Symptom Complex Research Articles

Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study

Objective The aim of the study was to identify groups of young adults with distinct longitudinal patterns of use of treatment for substance use disorders and mental health (MH) problems and to investigate potential explanatory factors for different patterns of treatment use over time, including sociodemographic factors. Methods The sample consisted of 447 young adults aged 16–29 years who entered long-term residential substance use disorder treatment facilities in Norway from 2011 to 2016. In this study, we obtained data collected by the Norwegian Patient Registry and Statistics Norway. These data were linked with the electronic health record data of the substance use disorder treatment facilities from which the participants were recruited. Growth mixture modeling was performed. The identified groups were further compared using analysis of variance or χ 2 test. Results Four groups of participants for total treatment use, substance use disorder treatment use, and MH treatment use were identified. Most participants from the overall sample were classified as members of a group characterized by a low and stable pattern of treatment use over time. A group with a high and stable pattern of treatment use was identified in total and MH treatment use. The proportion of participants with higher levels of substance use disorder treatment use at the end of the study period than at the beginning was larger (35%) than in the case of MH treatment use (14.2%). Younger age was associated with a decreasing pattern of MH treatment use and with an increasing pattern of substance use disorder treatment use over time. There were larger proportions of female participants in groups with a stable high use of MH treatment and in groups with an initially increasing trend of substance use disorder treatment use. Findings revealed that most participants across the identified groups were recipients of welfare benefits, had low educational attainment, and were not working. Conclusions Results demonstrated significant variation in trajectories of treatment use among young adults with substance use disorder. Differences in treatment use could indicate differences in symptom severity and complexity. In this study, treatment use was associated with socioeconomic factors, sex, and age. Integrative approaches, including interagency and interdisciplinary collaboration, will often be necessary to sufficiently address the multidimensionality of substance use disorder.

Investigating the different forms of premenstrual syndrome in Kursk students

Background: Premenstrual Syndrome (PMS) is a complex of symptoms experienced by women before their menstrual period, which can significantly impact daily functioning and quality of life. While the prevalence of PMS varies globally, detailed studies on its manifestation among medical students are limited. This research aims to fill this gap by investigating the prevalence and types of PMS among female medical students at Kursk State Medical University. Methods and Materials: A descriptive cross-sectional study was conducted using a sample of 128 female medical students aged 18 to 25 years. Participants were surveyed using a validated PMS questionnaire, which classifies symptoms into four categories: psychological, behavioral, physical, and atypical. Data on demographic variables and lifestyle factors were also collected to explore potential correlations. Results: The study found that 84% of participants experienced some form of PMS, with 25% reporting severe symptoms. Psychological symptoms were the most prevalent, followed by physical, behavioral, and atypical symptoms. The incidence of PMS was higher among older students and those with less physical activity. Seasonal variations also influenced symptom severity, with winter months showing a higher incidence rate. Conclusion: The findings suggest a high prevalence of PMS among medical students at Kursk State Medical University, with significant impacts on their academic and personal lives. These results underscore the need for targeted educational programs and support systems to help manage PMS effectively. Further research is recommended to explore intervention strategies and to assess their efficacy in this population.

Clinical subtypes of postpsychotic depression in the first episode of schizophrenia: results of a cross-sectional observational study

