Etiological Aspects Research Articles

Revisiting Diagnostic Criteria for Bilateral Vestibulopathy: A New Comprehensive Instrumental Model.

Background: Bilateral vestibulopathy (BVP) is a disabling condition characterized by a deficit in vestibular function on both sides. Current diagnostic criteria consider instrumental data only from horizontal canals, excluding vertical canals and otolithic function, with the possibility of not including some variants of BVP. This study aims to evaluate vestibular functions in people with chronic vestibular syndrome through a comprehensive battery of tests. Methods: This diagnostic accuracy study included patients who met criteria for probable BVP. The index test included a thorough evaluation of the vestibular system, using the video Head Impulse Test (vHIT) to measure the gain of the angular vestibulo-ocular reflex (aVOR) in all six semicircular canals and the cervical and ocular vestibular-evoked myogenic potentials (VEMPs) to assess otolith function. The diagnostic criteria established by the Barany Society were considered the standard reference, including only the horizontal vHIT as an instrumental assessment. Results: 78 patients (41 male, age 61.40 ± 12.99) were enrolled. The Barany criteria showed a low ability to rule out BPV (sensitivity = 46%). The median Dizziness Handicap Inventory (DHI) varied from 66 to 69 among the models studied, and a significant difference in DHI scores between positive and negative tests was observed for the Barany criteria and the six-canals vHIT model. Conclusions: Our findings highlight the potential to transform BPV diagnostic criteria. The identification of new bilateral vestibular dysfunction variants through improved diagnostic tools calls for revising current criteria, with promising implications for patient care and understanding of etiological and prognostic aspects.

Diagnostic significance of the method of computerized joint vibration analysis in studying the functional state of temporomandibular joints

polyetiology, progressive course and high frequency of relapses is one of the urgent problems of modern dentistry. Different conceptual approaches to the analysis of etiological and pathogenetic aspects of the development of dysfunctional TMJ disorders predetermine the increased interest in the search for highly informative diagnostic methods, especially at the stage of preclinical manifestations.Goal. Evaluation of possibilities of computerized joint vibration analysis method in diagnostics of TMJ functional state.Materials and methods. The study involved 42 people of both sexes with physiologic types of bite, preserved tooth rows, no signs of functional disorders in TMJ and masticatory muscles. The patients underwent clinical dental examination, «Hamburg test», selective grinding of teeth, and measurement of mouth opening amplitude. Joint vibration analysis was performed on the hardware-software complex «BioPAK» with registration of TMJ noise oscillations according to the following indices: «Total Integral», «High Integral», «Low Integral», «Ratio». A flow chart (Ishigaki S. et al., 1993) was used to interpret the numerical values. The functional state of TMJ was de-termined according to the flowchart using numerical parameters in accordance with the classification of TMJ disorders (Wilkes С.Н., 1989).Results. In patients with physiologic occlusion, according to joint vibration analysis, Me «Total Integral» of the right TMJ was 11.7 PaHz, left TMJ – 12.6 PaHz, [Q-25; Q-75] – [9.3; 15.1] PaHz and [10.5; 18.3] PaHz respectively, Me «High Integral» of the right TMJ – 1.3 PaHz, left TMJ – 1.4 PaHz, [Q-25; Q-75] – [1.0; 1.8] PaHz and [1.2; 2.1] PaHz respectively, with no statistically significant (p≤0.05) differences in the studied parameters between the right and left TMJ.Conclusions. The diagnosis of «structurally intact» TMJ, corresponding to stage I of the American classification of TMJ disorders (Wilkes S.N., 1989) in people with physiologic types of bite, is confirmed by the numerical values [Q-25; Q-75] of «Total Integral», «High Integral» (block diagram of S. Ishigaki et al., 1993), the degree of maximum mouth opening [43; 50] mm in the absence of pronounced signs of facial asymmetry.

