Impaired General Health Research Articles

Metastatic Solitary Fibrous Tumor of Parapharyngeal Region: A Case Report with Review of Literature

AbstractSolitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm with a low metastatic potential. The parapharyngeal area in the head and neck is one of the rarest subsites. Surgical excision remains the standard of care. The local recurrence rate stands at 4%, while the distant recurrence rate is 7% over a 5-year period. Radiation can be used in adjuvant, metastatic, and palliative settings. In metastatic disease, therapeutic options are limited, with the most common regimen used in the first line being a combination of dacarbazine and doxorubicin. With a better understanding of molecular biology, many centers use bevacizumab with temozolomide in the first line. A 50-year-old man underwent a wide excision of a mass in the parapharyngeal region in 2014. Histopathology showed a SFT with negative margins and a low mitotic index. He was under regular follow-up. He presented in January 2024 with abdominal discomfort and distension, fever, cough, and substantial weight loss. Clinically, he had hepatomegaly, lab investigations revealed transaminitis and elevated serum alkaline phosphatase. 18F fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET CT) revealed multiple lung and liver metastases. Ultrasound-guided tru-cut biopsy of the liver lesion with immunohistochemistry (IHC) confirmed metastasis from SFT (positive for signal transducer and activator of transcription 6 and cluster of differentiation 34). He received bevacizumab and temozolomide for four cycles, and a PET CT scan showed progressive disease as per Choi's criteria. Treatment was changed to pazopanib 800 mg once daily as the patient was not keen on intravenous chemotherapy. The patient progressed clinically and radiologically. His programmed death-ligand 1 IHC showed a tumor proportion score of 0%. Next-generation sequencing 75 gene panel could not be done due to low tumor content in the block. The treatment was changed to doxorubicin. He received three cycles of doxorubicin and progressed clinically with deterioration of general health and hence offered the best supportive care. He succumbed to the illness in September 2024.

How to undertake effective mouth care in adults who require support.

Optimal oral health is essential at all stages of life, to enable individuals to eat and speak without discomfort, and to socialise, thereby contributing to their general health, well-being and quality of life. Effective daily mouth care for people who require support is essential to prevent deterioration in oral health and general health and should be part of their overall care. This How to article details the preparation, equipment and procedure involved in undertaking mouth care in adults. The article also provides an overview of mouth care in patients who are intubated, neurodivergent people and/or those with cognitive impairment or learning disabilities, and those receiving end of life care. Nurses undertaking mouth care must have the knowledge and skills needed to do so safely and effectively, and work within their competence level. • Inadequate mouth care can lead to dehydration and malnutrition, while a dry mouth creates an ideal environment for fungus or bacteria to become dominant pathogens within the oral cavity, adversely affecting the person's appetite, creating soreness within the oral cavity and leading to a general decline in health. • Maintaining a healthy, functioning mouth and routinely removing food debris can reduce the risk of choking and/or aspiration pneumonia, particularly in people with dementia and/or dysphagia. • All healthcare professionals should seek to promote oral health and have an understanding of the link between optimal oral health and general health, and be able to explain this to patients; it is also vital that nurses are aware of current evidence and best practice in oral hygiene. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when providing mouth care. • How you could use this information to educate nursing students or colleagues about appropriate methods for providing effective, person-centred mouth care.

Temporal Artery Biopsies: Understanding the Low Positivity Rate.

Objective We compared the yield of temporal artery biopsies with the clinical diagnoses made by referring physicians and determined the factors associated with a positive biopsy. Methods This is a monocentric, retrospective analytical study of patients treated between January 2021 and December 2024 who underwent temporal artery biopsy for suspected giant cell arteritis. The primary endpoint was the biopsy positivity rate. We also studied patient-related factors, symptoms, and clinical variables, including surgical and pathological factors, to identify those associated with a positive biopsy result. Results The study included 72 patients (40 females, 32 males). General health deterioration (OR = 3.71, p = 0.05) was significantly associated with a positive biopsy in the univariate analysis. The average length of the biopsy specimen after fixation was 13.4 mm. The positivity rate of temporal artery biopsies was 16.6% (n=12), while in 55.5% of cases (n=40), referring physicians ultimately diagnosed typical isolated Horton's disease (n=29, 40.2%) or isolated Horton's disease associated (n=10, 13.8%) with pseudo-polyarthritis rheumatica. Conclusion The anatomic-clinical discordance highlighted in our study supports findings from the literature. This can be explained by factors related to the pathology itself but also by a proactive diagnostic approach and variability in performing the surgical procedure. We have proposed avenues to refine the indications for this procedure and improve the performance of our technique. Temporal artery biopsy should be reserved for well-supported suspicions of Horton's disease. Sampling upstream from the bifurcation of the superficial temporal artery appears to offer the best reproducibility.

