and-bowel diaries at baseline and 6 weeks after DMI were examined for how frequently participants consumed food categories and FI triggers. Adherence to recommended dietary guidelines was assessed between 2 and 4 weeks using a 24-hour diet recall. Baseline and postintervention consumption were compared using the Wilcoxon signed rank test. Spearman correlation was used to compare dietary intake changes with FI symptom changes. Twenty-four women completed the 24-hour diet recalls, and 17 women completed the 7-day diet-and-bowel diaries at baseline and 6 weeks. More participants who were adherent had clinically significant improvement in symptoms compared with those who were not adherent (70% vs 30%, P =0.57). Decreased consumption of saturated fats ( P =0.01) and fried foods ( P <0.001) was associated with improvement in FI symptoms. In this small population, overall dietary intake quality was not associated with change in FI symptom improvement. Decreased intake of saturated fat and fried food was associated with FI symptom improvement.

The safety and clinical efficacy of superficial temporal artery-middle cerebral artery bypass grafting combined with superficial temporal artery branching and cerebral-dural-temporal vascular grafting in the treatment of adult moyamoya disease are investigated. A retrospective analysis of the data of 22 adult patients with moyamoya disease who underwent superficial temporal artery-brain artery bypass grafting combined with superficial temporal artery branching and cerebral-dural-muscle vascular stenting from June 2012 to June 2018 is performed to analyze the patient’s treatment outcome, functional recovery, and complications. Among the 22 patients, 17 (77.3 %) patients have improved clinical symptoms 1 w after surgery, and 5 patients (22.7 %) have no significant improvement in symptoms. After 3 mo follow-up, 21 patients (95.5 %) have significant improvement in clinical symptoms and spontaneous living ability compared with preoperative, and 1 patient (5.3 %) has no improvement in symptoms of new cerebral infarction. In patients with ischemic moyamoya disease, the clinical symptoms and quality of life of patients with superficial temporal artery-middle cerebral artery bypass graft combined with superficial temporal artery branching and cerebral-dural-temporal muscle vascularization are significantly improved. It shows that it can improve the prognosis of patients with ischemic moyamoya disease and has important clinical significance for the recovery of neurological function and the improvement of quality of life.

Disclosure: M.K. Shakir: None. H. Babu: None. N.O. Vietor: None. A.J. Spiro: None. T.D. Hoang: None.Background: Clomiphene Citrate (CC), a selective estrogen receptor modulator, is widely used for treating male hypogonadism. Although serum testosterone (T) levels show a diurnal variation, it is not clear whether patients receiving CC demonstrate such diurnal variation. The diurnal variation of serum T was analyzed in 3 CC-treated patients with secondary hypogonadism. Methods: The serum T was drawn at 7AM while fasting, 11AM before lunch, and 4PM before dinner. T levels were assayed by LC/MS LabCorp TM. Case 1. A 48-year-old man presented with symptoms of hypogonadism. Lab Results: Serum T 148 ng/dL, FSH 4.8 mlU/mL, LH 9.2 mIUL, prolactin 9.6 ng/mL and IGF-1 168 ng/mL. Pituitary MRI revealed a 4 mm pituitary tumor (non-functioning). After counseling, patient was placed on CC 25 mg every other day. Patient noted improvement in hypogonadism symptoms and pituitary MRI remained stable. T levels performed 12 months later showed the following values: T: 7 AM 438 ng/dL; 11AM 399 ng/dL; and 4 PM 378 ng/dL. Case 2. A 38-year-old man presented with symptoms of hypogonadism. Laboratory values: Serum T 154 ng/dL, FSH 4.9 mIU/mL. LH 5.8 mIU/mL, prolactin 9.8 ng/mL, IGF-1 198 ng/mL. Pituitary MRI was normal. He was treated with CC 25 mg every other day. Six months later, T level showed the following values: T 7 AM 326 ng/dL; 11 AM 411 ng/dL; and 4 PM 458 ng/dL. He also had significant improvement in symptoms. Case 3. A 52-year-old man was seen for evaluation of erectile dysfunction and secondary hypogonadism. Laboratory values: Serum T 138 ng/dL, FSH 3.0 mIU/mL, LH 7.1 mIU/mL, prolactin 11.8 ng/mL, IGF-1 138 ng/mL. Pituitary MRI was normal. Patient was treated with CC 50 mg every other day and 9 months later T values were: T 7 AM 478 ng/dL; 11AM 412 ng/dL and 4 pm 398 ng/dL. He noted significant improvement in hypogonadal symptoms. Conclusion: In this case series the serum T levels did not show any diurnal variation. The exact significance of a steady state serum T levels during daytime is not clear. Further studies involving a large number of patients are needed.Presentation: Saturday, July 12, 2025