Features of the state of bone tissue in children with cerebral palsy. Part 1. Etiological aspects. A literature review

BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm. АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists. MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions. RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density. CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.

Etiology of epilepsy in Mexico: results from the national multi-centre register

Epilepsy affects millions of people and its geographical patterns are usually linked to etiological aspects. Our objective was to describe main etiologies of epilepsy in Mexico. We selected patients from the Multicenter Epilepsy Registry carried out from 2021 to 2022 in 89 Mexican hospitals in 31 states, a sample predominantly of pediatric age. Only patients with electroencephalography and neuroimaging studies were included. We analyzed 6,653 patients with documented etiologies. Etiology frequency with confidence interval (95% CI) was: structural 46.1% (44.9-47.3), genetic 12.9% (12.1-13.7), infectious 2.9%. (2.5-3.3), metabolic 1.4% (1.1-1.7), immune 0.9% (0.8-1.3) and unknown 40.9% (39.8-42.2). The two main structural etiologies were malformations of cortical development and hypoxic-ischemic encephalopathy. Neurocysticercosis represented a minority with only 1%. Structural and genetic etiologies were associated with focal and generalized onset seizures respectively. Status epilepticus was identified, mostly with motor component, associated with immune and infectious etiologies. Comorbidities were found in 61.6%, mainly neurological development disorders. Drug-resistant epilepsy was more common in patients with immune, infectious and structural etiologies. The main etiology of epilepsy was structural. The frequency of genetic etiology was relatively lower than in other series, possibly due to the limited availability of genetic tests. Despite technological advances, a large fraction of epilepsies still has unknown origin.

Maternal death before admission to the Sylvanus Olympia University Hospital Center (CHU SO) epidemiological and etiological aspects

Objective: determine the epidemiological and etiological profiles of a pregnant, parturient or women given birth before or within 10 minutes of admission Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study. Of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: in total, 654 maternal deaths including 153 maternal deaths before admission were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum; 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel; 46.3% referred without a reference form, 94.3% were referred without a venous access. In 10.7% the reason for evacuation was bleeding from the delivery with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: deaths before admission constitute an increasingly growing problem at CHU SO. Late referral is a determining factor in maternal deaths before admission.

Animal Models of Autistic-like Behavior in Rodents: A Scoping Review and Call for a Comprehensive Scoring System

Appropriate animal models of human diseases are a cornerstone in the advancement of science and medicine. To create animal models of neuropsychiatric and neurobehavioral diseases such as autism spectrum disorder (ASD) necessitates the development of sufficient neurobehavioral measuring tools to translate human behavior to expected measurable behavioral features in animals. If possible, the severity of the symptoms should also be assessed. Indeed, at least in rodents, adequate neurobehavioral and neurological tests have been developed. Since ASD is characterized by a number of specific behavioral trends with significant severity, animal models of autistic-like behavior have to demonstrate the specific characteristic features, namely impaired social interactions, communication deficits, and restricted, repetitive behavioral patterns, with association to several additional impairments such as somatosensory, motor, and memory impairments. Thus, an appropriate model must show behavioral impairment of a minimal number of neurobehavioral characteristics using an adequate number of behavioral tests. The proper animal models enable the study of ASD-like-behavior from the etiologic, pathogenetic, and therapeutic aspects. From the etiologic aspects, models have been developed by the use of immunogenic substances like polyinosinic-polycytidylic acid (PolyIC), lipopolysaccharide (LPS), and propionic acid, or other well-documented immunogens or pathogens, like Mycobacterium tuberculosis. Another approach is the use of chemicals like valproic acid, polychlorinated biphenyls (PCBs), organophosphate pesticides like chlorpyrifos (CPF), and others. These substances were administered either prenatally, generally after the period of major organogenesis, or, especially in rodents, during early postnatal life. In addition, using modern genetic manipulation methods, genetic models have been created of almost all human genetic diseases that are manifested by autistic-like behavior (i.e., fragile X, Rett syndrome, SHANK gene mutation, neuroligin genes, and others). Ideally, we should not only evaluate the different behavioral modes affected by the ASD-like behavior, but also assess the severity of the behavioral deviations by an appropriate scoring system, as applied to humans. We therefore propose a scoring system for improved assessment of ASD-like behavior in animal models.

