Etiological Causes Research Articles

Historical and current aspects of angiovisualization methods in CАD (a literature review)

The aim of the work. To summarize and expand knowledge about current methods used for visualization of coronary arteries, their evolution, capabilities, effectiveness, indications for use, safety for patients, guided by the principles of evidence-based medicine. Coronary artery disease (CАD) is an extremely common clinical cardiovascular disease, which is caused by atherosclerosis of the subepicardial coronary arteries (CAs) and can have both acute and chronic course. The incidence of CАD is increasing every year and getting younger. CАD has not only a high morbidity rate, but also a high mortality rate. In Ukraine, mortality from CАD is the main cause of population mortality. Without timely diagnosis and effective treatment, myocardial infarction or sudden cardiac death may develop. It is possible to ascertain the etiological cause of myocardial ischemia only after visualization of the СAs. A practicing physician is able to visualize the СAs using X-ray contrast coronary angiography or contrast-enhanced computed tomography of the chest. СA visualization methods have been used in clinical practice for more than half a century. The hardware and software are constantly upgraded, the diagnostic options of these methods are improved and expanded, and recommendations regarding their use in general clinical practice are updated. The main task for clinicians is to confirm or rule out the presence of a СA atherosclerotic lesion, as well as to determine its localization, extent, degree of stenosis and its significance for coronary blood flow, the presence of СA calcification, collateral pathways, plaque composition and its internal structure. Only after identifying the anatomical and physiological aspects of the atherosclerotic process in СA, it is possible to choose the right strategy for the treatment of patients by a multidisciplinary heart team including pharmacological therapy, a method of cardiac revascularization, and measures for primary or secondary prevention. Conclusions. CАD is a common disease worldwide. Today, two methods of the CА visualization are available – invasive coronary angiography and non-invasive coronary CT angiography. Further research is needed on the efficacy and safety of different СA imaging methods in CAD. Better results of the diagnostic search depend on both the capabilities of the clinic hardware component and on the optimal sequence for diagnostic processes rationally constructed by physicians.

Dilemma of chronic kidney disease of unknown origin

Over the past two decades, cumulative increases in the prevalence of chronic kidney disease (CKD) have been observed in selected geographic areas in several countries. The etiology of this CKD cannot be attributed to known or traditional causes or risk factors, and the term chronic kidney disease of unknown etiology (CKDu) has been used to describe this entity. These regional endemic nephropathies are commonly known as CKD of unidentified cause (CKDu) or CKD of nontraditional etiology (CKDnt) and, more recently, Chronic interstitial nephritis of agricultural communities (CINAC). Unlike the traditional causes of CKD (i.e., Hypertension, Diabetes, chronic glomerulonephritis, etc), CKDu has been associated with agricultural and arid regions. Also, the socioeconomic state of those regions is key. This review addresses the present status of the knowledge for different aspects of this regional health problem as well as summarizes available evidence on the risk factors, epidemiology, clinical features, diagnosis, treatment, and prevention of CKDu. It will also highlight the reasons why Africa should be concerned about this condition. Using the keywords “Africa, CKD of unknown origin,” a literature search was conducted on PubMed, Scopus, and Google Scholar, focusing on the research published between 2000 and 2022. Results from the literature show that predisposition to heat stress and dehydration, subclinical rhabdomyolysis, toxins from alcoholic beverages, agrochemicals, and heavy metals all result in acute kidney injury, and repeated exposures to these factors can then cause CKDu. Earlier studies in Sri Lanka nephropathy by Nanayakkara and his team in 2014 identified that a genetic variant of SLC13A3 (sodium-dependent dicarboxylate transporter member 3) is associated with CKDu. Later research conducted in 2015 discovered KCNA10 (a voltage-gated potassium channel) also as a gene implicated in CKDu; these genetic variances were discovered to be common among the populace suffering from kidney diseases, hence suggesting that, people with these genes have a high risk of developing kidney disease. Predisposition to heat stress and dehydration, subclinical rhabdomyolysis, and toxins from alcoholic beverages, agrochemicals, and heavy metals all results in acute kidney injury, and repeated exposures to these factors can then cause CKDu. Also, certain genes have been found to be associated with CKDu.

