Clinical Course Research Articles

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Background. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The cardiotoxic effect of anesthesia in one way or another is present with any variant of anesthesia. One of the most transparent signs is rhythm alterations on the ECG. These changes can occur not only intraoperatively, but also in the early postoperative period, have an asymptomatic clinical course. But the presence of these signs can have a negative impact on the patient’s prognosis. That is why we performed daily Holter monitoring for patients undergoing trauma surgery. The purpose of the study was to compare regional and general anesthesia as a risk factor for perioperative rhythm disturbances. Materials and methods. It was a 2-group observational study that included 120 trauma patients undergoing surgery using general (group GA) or regional anesthesia (group RA). Postoperative Holter monitoring lasted 24 hours. Further analysis of the recording included the assessment of the presence of ischemic changes or extrasystoles. Results. The incidence of ST-depression episodes within 24 perioperative hours was 10 % in the GA group compared to 3 % in the RA group. In the GA group, the percentage of extrasystole was significantly higher compared to the RA group: 1.5 ± 2.1 % versus 0.7 ± 1.3 % (p = 0.0145). An increase in Qtd was significantly higher in the GA group 15 minutes after the start of anesthesia (51.31 ± 23.09) compared to the RA group (40.70 ± 19.97; p = 0.008). At the same time, QT dispersion was statistically significantly higher in the RA group 1 hour after the start of anesthesia compared to the GA group — 38.22 ± 12.30 versus 50.1 ± 19.5 (p = 0.04). The QT interval was significantly longer in the GA group 15 minutes after the start of anesthesia: 440.00 ± 33.09 versus 400.70 ± 23.18 in the RA group (p = 0.04). One hour after the start of anesthesia, QTt was longer in the RA group: 390.22 ± 23.60 versus 410.1 ± 30.1 in the GA group (p = 0.05). Conclusions. Regional anesthesia has less hemodynamic effects and is the method of choice in patients with cardiovascular comorbidity. However, given the risk of cardiotoxicity due to the resorptive effect of the local anesthetic, in older patients and with existing risk factors, it is crucial to account for the arrhythmogenic effects of local anesthetics and adjust the dosage accordingly.

Pregnancy outcomes in adolescent and young adult patients with multiple sclerosis: A case series.

While there is increasing understanding of the effect of pregnancy on the clinical course of multiple sclerosis (MS), there are limited studies focused on younger populations. We report neurologic and obstetric outcomes for 14 pregnancies from 11 adolescent and young adult female patients with pediatric-onset MS who delivered live births prior to age 26, and describe their relevant social determinants of health. Neurologic and obstetric outcomes in this cohort were generally good. Many of the pregnancies in our cohort appeared unplanned, underscoring the importance of discussing family planning with all MS patients of childbearing potential.

Wound formation in patients with Rutherford category IV disease after endovascular therapy: rates and risk factors

BackgroundLower limb peripheral artery disease classified as Rutherford category IV, is characterized by lower limb ischemic pain both during exertion and at rest. This disease has an unclear course. We aimed to evaluate outcome predictors in this patient group after endovascular therapy. This single-center, retrospective, observational study included 234 consecutive patients (264 limbs), between April 2007 and December 2020. We investigated the disease clinical course after endovascular therapy. The primary endpoint was the wound formation rate 3 years after endovascular therapy.ResultsThe mean observation period was 48.2 ± 8.9 months. The patients (61.9% male; mean age, 76 ± 10 years) presented with diabetes (64.1%), and received hemodialysis with chronic kidney disease (35.0%) and ambulatory treatment (85.0%). The average ankle-brachial index before endovascular therapy was 0.69 ± 0.23. Skin perfusion pressure on the dorsal and plantar sides was 38 ± 13 mmHg and 36 ± 12 mmHg, respectively. The wound incidence rates at 1, 2, and 3 years after endovascular therapy were 8.3%, 11.4%, and 14.4%, respectively. Multivariate analysis revealed the following factors associated with wound formation: P2 in inframalleolar/pedal disease category in the Global Limb Anatomical Staging System (hazard ratio: 1.73, 95% confidence interval: 1.22–2.83, P = 0.01), non-ambulatory status (hazard ratio: 1.09, 95% confidence interval: 1.11–1.36, P = 0.02), intervention up to infrapopliteal lesion (hazard ratio: 1.55, 95% confidence interval: 1.17–2.46, P = 0.03), and patient with chronic kidney disease on hemodialysis (hazard ratio: 1.61, 95% confidence interval: 1.32–2.18, P = 0.03).ConclusionsThe 3-year incidence of wound onset in this study was 14.4%. Factors associated with this outcome included P2 in the Global Limb Anatomical Staging System, non-ambulatory status, intervention up to infrapopliteal lesion, and patient with chronic kidney disease on hemodialysis.

