Systemic Complications Research Articles

Pediatric COVID-19 severity by SARS-CoV-2 lineage and vaccine status in Canada: an IMPACT study.

Interpretations of pediatric COVID-19 severity are complicated by novel lineages and COVID-19 vaccine introduction. We estimated the risk of severe COVID-19 by SARS-CoV-2 lineage and vaccination status among hospitalized Canadian children. Data were collected through the Canadian Paediatric Surveillance Program (April 2020-May 2021) and Canadian Immunization Monitoring Program, ACTive (June 2021-December 2022). Patients <17 years hospitalized for COVID-19 (excluding incidental SARS-CoV-2) at 13 pediatric hospitals were included. Lineages were defined via genetic sequencing or dominant lineage upon hospitalization. Severe disease included intensive care, ventilatory/hemodynamic requirements, systemic complications, and/or death. We analyzed 3218 COVID-19 hospitalizations, including 81.4% admitted during Omicron predominance. Median age was highest among Delta cases (2.9 years, interquartile range [IQR] 0.2-10.9) and lowest among Omicron BQ.1 cases (0.6 years, IQR 0.2-1.8). Severe COVID-19 remained common in Omicron vs. ancestral cases (27.2% vs. 23.2%). The proportion of hospitalized cases aged 5-16 years declined following the introduction of age-specific COVID-19 vaccines. Vaccination reduced the risk of in-hospital severe disease for ages 12-16 years (two vs. zero doses; adjusted risk ratio 0.49, 95% confidence interval 0.32-0.77). More children were hospitalized with Omicron lineages than all prior lineages. COVID-19 vaccination was associated with a lower burden of severe disease among ages 5-16 years. This study estimates the effect of SARS-CoV-2 lineage, Omicron sub-lineage, and vaccination on COVID-19 disease severity, using data from two Canadian national surveillance programs. Few national studies describe the clinical presentation and severity of Omicron sub-lineages among hospitalized children. In Canada, Omicron lineages were associated with substantially more pediatric COVID-19 hospitalizations than all prior lineages combined, though risk of severe COVID-19 was highest during the Delta period. COVID-19 vaccines were associated with reductions in hospitalization (ages 5-16 years) and severe disease (ages 12-16 years) across Omicron sub-lineages.

Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review.

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents. A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application. Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others. Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Treatment of Femoral Neck Fractures in Adults With Improved Biplane Double-Supported Screw Fixation and Femoral Neck System: Complications andSurgical Techniques.

Treating femoral neck fractures remains a significant challenge for orthopedic surgeons and imposes a substantial economic burden on developing regions. Current novel internal fixation methods demonstrate excellent biomechanical performance. However, these new internal fixation methods are still associated with various complications. This study aimed to report the clinical complications of femoral neck system (FNS) and biplane double-supported screw fixation (BDSF) treatments for femoral neck fractures at our institution and provide directions for selecting cost-effective internal fixation methods. A retrospective case-control study of adult patients with femoral neck fractures treated with BDSF or FNS was conducted at Nanfang Hospital from April 2019 to April 2022. General medical records were collected both preoperatively and intraoperatively. Primary complication measures included osteonecrosis of the femoral head, nonunion, screw-out, and subtrochanteric fractures, along with femoral neck shortening. The primary functional measure evaluated was the Harris hip score. This study employed t-test, Wilcoxon rank-sum test, and chi-square test to statistically analyze the data. Statistically significant differences were observed between the BDSF and FNS groups in terms of surgery duration (60.8 ± 12.6 min vs. 71.0 ± 12.0 min), incision length (5.5 ± 1.2 cm vs. 9.1 ± 1.6 cm) and hospitalization costs (39563.8 ± 9086.4 RMB vs. 24960.4 ± 10154.4 RMB). No statistically significant differences between the BDSF and FNS groups were found in the baseline data, blood loss or hospital stay. Moderate femoral neck shortening was significantly less common in the BDSF group than in the FNS group (27.1% vs. 61.5%, p = 0.016). Postoperatively, no statistically significant differences in complication rates, such as femoral head necrosis, nonunion, subtrochanteric fractures or screw-out, were observed between the BDSF and FNS groups. This study revealed no significant difference in the incidence of postoperative complications such as femoral head necrosis, nonunion or screw cut-out between BDSF and FNS. Although BDSF has drawbacks, such as a long learning curve and the potential to cause subtrochanteric fractures, it is cost-effective and better maintains the length of the femoral neck. The modified BDSF technique may be more suitable for developing regions with limited health care budgets.