Abdominoperineal resection (APR) is a disfiguring procedure, frequently associated with significant urogenital dysfunction. The aim of this prospective study was to repeatedly assess quality of life (QoL) 1, 6, and 12 months after APR. Twenty patients who underwent APR between June 2002 and September 2005 were considered for analysis. QoL was assessed using two self-rating validated questionnaires developed by the European Organization for Research and Treatment of Cancer (EORTC). All patients were free of recurrence at time of last interview. At 1-year follow-up patients reported significant improvement in global QoL [scores: 53 +/- 23 (1 month) vs. 70 +/- 15 (1 year), P = 0.01], and physical function (74 +/- 16 vs. 91 +/- 12, P = 0.001). Patients also reported significant improvement in symptoms such as fatigue (39 +/- 30 vs. 15 +/- 19, P = 0.01); and pain (33 +/- 31 vs. 10 +/- 14, P = 0.01). By contrast, there was no improvement at 1 year for the following items: body image (75 +/- 33 vs. 75 +/- 30, P = 0.99), sexual dysfunction (10 +/- 21 vs. 21 +/- 27, P = 0.40); and stoma-related problems (19 +/- 14 vs. 11 +/- 28, P = 0.34). One year after APR, patients demonstrated significant improvement in global QoL and tumor-related symptoms, while body image remained significantly altered. Similarly, treatment-related side effects did not improve over the time period considered.

Introduction:The adolescent clinic is a tertiary referral clinic including patients with a wide variety of complex gastroenterology conditions predominantly tertiary referrals fromGreat Ormond Street Hospital transition clinic. Purpose: To assess the benefit of the low FODMAP diet versus the “Milk, egg, wheat and soya” (MEWS) free diet for symptom control in patients with functional gut disorders and/or food allergy from June 2013 to June 2015.Methods:A total of 436 patients were seen during this time period for dietetic advice and the age range varied from 13–21 years old with 43terms of diagnosis used. These included the broad categories of inflammatory bowel disease, food allergy, functional gut conditions, congenital gut disorders, autoimmune disorders and oncology conditions. For functional gut disorders/food allergy there were 14 terms used which varied from “Functional gut disorder” to “Irritable bowel syndrome” and also included patients with delayed gastric emptying. For patients with food allergy the terms “multiple food allergy” or EosinophilicOesophagitis or Colitis were used. A total of 40 patients with functional gut disorders were referred for the MEWS or low FODMAP diet. The efficacy of the diet was measured using a symptom scale pre and post dietary intervention assessing if patients symptoms changed from nil/mild/moderate tosignificant. The results indicate whether the presenting predominant symptom e.g., bloating, constipation or abdominal pain improved following the dietary intervention.Results:A total of 29 patients were seen for the “MEWS” free diet.These were 17 functional, 3 food allergy, 6 IBS, 2 EosinophilicOesophagitis, 1 oncology patient. The age ranged from 14 to 21 and average ageat treatment was 16.6 years old with 11 males and 18 females. 13 patients were referred for the low FODMAP diet. The patients referred for the low FODMAP diet were 7 with a functional gut disorder, 5Irritable Bowel Syndrome and1 EosinophilicColitis. The age range was 14 to 19 years old with average age at treatment 16.3 years old. There were 6 males and 7 females. The success rate of the MEWS diet measured by reported significant improvement in predominant presenting symptom was 14/29 (48.2%),moderate 4/29 (13.7%) mild 2/29(6.9%) and 9/29 (31%) nil improvement. For the low fodmap diet 6/13 (46.1%) of patientsreported a significant improvement in symptoms,0/13 (0%) moderate,mild 2/13 (15.4%)and 5/13 (38.5%) had nil improvement.Conclusions:This review suggests that although there were larger referral rates for the MEWS diet both the MEWS and low FODMAP diet appear to beequally effective dietary approaches for treating patients with functional gut disorders and/or food allergy.