Genetic Diversity in Schizophrenia: Developmental Implications of Ultra-Rare, Protein-Truncating Mutations.

The genetic basis of schizophrenia (SZ) remains elusive despite its characterization as a highly heritable disorder. This incomplete understanding has led to stagnation in therapeutics and treatment, leaving many suffering with insufficient relief from symptoms. However, recent large-cohort genome- and exome-wide association studies have provided insights into the underlying genetic machinery. The scale of these studies allows for the identification of ultra-rare mutations that confer substantial disease risk, guiding clinicians and researchers toward general classes of genes that are central to SZ etiology. One such large-scale collaboration effort by the Schizophrenia Exome Sequencing Meta-Analysis consortium identified ten, high-risk, ultra-rare, protein-truncating variants, providing the clearest picture to date of the dysfunctional gene products that substantially increase risk for SZ. While genetic studies of SZ provide valuable information regarding "what" genes are linked with the disorder, it is an open question as to "when" during brain development these genetic mutations impose deleterious effects. To shed light on this unresolved aspect of SZ etiology, we queried the BrainSpan developmental mRNA expression database for these ten high-risk genes and discovered three general expression trajectories throughout pre- and postnatal brain development. The elusiveness of SZ etiology, we infer, is not only borne out of the genetic heterogeneity across clinical cases, but also in our incomplete understanding of how genetic mutations perturb neurodevelopment during multiple critical periods. We contextualize this notion within the National Institute of Mental Health's Research Domain Criteria framework and emphasize the utility of considering both genetic variables and developmental context in future studies.

Clinical, Aetiological and Scannographic Aspects of Ischaemic Stroke in Children Aged 1 Month to 15 years at the Ignace Deen National Hospital

Clinical, Aetiological and Scannographic Aspects of Ischaemic Stroke in Children Aged 1 Month to 15 years at the Ignace Deen National Hospital

Epidemiological, Clinical, Etiological, and Therapeutic Aspects of Cerebral Palsy in Dakar

AbstractCerebral palsy is one of the most frequent causes of motor disability in children. The aim of our study was to characterize the epidemiological, clinical, paraclinical, etiological, and therapeutic aspects in Dakar. This was a retrospective and descriptive study from March 2010 to March 2020 at the Albert Royer National Children's Hospital and the Neurology Department of the Fann National University Hospital. We collected 913 patients, 13.7% of all pediatric neurology consultations, out of which 556 (60.9%) were males. The average age of the patients was 32.99 months (ranging between 25 days and 17 years). The most common subtype was isolated axial hypotonia (50%) followed by pyramidal (40.5%) and 45% had epilepsy. Brain imaging revealed cortico-subcortical atrophy in 15% of cases. Five hundred and fifty-two children (60.5%) had an electroencephalogram out of which 19.4% had diffuse irritative anomalies. In terms of treatment, 73% had received motor kinesitherapy. Sodium valproate was the most commonly used antiseizure medication at 76.67%. The average follow-up was 12 months. Seven hundred and ninety-two children (86.8%) were lost to follow-up and 5 children (0.5%) died. Psychomotor development improved in 219 children (13.4%) who acquired standing. Note that 267 children (30%) in a stable sitting position and 29 children had acquired language. Cerebral palsy is a disabling condition that needs to be diagnosed early and early interventions can improve the quality of life of the child.