Poor muscle quality: A hidden and detrimental health condition in obesity.

Poor muscle quality (MQ) is a hidden health condition in obesity, commonly disregarded and underdiagnosed, associated with poor health-related outcomes. This narrative review provides an in-depth exploration of MQ in obesity, including definitions, available assessment methods and challenges, pathophysiology, association with health outcomes, and potential interventions. MQ is a broad term that can include imaging, histological, functional, or metabolic assessments, evaluating beyond muscle quantity. MQ assessment is highly heterogeneous and requires further standardization. Common definitions of MQ include 1) muscle-specific strength (or functional MQ), the ratio between muscle strength and muscle quantity, and 2) muscle composition (or morphological MQ), mainly evaluating muscle fat infiltration. An individual with obesity might still have normal or higher muscle quantity despite having poor MQ, and techniques for direct measurements are needed. However, the use of body composition and physical function assessments is still limited in clinical practice. Thus, more accessible techniques for assessing strength, muscle mass, and composition should be further explored. Obesity leads to adipocyte dysfunction, generating a low-grade chronic inflammatory state, which leads to mitochondrial dysfunction. Adipocyte and mitochondrial dysfunction result in metabolic dysfunction manifesting clinically as insulin resistance, dyslipidemia, and fat infiltration into organs such as muscle, which in excess is termed myosteatosis. Myosteatosis decreases muscle cell function and insulin sensitivity, creating a vicious cycle of inflammation and metabolic derangements. Myosteatosis increases the risk of poor muscle function, systemic metabolic complications, and mortality, presenting prognostic potential. Interventions shown to improve MQ include nutrition, physical activity/exercise, pharmacology, and metabolic and bariatric surgery.

Outcomes and comparative analysis of therapeutic approaches for choroidal neovascular membranes associated with optic nerve head drusen in pediatric patients.

Choroidal neovascular membranes (CNVM) associated with optic nerve head drusen (ONHD) are rare but vision threatening. A variety of treatments, including laser photocoagulation, subretinal surgery, and anti-VEGF injections, are effective but pose risks, particularly in pediatric patients, underscoring the need for a comprehensive review. A systematic review was conducted using PubMed, Embase, and Web of Science. Studies with treated pediatric cases of ONHD and CNVM were included. Age >18 years, non-English-language articles, minimal/irrelevant data, and duplicate studies were excluded. Data about patient characteristics, treatment details, and visual outcomes were extracted. Of 309 screened publications, 28 studies with 29 patients were included. Of the 19 pediatric patients (22 eyes) receiving anti-VEGF treatment, best-corrected visual acuity (BCVA) improved from 0.84 ± 0.60 logMAR to 0.13 ± 0.15 logMAR (P < 0.0001). In the surgical or laser treatment cohort of 10 patients (12 eyes), BCVA improved from 0.76 ± 0.43 logMAR to 0.18 ± 0.15 logMAR (P = 0.0025). Anti-VEGF treatment was equally effective as surgical or laser treatment. We found no significant difference in the number of injections needed among anti-VEGF agents utilized (ranibizumab, aflibercept, and bevacizumab). No cases developed systemic or extraocular complications with anti-VEGF treatments. One case (5%) had a recurrence of CNVM after treatment. This study reinforces the equal efficacy of surgical, laser, and anti-VEGF treatments for CNVM associated with ONHD in pediatric patients. No adverse outcomes of anti-VEGF therapy were reported.

Innovative production of highly potent equine neutralizing antibody against Hemiscorpius lepturus scorpion venom using recombinant mPLD1 protein.