Therapeutic Approach to Primary Tic Disorders and Associated Psychiatric Comorbidities

Background/Objectives: The treatment of tics and psychiatric comorbidities is crucial when they affect the patient’s well-being and relationships. However, the optimal pharmacological treatment (PT) tailored to each patient’s phenotype remains unclear. The primary objective of this study is to describe the clinical characteristics and treatment received for tics and psychiatric comorbidities in our cohort of children and adult patients with tic disorders. Additionally, a further aim was to quantify the severity of tics, comorbidities and overall severity, and the overall clinical changes observed during the follow-up. Methods: Retrospective descriptive study of patients with tic disorders under follow-up at our Tic Functional Unit from January 2022 to March 2024. Two independent neurologists retrospectively applied the Clinical Global Impression of Change (CGI-C) and the Clinical Global Impression of Severity (CGI-S) scales at baseline and at last assessment. Results: A total of 36 individuals were included (63.8% males, median age = 18 years, IQR 19): 94.4% with Tourette syndrome (TS), 2.8% with chronic tic disorder (CTD), and 2.8% with provisional tic disorder (PTD). A total of 86% had at least one psychiatric comorbidity, the most common being obsessive–compulsive symptomatology (OCS) (52%), anxiety (52%), and attention deficit hyperactivity disorder (ADHD) (35%). At last assessment, 26 patients (72.2%) were on undergoing PT for tics and 3 were receiving additional botulinum toxin. The most used medication for tics were aripiprazole (46.2%) and clonazepam (46.2%), and for psychiatric comorbidities, SSRIs (42.9%), methylphenidate (19%), and benzodiazepines (57.1%). Overall improvement according to the CGI-C scale was mild (CGI-C 3). Children and adolescents showed greater improvement than adults (CGI-C 2 vs. 3; p = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C. Conclusions: We observed a favorable clinical course in patients treated with aripiprazole and clonazepam, which appear to be better than that obtained with other treatments. We consider that clonazepam may be useful as a first-line monotherapy and as an adjuvant for both tics and comorbidities in selected cases.

Bilateral rib-to-pelvis growth-friendly spinal surgery for congenital kyphosis in the child with myelomeningocele delays but does not prevent a definitive procedure.

To determine the efficacy of bilateral rib-to-pelvis distraction instrumentation for the growth-friendly surgical treatment of congenital kyphosis in children with myelomeningocele. The clinical courses of nine children (five males, four females), mean age 4.3 years (range 1.4 years-10.0 years), with myelomeningocele and congenital kyphosis treated by the rib-to-pelvis surgical method were studied. Radiographic measurements established the extent of deformity corrections, spinal elongation and growth, and rib levels. Surgical complications were categorized as wound or instrumentation related. The mean follow-up was 5.2years (range, 2.4years-10.4years). Following the index procedure, a mean of seven procedures (range, 4-20), or 1.2 procedures per year, were performed on each child. The mean preoperative, postoperative, and final follow-up kyphotic deformity was 139° (range, 93°-180°), 86°(range, 45°-150°) and 98° (range, 50°-176°) respectively. Eight children lost some of the initial correction and the two youngest lost all correction. Six children were converted to spine-based procedures. The mean growth for the cohort was 0.6cm/year (range, -1.2cm-1.9cm). Twenty-two complications occurred in eight children-14 in the three youngest children. In two children the procedure was abandoned due to ulceration over the gibbus after 2.8 years and 5.6 years of treatment. The bilateral rib-to-pelvis surgical procedure produced modest deformity correction and spinal growth, and prevented deformity progression. It delayed but did not eliminate the need for spine-based deformity correction, and was associated with the significant morbidity of distraction-based growth-friendly spinal surgery. The rib-based technique may have a role in a child with myelomeningocele kyphosis when surgical intervention is required in the very young.

