Male Patients Research Articles

Gender Influence on Bimekizumab Response in Patients with Psoriasis: Results of a Real-World Multicenter Retrospective Study-IL PSO (Italian Landscape PSOriasis).

Several studies have demonstrated that psoriasis severity is generally greater in male patients, but it is unclear whether this gender difference may affect short-term therapeutic response. Notably, no studies have specifically investigated bimekizumab, a humanized, full-length IgG1 monoclonal antibody that acts as a dual inhibitor of interleukin (IL)-17A and IL-17F. This was a cross-sectional, observational, retrospective, multicenter analysis. A cohort of 318 patients with moderate to severe psoriasis, 229 male patients (median [IQR] age 35 [23-67] years) and 89 female patients (median [IQR] age 33 [20-68] years), were retrospectively evaluated for short-term response (16weeks) to bimekizumab according to standard dosage (320mg at weeks0, 4, 8, 12, and 16, and every 8weeks thereafter). Patients were assessed to evaluate whether gender differences in demographic and clinical characteristics can affect treatment response to standard dose of bimekizumab, during the first 16weeks of treatment. Therapeutic outcomes were evaluated by analyzing Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores recorded in each patient at three consecutive time points: baseline (T0), after 4weeks (T4), and after 16weeks of treatment (T16). Male patients showed more severe disease at baseline, compared to female patients (p = 0.01). A significant reduction in disease severity was observed in both male and female patients after 16weeks of treatment, but male patients showed a faster decrease in PASI score between baseline and week4 of treatment compared to female patients (p < 0.001). Nevertheless, by week16, difference in PASI response and DLQI reduction between genders became less pronounced. Although male patients exhibit greater disease severity at baseline compared to female patients, this does not result in a differential response to bimekizumab over the short term. Both male and female patients had equal probability of achieving complete or near-complete disease remission within the first 4weeks of treatment, and both maintain this response status through week16. The therapeutic benefit of bimekizumab may be due to the rapid dual inhibition of IL-17A and IL-17F, which may lead to consistent and robust clinical response across genders, regardless of baseline disease severity. Our results suggest a "gender severity-invariant effect" of bimekizumab, highlighting the treatment as rapidly effective in both genders, despite initial differences in disease severity.

Correlation of enzyme activities and genotype with clinical manifestations in Chinese patients of different sexes with classical and late-onset Fabry disease.

Fabry disease, a rare genetic disorder affecting multiple organs, has understudied correlations among enzyme activity, genotype, and clinical manifestations in patients of different sexes with classical and late-onset phenotypes. In this study, clinical data, α-Gal A activity, and GLA gene test results of 311 patients, who were categorized by classical and late-onset phenotypes, ⩽5% and > 5% of the normal mean value of enzyme activity, and truncated and nontruncated mutation groups, were collected. The common clinical manifestations of Fabry disease included acroparesthesia, hypohidrosis/anhidrosis, neuropsychiatric system, and renal and cardiovascular involvement. Multiorgan involvement was higher in males and classical phenotype patients. In both sexes, classical patients commonly presented with acroparesthesia and multiorgan involvement, whereas late-onset patients showed renal, neuropsychiatric, and cardiovascular involvement. Male and classical patients had lower enzyme activity than female and late-onset patients, respectively. Classical males with enzyme activity of ⩽5% of the normal mean level showed higher multiorgan involvement frequency than those with enzyme activity of > 5%, whereas no significant difference was observed among females. Ninety-five gene mutation sites were detected, with significant phenotype heterogeneity in patients with the same mutation. No significant difference in enzyme activity or clinical manifestations was observed between truncated and nontruncated mutations. Overall, male patients with Fabry disease, regardless of classical or late-onset phenotype, have a higher frequency of multiple-organ involvement and lower α-Gal A activity than female patients. α-Gal A activity was closely correlated with clinical symptoms in males but weakly correlated with clinical manifestations in females. The clinical manifestations of patients with the same mutation are heterogeneous, and the correlation between gene mutation and enzyme activity or clinical manifestation is weak.

Sex-Based Differences in Clinically Significant Outcome Achievement Following Primary Osteochondral Allograft Transplantation of the Knee at a Minimum 5-Year Follow-up.