Vertebral osteomyelitis caused by Campylobacter jejuni in an immunocompetent patient

BackgroundCampylobacter jejuni is the leading cause of human bacterial gastroenteritis worldwide. However, systemic infection with C. jejuni is uncommon, and osteomyelitis caused by C. jejuni is extremely rare. Cultivation from spinal bone biopsies has not previously been reported in the literature.Case presentationA 79-year-old immunocompetent male was admitted to the emergency department at Aalborg University Hospital in Denmark with lower back pain, fever and diarrhoea. A FecalSwab obtained upon admission was PCR-positive for Campylobacter spp, while an aerobic blood culture bottle was positive for C. jejuni (Time to detection: 70.4 h). A MRI of columna totalis showed osteomyelitis at L1/L2 with an epidural abscess from L1 to L2 with compression of the dura sack. The patient underwent spinal surgery with spondylodesis and decompression of L1/L2. The surgery was uncomplicated and the discus material was also culture positive for C. jejuni. The patient was treated with meropenem for a total duration of four weeks, followed by four weeks of oral treatment with clindamycin in tapered dosage. The patient recovered quickly following surgery and targeted antibiotic treatment with decreasing lumbar pain and biochemical response and was fully recovered at follow-up three months after end of treatment.ConclusionsWhile C. jejuni osteomyelitis is rare, it should still be suspected as a possible causative bacterial aetiology in patients with vertebral osteomyelitis, in particular when symptoms of diarrhoea is involved in the clinical presentation. Susceptibility testing is crucial due to emerging resistance, and targeted treatment strategies should rely upon such tests.

Chronic Heart Failure and Progressive Angina

Chronic heart failure (CHF) is a “pathophysiological syndrome in which, as a result of a particular disease of the cardiovascular system or under the influence of other etiological causes, the heart’s ability to fill or empty is impaired, accompanied by an imbalance of the neurohumoral systems (RAAS, sympathoadrenal system, natriuretic peptides, kallikrein-kinin system). As well as the development of vasoconstriction and fluid retention, there is a dysfunction of the heart (remodeling) and other target organs (proliferation), as well as a discrepancy between the provision of organs and tissues of the body with blood and oxygen with their metabolic needs” [1-3].

Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of São Paulo City, Brazil

BackgroundCommunity-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. MethodsThe aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. ResultsA total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. ConclusionOur study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics.

Acute Chemical Poisoning in an Industrial City: Current Situation, Dynamics and Forecast

Introduction: The urgency of the problem of acute chemical poisoning is attributed to the fact that it is the cause of poor health, disability and premature death of the population, as well as a significant medical and socio-economic damage. Objective: To conduct a retrospective and prospective epidemiological study of acute chemical poisoning based on the results of toxicological monitoring in the city of Taganrog for 2008–2022. Materials and methods: We carried out a comprehensive analysis of statistical reporting forms and a personalized database of 2,466 cases of acute chemical poisoning registered in the city of Taganrog, Rostov Region, in 2008–2022. To do this, we used software of our own design and professional software packages IBM SPSS Statistics version 19.0 and Matlab R2021a with a set of tools for synthesizing and analyzing neural networks Neural Network Toolbox. Results: Over the 15-year period under study, trends towards a decrease in the rates of acute chemical poisoning, mortality and lethality had formed, as confirmed by a favorable assessment of the situation based on regional criteria and actual risk indicators. Alcohol surrogates, pharmaceutical drugs, and carbon monoxide remain the priority etiological causes of poisoning. Relatively high rates were observed among children aged 0–6 not attending preschools and schoolchildren aged 7–17, as well as among the unemployed and pensioners, which allowed us to attribute them to risk groups. High accuracy of forecasts generated using artificial neural networks has been confirmed. Conclusion: The results of toxicological monitoring are the basis for assessing the situation and optimizing toxicological care, both necessary for managerial decision-making and elaboration of targeted chemical safety programs.