HIV Infection Among Adolescent Girls and Young Women in Sub-Saharan Africa: Philosophical Perspectives of Sociostructural Risk Factors

Background and Objective Sociostructural risk factors influence human immunodeficiency virus (HIV) infection outcomes among adolescent girls and young women (AGYW) aged 15–24 in Sub-Saharan Africa. The philosophical perspectives on sociostructural risk factors can be helpful in reducing new HIV infections in this age group. This review aims to describe these perspectives to guide the development and implementation of targeted interventions at preventing new HIV infection among AGYW, while addressing age-gender inequalities in HIV infection risk reduction. Methods This literature review examined philosophical perspectives on sociostructural risk factors of HIV infection from June 1981 when improvements in HIV knowledge regarding clinical course and epidemiology began to November 2023. We utilized literature from peer-reviewed papers and books on HIV risk factors and infection outcomes among AGYW, gathered from search engines like PubMed, Google Scholar, and Medline. Results The philosophy of sexuality is linked to sociostructural tenets like seduction, early marriage, adultery, and prostitution. Ubuntu’s philosophy is influenced by Western culture, such as pornography and adolescent marriages. Realism is linked to sexual violence, HIV stigma, and unfavorable health policy decisions. The philosophy of health integrates natural and holistic phenomena to address HIV infection. Conclusion and Implications for Translation The literature reviews suggest that addressing philosophical issues like seduction, early marriages, adultery, prostitution, pornography exposure, sexual violence, and unfavorable policies are crucial for reducing new HIV infection among AGYW and recommend the Ministries of Health to review and adopt these considerations in their respective national HIV prevention guidelines.

Interrupted Versus Running Sutures for Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass.

Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is the workhorse for flow augmentation surgery. Although either interrupted or running sutures can be used to complete the anastomosis with high intraoperative patency rates, no previous study in the cranial bypass literature has compared long-term patency and maturity of end-to-side STA-MCA anastomoses. We compared STA-MCA anastomoses performed with running vs interrupted sutures by evaluating bypass flow and anastomotic maturation on follow-up vascular imaging. Ninety-six STA-MCA anastomoses were performed from 1/2019 to 6/2024. Forty-seven anastomoses (40 patients) with long-term vascular imaging were retrospectively analyzed. All anastomoses were intraoperatively patent on initial revascularization. Patient demographics, clinical course, and imaging were reviewed. All images were reviewed by a neuroradiologist or a cerebrovascular neurosurgeon. Twenty-five anastomoses were performed with interrupted sutures and compared with 22 anastomoses performed with running sutures. All patients underwent a preoperative perfusion assessment confirming a significant hypoperfusion state. There were no significant differences between cohorts in demographics, bypass indication, or time to follow-up. Formal digital subtraction angiography was performed for 35 anastomoses (21 interrupted, 14 running). On digital subtraction angiography follow-up, there was no difference in STA caliber between cohorts (P = .204), but there was a difference in anastomotic growth (P = .014), with 5/21 (23.8%) anastomoses stable or enlarged in the interrupted cohort vs 9/14 (64.3%) stable or enlarged in the running cohort. Notably, of the 47 total anastomoses, there was no difference in long-term bypass patency between interrupted and running anastomoses (22/25 (88.0%) vs 22/22 (100.0%), respectively, P = .380). No significant differences in patency or STA caliber on follow-up imaging were observed between STA-MCA anastomoses performed with interrupted vs running sutures although a difference in anastomotic maturity was observed, with the running suture cohort having a higher proportion of enlarged or stable anastomoses. Further studies are needed for validation.