Primary osteochondral allograft transplantation (OCA) of the knee has been shown to improve patient-reported outcome measure (PROM) scores at various follow-up time points. However, studies analyzing the effects of patient sex on primary OCA outcomes remain limited and show conflicting results. To compare PROM scores and clinically significant outcome (CSO) achievement rates at a minimum 5-year follow-up between male and female patients who underwent primary OCA of the knee. Cohort study; Level of evidence, 3. A prospectively collected database was queried for patients who underwent primary OCA, regardless of the presence of concomitant procedures, between January 2003 and January 2018. Inclusion criteria consisted of (1) primary OCA, (2) a minimum 5-year follow-up, and (3) age >18 years at the time of OCA. Patient characteristics, intraoperative variables, PROM scores, reoperations, and failures were compared. Rates of achieving the CSOs of the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) were compared at 5-year follow-up for the International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Regression analyses were performed to determine the factors associated with achieving the MCID, PASS, or SCB. A total of 235 patients (119 female, 116 male) with a mean age of 31.0 ± 9.5 years, a mean follow-up of 6.5 years, and a mean body mass index of 26.7 ± 4.2 kg/m2 were included in this study. Male patients had a higher body mass index (28.0 ± 4.3 vs 25.5 ± 3.8 kg/m2, respectively; P < .001), larger medial femoral condyle defects (20.2 ± 4.5 vs 17.7 ± 3.5 mm, respectively; P < .001), and larger lateral femoral condyle defects (20.3 ± 4.0 vs 18.1 ± 3.1 mm, respectively; P = .002) and were more likely to undergo concomitant osteotomy (24.1% vs 13.4%, respectively; P = .036), particularly concomitant high tibial osteotomy (14.7% vs 3.4%, respectively; P = .002), compared with female patients. At baseline, male patients had higher IKDC (41.8 ± 15.1 vs 33.3 ± 15.2, respectively; P = .003) and KOOS Sport (35.2 ± 24.1 vs 25.1 ± 22.0, respectively; P = .032) scores compared with female patients. At a minimum 5-year follow-up, female patients demonstrated higher Lysholm (79.6 ± 15.9 vs 73.8 ± 15.6, respectively; P = .026) and KOOS Pain (82.6 ± 16.9 vs 79.1 ± 13.7, respectively; P = .049) scores and achieved the MCID for the KOOS Sport (75.7% vs 46.7%, respectively; P = .015), the PASS for the KOOS Quality of Life (89.6% vs 67.3%, respectively; P = .003), and the SCB for the KOOS Sport (64.9% vs 23.3%, respectively; P < .001) at higher proportions than male patients. On multivariate regression analysis, male sex was associated with decreased odds of achieving the MCID (odds ratio, 0.234 [95% CI, 0.086-0.636]; P = .004) and SCB (odds ratio, 0.433 [95% CI, 0.205-0.917]; P = .028) for the IKDC score. Reoperations occurred in 37.9% of patients, and failure occurred in 26.8% of patients, with male and female patients demonstrating comparable rates for both. Despite male patients exhibiting higher preoperative scores for certain PROMs, female patients demonstrated higher or comparable postoperative PROM scores and CSO achievement rates after primary OCA of the knee at a minimum 5-year follow-up. Male sex was significantly associated with decreased odds of achieving the MCID and SCB for the IKDC score.

Challenges of differential diagnosis in the verification of Behçet's disease with neurological manifestations

Behçet's disease (BD) is an autoimmune vasculitis of unclear etiology characterized by a wide range of systemic manifestations. The nervous system is involved in approximately 10% of patients with BD (neuro-Behçet). Diagnosis of neuro-Behçet is challenging, especially in the case of BD onset with neurological manifestations, and is based on a combination of clinical, laboratory, and neuroimaging data. To verify the diagnosis of neuro-Behçet, a wide range of conditions with similar manifestations must be ruled out: multiple sclerosis, neuromyelitis optica spectrum disorder, neurosarcoidosis, and many rare autoimmune diseases (e.g., Cogan syndrome, Susac syndrome, Vogt-Koyanagi-Harada syndrome). This article presents a brief literature review highlighting the challenges of neuro-Behçet differential diagnosis and a clinical case of a 34-year-old male patient with a criteria-based diagnosis of BD with neurological manifestations.