BACKGROUND: Clinical diagnosis of depression in schizophrenia is difficult because of the dimensional overlap of a number of affective symptoms with negative manifestations of schizophrenia spectrum disorders. In the very first attack of schizophrenia, when the negative symptom complex is not yet clear enough, the difficulties of differential diagnosis become even more relevant, especially when depression occurs in the post-attack stage during the formation of remission and the manifestation of postpsychotic depression.
 AIM: To establish a diagnostic approach based on a combination of clinical-psychopathological and psychometric methods for the assessment of postpsychotic depression in patients with a first episode of schizophrenia.
 MATERIAL AND METHODS: We are examined 1112 patients who had suffered a first psychotic episode. Аfter introducing inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression (PPD) and 119 patients without depression in partial remission. Clinical-psychopathological, psychometric (PANSS, CDSS, SCL-90-R scales), and statistical (descriptive, non-parametric statistics — significance level p 0.05) methods were used.
 RESULTS: Based on the concept of positive-negative affectivity, three types of PPD have been identified: with signs of positive affectivity — anxious, sensitive-psychasthenic, depersonalisation-hypochondriacal and melancholic-anergic subtypes; with signs of negative affectivity anhedonic, dysthymic-apathetic and dysphoric subtypes; formed due to psychopathological manifestations of the non-affective register — obsessive-ruminative, agoraphobic, paranoid-symbolic subtypes. Patients who were diagnosed with PPD with positive affectivity after an attack were predominat (p 0.05): 46.91% of the total number of depressed patients. PPD formed due to non-affective spectrum disorders is accompanied by the strongest subjective severity of suffering in patients, compared to patients diagnosed with PPD with positive affectivity. Subjectively, the easiest for patients is PPD with negative affectivity, which, however, does not mean that it can be considered as favourable from the standpoint of therapy and rehabilitation.
 CONCLUSION: PPD is detected in a significant number of patients with a first psychotic episode, even after excluding the group with pharmacogenic depression, both due to subjective complaints, nosogenic depressive experiences, and as a result of a psychometric assessment of the patients’ condition. The concept of “dissociated post-attack depression” is substantiated.

Informal Family Care Partner Well-Being Is Diminished in End-Stage Liver Disease.

Chronic liver disease is a significant global neglected public health problem. End-stage liver disease is associated with substantial symptom complexity, disability, and care needs that require assistance from informal family care partners. Research on these care partners' caregiver burden or strain, symptoms, and quality of life is sparse and has not focused on these variables as co-occurring or in the context of the quality of the relationship care partners have with the patients. The purpose of this study was to provide a collective presentation of patterns and determinants of well-being as measured by caregiver strain, depression, sleep, and quality of life in a cohort of informal family care partners for adult outpatients with end-stage liver disease. Care partners (age > 18 years) were recruited from two liver clinics within two tertiary health care systems and invited to complete a cross-sectional survey. They completed the Multidimensional Caregiver Strain Index, Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Short Form Health Survey, and Mutuality Scale. Descriptive statistics and latent class mixture modeling were used to analyze these data. The sample was predominantly female and White. The well-being of care partners was diminished. Three distinct classes of well-being were identified: mildly diminished (53.2%), moderately diminished (39.0%), and severely diminished (7.8%). Those at greater risk of worse well-being were younger, spouses, and had poorer relationship quality with the patients. To improve the well-being of care partners in moderately and severely diminished classes, assessing and addressing caregiver strain and co-occurring symptoms is essential. Addressing this strain and symptoms has the potential to maintain or optimize care partners' ability to provide care to patients. Future researchers should include longitudinal and dyadic studies to examine how patients' disease progression and symptoms may affect family care partners well-being and vice versa.

Cannulated prolactin test in the diagnosis of the hyperprolactinemia syndrome

Hyperprolactinemia (HP) is a persistent pathological increase in a prolactin serum concentration amounting to more than 20 ng/ml in males and 25 ng/ml in females and leads to developing the pathological symptom complex of HP primarily from the reproductive system. To confirm the persistent etiology of HP and to eliminate physiological short-term hormone enhancement, a number of recommendations, including Russian and Belarusian, were proposed to make several prolactin measurements.This study included 120 patients with HP (96 females, 78.0 %) and (27 males, 22.0 %) aged 18–50 years who sought medical help at the Health Institution “Minsk City Clinical Endocrinology Center” in the period from December 2022 to September 2023. After catheterizing the vein, a venous cannula was inserted and blood was taken immediately after cannulating (T0), and then in 60 minutes (T1) and 120 minutes (T2). The cannulated prolactin test results were considered positive – with HP remaining in all three samples (T0, T1, T2), questionable – if HP was kept at T0 and T1, and negative if HP was only at T0. When evaluating the cannulated test results, true HP is 36.7 %. Patients with a positive cannulated test had a higher prolactin at T0, which was 888.5 mME/L (U = 97.0; z = 7.92; p < 0.001). Patients with stress-induced HP (negative test) and patients with true HP (positive test) had no statistically significant differences in age and occurrence frequency of specific and non-specific complaints and symptoms for HP.