Efficacy of double filtration plasmapheresis in the treatment of steroid and/or IVIG unresponsive neuronal surface antibodies associated autoimmune encephalitis

IntroductionWhether double filtration plasmapheresis (DFPP) is effective in the patients who do not response to the initial immunotherapy is uncertain. This retrospective study aimed to evaluate the efficacy and safety of DFPP in the treatment of patients who had no improvement after initial immunotherapy (steroids and/or immunoglobulin (IVIG)), and moreover, to investigate the factors associated with the efficacy of DFPP.MethodsFrom January 1st, 2014, to December 30th,2018, a total of 26 patients who were diagnosed autoimmune encephalitis (AE) and were received the treatment of DFPP after unsuccessful or incomplete recovery from their early immune therapy (including intravenous high-dose cortisone, IVIG and or immunosuppressant) for at least 21 days were investigated. Their plasmapheresis volume, the course of disease, treatment sessions, and complications were recorded. The efficacy of DFPP within a week were assessed by modified Rankin scale (mRS). These patients were followed until six months after the last session of DFPP treatment.ResultsThe duration between the onset of symptoms and DFPP administration was 54.5 days (range 21—243 days). The median DFPP sessions for each patient were three (range 2–6 sessions), and the mean volume of plasma exchange was 50.5 ± 11.1 ml/kg/session. Total clinically relevant improvement was observed in 57.7% of the patients. The median mRS was decreased from 5 to 4 within one week after DFPP treatment (P < 0.001). Only one patient relapsed in the following six months after DFPP. The effectiveness of DFPP has no relationship with age, gender, the type of antibody, with or without neoplasm, clinical course and the volume of plasma exchange. Most patients tolerated well, except 2 cases. One encountered mild allergic reaction and the other had a transient hypotension during DFPP treatment, but both were corrected rapidly.ConclusionDFPP is an effective and safe treatment option for patients who have poor responsiveness to early immunotherapy).

Defining high-risk patients: beyond the 8the AJCC melanoma staging system.

Since melanoma incidence is steadily increasing, guidelines regarding the diagnosis, staging, and treatment of melanoma are constantly being updated. In particular, the use of adjuvant therapy in stage IIb/c melanoma has been recently approved by the international regulatory agenicies. We performed a retrospective study with 92 melanoma patients namely 42 patients with IIb/c melanoma and 42 patients with IIIa stage melanoma, describing demographics, clinical, histology and disease course during the 5-year follow-up.Several significant evidences emerged between the two groups. Stage IIb/c patients possess a higher age of disease onset (69.6 vs. 55.5 years) with respect to stage III patients and the acral localization appeared as the most frequent (24% vs. 4%). Histologically, stage IIb/c melanomas more frequently exhibit ulceration (70% vs. 2%), angiotropism (54% vs. 8%) and are characterized by a greater presence of TILS (52% vs. 15%). Although it is not statistically significant, we observed a difference in terms of presence of metastasis during the 5-year follow-up: 15% of stage IIb/c patients showed metastasis vs. 4% of stage IIIa patients. Our data support the use of adiuvant immunotherapy in stage IIb/c patients.

PEDIATRIC DENGUE IN NONENDEMIC AREAS: THE IMPORTANCE OF THE AWARENESS TO DETECT NEW CASES AND WARNING SIGNS: A CASE REPORT.

A substantial increase in dengue cases has been reported globally lately, particularly in the Region of the Americas. Children have a higher risk of severity, so it is important to be aware of dengue clinical courses. We present an unusual pediatric case of imported primary dengue infection with warning signs diagnosed in a nonendemic area.

The endothelial NO synthase content in the blood serum of patients with coronavirus disease (COVID-19) with pneumonia in association with hemostatic parameters depending on the clinical course and its prognostic significance