Case report: A case of tibial tuberous osteochondroma complicated with gouty calculus

Osteochondroma (OC) mainly occurs in the metaphysis of long bones in children and adolescents, and it is extremely rare to occur in the tibial tuberosity and usually has no clinical symptoms. Here, we report a rare case of osteochondroma of the tibial tuberosity combined with gouty stones in a 44-year-old male patient who was found to have a mass on the left upper tibia for 20 years that had not been taken seriously or treated, and the patient was admitted to the hospital after the mass developed painful symptoms. In this case, X-ray examination clearly showed a lesion, which manifested as a limited bony protuberance with a wide base attached to the tibial tuberosity, and the imaging diagnosis was osteochondroma of the tibial tuberosity. The patient underwent surgical resection, and the pathologic results suggested that osteochondroma of the tibial tuberosity was combined with gouty stones. The patient’s symptoms improved significantly after the surgery, and no obvious discomfort or dysfunction has been found in the follow-up so far.

A clinical case of X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy is the most common peroxisomal disease among primary leukodystrophies, characterized by a progressive course and combined damage to the adrenal glands and central and peripheral nervous systems. The disease is caused by mutations in the ABCD1 gene, which encodes the ALDP transmembrane peroxisome protein, which is involved in transporting very long-chain fatty acids (VLFAs). Dysfunctions of peroxisome metabolism occur due to a lack of acyl-CoA synthetase, reducing the efficiency of beta-oxidation of VLFAs with a carbon chain length ≥C22 and resulting in the accumulation of toxic substances in the adrenal cortex and the white matter of the brain and spinal cord. We present a clinical case of X-linked adrenoleukodystrophy in a male patient with a disease onset at the age of 22 years in the form of progressive lower spastic paraparesis and neurogenic dysfunction of the pelvic organs with long-term preservation of cognitive functions. Four years after the onset of symptoms (in 2021), multiple sclerosis was clinically diagnosed. The patient received therapy with multiple sclerosis disease-modifying drugs and glucocorticosteroids. Despite treatment, disability progressed. In January 2024, a brain MRI was performed, and a diagnosis of «Leukodystrophy, Alexander's disease?» was made. Blood serum was sent to the Research Center for Medical Genetics in Moscow under the program «Study of Genetic Heterogeneity of Leukodystrophies» for testing. In May 2024, dysphagia and apnea occurred, and after 1.5 months, the patient died outside the hospital. No necropsy was performed. Information on the course of the disease was obtained during the review of medical documentation. The diagnosis was made after the patient's death based on the results of gas chromatography of plasma (GCP), massive parallel panel sequencing, and neuroradiological and clinical presentations. The article discusses the main MR patterns and an algorithm for diagnosing leukodystrophies.

Nutritional Status and Actual Dietary Practice of Lung and Gastrointestinal Cancer Patients at Nghe An Oncology Hospital: A Cross-Sectional Study

Introduction: Malnutrition remains a prevalent and critical issue among hospitalized cancer patients, particularly those with lung and gastrointestinal (GI) cancers. In low- and middle-income countries such as Vietnam, cancer-related malnutrition may be further aggravated by limited access to nutritional support services. However, data on the nutritional status of Vietnamese cancer patients is limited. This study aimed to assess lung and GI cancer patients' nutritional status and actual dietary intake at Nghe An Oncology Hospital. Methods: A cross-sectional descriptive study was conducted from February to June 2023. Adult inpatients with confirmed lung or GI cancer were randomly selected. Nutritional status was evaluated using the Patient-Generated Subjective Global Assessment (PG-SGA), categorizing patients as well-nourished (A), moderately malnourished (B), or severely malnourished (C). Dietary intake was assessed via a 24-hour dietary recall and analyzed using the Vietnamese food composition tables. Nutrient intake was compared with the Vietnamese Recommended Nutrient Intake (RNI) standards. Results: Among 100 patients, 72% were classified as malnourished, with 52% falling into PG-SGA category C and 20% in category B. Nutritional status showed no significant differences based on sex, cancer type, or duration since diagnosis. The median daily energy intake was 1,305 kcal, accounting for 72% of the RNI. Despite a lower absolute intake, females achieved a higher percentage of their RNI than males. Intake of protein, carbohydrates, and lipids met 80%, 70%, and 90% of the RNI, respectively. Intakes of vitamins A and C exceeded RNI, particularly among male patients, while vitamins B1, B2, and niacin were consumed below recommended levels. Mineral intake was also insufficient: calcium met 65% of RNI, iron 48%, and magnesium 80%. Conclusion: The study revealed a high prevalence of malnutrition among hospitalized cancer patients, along with substantial gaps between actual dietary intake and nutritional requirements.