Scorpion envenomation, especially from Hemiscorpius lepturus, poses a significant health risk, leading to considerable morbidity and mortality. The venom's major toxin, which includes phospholipase D (PLD), is responsible for various systemic complications. In prior studies, we identified a native phospholipase D (PLD) toxin as a key lethal factor in the venom of H. lepturus. A recombinant PLD that retained its toxicity was developed and designated as PLD1. Additionally, a non-toxic and devoid of lethal effects mutant form of the recombinant PLD1 protein, was produced and named as mPLD1. Building on this knowledge, we aimed to produce a novel antivenom using recombinant mPLD1-based immunogen and commercial antisera were included for comparison. Two horses were immunized separately with either recombinant or mutant PLD1, resulting in high titer antisera with no significant difference between the two immunogens. Purified F(ab')2 fragments derived from horse antisera demonstrated a markedly enhanced specificity in the detection of PLD1 and crude venom when compared to commercial alternatives. Furthermore, in vivo neutralization assays revealed that the antisera generated from mPLD1 protein was 89 and 36 times more potent than those of commercial ones. Horses produced highly neutralizing antibodies against PLD1 than the two local commercial antisera. These findings underscore the promise of the developed anti-mPLD1 as a highly effective therapeutic molecule for H. lepturus envenomation. Given that the production process for the recombinant immunogen is straightforward and utilizes cost-effective technologies, focusing on the manufacture of this highly efficient antisera could lead to significant advancements in horse antisera production platforms.

Intra-Articular Adductor Canal Block Has Equivalent Analgesic Effect to Traditional Ultrasound-Guided Adductor Canal Block after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

An adductor canal block (ACB) is widely accepted as a regional nerve block for pain management following total knee arthroplasty (TKA). However, no consensus exists concerning whether the analgesic effect is greater when joint surgeons perform intra-articular ACBs (IA-ACBs) or when anesthesiologists perform ultrasound-guided ACBs (UG-ACBs). We hypothesized that IA-ACBs performed by joint surgeons and UG-ACBs performed by anesthesiologists based on periarticular injections (PAIs) would yield equivalent analgesic effects. This prospective randomized controlled trial included 61 patients who underwent IA-ACBs and 56 patients who received UG-ACB with additional PAI for post-TKA pain management. The primary outcome was postoperative pain assessed using numeric rating scale scores at rest and during exercise. Secondary outcomes included opioid consumption and functional recovery. We also investigated local and systemic adverse events, including nausea, vomiting, and wound complications. Both groups of patients experienced comparable analgesic effects for both IA-ACB and UG-ACB pain management; however, those who received IA-ACBs were prescribed more opioid equivalents than those in the UG-ACB group on postoperative day 1 (p = 0.048). No differences between the groups were observed regarding local or systemic adverse events. IA-ACBs performed by joint surgeons provided equivalent analgesic effects to UG-ACBs performed by anesthesiologists. However, IA-ACBs may lead to a higher postoperative requirement for opioid analgesics.

Celiac disease: an update

Celiac disease is one of the most common lifelong autoimmune disorders and is currently understood as agenetically determined immune intolerance to gluten. In genetically predisposed individuals, the consumption of gluten, along with additional environmental factors, triggers an immunological reaction in the small intestinal epithelium, leading to the destruction of the mucosal architecture with villous atrophy. This can be asymptomatic, but may also cause awide range of symptoms and lead to systemic complications, such as osteoporosis or infertility. The only treatment is alifelong, strictly gluten-free diet. Despite advances in diagnostics, many cases remain unrecognized. Diagnosis is based on the serological detection of autoantibodies against tissue transglutaminase2 (tTG-IgA) and, if necessary, asmall intestinal biopsy. Population-wide screening during childhood or adolescence, as legally introduced in Italy in September 2023, could promote early detection and prevent long-term complications. For the monitoring of diagnosed patients, regular clinical check-ups and serological testing are standard practice. In cases of persistent symptoms or risk factors for ongoing villous atrophy, afollow-up duodenal histology examination is recommended. Persistent symptoms despite adherence to agluten-free diet are often due to continued gluten exposure; however, alternative causes must also be ruled out. In cases of severe malabsorptive symptoms, the rare condition of refractory celiac disease should be considered, with management carried out in specialized centers.

Insights into skeletal involvement in adult Gaucher disease: a single-center experience.