The Current State of Tinnitus Diagnosis and Treatment: a Multidisciplinary Expert Perspective

Tinnitus, the perception of sound without an external source, affects 15% of the population, with 2.4% experiencing significant distress. In this review, we summarize the current state of knowledge about tinnitus management with a particular focus on the translation into clinical practice. In the first section, we analyze shortcomings, knowledge gaps, and challenges in the field of tinnitus research. Then, we highlight the relevance of the diagnostic process to account for tinnitus heterogeneity and to identify all relevant aspects of the tinnitus in an individual patient, such as etiological aspects, pathophysiological mechanisms, factors that contribute most to suffering, and comorbidities. In the next section, we review available treatment options, including counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches. The evidence for the effectiveness of the various treatment interventions varies considerably. We also discuss differences in current respective guideline recommendations and close with a discussion of how current pathophysiological knowledge, latest scientific evidence, and patient perspectives can be translated in patient-centered care.

Splenic abscess secondary to COVID-19 acute infection: A case report and literature review.

Splenic abscess is relatively rare in clinical practice as an invasive disease. However, during the continuous prevalence of coronavirus disease 2019 (COVID-19), the incidence rate of splenic abscess showed an upward trend. However, because the etiology of splenic abscess is not specific, it is easy to be covered by the respiratory symptoms of COVID-19, resulting in omission or delay in diagnosis. If splenic abscesses cannot be treated in a timely manner, the mortality rate can reach 100%. Therefore, it is important to fully understand the correlation between COVID-19 and the development of splenic abscesses. A female patient, 71 years of age, was admitted to our hospital because of cough and sputum for 1 week and fever for 2 days. According to the positive results of novel coronavirus nucleic acid and chest computed tomography, novel coronavirus pneumonia was diagnosed. On the 4th day after treatment, abdominal distension and vomiting were observed. Abdominal ultrasound indicated splenomegaly and mixed echo masses in the spleen and abdominal computed tomography indicated 2 new round low-density lesions were found in the spleen. The patient was diagnosed with secondary splenic abscess after COVID-19 infection. The patient and her family members refused to undergo ultrasound-guided splenic puncture drainage and splenectomy. In terms of treatment, she was given meropenem combined with vancomycin to continue anti-infection treatment. The patient's body temperature and infection indicators gradually increased, and the scope of splenic abscess continued to expand. The infection worsened and progressed to septic shock. The patient abandoned rescue drugs and invasive treatment, and died on the 9th day after admission. This case introduces the clinical characteristics of secondary splenic abscess caused by COVID-19 from the aspects of etiology, disease course, clinical manifestations, auxiliary examinations, and treatment methods. The focus is on improving the understanding of clinical doctors about secondary splenic abscesses caused by COVID-19, providing reference for early diagnosis and timely treatment.

Imaging of bones dysbarogenic changes in navy divers

The number of diving descents in the world is steadily growing, as is the complexity of the work performed under conditions of increased environmental pressure. Also, in order to increase efficiency and expand the range of tasks performed, the intensity, depth of dives and the time divers spend in hyperbaric conditions are increasing. These factors contribute to an increase in the number of diving pathologies, including damage to the skeletal bones of dysbarogenic genesis. X-ray diagnostic methods used during annual medical examinations of divers do not always allow the detection of dysbarogenic changes in the bones; in addition, the clinical manifestations of this pathology do not have obvious specificity. In this regard, it can be assumed that the occurrence of this pathology among divers has not been reliably established to date. This article is devoted to a review of the literature on the possibilities of radiodiagnosis of dysbarogenic changes in skeletal bones in specialists whose work involves being in conditions of high environmental pressure. The article highlights the results of a literature review of English-language and Russian-language publications presented in the databases of PubMed and scientific electronic libraries of Russia (eLIBRARY.RU and CYBERLENINKA.RU). In order to determine the optimal methods of radiation diagnostics, the etiological and pathogenetic aspects of the development of dysbarogenic degenerative and necrotic changes in the bones of the skeleton, as well as the experience of scientists in determining the corresponding radiation semiotics, were analyzed. Considering that the worst manifestation of bone pathology of dysbarogenic origin is dysbaric (aseptic) osteonecrosis, we studied the literature on the issues of its clinical and instrumental diagnosis. One of the directions in scientific research was the work of authors exploring the possibilities of early instrumental diagnosis of changes in bone tissue, in particular the possibilities of magnetic resonance imaging in the diagnosis of dysbaric osteonecrosis. In addition, data on modern x-ray methods were analyzed, which may be promising as a screening diagnosis of dysbarogenic degenerative and necrotic changes in the bones of the skeleton.