Comparison of the clinical and prognostic characteristics of patients with different pathological types in acromegaly

ContextAcromegaly is caused by somatotroph tumors. Recently, the WHO recommended the use of transcription factors (TFs) together with pituitary hormones to accurately classify the subtypes.ObjectiveThis study aims to evaluate differences in the clinical and prognostic characteristics of acromegaly patients with different pathological types.MethodsA retrospective study was conducted on 94 acromegaly patients who underwent surgical treatment. Patients were classified into two groups on the basis of TFs expression by IHC. PIT1 tumors were positive only for PIT1, and PIT1/SF1 tumors were positive for both PIT1 and SF1. Additionally, on the basis of the expression of GH and PRL by IHC, PIT1 tumors were further subdivided into GH positive tumors (those positive for only GH) and GH/PRL positive tumors (those positive for both GH and PRL). Differences in clinical and prognostic features among the pathological groups were evaluated.ResultsPIT1/SF1 tumors represented 30.9% (n = 29) of the acromegaly patients in this cohort. PIT1/SF1 tumors had a higher baseline IGF-1 index (2.77 ± 0.73 vs. 2.39 ± 0.74, P = 0.024) than PIT1 tumors. Despite the higher proportion of postoperative GH &amp;lt; 1 μg/L, the biochemical remission rate of PIT1/SF1 tumors (30.8% vs. 27.6%, P = 0.812) was similar to that of PIT1 tumors. Compared with those with GH positive tumors, patients with GH/PRL positive tumors were younger at diagnosis (42.50 ± 13.36 vs. 49.05 ± 11.69, P = 0.046), and the proportion of male patients was higher (50.0% vs. 23.3%, P = 0.048). Furthermore, patients with GH/PRL positive tumors had a significantly higher postoperative GH level [7.30 (3.18–11.08) vs. 2.49 (1.57–6.84), P = 0.011] and IGF-1 index (1.82 ± 0.94 vs. 1.31 ± 0.63, P = 0.011) during follow-up. The biochemical remission rate in GH/PRL positive tumors was lower, but the difference was not statistically significant (18.2% vs. 37.2%, P = 0.159).ConclusionPIT1/SF1 tumors represent approximately 30.0% of acromegaly patients. Despite higher baseline IGF-1 levels, the clinical and prognostic features of patients with PIT1/SF1 tumors are similar to those of patients with PIT1 tumors. GH/PRL positive tumors, characterized by their earlier age at diagnosis and male predominance, tend to exhibit a lower biochemical remission rate compared to GH positive tumors.

Navigating the diagnosis and treatment of primary progressive aphasia: Lived experience of a rural patient.

Frontotemporal dementias (FTD) are a group of early-onset neurodegenerative disorders that primarily affect the frontal and temporal lobes, leading to changes in behavior, motor abilities, communication, and executive functions. Primary progressive aphasias (PPA), the language variant of FTD, specifically impair speech and language abilities. The heterogeneous presentation of FTD, particularly PPA, complicates differential diagnosis and treatment selection for healthcare professionals. These challenges are further exacerbated for patients in rural areas due to limited access to specialized healthcare services. This cross-sectional, descriptive case study examines a 76-year-old male patient diagnosed with agrammatic primary progressive aphasia (nfvPPA) living in a rural area in the U.S. We conducted a semi-structured interview with his caregiver to explore the lived experience of being diagnosed and treated for PPA in a rural setting and to identify challenges encountered during the diagnostic and therapeutic processes. Several critical barriers were identified, including poor interprofessional communication, inadequate practitioner-patient and caregiver communication, limited access to educational resources, inconsistent intervention and follow-ups, and restricted healthcare services. To improve the patient and caregiver experience, we propose a collaborative management model centered around speech-language pathologists with expertise in FTD/PPA. This model aims to facilitate smoother navigation of the healthcare system and improve patient outcomes. Effective care management requires clear and continuous communication among providers, patients, caregivers, and other professionals. Additionally, educating and supporting FTD/PPA patients and their families is essential. Research gaps in rural areas regarding diagnosis and treatment outcomes further hinder care, underscoring the need for targeted studies to enhance clinical practices and improve the quality of life for both patients and caregivers.