An underestimated old friend: Serum protein electrophoresis in the differential diagnosis of glomerulopathies

Background: Serum protein electrophoresis (SPEP) is an easy test separating serum proteins based on their physical and chemical properties. Although it is frequently used in the differential diagnosis of multiple myeloma and various chronic inflammatory diseases, its value in the etiologic classification of glomerular diseases has yet to be studied.
 Material and Methods: We retrospectively reviewed the medical records of patients who underwent renal biopsy from 2008 to 2016 at our institution. We excluded patients who can not be classified as primary (PGn) or secondary glomerulonephritis (SGn). Univariate and multivariate logistic regression analyses were performed for the prediction of SGn. 
 Results: Four hundred thirty-two patients were included in the study. Of those, 57.9% had PGn. Rheumatological diseases, malignancies, and infections were the most common etiologic causes of SGn, accounting for nearly 75%. Univariate analysis revealed that alpha-1 (α1), gamma (Ɣ), and albumin fractions significantly differ between PGn and SGn groups. ROC curve analysis determined the cut-off value of (α1*Ɣ)/albumin ratio as 1.48. Multivariate analysis revealed that total serum protein and (α1*Ɣ)/albumin ratio were significantly independent predictors for SGn (p=0.020 and p

Enhancing Omphalocele Care: Navigating Complications and Innovative Treatment Approaches.

Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral abdominal wall can be diagnosed by their distinctive anatomical presentations. Among them, omphalocele, gastroschisis and umbilical cord hernias are the most frequently observed clinically detected abdominal wall anomalies. Omphalocelerefers to the herniation of abdominal contents through a defect in the abdominal wall at the umbilicus with or without the presence of a sac. This article gives an insight into the embryology, risk factors, treatment, investigations and complications of omphalocele, a common congenital abdominal wall defect. There is minimal proof that environmental factors contribute to the development of omphalocele. However, there is a considerable amount of evidence which points to the importance of genetic or familial risk factors. Newborns and infants with prenatal diagnoses are the most frequently presenting patients with omphalocele to paediatric surgeons. This article describes the problems and the steps of managementfor handling each circumstance, as well as any further complications. Omphalocele and gastroschisis are frequently described together in many research papers. However, it's crucial to considerthat they are two different conditions which vary in anatomy, pathologyand associated conditionswhich account for the difference in their treatments and noticeably varied outcomes. Additionally, there is evidence that each has a different set of factors associated with risk for occurrence. There are no known etiologic causes that cause these abnormalities to develop. The size of the baby, the extent of the lesion, and any other disorders all affect how individuals with these congenital abdominal wall anomalies are treated.

The Comparison of the Anti-inflammatory Efficacy of Phytochemical Extracts in Punica granatum and Lawsonia inermis Among Patients Diagnosed With Chronic Periodontitis.