Infectious Spondylodiscitis: Experience of the Rheumatology Department

Introduction: Infectious spondylodiscitis (IS) is increasingly prevalent, presenting significant diagnostic challenges. Objectives: To investigate the epidemiological, clinical, paraclinical, bacteriological, histological, therapeutic, and prognostic characteristics of IS. Materials and Methods: This descriptive, retrospective study involved 49 patients hospitalized in a rheumatology department over a 14-year period (2004-2018) for IS management, diagnosed through clinical, radiological, histological, and bacteriological criteria. Results: The mean age of patients was 49.3 years. The male-to-female ratio was 0.6. Diabetes was the predominant comorbidity (19%). The average diagnostic delay was 5 months. Low back pain was the most common symptom (68%). General deterioration of health was observed in 45% of cases. An inflammatory syndrome was present in 88% of cases. Positive blood cultures were noted in 6 patients. Radiographic signs suggestive of IS were evident in 78.6% of cases. MRI was necessary for 80.9% of patients. Lumbar involvement was most frequent (40.5%). Disco-vertebral biopsy was performed in 26% of patients. Tuberculosis accounted for the majority of cases (52.4%). The average duration of antibiotic therapy was 6.5 months. Surgery was required in 26.2% of patients. Favorable outcomes were observed in 23.8% of cases, while 26% of patients experienced persistent neurological sequelae. Conclusion: Tuberculosis remains the predominant etiology of IS in our region. Despite advancements in imaging modalities, diagnostic delays persist, impacting both survival and functional outcomes.

P202 A rare association of iliac psoas myositis and vasculitis in a rheumatoid arthritis patient

Abstract Background/Aims Rheumatoid arthritis (RA) is a multi-systemic disease with various manifestations. Vasculitis and myositis are two very rare complications of RA. Methods We report an infrequent observation of iliac psoas myositis associated with vasculitis in a patient with RA. Results An 80-year-old man with no medical history, followed for 35 years for seropositive rheumatoid arthritis, treated with leflunomide (20mg/day) discontinued on his own. He was hospitalized for a general deterioration of health associated with muscle weakness in all 4 limbs, predominantly distal, worsening progressively. On examination, besides signs of rheumatoid disease, he had a motor deficit in the hands rated at 2+/5. Osteotendinous reflexes were present and symmetrical in the upper limbs, weak in the lower limbs with limb atrophy. In laboratory tests, there was a biological inflammatory syndrome and an elevation of lactate dehydrogenase to 307IU/L [120-245]. Liver tests, renal function, and creatine phosphokinase levels were normal. Given the neurological deficit, a spinal MRI was requested, revealing a hypertrophied heterogeneous appearance with contrast enhancement of the iliac psoas muscle without detectable abscess. Muscle biopsy of the psoas showed nonspecific inflammatory changes without neoplastic proliferation or abscess formation. Electromyography revealed severe and asymmetrical neurogenic involvement of all four limbs with decreased amplitude of motor and sensory potentials indicative of severe and asymmetrical axonal sensorimotor polyneuropathy. Neuromuscular biopsy concluded severe axonal involvement of ischemic nature secondary to vasculitis. The diagnosis made was RA associated with myositis and multinervous involvement. The patient received 3 monthly boluses of methylprednisolone for 6 months. At 6 months, there was a substantial clinical and biological relief. Conclusion Muscle involvement in rheumatoid arthritis may result from pain or chronic steroid use. Other RA medications, like D-penicillamine and chloroquine, can also induce myositis. Inflammatory myopathies can coincide with RA, causing rheumatoid myositis, which can develop regardless of active joint disease, potentially leading to muscle atrophy. Disclosure I. Jabrouni: None. S. Rekik: None. M. Dhifallah: None. M. Abbess: None. S. Rahmouni: None. K. Zouaoui: None. S. Boussaid: None. H. Sahli: None.