Xp21 contiguous gene deletion syndrome

Contiguous gene syndromes (CGS) arise from microdeletions and other aberrations of a chromosome region containing several gene loci. One of the CGSs is Xp21 contiguous gene deletion syndrome (Xp21.3-p21.2) (Xp21 deletion syndrome). Slightly more than 100 male patients suffering from Xp21 contiguous gene deletion have been described in the world literature. This article describes a clinical case of a boy with Xp21 deletion syndrome. Chromosomal microarray analysis revealed a microdeletion of the X chromosome region from position 28085320 to position 33391678 with a size of 5306358 bp, including 11 genes in the imbalance region. The illness declared itself in the neonatal period and manifested early and rapidly as primary adrenal insufficiency (PAI) on the first and second days after birth, with severe metabolic disorders. At 2 years and 7 months, an increase in transaminases was detected for the first time due to metabolic disorders caused by PAI, which led to a misdiagnosis of autoimmune hepatitis. At 2 years and 10 months, the signs of myopathic syndrome were noted, and primary muscular dystrophy was diagnosed. The patient had a pronounced psychomotor development delay from an early age. The child's mother was diagnosed with the same mutation, including 11 genes in the imbalance region. The hereditary history showed the death of the first boy in the family due to PAI at the age of 6 weeks, which should have been the reason for a comprehensive assessment of the clinical situation and timely medical and genetic counseling to prevent the birth of a sick child from subsequent pregnancies.

A case of allergic bronchopulmonary mycosis caused by Triodiomyces crassus

There are few published cases of non-aspergillus allergic bronchopulmonary Mycosis (ABPM) worldwide. Here we report the first case where the fungus Triodiomyces crassus was found to be the causative pathogen of non-aspergillus ABPM. This study provided an overview of the diagnosis, treatment and follow-up of the case. In May 2018, a 60-year-old male patient presented with a 1-month history of dry cough with mild chest tightness. He had no history of asthma and no clinically reported illness. The routine pulmonary auscultation on admission revealed no abnormalities. Subsequent laboratory tests revealed marked peripheral blood eosinophilia and an increased level of serum total IgE. However, the specific IgE antibody test for Aspergillus fumigatus was negative. A chest CT scan showed peribronchial consolidation in the right upper lobe with high-attenuation mucoid impaction in the corresponding bronchi. Bronchoscopy confirmed these mucus plugs. The bronchoscopic biopsy specimen showed a large number of eosinophils and fungal hyphae. The fungal smear from the bronchial lavage fluid showed fungal hyphae, although the fungal culture showed no growth. A CT-guided transthoracic needle biopsy was performed on the lesion in the right upper lung, which showed significant eosinophil infiltration in the pulmonary parenchyma. The biopsy specimen was cultured and yielded colonies with a yeast-like appearance. Microscopic examination of these colonies revealed yeast-like fungi and pseudohyphae. The fungal morphology observed in the bronchial wash smear and the pathology of the bronchoscopic biopsy were consistent with that seen in the cultured colonies. The organism was identified as Triodiomyces crassus through sequencing of the internal transcribed spacer (ITS) region of its ribosomal DNA (rDNA). The patient was initially treated with a 2-week course of voriconazole, 200 mg orally twice daily, but there was no significant improvement in symptoms. Follow-up bronchoscopy revealed persistent obstructive mucus plugs. Based on these findings, the diagnosis was revised to ABPM caused by Triodiomyces crassus rather than an invasive fungal infection, and corticosteroid treatment was added, with prednisone administered at 20 mg/day. After two weeks, the patient coughed up a mung-bean-sized gelatinous substance (mucus plug), and there was a marked improvement in cough and chest tightness. Treatment continued for a further two weeks, but was then discontinued by the patient's own decision. The patient returned for the first follow-up, 77 days after the initial admission. Clinical symptoms had subsided. Repeat tests showed normal eosinophil counts and total IgE levels, and a chest CT scan showed significant absorption of the lesions, with only mild bronchiectasis remaining. As the patient had discontinued steroid therapy and there were no recurrent symptoms, no further medication was prescribed, but continued observation was suggested. At the second follow-up, 6 months after the initial admission, routine blood tests and total IgE levels remained normal, and a chest CT scan showed only minor streaky shadows, with no recurrent symptoms. The clinical characteristics of ABPM caused by non-Aspergillus fungi differ from those of ABPA. If ABPA is clinically suspected but tests for specific IgE antibodies to Aspergillus fumigatus are negative, the possibility of ABPM caused by rare non-Aspergillus fungi should be considered. Early and proactive mycological investigation is crucial for the diagnosis of this condition and the identification of rare pathogenic fungi.