Aim: to investigate the content of eNOS in the blood serum of patients with coronavirus disease (COVID-19) with pneumonia in association with hemostatic parameters and to determine its prognostic value in assessing the risk of oxygen dependence and death. Material and methods. There were 123 patients with COVID-19 with pneumonia under observation. All patients were examined and treated in accordance with the Order of the Ministry of Health of Ukraine No. 722 dated 28.03.2020. The eNOS content in the patients’ serum was determined by enzyme-linked immunosorbent assay. Results. It was found that the content of eNOS in the blood serum of patients with COVID-19 with pneumonia at the time of hospitalization was 9.0 [7.0; 12.0] days lower (p &lt; 0.001) than in healthy subjects. The development of oxygen dependence in patients with COVID-19 with pneumonia was accompanied by worsening of endothelial dysfunction and procoagulant changes, which was confirmed by a decrease in the content of eNOS in the blood serum (p &lt; 0.001), an increase in the level of fibrinogen (p &lt; 0.05) and D-dimer (p &lt; 0.05). The threshold level of eNOS in the blood serum ≤327.09 pg/ml (AUC = 0.861, p &lt; 0.001) was predictive of the onset of oxygen dependence. In patients with COVID-19 with pneumonia who subsequently died, at the time of hospitalization, eNOS levels were lower (p &lt; 0.001) than in patients who recovered, which was combined with a higher level of D-dimer (p &lt; 0.05) and its more frequent increase (p = 0.04) compared with patients who recovered. The eNOS content in the blood serum of patients with COVID-19 with pneumonia was correlated (p &lt; 0.05) not only with the lethal outcome of the disease, but also with the formation of thrombotic complications, which occurred more often in patients with COVID-19 with pneumonia in the event of an adverse outcome (p = 0.0001). The threshold level of eNOS in the blood serum ≤201.75 pg/ml (AUC = 0.892, p &lt; 0.001) was indicative of a high probability of death. Conclusion. The eNOS content in the blood serum of patients with COVID-19 pneumonia at the time of hospitalization is lower (p &lt; 0.001) than in healthy individuals, and the degree of its decrease depends on the severity of the disease, the development of oxygen dependence and the subsequent outcome of this disease. Limiting levels of eNOS in the blood serum of patients with COVID-19 pneumonia, which are important for predicting the risk of developing oxygen dependence and fatal outcome of the disease, have been established.

Exploring the perception of nursing students facing burnout in clinical settings during COVID pandemic

Abstract Aim. The purpose of this study was to learn about the experience of the group of students who are at high risk for experiencing burnout and nursing shortage. This study seeks to reveal students’ perception of nursing burnout and nursing shortage observed during a clinical course. Material and methods. This study was conducted with a qualitative method using conventional content analysis approach. Data were collected by conducting in-depth semi-structured interviews. Results. Thematic analysis of the interview transcripts identified four core themes, with corresponding sub-themes: Sources of burnout, Uncertainty, Coping Strategies, Varying faculty support during clinical rotation. This study proves that nursing students experienced similar feelings of burnout and emotional strain during their clinical rotation during COVID. Evidence highlights the impact of psychological stress on nursing students in pandemic circumstances and additionally the stress of completing all required competencies to complete their degree. Conclusions. The findings of this study include sources of burnout such as working conditions, workload, dealing with suffering, death, and dying, and uncertainty in the present and future such as the evolving and changing understanding of COVID. Coping mechanisms involve staying positive and talking to family and friends. Finally, the varied opinions of the students regarding emotions and feelings of support from faculty.

What is known about Peutz–Jeghers syndrome (a literature review)

Peutz–Jeghers syndrome (PJS) is an autosomal dominant disease, which in most cases is caused by mutation of the tumor suppressor gene STK11 and is characterized by the development of hamartomatous polyps in the digestive tract and the presence of hyperpigmented spots on the skin and mucous membranes. Late diagnosis of PJS leads to acute intestinal obstruction or bleeding. The aim of the study is to summarize the data and current views on the early diagnosis and treatment of PJS in children and processing information on monitoring of PJS complications. To achieve this goal, we have analyzed the sources of professional literature indexed in scientometric databases for the period 2014–2024. The analysis of the professional literature has shown that the triad is characteristic for PJS diagnosis: pigmented spots on the skin and oral mucosa, digestive tract polyposis, and heredity. The timing of symptom onset is an important aspect that requires further study of the clinical course and prognosis of the disease. Conclusions. Phenotypic suspicion involves the formation of risk groups using extraintestinal signs – pigmentation of the mucous membranes and lips – an early visual symptom that makes it possible to recognize PJS, prescribing timely examination and treatment long before the onset of complications. Dynamic observation and prevention of complications in risk groups – both in the presence of a family history and in newly diagnosed children with polyps and specific pigmentation should be provided. The main method of PJS diagnosis is endoscopic, and the main treatment is surgical.