Синдром микроцефалии с капиллярными мальформациями: клинический случай

ABSTRACT INTRODUCTION. Microcephaly-capillary malformation syndrome (MIC-CAP syndrome; OMIM: 614261) is a rare severe autosomal recessive disorder characterized mainly by congenital microcephaly, multiple small capillary malformations of the skin, and drugresistant epilepsy with early onset. The disease results from a mutation in the STAMBP gene. To date, the worldwide prevalence is less than 1:1000000 and less than 30 cases have been described. CASE PRESENTATION. We present a case of MIC-CAP syndrome in a child with a homozygous mutation NC_000002.12: g.73831044A>G (c.188A>G, p.Tyr63Cys) in the STAMBP gene. In the clinical picture: congenital microcephaly, multiple capillary malformations, drug-resistant epilepsy with early onset, gross psycho-motor developmental delay. CONCLUSION. The presented case has all the main characteristic symptoms of the clinical picture of MIC-CAP syndrome. The peculiarity of the case can be considered the presence of renal multicystosis, which has not been previously described in this syndrome. In antiepileptic therapy, the best effect was obtained on duotherapy with valproate and vigabatrin with course addition of clobazam. Given the typical symptom complex of this syndrome, it is advisable to immediately search for a mutation in the STAMBP gene. KEYWORDS: microcephaly, capillary malformations, STAMBP gene, drug-resistant epilepsy

New categorization of chest pain: noncardiac is in, atypical is out!

Chest pain poses adiagnostic challenge in the emergency department and requires athorough clinical assessment. The traditional distinction between "atypical" and "typical" chest pain carries the risk of not addressing nonischemic clinical pictures. The newly conceived subdivision into cardiac, possibly cardiac, and (probably) noncardiac causes of the presenting symptom complex addresses amuch more interdisciplinary approach to asymptom-oriented diagnostic algorithm. The diagnostic structures of the chest pain units in Germany do not currently reflect this. An adaptation should therefore be considered.

High Symptom Burden in Patients Receiving Radiotherapy and Factors Associated with Being Offered an Intervention.

Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64-62.8) and 10 (OR = 7.90, 95% CI 1.69-38.2); palliative intent radiation (OR 3.87, 96% CI 1.46-11.1); and last review appointment (OR 6.22, 95% CI 1.84-23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47-91.1), nausea (OR 15.7, 95% CI 1.51-412), shortness of breath (OR 7.97, 95% CI 1.20-63.7), and anxiety (OR 6.69, 95% CI 1.58-31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients' symptoms.

Meralgia Paresthetica as a Result of Surgery With an Emphasis on Harvesting Iliac Bone Grafts: A Review.

Meralgia paresthetica is a neurological disorder characterized by a symptom complex of numbness, burning, tingling, aching, or stabbing in the anterolateral portion of the upper thigh. Typically, this disorder is seen in patients with diabetes mellitus, obesity, and pregnancy. Also, it may result from a wide array of surgical interventions involving the region of the anterior superior iliac spine. Underlying pathophysiology concentrates on entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). Due to its location and wide anatomic variation, the LFCN is susceptible to compression, scarring, and injury during surgery. It is important to understand the regional anatomy. In addition, the plastic surgeon must have a working knowledge of the most common variations that can precipitate entrapment and increase susceptibility to injury during surgery. Surgeons lacking a substantial background on the numerous risk factors, origins, and anatomic variations of the LFCN may place patients at an even higher risk of damage to the nerve. An extensive knowledge of the anatomy and careful technique may be utilized by surgeons to prevent iatrogenic neuropathy of the LFCN.