Acute intestinal obstruction due to duodenal metastasis of laryngeal squamous cell carcinoma: A CARE case report.

Acute intestinal obstruction due to duodenal metastasis of laryngeal squamous cell carcinoma: A CARE case report.

Extrahepatic Cholangiocarcinoma Diagnosis and Therapeutic Management

Introduction: Extrahepatic cholangiocarcinoma is a rare and severe cancer, representing less than 3% of malignant digestive neoplasms and is the second most common primary liver cancer after hepatocellular carcinoma (HCC). Its frequency is often underestimated. The resectability rate depends on the tumor's location (5-30% in hilar forms). Objective: Evaluate the surgical treatment outcomes of extrahepatic cholangiocarcinoma. Patients and Methods: This retrospective, single-center, and analytical study spanned from January 1, 2018, to September 30, 2023, involving 20 patients (excluding Klatskin tumors). The mean patient age was 65 years (range: 55-74), with a male-to-female ratio of 2.3. Most patients were classified as ASA I and II (American Society of Anesthesiologists). Results: Clinically, jaundice was observed in 100% of cases. Nine patients exhibited general health deterioration. The diagnostic delay averaged 9 months (range: 9-18 months). Histologically, adenocarcinoma was identified in 100% of surgical specimens. Surgery was performed in 40% of patients, while palliative care was applied in 45%. Post-resection morbidity was 35%, and mortality was 37.5%. Conclusion: Surgical resection remains the only treatment offering prolonged survival, though five-year survival rates are low, even after curative procedures.

Management of menopausal disorders in women at risk: potential and advantages of transdermal estrogen

Background. Global trends of increasing life expectancy against the background of a decrease in the average age of natural menopause highlight the problem of qualified management of this contingent of women. The menopausal period can be associated with many clinical signs, such as vasomotor symptoms, genitourinary problems and additional psychological disorders (anxiety, mood swings and sleep disorders). Ignoring the first symptoms of age-related changes can lead to a decrease in the quality of life, workforce productivity and general health deterioration. Objective of the review: to analyze modern approaches to the management of patients with menopausal disorders in risk groups; to study the possibilities and benefits of transdermal estrogen.Analysis of literary data. The key link in the pathogenesis of menopausal disorders is objectively considered to be a decrease in estrogen synthesis in the ovaries, which leads to the development of clinical symptoms of menopause and a significant increase in the risk of developing cardiovascular diseases, obesity, diabetes, bone loss, osteoporosis, etc. Timely administration of menopausal hormone therapy is currently considered the most effective method of treating vasomotor symptoms, genitourinary syndrome, sleep disorders and emotional changes in women. The management of this women contingent requires the mandatory consideration of absolute and relative contraindications to the appointment of hormonal therapy. The general management strategy of women with menopausal disorders, including genitourinary menopausal syndrome, involves a comprehensive approach to diagnosis and treatment. Its important component is the use of menopausal hormone therapy, taking into account contraindications in women at risk of developing cardiovascular, thrombotic, and metabolic complications. Educating health care professionals about the benefits of hormone therapy, including transdermal estrogens potential, will optimize menopausal management and reduce the various risks and adverse effects of oral administration. In this context, the use of the transdermal form of 17β-estradiol (Estrogel) and the original micronized progesterone medication (Utrozhestan) in menopausal disorder management regimens, given their proven efficacy, is gaining clinical significance for the correction of estrogen deficiency and its symptoms, particularly in risk groups. Conclusions. Management of patients with menopausal disorders is a matter of a personalized approach to choosing the optimal treatment regimen with adherence to the principles: timely, effective and as safe as possible.

Endocrine disorders in Kearns-Sayre syndrome with different severity of symptoms: two case reports and a literature review.