Studying the impact of probiotic agents on the pathogenetic and clinical features of generalized periodontitis

Generalized periodontitis remains one of the most prevalent dental diseases, complications of which significantly deteriorate patients’ quality of life. Currently, the use of probiotic agents is considered a promising direction to enhance the effectiveness of non-surgical treatment of this pathology. Studying the impact of different probiotics on the pathogenetic and clinical features of generalized periodontitis will allow proposing optimized protocols for comprehensive treatment, reducing patient rehabilitation periods and improving the overall dental health of the population. The aim of this study is to examine the influence of various probiotic agents on the pathogenetic and clinical characteristics, treatment effectiveness of generalized periodontitis in adult patients by analyzing professional scientific literature. The literature review provides a brief overview of various probiotic groups and discusses pathogenetic mechanisms of their interaction with the microbiota of oral biofilms. The immunomodulatory mechanisms of probiotics on local and systemic immune responses in patients with generalized periodontitis, inhibition of enzymes responsible for bone tissue resorption, are presented. The analysis results of scientific sources regarding the dynamics of changes in clinical symptoms, microbiological, immunological, and biochemical parameters of saliva and blood serum in individuals with generalized periodontitis receiving comprehensive rehabilitation using probiotic agents compared to patients treated with traditional protocols are provided. The study highlights statistical differences in clinical and laboratory indicators of periodontitis progression at different treatment intervals. Conclusions. The use of probiotic agents for treating patients with generalized periodontitis significantly influences the clinical course of the disease by altering the species composition of dental biofilms and modulating local immune and inflammatory reactions. However, the known results of experimental and clinical studies often have conflicting findings regarding the efficacy of specific probiotic strains and the duration of inflammatory process stabilization over extended periods after treatment, which means a further study is required.

Precision Medicine in Prostate Cancer: Integrating Genomics, AI, and Big Data for Personalized Treatment

Prostate cancer (PCa) remains one of the most prevalent cancers among men worldwide, exhibiting significant heterogeneity in its molecular profile and clinical course. Traditional approaches to treatment have often been generalized, leading to variable outcomes and, at times, unnecessary overtreatment. Precision medicine promises to transform PCa management by leveraging genomics, artificial intelligence (AI), and big data to tailor treatments to each patient’s molecular profile. This review examines how genomics has enhanced our understanding of PCa, identifying critical genetic mutations and molecular subtypes that influence disease progression. Additionally, the application of AI and machine learning in analyzing complex datasets has proven instrumental in discovering novel biomarkers, optimizing therapeutic choices, and predicting patient responses. The integration of big data from multiple platforms, including genomics, imaging, and electronic health records (EHRs), offers an unprecedented level of insight into the nuances of PCa. We discuss key genomic biomarkers, emerging AI-based predictive models, and the role of big data in advancing PCa precision medicine. Finally, we explore the challenges of clinical implementation, including data privacy, ethical concerns, and the need for interdisciplinary collaboration. The insights from this review underscore the transformative potential of precision medicine in enhancing prostate cancer treatment outcomes and the necessity for further research to overcome existing limitations. Keywords: Prostate cancer, precision medicine, genomics, artificial intelligence, big data, personalized treatment, biomarkers, molecular subtypes, machine learning.

Clinical characteristics and predictive indictors of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a retrospective study

IntroductionMacrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.Material and methodsWe conducted a retrospective review of 161 patients with M. pneumoniae pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP) group.ResultsMUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO2) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.ConclusionsOur findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.