[Long-Term Outcomes after Surgery of the Neurogenic Thoracic-Outlet Syndrome in Adolescents].

Neurogenic Thoracic Outlet Syndrome (nTOS) describes a complex of symptoms caused by the compression of neural structures at the upper thoracic outlet. Typical symptoms include pain, numbness and motor weakness of the affected extremity. The incidence of nTOS is 2-3 per 100,000 and is highest between the ages of 25 and 40. There are only a few studies evaluating the surgical outcomes of nTOS in adolescent patients. In particular, there is a lack of long-term data. In a retrospective study of nTOS cases receiving surgical treatment in our clinic between 2002 and 2021, eight patients between 15 and 18 years of age were included. Demographic data, risk factors, clinical symptoms, clinical functional tests, neurophysiological, radiological and intraoperative findings were evaluated. Postoperative data were recorded using a standardised questionnaire. Decompression of the inferior truncus and the C8 and Th1 nerve roots was performed via a supraclavicular approach. The average duration of symptoms before surgery was two years. Of the eight patients who underwent surgery, six answered the written questionnaire and could be analysed for the study. The average follow-up was nine years (1-18 years). After surgery, all patients experienced pain reduction; three were pain-free in the long run and five no longer required pain medication. Strength improved in all patients, but two patients still had mild motor deficits. Sensory disturbances were reduced in all patients, but residual hypoesthesia persisted in five. With regard to overhead work, half of the patients had no impairment after surgery. All patients were able to work at the time of the survey. Half of the patients pursued their sports activities without impairment, while mild impairment was reported by the other half. nTOS in adolescents is a rare compression syndrome. Decompression of the lower parts of the brachial plexus using a supraclavicular approach without resection of the first rib is an adequate treatment. This retrospective study showed that a reduction in pain was achieved in all patients. In some patients, slight sensory and motor disturbances as well as a certain restriction in overhead work persisted. Patients were able to return to sports.

Onset of Irritable Bowel Syndrome, Dyspepsia, Diarrhea, Bloating, and Constipation in Deployed Gulf War Veterans.

An estimated 694,550 United States service members were actively deployed to the Persian Gulf from 1990-1991. Many veterans who were deployed developed Persian Gulf War Syndrome along with chronic gastrointestinal symptoms after returning from the Persian Gulf. Our objective in this study was to determine the phenotypic expression of gastrointestinal symptom complexes in previously healthy veterans who had been stationed in the Persian Gulf. One hundred and four consecutive veterans (88 males, 16 females) who had previously been deployed in 1990-91 were evaluated for their bowel habits and gastrointestinal symptoms. A workup was completed to find identifiable causes of their symptoms and all veterans were asked to do a modified version of the Bowel Disease Questionnaire symptom survey. None of the veterans reported gastrointestinal symptoms before deployment. During deployment to the Persian Gulf: 22 veterans (21%) developed irritable bowel syndrome; 17 (16%) developed dyspepsia; 50 (48%) developed diarrhea; 11 (11%) developed bloating; and 4 (4%) developed constipation. The results of the current study suggest that the development of irritable bowel syndrome, dyspepsia, diarrhea, bloating, and constipation is frequently seen in deployed Gulf War Veterans and the gastrointestinal symptoms commonly persist upon returning home. These novel findings are very important for currently deployed veterans who are serving in the Middle East and are at a high risk of developing gastrointestinal disorders.

Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers

Objective. This study examines factors predicting self-reported voice symptoms in call center workers. Methods. Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed. Results. Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment. Limitations. This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis. Value. This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders. Conclusion. Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study

The long-term effects of SARS-CoV-2 infection represent a relevant global health problem. Long COVID (LC) is defined as a complex of signs and symptoms developed during or after SARS-CoV-2 infection and lasting > 12 weeks. In common variable immunodeficiency (CVID) patients, we previously reported higher risk of hospitalization and death during SARS-CoV-2 infection, as well as prolonged swab positivity and frequent reinfections. The aim of the present study was to assess the risk of LC in an Italian cohort of CVID patients. We used a translated version of the survey proposed by Centers for Disease Control and Prevention (CDC) to collect data on LC. In the enrolled cohort of 175 CVID patients, we found a high prevalence of LC (65.7%). The most frequent LC symptoms were fatigue (75.7%), arthralgia/myalgia (48.7%), and dyspnea (41.7%). The majority of patients (60%) experienced prolonged symptoms, for at least 6 months after infection. In a multivariate analysis, the presence of complicated phenotype (OR 2.44, 95% CI 1.88–5.03; p = 0.015), obesity (OR 11.17, 95% CI 1.37–90.95; p = 0.024), and female sex (OR 2.06, 95% CI 1.09–3.89; p = 0.024) significantly correlated with the development of LC. In conclusion, in this multicenter observational cohort study, we demonstrated that CVID patients present an increased prevalence of LC when compared to the general population. Improved awareness on the risk of LC in CVID patients could optimize management of this new and alarming complication of SARS-CoV-2 infection.

[Watch and Wait for Rectal Cancer].

About one third of all colorectal carcinomas (CRC) are localised in the rectum. As part of a multimodal therapy concept, neoadjuvant therapy achieves downstaging of the tumour in 50-60% of cases and a so-called complete clinical response (cCR), defined as clinically (and radiologically) undetectable residual tumour after completion of neoadjuvant therapy, in 10-30% of cases.In view of the perioperative morbidity and mortality associated with radical rectal resection, including the occurrence of a symptom complex known as low anterior resection syndrome (LARS) and the need for deviation, at least temporarily, the question of the risk-benefit balance of organ resection in the presence of cCR has been raised. In this context, the therapeutic concept of a "watch-and-wait" approach with omission of immediate organ resection and inclusion in a structured surveillance regime, has emerged.For a safe, oncological implementation of this option, it is necessary to develop standards in the definition of a suitable patient clientele and the implementation of the concept. In addition to the initial correct selection of the patient group that is suitable for a primarily non-surgical procedure, the inherent goal is the early and sufficient detection of tumour recurrence (so-called local regrowth) during the "watch-and-wait" phase (surveillance).In this context, in this paper we address the questions of: 1. the optimal timing of initial re-staging, 2. the criteria for assessing the clinical response and selecting the appropriate patient clientele, 3. the rhythm and design of the surveillance protocol.

The role of chronic systemic inflammation in the formation of functional disorders of the biliary tract

Functional disorders of the biliary tract are included in the group of functional diseases of the digestive system, widespread everywhere, and represent a complex of clinical symptoms developing as a result of motor-tonic dysfunction of the gallbladder, bile ducts and sphincters. Their clinical manifestations are often quite diverse and non-specific. Therefore, the problem of verification, treatment and prevention of this pathology continues to be relevant. In our study, among 37 practically healthy volunteers, in 55% of cases, a functional disorder of the gallbladder of the hypomotor type was detected, correlations of indicators of the motor function of the gallbladder with markers of systemic inflammation were established.

POST-COVID SYNDROME. OPTIC NERVE LESIONS (Literature Review)

Coronavirus infection COVID19 is an acute respiratory viral disease, which in most cases is severe and leads to the development of various complications known as post-COVID syndrome. Post-covid syndrome or long-covid syndrome is a consequence of coronavirus infection (COVID-19), while 20% of those who have been ill suffer from long-term symptoms, the duration of which varies greatly and is more than 12 weeks. According to the WHO, the post-covid syndrome includes 33 symptoms, while in younger people who have been ill, the incidence of this symptom complex is much higher. According to the literature, post-COVID syndrome may reappear 3-6 months after clinical recovery. This condition is characterized by various non-specific symptoms, which can be manifested by dysfunction of individual organs, skin vasculitis, neurological symptoms up to the development of mental disorders. Summing up, it should be noted that during the pandemic period, certain experience has been accumulated regarding ophthalmic problems. The data obtained are sometimes contradictory, but it is already clear that ophthalmic disorders in COVID-19 can be leading along with damage to other organs. Perhaps a new disease leads to an exacerbation of an existing or manifestation of dormant ophthalmopathology. Regardless of what is the cause, it is necessary to remain vigilant about the state of the organ of vision both in the immediate and long-term period after a new coronavirus infection. KEYWORDS. Postcovid syndrome, optic neuritis, optic vasculitis, anterior ischemic neuropathy