Etiological and immunopathogenetic aspects of multiorgan failure development in coronavirus disease (COVID-19)

The COVID-19 epidemic has already come to be seen as an emergency of international concern. This relates not only to the wide occurrence of the infection, but also to a fairly high mortality rate, currently more than 6.5 million deaths in the world. The aim of this study was to analyze, generalize and systematize the currently available literary data on the study of the novel coronavirus infection pathogenesis in the human body and to determine key changes that occur after the SARS-CoV-2 penetration into cells. In this way to target physicians primarily based on the pathogenetic processes that occur in the human body, syndromes and symptom complexes that are observed in treatments. Results. The article presents a literature review demonstrating that the specific interaction between the virus and somatic cells is the triggering mechanism for the pathogenesis of coronavirus infection. The main route for SARS-CoV-2 entry into the body is the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed not only in type 2 alveolar epithelial cells, but also in cells of the kidney, heart, blood vessels and gastrointestinal tract, including endotheliocytes and pericytes. Expression of the ACE2 receptor has also been shown in various structures and parts of the brain, cells of the conjunctiva, limbus, cornea and cells of the substantia propria. A high expression of the ACE2 receptor has been found in the epithelial cells of the oral mucosa, salivary glands, tonsils and tongue. These factors explain a possible involvement of different organs and systems in the development of multiorgan failure. Conclusions. In the development of multiorgan disfunction, two components are important: first, direct cell tropism and viral load, that may be unique in each patient. Secondly, it is the development of immune-mediated reactions to infected cells. Under conditions of hyperimmune inflammation, that is, the development of cytokine storm, acute respiratory distress syndrome progresses, and multiple organ failure develops. Endothelial damage is directly involved in the pathophysiology of this process, that results in the development of endothelial dysfunction, disruption of microcirculation, as well as perivascular inflammation, which aggravates damage to the endothelium and can lead to thrombus formation. The use of modern knowledge about the immunopathogenesis of COVID-19 would help to estimate the risk for severe infection and the possible development of complications, allowing for the timely implementation of effective pathogenetic therapy.

Disturbance in communication between mitochondrial redox processes and the AMPK/PGC-1α/SIRT-1 axis influences diverse organ symptoms in lupus-affected mice

BackgroundMechanisms behind multiple organ involvement in lupus, is still an enigma for researchers. Mitochondrial dysfunction and oxidative stress are known to be important aspects in lupus etiology however, their role in lupus organ manifestation is yet to be understood. The present study is based on the understanding of interplay between AMPK/PGC-1α/SIRT-1 axis, mitochondrial complexes, and anti-oxidants levels, which might be involved in lupus organ pathology. MethodologyPristane-induced Balb/c mice lupus model (PIL) was utilised and evaluation of anti-oxidants, mitochondrial complexes, pro-inflammatory cytokines levels, biochemical parameters were performed by standard procedures. Tissues were studied by haematoxylin and eosin staining followed by immunohistochemistry. The AMPK/PGC-1α/SIRT-1 expression was analysed by using qPCR and flowcytometry. Analysis of reactive oxygen species (ROS) among WBCs was performed by using various dyes (DCFDA, Mitosox, JC-1) on flowcytometry. ResultSignificant presence of immune complexes (Tissue sections), ANA (Serum), and pro-inflammatory cytokines (plasma), diminished anti-oxidants and altered biochemical parameters depict the altered pathology in PIL which was accompanied by dysregulated mitochondrial complex activity. Differential expression of the AMPK/PGC-1α/SIRT-1 axis was detected in tissue and correlation with mitochondrial and antioxidant activity emerged as negative in PIL group while positive in controls. Close association was observed between ROS, mitochondrial membrane potential, and AMPK/PGC-1α/SIRT-1 axis in WBCs. ConclusionThis study concludes that mitochondria play a dual role in lupus organ pathology, contributing to organ damage while also potentially protecting against damage through the regulation of interactions between antioxidants and the AMPK axis expression.