Kearns-Sayre Syndrome (KSS) is a variant of mitochondrial disorder caused by a Mitochondrial Deoxyribonucleic Acid (mtDNA) deletion. Clinical manifestations of KSS can include different organ and system involvement. Different organ malfunctions, more often cardiac dysfunction, can lead to death. No effective treatment of this condition exists to date. Here, we report two patients with KSS. Female patient with a large-scale deletion of 7,020 base pairs (bp) suffered from hypogonadism, diabetes mellitus with fluctuating glucose levels, and had poor general health. A male patient with a common 4,977 bp deletion did not have diabetes mellitus but had impaired glucose tolerance. He also had a higher level of general health than our female patient. Both patients had reduced Bone Mineral Density (BMD). In female patients, calcium and vitamin D supplementation combined with metabolic therapy and nutritional drink supplements helped increase BMD (up to 32% in L1-L4). Comparing these two patients suggests that the larger the mtDNA deletion is, the more severe the course of the disease is. Not only does the size of the mtDNA deletion probably determine the severity of the disease, but also such factors as mtDNA heteroplasmy level, presence of mtDNA duplications, and pleioplasmy. Moreover, continuous nonconsecutive metabolic therapy and nutritional supplements are helpful in the prevention of deterioration of symptoms and general health.

Discrimination and health outcomes in England's black communities amid the cost-of-living crisis: evaluating the role of inflation and Bank Rates

ABSTRACT This study utilised longitudinal data from Black History Month events in London from 2021 to 2023. Novel findings revealed that increased inflation and Bank Rates, related to the cost-of-living crisis, were associated with greater discrimination and deteriorations in both general and mental health for Black individuals. Moreover, it was found that during the cost-of-living crisis period, i.e. 2022–2023, discrimination was more adversely related to general and mental health deterioration compared to the period before the cost-of-living crisis, i.e. 2021. In addition, women, non-native individuals, non-heterosexual individuals, the unemployed, economically inactive individuals, those with lower educational attainment, and older individuals experienced higher levels of discrimination and reduced general and mental health compared to reference groups. The findings of the study contribute to the literature by demonstrating the intertwined associations of macroeconomic deteriorations and discrimination with the health of the Black community, and its subgroup differences, providing a basis for targeted policies.

Resection of colorectal liver metastases with second-line aflibercept plus FOLFIRI: Results from the RESECTION prospective French cohort

Resection of colorectal liver metastases with second-line aflibercept plus FOLFIRI: Results from the RESECTION prospective French cohort

Combining patient-reported outcome measures to screen for active disease in rheumatoid arthritis and psoriatic arthritis

ObjectivesTo investigate whether a combination of general health (Visual Analogue Scale (VAS)), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain (VAS/Numerical Rating Scale (NRS)), quality of life (EQ-5D), fatigue (VAS/NRS) and presenteeism...

Analysis of disease burden in patients with hereditary angioedema from Japan by patient-reported outcomes.

Hereditary angioedema (HAE) symptoms can vary greatly. Disease burden evaluation is essential for providing adequate treatments for patients. Patient-reported outcome measures (PROMs), including the 12-Item Short Form Health Survey (SF-12), the Angioedema Quality of Life (AE-QoL), the Hospital Anxiety and Depression Scale (HADS), and the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaires, were collected in 2021, before modern medications for long-term prophylaxis (LTP) of HAE were licensed in Japan. Patients also reported their HAE attack frequency as "annual" (several attacks annually), "monthly" (several attacks monthly) or "weekly" (several attacks weekly). Multiple linear regression analyses were conducted on the relationship between independent parameters (sex, age, attack frequency, HAE type, and HADS scores) and dependent parameters (AE-QoL and SF-12 scores). Fifty-four patients reported PROMs. All PROMs showed substantial health-related quality of life (HRQoL) impairment. Overall, the higher the attack frequencies, the greater the reported impairment in the PROMs tended to be. In multiple linear regression analyses, higher AE-QoL Fatigue/Mood and Fears/Shame domain scores (greater impairment) were associated with higher HADS anxiety subscale scores; higher AE-QoL total scores (greater HRQoL impairment) and lower SF-12 Physical and Mental Health Composite scores (greater general health impairment) were associated with higher HADS depression subscale scores. Patients with monthly or weekly HAE attacks reported numerically low absenteeism and numerically high presenteeism and work productivity loss as measured by the WPAI:SHP questionnaire. In this study, conducted before modern LTP options were available in Japan, patients with HAE reported notable impairment in HRQoL and work productivity. Weekly or monthly HAE attack frequencies were associated with a high disease burden. Furthermore, a substantial number of patients reported notable fatigue/mood impairment as measured by the AE-QoL and depression as measured by the HADS regardless of attack frequency. These results provide a basis for future studies evaluating the effect of LTP on the clinical manifestations and HRQoL in patients with HAE.