Profil Kesesuaian Terapi Obat Pada Pasien Dispepsia di Ruangan IGD RSUD dr. Zainal Umar Sidiki

Dyspepsia is an upper gastrointestinal symptom complex that has symptoms of fulllness after eating, early satiety, or epigastric pain of burning without any sturctural cause. The research aims to determine the suitability of drug therapy based on the right patient, the right drug, and the right dose in the emergency room at dr. Zainal Umar Sidiki Regional Public Hospital, North Gorontalo Regency. This research is descriptive research with retrospective data collection. The data used were obtained from medical records of patients in the ER, with 215 patients whose paatient characteristics were processed using the Microsoft Excel program. The results showed that most dyspepsia patients were female, namely 124 (58%), the age range 50-60 years was 74 (34%). The most widely used therapy is combination therapy 154 (72%). The largest variation in the number of single drug uses Inj. Omeprazole amounted to 34 (16%), and a combination of two types of drugs that are widely used, namely Inj. Omeprazole with Inj. Ondansetron has a total of 36 (17%) and a combination of three types of drugs that are widely use, including PPIs, cytoprotectants, and prokinetics, totaling 23 (11%). The rationality of the right patient treatment was 53,48%, the right medicstion was 78%, and the right dose was 100%. In conclusionm the appropriateness of therapy based on the right patient was 53,48%, the right drug was 78%, and the right dose was 100%.

Gorner syndrome as a sign of dyscirculatory disorders

The article discusses the issues of the normal anatomy of the autonomic innervation of the eye muscles, mainly its sympathetic part. The symptoms included in the Claude Bernard Horner's syndrome, which occurs when the sympathetic pupillomotor pathway is affected, are considered. The causes of this syndrome are numerous. The classification of acquired conditions the clinical picture of which involves Horner syndrome is given. Three classes of etiological processes are distinguished: central (suprasegmental and segmental), peripheral, and idiopathic. Nosological components are listed for each of these. The complexity of the topographic anatomy of the sympathetic pathways innervating the eye muscles leads to significant difficulties in diagnosing the level of their lesion. Pathological processes affecting the peripheral part of the sympathetic chain are detected much faster, as the causes that provoked the development of Horner syndrome are often more obvious and diagnostically accessible. Cases of Horner syndrome of central genesis are significantly more difficult in diagnostic terms. The ar ticle discusses additional symptoms that form the clinical picture for stem strokes, tumors of the hypothalamic-pituitary region and brain stem, multiple sclerosis, and various diseases of the spinal cord, where the Claude Bernard Horner's syndrome is part of the clinical picture. In such cases, the analysis of neurological symptoms provides the basis for niveau diagnosis. The most difficult situations are when the only reason for the patient's visit and the objective component of the neurological status is just a triad of symptoms: miosis, partial ptosis, and enophthalmos. The paper presents an example of a similar case from clinical practice, when a patient with an acutely developed isolated left-sided symptom complex, including miosis, ptosis, and enophthalmos, had a focus of lacunar strok e in the lef t thalamo-hypothalamic region.

Romheld's Gastrocardiac Syndrome, diagnosing a complex of cardiologic and gastroenterologic symptoms


 In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. 
 
 
 In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. 
 
 
 The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome.

The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans.

Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness. Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans. We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed. These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.