Introduction The oral cavity is the gateway to the human body. Periodontitis is a common inflammatory condition affecting the oral cavity and a known etiological cause of tissue destruction, discomfort, and halitosis. Pomegranate (Punica granatum)and henna (Lawsonia inermis) are herbs known to mankind from timeimmemorial whose extracts are proven to fight inflammation. The current study was done to evaluate the phytochemical anti-inflammatory efficacy of Punica and Lawsonia in patients with chronic periodontitis and test the potency of herbal mouthwashes in fighting the inflammatory condition affecting the oral cavity using distilled water as a control group. Materials and methods A double-blinded randomized control trial was conducted on 60 patients who were recruited and divided into three groups, in which 20 patients were prescribed with pomegranate (Punica: n=20) mouthwash and 20 patients with henna (Lawsonia: n=20) mouthwash along with distilled water (n=20). All patients were randomly allocated using the coin toss methodand advised to use the prescribed mouthwash for a period of two weeks. Unstimulated saliva was collected before using the mouthwash, and salivary enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) and their levels were assessed spectrometrically using the infrared spectrophotoscopy (IFSC) method. Each patientwas assigned a mouthwash and recalled after two weeks. Unstimulated saliva was again collected, and salivary activity levels of enzymes AST, ALT, and LDH were analyzed after using mouthwash in a similar method as done before. Later on, the salivary levels of enzymes AST, ALT, and LDH were compared before and after the usage of mouthwashes. Statistical significance was seen in the salivary enzymatic activity of AST, ALT, and LDH before and after using Punica and Lawsonia mouthwashes due to their potent phytochemical action in fighting inflammation. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS)22 (IBM SPSS Statistics, Armonk, NY). The Shapiro-Wilk test was used to determine the normality and significance; intragroup comparison was done using the Wilcoxon signed-rank test and Mann-Whitney U test. Intergroup comparison was done using the Kruskal-Wallis test. Results Punica patients had much lower levels ofsalivary AST and ALT (p<0.001) and a decrease in LDH (p=0.002) after the usage of mouthwash for a period of two weeks. Also, patients using Lawsonia as herbal mouthwash had reduction in the values of AST (p=0.001) and LDH (p=0.003) and prominent reduction in ALT (p<0.001) aftera period of two weeks. But in the case of patients using distilled water, there was an increase in the salivary enzymatic activity of AST and ALT, which was statistically significant (p<0.001), and LDH (p=0.006)depicting the disease progression even after using mouthwash for the given time period of two weeks. Conclusion This study demonstrated that both Punica and Lawsonia were effective in reducing the inflammation in patients diagnosed with chronic periodontitis. However, when intergroup comparison was done, the anti-inflammatory efficacy was superior in Punica with significant reductionin the parameters such as ofAST, ALT, and LDHwhen compared to Lawsoniaowing to its potent phytochemical constituency in cutting down the inflammation. Hence,Punica can be used as an implicatedeffective anti-inflammatory herbal mouthwash.

Survival of unconstrained ceramic wrist joint implants

Introduction Survival of implants is an important indicator of improvement in the patient's quality of life. In foreign literature, the issue of implant survival finds special attention.The aim of the work was to evaluate the efficacy and survival of an unconstrained ceramic wrist joint endoprosthesis.Materials and methods We analysed 83 cases of total wrist arthroplasty with an unconstrained ceramic implant at long-term follow-up. At the Novosibirsk RSITO, total wrist arthroplasty was performed in 81 patients with severe changes in the wrist joint from 2011 to 2021. Two patients underwent arthroplasty on two joints. A retrospective uncontrolled cohort study was conducted which divided the hospitalized patients into three groups according to the etiological cause of the disease. Radiological methods were used to control the state of the implant (radiography in two projections and CT-scans of the wrist joint). For binary indicators, the number, rates and 95 % confidence interval of frequencies were calculated according to the Wilson formula in the groups. Comparison was carried out by Fisher's exact two-sided test. The p-error was corrected using the Benjamini – Hochberg method. Kaplan – Meier curves were constructed for survival analysis. The groups were compared using a generalized chi-square test.Results Each case of repeated surgical intervention was evaluated from the standpoint of selected groups. Depending on the time elapsed from surgery to revision, we calculated the time frame for overall and group survival of the components of the wrist joint endoprosthesis. The causes and scope of surgical revision are presented.Discussion There are no data on the survival of unconstrained ceramic wrist joint implants in the foreign literature. Graphic images according to a proposal for the division of the orthopaedic postoperative period are presented. Conclusions 1. Intermediate conclusions in regard to total arthroplasty with an unconstrained ceramic endoprosthesis of the wrist joint inspire optimism in obtaining a stable positive effect of motion range lost due to the degenerative process in the wrist joint. 2. An 11-year follow-up period demonstrates that the survival rate of an unconstrained ceramic wrist endoprosthesis is 88 %.