Epidemiological and Etiological Aspects of Acute Renal Failure in the Nephrology and Haemodialysis Department of the Point G University Hospital

Introduction: Acute renal failure (ARF) represents a major public health problem associated with high mortality. The incidence is increasing with the emergence of multiple risk factors. In Mali, there are currently no data on the extent and severity of this condition in either hospital or community settings. The aim of our study was to describe the epidemiological, therapeutic and prognostic aspects of ARF in adults treated at the University Hospital Centre (CHU) of Bamako. Patients and Methods: This was a retrospective and descriptive study that took place from 1 July 2021 to 30 June 2022 at the CHU du Point G in Bamako. It focused on patients hospitalised and/or followed up on an outpatient basis in the nephrology department during the study period. Results: The prevalence of acute renal failure was 11.55% with a sex ratio of 1.49. The mean age was 42.37±20.7 (range 6-88 years). Elevated plasma creatinine was the main reason for consultation. Creatinine levels were above 500µmol/l in 65.21% of cases. High blood pressure was the main presenting condition in 33.7% of cases. Acute renal failure was organic, obstructive and functional in 72.8%, 15.2% and 12% respectively. Rehydratation was used in 97.8% of cases. Dialysis was indicated in 40% of cases. Age over 60 years was a major risk factor for ARF. The outcome was favourable in 81.5% of cases. Conclusion: Mortality in dialysis patients with ARF remains high. Several factors influence the prognosis of these patients, including the severity of ARF and pre-existing comorbidity.

Acquired High Flow Arteriovenous Malformation of the Lower Lip Induced by Hormonal Variation- Report of a Rare Case and Review

Arteriovenous malformations (AVMs) are uncommon vascular lesions. AVMs are the most serious type of vascular malformations, causing substantial deformity and functional disability. AVMs of the acquired type are rarely confronted in the head and neck region. They may present as a medical emergency while performing dental procedures due to their potential for uncontrollable haemorrhage. Dental professionals should be aware of their potentially fatal complications and management. Accurate diagnosis of AVMs is critical and their management remains challenging. Vascular anomalies involving the lips can negatively impact the functionality and facial appearance. In this article, we discuss a very rare case of acquired AVM of the lower lip triggered by hormonal variation occurring during menopause in a female patient, 58 years of age. There are no reported cases of acquired AVM of the lip with hormonal variation occurring during menopause as the trigger for proliferation of the lesion. An overview of the clinical, etiological, diagnostic and management aspects of head and neck region-acquired AVMs is also presented in this paper.

Histone Deacetylases in Retinoblastoma.

Retinoblastoma, a pediatric ocular malignancy, presents significant challenges in comprehending its molecular underpinnings and targeted therapeutic approaches. The dysregulated activity of histone deacetylases (HDACs) has been associated with retinoblastoma pathogenesis, influencing critical cellular processes like cell cycle regulation or retinal ganglion cell apoptosis. Through their deacetylase activity, HDACs exert control over key tumor suppressors and oncogenes, influencing the delicate equilibrium between proliferation and cell death. Furthermore, the interplay between HDACs and the retinoblastoma protein pathway, a pivotal aspect of retinoblastoma etiology, reveals a complex network of interactions influencing the tumor microenvironment. The examination of HDAC inhibitors, encompassing both established and novel compounds, offers insights into potential approaches to restore acetylation balance and impede retinoblastoma progression. Moreover, the identification of specific HDAC isoforms exhibiting varying expression in retinoblastoma provides avenues for personalized therapeutic strategies, allowing for interventions tailored to individual patient profiles. This review focuses on the intricate interrelationship between HDACs and retinoblastoma, shedding light on epigenetic mechanisms that control tumor development and progression. The exploration of HDAC-targeted therapies underscores the potential for innovative treatment modalities in the pursuit of more efficacious and personalized management strategies for this disease.