Fatal Paraquat Poisoning: A Case Report

Abstract: Paraquat, a widely used herbicide, is notorious for its high toxicity and limited antidotal options. This case report details the clinical presentation, management strategies, and outcomes of a patient with paraquat poisoning. A 32-year-old male presented to the emergency department with a history of intentional ingestion of paraquat. The patient exhibited signs of acute toxicity, including gastrointestinal distress, respiratory distress, and multi-organ failure. Prompt recognition and initiation of treatment were crucial in navigating the complex clinical course. The treatment protocol involved aggressive decontamination, administration of activated charcoal, and utilization of specific antidotes such as cyclophosphamide and methylprednisolone. The patient received supportive care, including mechanical ventilation and hemodynamic support. Continuous monitoring of renal and hepatic functions was implemented to detect and manage complications promptly. Despite the aggressive therapeutic approach, the patient faced significant challenges, with progressive deterioration of respiratory and renal functions. The case highlights the limited efficacy of current treatment modalities in severe paraquat poisoning. The patient eventually succumbed to multi-organ failure, underscoring the need for further research to explore alternative interventions. Paraquat poisoning remains a significant clinical challenge with high mortality rates. This case report emphasizes the importance of early recognition, aggressive decontamination, and advanced supportive care in managing paraquat toxicity. Further research is imperative to explore novel treatment strategies and improve outcomes in cases of severe paraquat poisoning.

Hypopituitarism secondary to pediatric traumatic brain injury – A need for active vigilance

Hypopituitarism, a known sequelae of pediatric traumatic brain injury (TBI), is often overlooked, especially in acute settings where more dynamic issues warrant the clinician’s attention. Pituitary dysfunction following pediatric TBI usually develops early and is often transient. However, a long-term follow-up is required to monitor the ongoing needs of hormonal replacement therapy as well as to identify the onset of new hormonal deficiencies, which can develop many years after the brain injury. This case describes the clinical course of an infant who suffered a fall and developed multiple skull fractures. The child required admission to intensive care and developed hypopituitarism (cortisol, thyroid, vasopressin, and growth hormone) secondary to severe TBI. The clinical (refractory shock and polyurea) and radiological red flags (empty sella) can assist in predicting the development of pituitary dysfunction in such cases.

Acute myelin oligodendrocyte glycoprotein (MOG)-IgG optic neuritis without optic nerve enhancement

Introduction: Optic neuritis (ON) is a common neuro-ophthalmological condition and remains a significant indicator of inflammatory conditions affecting the central nervous system (CNS). Varying etiologies exist for ON including MS, NMOSD and MOGAD. Differential diagnosis is achieved using both radiological and serological testing. MRI characteristics of MOG-ON include T2 hypersensitive lesions, nerve swelling and gadolinium enhancement of the affected optic nerve. While acute MOG-ON usually presents with optic nerve enhancement, recognizing atypical presentations is critical in accurate diagnosis and effective management. Case Presentation: We herein present a case of a 67-year-old woman presenting with sudden decrease in vision in the right eye. The patient underwent a 3T MRI of the orbits and brain five days post vision loss which returned normal right optic nerve appearance at presentation (no edema, enhancement or increased T2 signal). Further serological testing of the MOG antibody returned positive (1:100) while APQ4 antibodies were negative. This yielded a diagnosis of MOG-IgG-ON. Subsequently, the patient was treated with IV methylprednisolone 1 g daily for 5 days followed by prednisone 1 mg/kg, resulting in marked improvement in vision. Conclusion: This case highlights the complexity involved in diagnosing ON, especially in the context of MOGAD. Absence of optic nerve enhancement in this patient calls attention to the possibility of subclinical inflammation and/or detectable enhancement later in clinical course. Our findings, along with existing literature, highlight the need for clinicians to consider atypical MRI presentations in MOG-ON cases. Recognizing that normal MRI does not exclude MOG-ON is important for optimizing diagnostic accuracy and effective treatment interventions.

Clinical characteristics and outcome of central nervous system tumors harboring NTRK gene fusions.

TRK fusions are detected in less than 2% of central nervous system tumors. There are limited data on the clinical course of affected patients. We conducted an international retrospective cohort study of patients with TRK fusion-driven CNS tumors. 119 patients were identified. The median age at time of diagnosis was 4.5 years. The majority were reported to have a histology consistent with a diagnosis of high-grade glioma (HGG) (57.1%) followed by low-grade glioma (LGG) (27.7%). Pediatric patients had a better prognosis with a median overall survival of 185.5 months compared to 24.8 months in adults (p<.0001). Patients with LGG also had a better outcome when compared to HGG (p=0.0012). The objective response was 68.8% with larotrectinib compared to 38.1% for non-targeted treatment. Children with LGG glioma had a favorable outcome compared to adult and HGG. TRK inhibitors appear to improve tumor control.