Exploring Molecular Mechanisms of Traditional Persian Medicine-based Herbal Remedies for Depression: A Network-based Study

Background: Major Depressive Disorder (MDD) is a prevalent mental health condition that affects a significant portion of the general population. Despite the availability of pharmacological, psychological, and novel neurological approaches, optimal outcomes are only achieved in roughly 50% of patients. Traditional Persian Medicine (TPM) recommends a holistic approach to cure diseases based on the etiologic cause of malfunctions. This study aimed to explore the potential of integrating TPM and systems pharmacology approaches for the management of MDD. background: Depression is considered one of the most prevalent mental illnesses worldwide. Depression and the effectiveness of antidepressants are both influenced by genetic factors. Various anti-depressant remedies have been listed in Traditional Persian medicine (TPM) manuscripts, which may be useful as adjuvant therapy in the treatment of depression. The use of network-based studies is becoming more and more crucial for comprehending how medications apply their pharmacological actions. The growing fields of systems pharmacology (SP) and bioinformatics make use of computing to comprehend how drugs function at cellular and molecular levels. A common biological route that involves protein-protein (drug-target) interactions can be mechanistically understood using SP. Methods: A network-based investigation was conducted to explore the molecular mechanisms of TPM-based herbal remedies for depression. The study utilized a network pharmacology approach to identify active compounds, targets, and pathways involved in the treatment of depression. The study also conducted a literature review to identify the effectiveness of TPMbased remedies in treating depression. objective: The objective of the current study was to investigate the molecular mechanisms underlying TPM approach in the treatment of depression. Results: The study identified several active compounds, targets, and pathways involved in the treatment of depression by TPM-based herbal remedies. The study also identified several TPMbased remedies with anti-inflammatory properties that may be effective in treating depression. The literature review supported the potential of TPM remedies for the management of MDD. Conclusion: The integration of TPM and systems pharmacology may provide a holistic insight into the management of MDD. The study's findings suggest the potential of TPM-based remedies with anti-depressant properties, and further research is needed to understand the molecular mechanisms underlying their effectiveness. Integrating TPM-based remedies with bioinformatics may provide a complementary therapeutic avenue to MDD management and improve the quality of life for MDD patients. result: According to our study, many phytochemicals found in the plants used to make TPM-based prescriptions may impact various genes linked to depressive disorders. conclusion: The findings of these investigations suggested that many of the identified herbal remedies may have the potential to treat depression by activating a number of different pathways. The current study encourages further study of TPM as a model for creating efficient complementary therapies.

Internal Control Failure in SARS-CoV-2 PCR, Technical vs specimen Etiology

SARS-CoV-2 (COVID-19) pandemic was global threat and preventing the re-pandemic considered the main target nowadays in many of healthcare commissions. Early and rapid diagnosis was achieved by PCR testing for COVID-19, against this concept was the rejection and or reptation of testing because of failure of processing mainly due to internal control failure (ICF). The objective of our study was emerged to find out the main cause of Internal Control Failure in SARS-CoV-2 PCR, and whether it caused mainly by Technical or Specimen Etiology.50 specimens of SARS-CoV-2 PCR were used with their original testing result were of Internal Control Failure then repeated to conclude whether it caused by Technical (the second reading gave a valid result) or Specimen Etiology (the second reading gave a ICF result). The result was highly significant. (p &lt; .05). comparing the valid second result (technical causes) to ICF second result (specimen causes). We concluded that technical causes of ICF was the main cause of ICF result of PCR testing for COVID-19 with minimal specimen etiological cause that could recommend to interpret the result t of positive or negative from first reading with commenting on ICF with repetition especially in valid run and urgent specimen.

Diagnostic yield of chromosomal microarray in the largest Latino clinical cohort.

Copy number variants (CNVs) remain a major etiological cause of neurodevelopmental delay and congenital malformations. Chromosomal microarray analysis (CMA) represents the gold standard for CNVs molecular characterization. We applied CMA throughout the patient's clinical diagnostic workup, as the patient's medical provider requested. We collected CMA results of 3380 patients enrolled for 5 years (2016-2021). We found 830 CNVs in 719 patients with potential clinical significance, that is, (i) pathogenic, (ii) likely pathogenic, and (iii) variants of uncertain significance (VUS), from which 10.6% (predominantly involving chromosomes 15 and 22) were most likely the final cause underpinning the patients' clinical phenotype. For those associated with neurodevelopmental phenotypes, the rate of pathogenic or likely pathogenic findings among the patients with CNVs was 60.75%. When considering epileptic phenotypes, it was 59%. Interestingly, our protocol identified two gains harbored in 17q21.31 and 9q34.3, internationally classified initially as VUS. However, because of their high frequency, we propose that these two VUS be reclassified as likely benign in this widely heterogeneous phenotypic population. These results support the diagnostic yield efficiency of CMA in characterizing CNVs to define the final molecular cause of genetic diseases in this cohort of Colombian patients, the most significant sample of patients from a Latino population, and define new benign polymorphic CNVs.