Gaucher disease (GD) is a lysosomal storage disorder causing systemic and skeletal complications. This study evaluates bone health in adult GD type 1 patients, focusing on skeletal complications, bone mineral density (BMD), and biochemical markers. A cohort of adult GD type 1 patients followed up at Ege University Pediatric Metabolism Department were retrospectively examined. This study included 32 patients with GD type 1, comprising 11 males (34.4%) and 21 females (65.6%). The median age at diagnosis was 20.5years (min: 3-max:65), and at enrolment, it was 35years (min:18-max:71). Most patients (93.8%) had organomegaly, and 93.8% had cytopenia. Common genetic variants were p.Asn409Ser (60.9%), p.Leu483Pro (7.8%), and p.Asp448His(4.7%). All patients were on enzyme replacement therapy (ERT) for a median of 11years (min:2-max:18). Bone complications included pathologic fractures in six patients (19%) and avascular necrosis in 12 patients (37.5%). Bone pain was reported by 93.7% of patients at admission and persisted in 59.4% during follow-up. DXA scans showed abnormal bone mineral density (BMD) in 62.5% of patients initially, with a significantly low bone density in 3.1% and reduced bone density in 59.3%. BMD improved with treatment, as evidenced by a significant increase in Z scores (p < 0.05). Elevated chitotriosidase (75%), ferritin (50%), and immunoglobulin G (21.9%) levels were noted but did not correlate with BMD. Seven patients (22%) were splenectomized, all with bone issues. Bone health in GD involves multiple factors beyond biochemical markers. While ERT improves BMD, bone pain and fractures remain significant issues. Comprehensive management, including regular BMD monitoring and better vitamin D supplementation adherence, is crucial. Further research is needed to improve treatments for bone complications in GD.

Structural and vascular assessment of the optic nerve head and macula in chronic Chagas disease

Chagas disease (CD), a parasitic infection, may have ocular repercussions in its cardiologic form, since a history of heart disease of other etiologies already has been established as a risk factor for neuropathies and maculopathies. The aim of the present study was to investigate preclinical structural and vascular optic nerve head (ONH) and macular parameters in patients with chronic CD. Nineteen patients with CD and 19 healthy subjects were evaluated with optical coherence tomography, optical coherence tomography angiography, and Laguna ONhE® software. The main outcome measures were the glaucoma discriminant factor, average peripapillary retinal nerve fiber layer thickness, macular ganglion cell complex thickness, peripapillary vascular density (VD), foveal and parafoveal thickness, foveal avascular zone area, and total foveal and parafoveal VD from the superficial and deep capillary plexus that were compared between the two groups. No significant differences were observed among the studied variables. Although our findings suggested that the cardiovascular dysfunction resulting from chronic CD does not seem to cause significant structural or vascular preclinical changes to the ONH and the macula, the results herein benefit this patient population and may provide important preliminary information about the ocular impairment caused by the condition and its possible systemic complications.

Impact of High Glucose on Bone Collagenous Matrix Composition, Structure, and Organization: An Integrative Analysis Using an Ex Vivo Model.

Diabetes mellitus is a widespread metabolic disorder linked to numerous systemic complications, including adverse effects on skeletal health, such as increased bone fragility and fracture risk. Emerging evidence suggests that high glucose may disrupt the extracellular matrix (ECM) of bone, potentially altering its composition and organization. Collagen, the primary organic component of the ECM, is critical for maintaining structural integrity and biomechanical properties. However, definitive evidence and a comprehensive understanding of the molecular mechanisms through which high glucose impacts the ECM and collagen remain elusive. This study employed an ex vivo embryonic chicken femur model to investigate the effects of high glucose on the collagenous matrix. A comprehensive approach integrating histological evaluation, histomorphometry, ATR-FTIR spectroscopy, and proteomics was adopted to unravel structural, biochemical, and molecular changes in the ECM. Histomorphometric analysis revealed disrupted collagen fibril architecture, characterized by altered fibril diameter, alignment, and spatial organization. ATR-FTIR spectroscopy highlighted biochemical modifications, including non-enzymatic glycation that impaired collagen crosslinking and reduced matrix integrity. Proteomic profiling unveiled significant alterations in ECM composition and function, including downregulation of key collagen crosslinking enzymes and upregulation of inflammatory and coagulation pathways. High glucose profoundly disrupts the collagenous matrix of bone, weakening its structural integrity and organization. These findings emphasize the critical impact of high glucose environments on extracellular matrix composition and bone quality, offering insights into the mechanisms behind diabetic bone fragility and guiding future research toward targeted therapeutic strategies.

Analgesic Overdose in Patients With Dental Pain. A Cross-Sectional Study in Two Dental Emergency Clinics.