The role of neutrophils in chronic cough.

Chronic cough is a common disorder lasting more than 8weeks and affecting all age groups. The evidence supporting the role of neutrophils in chronic cough pathology is based on many patients with chronic cough developing airway neutrophilia. How neutrophils influence the development of chronic cough is unknown. However, they are likely involved in multiple aspects of cough etiology, including promoting airway inflammation, airway remodeling, hyper-responsiveness, local neurogenic inflammation, and other possible mechanisms. Neutrophilic airway inflammation is also associated with refractory cough, poor control of underlying diseases (e.g., asthma), and insensitivity to cough suppressant therapy. The potential for targeting neutrophils in chronic cough needs exploration, including developing new drugs targeting one or more neutrophil-mediated pathways or altering the neutrophil phenotype to alleviate chronic cough. How the airway microbiome differs, plays a role, and interacts with neutrophils in different cough etiologies is poorly understood. Future studies should focus on understanding the relationship between the airway microbiome and neutrophils.

Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases.

Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms.MRI is the reference examination, allowingnot onlythe early diagnosis of pachymeningitisbut alsothe assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaginghad revealed the presence ofpachymeningitis.The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13cases,and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsyconductedon an individual patient revealed non-diagnostic results. The etiological investigationwas dominatedby tuberculosis, which was detectedin 33.3% of cases.Idiopathic origin was identifiedin 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.

Prevalence and risk factors of functional abdominal disorders according to a survey study among young people

Introduction. The etiological aspects of functional dyspepsia (FD) and irritable bowel syndrome (IBS) are not clear; the epidemiology of diseases in age groups and societies can help in understanding the starting causes of the pathology.Aim. To assess the risk factors for the development and prevalence of abdominal symptoms characteristic of FD and IBS among active users of Internet communities.Materials and methods. An anonymous online survey was conducted among medical university students. The questionnaire contains questions about complaints typical of FD and IBS over the past week, “alarm” symptoms, personal characteristics of the respondent and possible risk factors: smoking, family history, taking antibiotics, iron pills, non-steroidal anti-inflammatory drugs (NSAIDs).Results and discussion. The study included 983 respondents aged 18−26 years, 279 men and 704 women. Symptoms of unstudied regular (>1 time per week) postprandial dyspeptic disorders, bloating and abdominal pain were identified in 391 (39.8%) people, of which 29% were men and 44% were women (p < 0.001). Risk factors for regular unstudied disorders were having relatives with chronic gastrointestinal diseases (OR 2.05 [1.56, 2.70]); female gender (OR 1.92 [1.43, 2.59]); taking NSAIDs (OR 1.48 [1.14; 1.91]); for women – smoking (OR 2.24 [1.57; 3.18]). 6.5% of respondents met the criteria for FD, of which 23.4% had isolated epigastric pain, 26.6% had isolated postprandial distress syndrome, and 50% had combined FD. 2.5% of respondents met the criteria for IBS, 64% of whom had overlap syndrome with FD. The presence of FD was associated with NSAIDs use: r = 0.081; p = 0.011 (OR 1.95 [1.16; 3.30]).Conclusions. The prevalence of FD and/or IBS among people aged 18−26 years is 7.4%, with no significant differences between men and women. Taking NSAIDs can be considered as a factor contributing to the development of FD.