A Rare Case of Kikuchi-Fujimoto Disease in an Indian Female

Kikuchi-Fujimoto disease is a self-limiting illness characterised by non-specific symptoms, most commonly reported symptoms being fever and lymphadenopathy. Unknown in its cause, Kikuchi-Fujimoto disease (KFD) is a benign, uncommon disorder usually presenting under the age of 30 years in women. This disease is mainly seen in Asian population mainly in Japan but it is rare in Indian population. The etiological cause of this disease remains unknown. This condition needs to differentiated from other closely resembling conditions such as tuberculosis, lymphoma, Systemic Lupus Erythematosus (SLE) and adenocarcinoma. The physician needs to be aware about this condition to avoid misdiagnosis and improper treatment. This case report is about a female of age 26 years who was diagnosed as having Kikuchi Fujimoto Disease on the basis of clinical and biopsy findings.

The etiological, demographic, and seasonal characteristics of patients with dizziness and vertigo

Background/Aim: Vestibular disorders are common and can negatively affect quality of life and result in workforce losses; they can also be life-threatening diseases. As a result, studies of their etiology and treatment approaches are of particular importance. The aim of this study was to analyze the etiological, demographic, and seasonal characteristics of patients presenting to the Kastamonu Training and Research Hospital Ear, Nose, and Throat (ENT) clinic in Kastamonu, Turkey complaining of vertigo/dizziness. Methods: In this retrospective cohort study, the files of 1033 patients who presented at the clinic with a report of vertigo/dizziness between September 2020 and September 2021 were examined. The patients’ demographic characteristics, presentation dates, and diagnoses were recorded. Results: Six hundred and fifty-one patients (63%) were female, and the mean age of the patient cohort was 50.3 years (standard deviation: 16.0 years). Six hundred and twenty-seven patients (60.7%) were identified with chronic subjective dizziness, 302 (29.2%) were identified with benign paroxysmal positional vertigo, 18 (1.7%) were identified with vestibular migraine, 7 (0.7%) were identified with bilateral vestibulopathy, 41 (4.0%) were identified with unilateral vestibulopathy, 16 (1.5%) were identified with vestibular neuritis, 6 (0.6%) were identified with Meniere’s disease, 10 (1.0%) were identified with central vertigo/dizziness, 3 (0.3%) were identified with labyrinthitis and 3 (0.3%) were identified with another form of vertigo/dizziness. An increase in the number of cases was observed in the spring, and the number of patients presenting with vertigo/dizziness decreased thereafter and reached a minimum in the fall (P&lt;0.001). Conclusion: The most common vestibular disorder was chronic subjective dizziness. Vestibular disorders are more common in women and in the spring season. Although ENT specialists generally focus on pathologies of the ear, vertigo/dizziness are symptoms that may involve several etiologies. Meticulous clinical examinations should be performed; the etiological cause and clinical diagnosis in these cases will dictate additional tests to be requested and therapeutic strategies. Due to the broad diagnostic spectrum of these cases, a multidisciplinary approach is also critical.

The Clinical Profile and Prognostic Factors Influencing Mortality in Patients With Acute Encephalitis Syndrome.