Buserelin, an LHRH agonist, was given by nasal spray to 20 women with premenstrual syndrome. In 10 women benefits were such that they continued treatment for periods varying from 5 to 15 months. There were significant improvements in mood and physical symptoms, and side-effects such as hot flushes were mild. The remaining 10 women were all made worse by the spray and stopped it within 2 months. Ovulation was blocked in all women though six showed evidence of ovulation during the first treatment month, and two women later in treatment. Of the long-term group, six eventually became amenorrhoeic, and four continued to menstruate. There was a significant improvement in symptoms during treatment in the long-term group. Physical symptoms continued to be worse before any menstrual bleeding. Mood change lost its relationship to menstruation. The adverse effects in the short-term group were sometimes severe and it is necessary to identify the characteristics of the woman who are likely to show such reactions before recommending this treatment for more general use.

The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid (HA) 1.6% and chondroitin sulfate (CS) 2.0% in patients with refractory painful bladder syndrome/interstitial cystitis (PBS/IC) and to observe their impact on Quality of Life. Twenty-three women were enrolled. They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months. Mean follow-up after completion of therapy was 5 months. We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency (p = 0.045), urgency (p = 0.005), and pain (p = 0.001). The O'Leary-Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index resulted in a significant improvement in both scores (p = 0.004 and 0.01, respectively). The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score (p = 0.001). This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC.

Wilson disease is an inherited disorder that results in copper accumulation in the tissues with liver injury and failure. Orthotopic liver transplant is one of the treatments of choice for this disease. The aim of this study was to compare the neurological symptoms, before and after orthotopic livertransplant, of patients with liver cirrhosis due to Wilson disease, who represent a special group of patients with liver failure. Between 2007 and 2020, there were 24 patients with Wilson disease resistant to medical treatment who underwent deceased donor orthotopic livertransplant and were followed up for 1 year, 5 years, and 10 years for evaluation with neurological scoring systems. Patients were also evaluated for postoperative complications and survival. Of the 24 patients evaluated, there were 13 (54.2%) female patients and 11 (45.8%) male patients, and the mean age was 34 years (range, 14-57 years). One of the patients died from early postoperative sepsis. After orthotopic livertransplant, disease scores returned to normal in 16 patients and improved in the remaining patients. Before transplant, all patients required help in their daily activities. After transplant, there were significant improvements in some symptoms, and the patients became more independent in their daily lives. Our study shows that orthotopic liver transplant provides significant improvement in neurological symptoms and quality of life in patients with Wilson disease.

Persons with severe mental illness have high rates of comorbid substance use disorders. These co-occurring disorders present a significant challenge to community mental health services, and few clinical trials are available to guide the development of effective services for this population. The study aimed to evaluate the effectiveness of a program for case managers that trained them to manage substance use disorders among persons with severe mental illness. A cluster-randomized controlled trial design was used in South London to allocate case managers either to training or to a waiting list control condition. Outcomes and service costs (health care and criminal justice) over 18 months of 127 patients treated by 40 case managers who received training were compared with those of 105 patients treated by 39 case managers in the control condition. Brief Psychiatric Rating Scale scores for the intervention group indicated significant improvements in psychotic and general psychopathology symptoms. Participants in the intervention group also reported fewer needs for care at follow-up. No significant differences were found between the two groups in levels of substance use at 18 months. At follow-up both groups reported increased satisfaction with care. Service costs were also similar for the two groups. Compared with standard care, integrated treatment for co-occurring disorders provided by nonspecialist mental health staff produced significant improvements in symptoms and level of met needs, but not in substance use or quality of life, at no additional cost.