Dental pain is common, and many patients use analgesics to alleviate the pain. Analgesics are readily accessible, and overdosing may lead to severe complications. This study explores the extent of analgesic overdosing in patients with dental pain. Data were collected from two dental emergency clinics in Copenhagen, Denmark, via questionnaires and interviews with 180 patients. Results showed that 82.8% (n = 149) had taken at least one type of analgesic, and 9% (n = 15) had exceeded the recommended maximum dosage. Of all patients with dental pain, 75.6% (n = 136) used paracetamol, 54.4% (n = 98) ibuprofen, 10% (n = 18) opioids, and 11.1% (n = 20) other types of analgesics. Most frequently, the pain was of pulpal origin (n = 119; 66.1%). Of all analgesics used, most were obtained places where guidance should be available, for example, pharmacies, dental clinics or hospitals (n = 152; 54%). The patients were aware of the recommended maximum daily dosage for paracetamol and ibuprofen in 39% (n = 70) and 41% (n = 73) of the cases, respectively. In conclusion, most patients with dental pain use analgesics to alleviate their pain. A substantial proportion of these patients overdose themselves, potentially putting them at risk of severe systemic complications. This study highlights the need for better patient education and safer pain management strategies.

The Role of Systemic Health Indicators, Including C-Reactive Protein and eGFR, in Predicting Periodontal Disease: A Longitudinal Study.

C-reactive protein (CRP) and estimated glomerular filtration rate (eGFR) are key biomarkers reflecting systemic inflammation and metabolic dysfunction. This study explored systemic and oral health indicators, including CRP and eGFR, as potential factors associated with periodontitis, using a longitudinal clinical dataset comprising 23,742 records from patients identified by ICD-10 codes between 2015 and 2022. Univariate Cox analysis and Gompertz models, selected based on AIC and BIC after evaluating alternative models, were employed to assess the predictive roles of CRP and eGFR in periodontitis incidence, adjusting for oral and systemic health factors. Elevated CRP (>15 mg/L) and reduced eGFR (<60 mL/min/1.73 m2) were significant predictors of periodontitis, with hazard ratios (HR) of 1.36 [1.05-1.77] and 1.39 [1.08-1.78], respectively. Atherosclerosis (HR: 2.12 [1.11-4.06]), diseases of the hard tissues of the teeth (HR: 7.30 [5.45-9.78]), and disorders of the teeth and supporting structures (HR: 3.02 [2.05-4.43]) also demonstrated strong predictive associations. CRP and eGFR emerged as potential biomarkers for predicting periodontitis, enabling early interventions to prevent tooth loss and systemic complications. Patients with chronic kidney disease, atherosclerotic heart disease, and lipid metabolism disorders are at higher risk, emphasizing the need for integrated care addressing both systemic and oral health factors.

Early-Onset Seizures After Orthotopic Liver Transplantation: A Single-Center Retrospective Study.

After encephalopathy, epileptic seizures (ES) are the second most common neurologic complication after orthotopic liver transplantation (OLT) and may announce a disabling/fatal neurologic disease. In this retrospective study, we collected clinical information from patients who underwent OLT at our institution and analyzed outcomes and potential risk factors for developing ES after OLT. Fourteen of our 376 patients (3.72%) who underwent OLT had ES. After excluding 2 patients with already known epilepsy, among the other 12 patients, 2 were diagnosed with nonanoxic cerebral edema, 2 with anoxic damage, 1 with intracranial hemorrhage, 1 with metabolic derangement, and 4 with neurotoxicity; 2 did not receive a diagnosis of certainty. 9 of 12 patients had structural abnormalities on neuroimaging exams. Patients with ES had lower body mass index, higher rate of pretransplant portal thrombosis, and lower pre-transplant plasma concentration of albumin than patients without ES. Multiple post-transplantation systemic complications, postoperative infections, and graft rejection were correlated with a significantly higher risk of ES. Compared with patients without seizures, patients with ES had longer in-hospital and intensive care unit (ICU) length of stay, higher probability of ICU readmission, in-hospital death, and need for rehabilitation. Just 3 of the 12 patients with ES had a good prognosis, while the other 9 had at least mild neurologic sequelae, 5 of whom died because of the underlying neurologic disease. ES after OLT may announce detrimental neurologic disease. When an underlying neurologic disease is excluded, prognosis in terms of seizure recurrence and long-term antiseizure medication need is warranted.

Emerging role of adaptive immunity in diabetes-induced cognitive impairment: from the periphery to the brain.