Introduction Acute encephalitis syndrome (AES) is a significant global public health concern. AES is a disorder characterized by fever and altered mental status, and it is associated with considerable morbidity and mortality. There is a limited amount of existing literature on the clinical profile and prognostic markers that influence mortality in these patients. Our study seeks to comprehend the etiology, clinical characteristics, complications, and prognostic markers that impact mortality among patients with AES. Methods The study was a prospective observational study conducted over 18 months, involving a sample size of 105 patients. Patients aged 12 years and older, who met the WHO case definition of Acute Encephalitis Syndrome (AES), were consecutively recruited for this study. The patients' details were recorded, including their medical historyand physical and clinical examination findings upon admission. The extent of cognitive impairment was evaluated using the Glasgow Coma Scale (GCS). Additionally, the patient's presenting symptoms, any complications experienced during their hospital stay, and the mortality rate were documented. The etiology, MRI results of the brain, laboratory parameters, and the need for assisted ventilation were also recorded.In-hospital characteristics were analyzed using the t-test for continuous variables and the chi-square test for binary variables. The log-rank test was employed to identify the predictors with the most significant independent influence on prognosis. All participants were selected only after obtaining their written informed consent. Results Most of the patients were in the age group of 21-30. 60% of the patients were male. Advanced age at presentation was associated with an increased risk of mortality (p-value=0.018). All patients presented to the hospital with symptoms of fever and altered sensorium. The most common agent isolated as the etiologic cause was HSV-1, found in 31.4% of the patients. 28.6% of the patients succumbed to death. The leading cause of death was raised intracranial pressure leading to hemorrhage in the brain. There was no significant correlation between the duration of symptoms and the primary outcome of death (p-value=0.498). The requirement for assisted ventilation was shown to increase the risk of death (p-value=0.001). A low GCS score at presentation was associated with a higher mortality rate (p-value=0.048). Conclusions The factors that predict mortality in AES involve a complex interplay of patient demographics, viral etiology, clinical severity, neuroimaging findings, and the need for assisted ventilation. Integrating these factors into clinical practice would enable healthcare providers to make informed decisions regarding patient management and interventions. As our comprehension of AES continues to develop, forthcoming advancements in diagnostics and therapeutics could refine prognostic assessments further. These developments could open new avenues for enhancing outcomes and diminishing mortality rates in this complex neurological disorder.

First and second-trimester biochemical serum markers in maternal familial Mediterranean fever: The impact of colchicine use

IntroductionWe aimed to investigate the effects of colchicine use on first and second trimester screening markers in pregnancies complicated with familial Mediterranean fever (FMF) and to evaluate the overall impact of these effects on perinatal outcomes. MethodsA retrospective case-control study was conducted in pregnancies complicated with FMF using colchicine and healthy pregnancies as controls without any defined risk factors and medication use. Biochemical markers for the aneuploidy screening, including free ß-hCG and PAPP-A in the first trimester, and AFP, HCG, and unconjugated estriol (uE3) in the second trimester, were recorded, and MoM levels of these markers were compared between the FMF and control groups. Obstetric history and outcomes were also compared between groups. We used propensity score matching to form a cohort in which patients had similar baseline characteristics. ResultsAmong 93 eligible pregnant women, 31 women in FMF group and 31 in control group had similar propensity scores and were included in the analyses. Levels of serum-free ß-hCG, PAPP-A and AFP were similar between FMF and control groups (p = 0.671, p = 0.387 and p = 0.963, respectively). For the second-trimester markers, maternal serum uE3 MoM level were significantly lower in the FMF group using colchicine than in the controls (p = 0.045). We also compared these markers according to the daily colchicine dose between FMF subgroups. We did not detect significant difference between the different colchicine treatment modalities (0.5–1 mg/day vs. 1.5–2 mg/day, p > 0.05). ConclusionMaternal biochemical serum markers of an aneuploidy screening test in the second trimester may be affected by FMF with colchicine use, leading to misinterpretation of the risk level of tests. For these tests with decreased uE3 levels, FMF and colchicine use should be considered as a causative etiology after ruling out common etiologies and confounding factors before recommending invasive diagnostic testing.

Measuring the Whole Wall Thickness of the Common Femoral Vein as a Distinctive Diagnostic Tool to Distinguish Behçet's Disease Presenting with Oral Ulcers from Recurrent Aphthous Stomatitis.