The aim of the study was to investigate the role of combined multichannel intraluminal impedance and pH (MII-pH) testing in clinical management of children with gastroesophageal reflux disease (GERD) by exploring the impact of treatment changes made based on MII-pH testing results on symptoms and quality of life outcomes. All patients (<18 years) referred to the Sydney Children's Hospital for MII-pH testing were recruited. Patients were classified by acid suppression therapy (AST) status (on AST and off AST) and changes in medical and surgical management were evaluated. Validated questionnaires (Pediatric Gastroesophageal Symptom and Quality of Life Questionnaire and Infant Gastroesophageal Reflux Questionnaire Revised) were administered at baseline at the time of MII-pH testing, and 4 weeks after treatment changes were made and questionnaire scores were compared. Of the 45 patients recruited, 24 patients (53.3%) were off AST and 21 patients (46.7%) were on AST. MII-pH testing led to medication changes in 30 patients (66.7%). This included 15 of 24 (62.5%) in those off AST and 15 of 21 (71.4%) in those on AST. More than 98% of patients who had treatment changes showed a significant improvement in both symptoms and quality of life scores. Our study is one of the first pediatric studies to evaluate the clinical validity of MII-pH testing in the pediatric population referred for suspected GERD, and its ability in guiding clinical management. Our study has shown that treatment decisions guided by and based on results of MII-pH testing led to a significant improvement in symptoms and quality of life in infants and children with GERD.

Objective: To observe the role of Intense Pulse Light therapy on dry eyes in Pakistani population. Study Design: Analytical cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Feb to Dec 2022. Methodology: A total of 88 patients with meibomian gland related dry eyes were included in this study, with age ranging between 25-65 years. Intense pulsed light therapy was used to treat Meibomian Gland Dysfunction related dry eyes. Tear film break up time before and after the sessions was recorded on a data collection tool and data analysis was done. Results: Out of 88 patients with Meibomian Gland Dysfunction related dry eyes, 60(68.2%) were females and 28(31.8%) were males. Mean age of the patients was 45.5±8.0 years and median tear film break up time (per Intense Pulse Light) was 4(5–3) seconds, whereas median tear film break-up time (post Intense Pulse Light) was increased to 12(13–11) seconds. Follow up was done until 4 months, which showed significant improvement in symptoms of patients. Tear Breakup Time did not improve in 2 patients as they were already on anti-glaucoma treatment (p-value &lt;0.01). Conclusion: Intense Pulse Light was found to be the safest way of treating Meibomian Gland Dysfunction-related dry eyes which showed significant improvement in patient symptoms.

After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients. Prospective cohort study. Tertiary referral center. Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included. All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient. Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations. Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups. Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.

BackgroundThis small, pilot study evaluated the impact of treatment with a natural multi-mineral supplement from seaweed (Aquamin) on walking distance, pain and joint mobility in subjects with moderate to severe osteoarthritis of the knee.MethodsSubjects (n = 70) with moderate to severe osteoarthritis of the knee were randomized to four double-blinded treatments for 12 weeks: (a) Glucosamine sulfate (1500 mg/d); (b) Aquamin (2400 mg/d); (c) Combined treatment composed of Glucosamine sulfate (1500 mg/d) plus Aquamin (2400 mg/d) and (d) Placebo. Primary outcome measures were WOMAC scores and 6 Minute Walking Distances (6 MWD). Laboratory based blood tests were used as safety measures.ResultsFifty subjects completed the study and analysis of the data showed significant differences between the groups for changes in WOMAC pain scores over time (p = 0.009 ANCOVA); however, these data must be reviewed with caution since significant differences were found between the groups at baseline for WOMAC pain and stiffness scores (p = 0.0039 and p = 0.013, respectively, ANOVA). Only the Aquamin and Glucosamine groups demonstrated significant improvements in symptoms over the course of the study. The combination group (like the placebo group) did not show any significant improvements in OA symptoms in this trial. Within group analysis demonstrated significant improvements over time on treatment for the WOMAC pain, activity, composite and stiffness (Aquamin only) scores as well as the 6 minute walking distances for subjects in the Aquamin and Glucosamine treatment groups. The Aquamin and Glucosamine groups walked 101 feet (+7%) and 56 feet (+3.5%) extra respectively. All treatments were well tolerated and the adverse events profiles were not significantly different between the groups.ConclusionThis small preliminary study suggested that a multi mineral supplement (Aquamin) may reduce the pain and stiffness of osteoarthritis of the knee over 12 weeks of treatment and warrants further study.Trial registrationClinicalTrials.gov number: NCT00452101.