Diabetic cognitive impairment (DCI) is a central nervous system complication induced by peripheral metabolic dysfunction of diabetes mellitus. Cumulative studies have shown that neuro-immune crosstalk is involved in the pathological progression of DCI. However, current studies mostly focus on the interaction between innate immunity cells and neurons, while ignoring the role of adaptive immunity cells in DCI. Notably, recent studies have revealed adaptive immune cells are involved in cognitive development and the progression of neurodegenerative diseases. Equally important, accumulated past studies have also shown that diabetic patients experience imbalanced peripheral adaptive immune homeostasis and disrupted transmission of adaptive immune cells to the central system. Therefore, this review first updated the cognitive mechanism of adaptive immune regulation, and then summarized the contribution of adaptive immunity to DCI from the aspects of peripheral adaptive immune homeostasis, transmission pathways, and brain tissue infiltration. Furthermore, we also summarized the potential of anti-diabetic drugs to regulate adaptive immunity, and looked forward to the potential value of regulatory adaptive immunity in the prevention and treatment of DCI, to provide a new strategy for the prevention and treatment of DCI.

Impact of diabetes mellitus on tear secretion, intraocular pressure, and contrast sensitivity: A comparative study of controlled and uncontrolled diabetics

Diabetes mellitus (DM) is a prevalent metabolic disorder associated with systemic and ocular complications that impair visual function. This study evaluates the impact of DM on tear secretion, intraocular pressure (IOP), and contrast sensitivity (CS), and explores the relationship between DM duration and these parameters.To compare tear secretion, IOP, and CS in non-diabetic individuals and diabetic patients with controlled and uncontrolled DM, and to assess the influence of DM duration on these ocular measures.This prospective observational study was conducted from August 2023 to July 2024 at a tertiary eye care center in Surat, India, with 150 participants (300 eyes). Participants were divided into three groups: 50 non-diabetic controls, 50 with controlled DM (HbA1c ≤7), and 50 with uncontrolled DM (HbA1c &amp;#62;7). Tear secretion was measured using the Schirmer test, CS with the Pelli-Robson chart, and IOP using non-contact tonometry. Statistical analysis included ANOVA for group comparisons and Pearson correlation to assess relationships with DM duration.Diabetic patients had significantly lower tear secretion (controlled DM: 12mm; uncontrolled DM: 8mm) than non-diabetic controls (18 mm; p &amp;#60;0.05). CS was also reduced in diabetic groups, with controlled DM patients averaging 1.4 log units and uncontrolled DM patients 1.1 log units, compared to 1.9 log units in controls (p &amp;#60;0.05). IOP was higher in diabetic groups but not statistically significant. DM duration positively correlated with reduced CS (r = 0.45, p &amp;#60;0.05) but not with tear secretion or IOP.DM significantly impairs ocular health, evidenced by elevated IOP, reduced tear secretion, and diminished CS, particularly in uncontrolled cases. While DM duration is strongly associated with progressive CS decline, it does not significantly affect tear secretion or IOP. These findings underscore the need for routine ocular assessments and effective glycemic control to prevent visual complications in diabetic patients.

Acute and chronic systemic inflammation associated with canine nodular splenic lesions composed of heterogeneous cell components: four cases (2020-2024).

To describe the clinical presentation and clinicopathological findings of dogs with nodular splenic lesions composed of heterogeneous cell components associated with systemic inflammation and to provide information on the outcome after surgical resection. Medical records were searched for dogs with histologically and immunohistochemically characterised nodular splenic lesions with mixed stromal, histiocytic and lymphoid cells and the presence of systemic inflammatory markers at the time of diagnosis. Four dogs were included, of which three had an undifferentiated splenic stromal sarcoma and one had a splenic leiomyosarcoma. Fever and abdominal pain were reported in three and four cases, respectively. All dogs showed hyperglobulinaemia and marked changes in the serum protein electrophoresis profile. C-reactive protein and fibrinogen concentrations were both increased in three cases. These abnormalities completely resolved after splenectomy. Moreover, two dogs had concomitant glomerular disease and one dog had liver amyloidosis. Three dogs were still alive and asymptomatic 1, 6 and 9 months after surgery. One dog died 16 months after the initial presentation due to complications related to progressive renal failure. Based on this report, nodular splenic lesions with heterogeneous cell components may directly be associated with a pro-inflammatory state and should be considered as part of the differential diagnosis of fever and hyperglobulinaemia in dogs. Furthermore, early recognition and treatment of these lesions could reduce the risk of systemic complications potentially associated with amyloid deposit and organ failure.

How Will Nanomedicine Revolutionize Future Dentistry and Periodontal Therapy?