Recurrent oral ulcers, which are the first and most common manifestation of Behçet's disease (BD), have several etiological causes but are often idiopathic and known as recurrent aphthous stomatitis (RAS). In recent years, publications have drawn attention to the fact that whole-wall thickness (WWT) and intima-media thickness (IMT) measurements of the common femoral vein (CFV) may be useful in the diagnosis of BD, which are independent of organ involvement. In this study, the usefulness of the WWT and IMT of the CFV measured by venous Doppler ultrasound (US) was investigated in differentiating BD presenting with oral ulcers from RAS. Patients with BD (n = 84), patients with RAS (n = 85), and healthy controls (HCs) (n = 70) were the three groups included. Both the right and left WWT of the CFV were significantly higher in the BD compared with the HCs and RAS groups (p < 0.001). The diagnostic cutoff values of ≥0.58 mm for the WWT of the CFV performed well against both the patients with RAS and HCs for the discrimination of BD (sensitivity = 79.8%, specificity = 64.7%). In patients with recurrent oral ulcers, the WWT of the CFV measurement may be a distinctive new diagnostic tool for the differential diagnosis of BD and RAS.

The Role of Hypothyroidism in the Etiology of Hyponatremia - Case Report and a Short Review

Abstract Hyponatremia induced by hypothyroidism is a rare phenomenon and a correlation between them can be argued only with possible mechanisms. Hyponatremia often results from the concomitant development of several overlapping pathological events. The association between hypothyroidism and hyponatremia should be considered only if explanations for any other etiological causes have been exhausted. We present the case of a female patient aged 67 years who has previously undergone surgery for a meningioma and who presented with symptoms such as nausea, biliary vomiting, headache and epigastric pain. Laboratory results indicated multiple electrolyte imbalances, including hyponatremia, but the brain imaging studies did not confirm cerebral edema or the presence of tumor development. Under electrolytic correction treatment which was supplemented with L-thyroxine, the biochemical parameters were corrected and normalized and the patient was relieved of her symptoms. This case thus raises the possibility that hyponatremia could be induced or at least precipitated by hypothyroidism. Thyroid dysfunction tests should be targeted in cases of hyponatremia with non-specific causes, even if hypothyroidism is rarely the cause.

Berberine chloride protects cochlear hair cells from aminoglycoside-induced ototoxicity by reducing the accumulation of mitochondrial reactive oxygen species

Aminoglycoside, a medicinal category of antibiotics, are used in treatment of Gram-negative bacterial infections. Although they are the most widely-used antibiotics due to their high efficacy and low cost, several main adverse effects have been reported including nephrotoxicity and ototoxicity. Since drug-induced ototoxicity is one of the major etiological causes of acquired hearing loss, we examined cochlear hair cell damages caused by three aminoglycosides (amikacin, kanamycin, and gentamicin), and investigated protective property of an isoquinoline-type alkaloid, Berberine chloride (BC). Berberine, a well-known bioactive compound found from medicinal plants, has been known to have anti-inflammatory, antimicrobial effects. To determine protective effect of BC in aminoglycoside-induced ototoxicity, hair cell damages in aminoglycoside- and/or BC-treated hair cells using ex vivo organotypic culture system of mouse cochlea. Mitochondrial ROS levels and depolarization of mitochondrial membrane potential were analyzed, and TUNEL assay and immunostaining of cleaved caspase-3 were performed to detect apoptosis signals. As the results, it was found that BC significantly prevented aminoglycoside-induced hair cell loss and stereocilia degeneration by inhibiting excessive accumulation of mitochondrial ROS and subsequent loss of mitochondrial membrane potential. It eventually inhibited DNA fragmentation and caspase-3 activation, which were significant for all three aminoglycosides. This study is the first report suggested the preventative effect of BC against aminoglycoside-induced ototoxicity. Our data also suggests a possibility that BC has the potential to exert a protective effect against ototoxicity caused by various ototoxic drugs leading to cellular oxidative stress, not limited to aminoglycoside antibiotics.