Synthesis and characterization of modified chitosan as a promising material for enterosorption of heavy metal ions

Synthesis and characterization of modified chitosan as a promising material for enterosorption of heavy metal ions

Anorexia nervosa: a new look at an old problem

In Russia, according to Rosstat, approximately 2.5% of adolescents suffer from anorexia. In Moscow, according to 2015 data, at least 5% of young women suffered from anorexia; however, most experts believe that the true figures are much higher because only advanced cases are documented. The relevance of the problem of anorexia nervosa is associated with its potential threat to the lives of patients, eating disorders, concomitant mental diseases, and, in general, the deterioration of mental status. Despite the apparent simplicity of diagnosis, patients with advanced stages of anorexia nervosa that require long-term therapy are more likely to seek a doctor’s help. Anorexia requires a comprehensive treatment approach, including psychopharmacotherapy, psychological influence, diet therapy, therapy of somatic pathology, and concomitant complications. All these aspects of treatment must be implemented simultaneously. The key to success is the constant monitoring of therapy by a psychiatrist. Malnutrition will result in the deterioration of general health, particularly in girls with menstrual disorders, complications associated with conception and gestation, and a difficult pregnancy. Thus, this condition must be considered from the point of view of psychiatry, obstetrics, and gynecology.

Adult niemann-pick disease: A case report

Adult niemann-pick disease: A case report

87/m with general deterioration of health and dizziness

87/m with general deterioration of health and dizziness

Frailty: Focus on Regenerative Medicine

Frailty, as a specific condition of increased vulnerability and deterioration of general health associated with aging in the elderly, is an emerging problem worldwide with serious implications for clinical practice and public health. Frailty increases the risk of falls, hospitalization, disability, and death. Muscle aging is associated with progressive loss of skeletal muscle mass and function. Loss of muscle mass with age can be related to muscle fiber atrophy and loss of muscle fibers. With increasing human age, remodeling of bone tissue becomes more prone to slow and steady loss of bone mass, which is primarily associated with loss of bone formation by osteoblasts. Recent preclinical and clinical studies have confirmed the safety of mesenchymal stem/stromal cells (MSCs) in the treatment of frailty. MSCs are attracted to sites of damage where they act to reduce inflammation and promote cell repair. Thus, there is an assumption that frailty can be treated with cell therapy

A good enough grip on life in youth

An increasingly large number of Western youth suffer from impaired general well-being and mental health. This is not least compounded by inappropriate use of psychological concepts and methods. They are trying to get a grip on life by, first of all, using psychology in a psychologizing way, which – contrary to the intention – creates an impaired image of one’s self and life, and which is nonpractical, because it is difficult to operationalize and does not point towards what actually can be done to get a good enough grip on own and common life. In this article, we discuss the danger of this inclination for psychologizing and introduce a psychological method which may avoid the psychologizing pitfalls. A research study is presented showing whether high school students can make use of the method, as well as the effect of their use of the method regarding mental health in the form of experienced stress, general well-being, and sense of coherence in life.

Impact of Duration of Orthodontic Treatment on Periodontal Health and Treatment Needs of Patients

Malocclusion is highly prevalent and can also affect the general health of patients. Orthodontic treatment is required to treat malocclusion. This treatment often leads to a deterioration in periodontal and general oral health of patients. Objective: To assess the impact of duration of orthodontic treatment on periodontal health and treatment needs of patients. Methods: A comparative cross-sectional study was done on a total of 51 individuals undergoing orthodontic treatment. The data were collected from July 2021 to June 2023 after obtaining ethical clearance. All participants above the age of 12 years irrespective of their gender were included in the study. Participants who had mixed dentition or other systemic illness were not included. Data were collected using the Community Periodontal index for treatment needs (CPITN). Results: The difference in CPITN scores across orthodontic treatment groups with respect to duration (p=0.382) was not significant. All groups irrespective of their treatment duration required Basic oral hygiene instructions (TN1) while Complex treatment (TN3) was only required by patients undergoing treatment for more than a year. Conclusions: Basic oral hygiene instructions (TN1) were the treatment need of all patients from all groups irrespective of their treatment duration. An equal percentage of patients from all three treatment groups required (TN2) while (TN3) was only required by patients undergoing treatment for more than a year.