Periodontitis is a prevalent inflammatory disease affecting the supporting structures of the teeth, leading to gum recession, tooth loss, and systemic health complications. Traditional diagnostic methods and treatments, such as clinical evaluation and scaling, often fall short in early detection and targeted therapy, particularly in complex or advanced cases. Recent advancements in nanomedicine offer promising solutions for improving both the diagnosis and treatment of periodontitis. Nanoparticles, such as liposomes, quantum dots, and nanorods, have demonstrated potential in enhancing diagnostic accuracy by enabling more precise detection of periodontal pathogens and biomarkers at the molecular level. Furthermore, nanotechnology-based therapies, including drug delivery systems and antimicrobial agents, offer localized and controlled release of therapeutic agents, enhancing efficacy and reducing side effects compared to conventional treatments. This study reviews the current applications of nanomedicine in the diagnosis and treatment of periodontitis, highlighting its potential to revolutionize periodontal care by improving early detection, reducing treatment times, and enhancing therapeutic outcomes.

Unveiling the Anti-Angiogenic Potential of Small-Molecule (Kinase) Inhibitors for Application in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation leading to joint damage and systemic complications. Angiogenesis promotes inflammation and contributes to RA progression. This study evaluated potential anti-angiogenic effects of several compounds including small-molecule kinase inhibitors, such as sunitinib (pan-kinase inhibitor), tofacitinib (JAK-inhibitor), NIKi (NF-κB-inducing kinase inhibitor), and the integrin-targeting peptide fluciclatide, using a scratch assay and 3D spheroid-based models of angiogenesis. For all drugs tested in the low micromolar range (1-25 μM), sunitinib (as positive anti-angiogenetic control) showed marked inhibition of endothelial cell (EC) migration and sprouting, effectively reducing both scratch closure and sprout formation. Tofacitinib exhibited marginal effectiveness in the scratch assay, but performed better in the 3D models (55% inhibition), whereas NIKi showed around 50% anti-angiogenic effects in both models. Fluciclatide changed EC morphology rather than migration, and only when stimulated with synovial fluid in spheroid model did it show inhibitory effects (at ≥2.5 µM), with none below this dosage. These results highlight the potential of NIKi and tofacitinib for angiogenesis inhibition and of fluciclatide for safe diagnostic targeting of microdose in RA, as well as the need for advanced screening models that mimic RA's complex inflammatory pro-angiogenic environment.

Advances in multimodal imaging for adrenal gland disorders: integrating CT, MRI, and nuclear medicine.

Adrenal diseases pose significant diagnostic challenges due to the wide range of neoplastic and non-neoplastic pathologies. Radiologists have a crucial role in diagnosing and managing these conditions by, leveraging advanced imaging techniques. This review discusses the vital role of computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine in adrenal imaging, and focuses on morphological and functional evaluations. First, the anatomy and physiology of the adrenal glands are described, followed by a discussion on ectopic adrenocortical adenomas and how they develop. The concepts and imaging findings of congenital diseases, such as congenital adrenal hyperplasia (CAH), adrenal rest tumors, and adrenocortical nodular disease, considering recent updates to the WHO Classification of Tumours (5th ed.) terminology are highlighted. The diagnostic value of dynamic contrast-enhanced CT and chemical-shift MRI for identifying adrenocortical adenomas are emphasized, alongside the use of adrenocortical scintigraphy such as 131I-adosterol scintigraphy for diagnosing Cushing's disease, Cushing's syndrome (CS), subclinical CS, and ectopic adrenocorticotropic hormone-producing tumors. Systemic complications associated with CS, and the diagnosis and treatment of pheochromocytomas, paragangliomas (PPGLs), and neuroblastomas, will also be discussed focusing on 123I-metaiodobenzylguanidine (MIBG) imaging and 131I-MIBG therapy. Pitfalls in 123I-MIBG imaging and the increasing importance of diagnosing hereditary PPGLs due to increased genetic testing are also be discussed. Additionally, the broad differential diagnosis for adrenal masses-including malignancies like adrenal carcinoma, metastases, and malignant lymphoma, as well as benign conditions like myelolipoma and ganglioneuroma, and complications, such as adrenal hemorrhage, infarction, and infections-will be outlined. The goal of this review was to provide an overview of adrenal diseases that includes the most recent information for radiologists to stay updated on the latest imaging techniques and advancements that can ensure accurate diagnosis and effective management.