EMCC dispatch priority for trauma patients in Norway: a retrospective cohort study

BackgroundDispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.MethodsThis registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019–2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.ResultsOur analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).ConclusionThis study primarily evaluated the national trauma system’s dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients’ needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.

Impaired LPS Tolerance in Monocytes of Coronary Atherosclerosis Patients Is Associated with the Intermediate Subset.

Endotoxin tolerance in monocytes is a mechanism that reduces the secretion of inflammatory cytokines upon repeated pathogen exposure, thereby protecting tissues from hyperinflammation. Previously, we demonstrated that monocytes from patients with asymptomatic carotid atherosclerosis exhibit impaired LPS tolerance. In this study, we aimed to investigate monocyte tolerance impairments in coronary atherosclerosis in greater detail. The study included 46 male patients with ischemic heart disease, divided into two groups based on coronary angiography results: with and without coronary atherosclerosis. CD14+ monocytes were isolated from patients' blood and subjected to LPS stimulation on days 1 and 7 of culture. Transcriptomic analysis of monocytes was conducted. Monocyte subpopulations were assessed and sorted based on CD14 and CD16 expression. Patients with coronary atherosclerosis exhibited disrupted inflammatory responses in monocytes, characterized by elevated basal and LPS-induced IL-1β secretion. These patients demonstrated impaired LPS tolerance, as evidenced by increased CCL2 secretion upon repeated stimulation. Transcriptomic analysis revealed upregulation of inflammatory genes, particularly those associated with minor CD16+ monocyte subpopulations. The proportions of non-classical and intermediate monocytes were elevated in patients with atherosclerosis, with IL-1β and CCL2 secretion levels correlating predominantly with the intermediate monocyte subset. Functional analysis revealed that non-classical monocytes from healthy donors developed stable endotoxin tolerance. In contrast, intermediate and classical monocytes from some donors exhibited a non-tolerant response to LPS, as evidenced by secretion of IL-1β, IL-6 and CCL2. The differentiation of classical monocytes into intermediate monocytes may play a key role in the impaired endotoxin tolerance observed in atherosclerosis.

Evaluation of the transcutaneous posterior tibial nerve stimulation in the treatment of life long premature ejaculation: A randomized controlled trial

Evaluation of the transcutaneous posterior tibial nerve stimulation in the treatment of life long premature ejaculation: A randomized controlled trial

Multiple liver lesions as an extraordinary finding of disseminated histoplasmosis in an immunocompromised patient.

Histoplasmosis is an opportunistic infection originating from endemic regions. Current factors such as immigration and immunosuppression associated with new therapeutic approaches increase the likelihood of disease dissemination. Hepatic involvement is uncommon and leads to an extensive differential diagnosis, potentially delaying diagnosis and resulting in a fatal outcome. We present the case of a male patient with human immunodeficiency virus (HIV) infection, whose clinical onset occurred in the context of disseminated histoplasmosis with hepatic involvement.

Unilateral Osteonecrosis of the Femoral Head in a Patient with Atopic Dermatitis Due to Uncontrolled Topical Steroid Treatment, a Case Report

Background and clinical significance: Osteonecrosis of the femoral head (ONFH) is a disease of the epiphysis caused by the death of osteocytes and osteoblasts, resulting in debilitating pain. ONFH can be traumatic or nontraumatic, with prolonged glucocorticoid use being the leading cause of nontraumatic ONFH. Atopic dermatitis (AD) is a chronic inflammatory skin condition typically treated with topical corticosteroids. ONFH following topical corticosteroid treatment is exceedingly rare, with limited documentation in the literature. We present a case of an under-recognized complication of prolonged topical corticosteroid treatment. Case presentation: We report a case of a 29-year-old Caucasian male patient with sharp right hip pain. Plain radiographs, a CT scan, and an MRI indicated Ficat and Arlet stage 3 ONFH. The patient reported the prolonged uncontrolled use of topical mometasone furoate for five years due to AD. Following the diagnosis, topical corticosteroids were discontinued, and the treatment was shifted to tacrolimus and, subsequently, to oral methotrexate with folic acid. The patient underwent a total hip arthroplasty in June 2022. Given his young age and poor response to previous treatments, he was transitioned to upadacitinib, which led to significant improvement without skin flare-ups or postoperative hip pain. Conclusions: This case highlights the rare, but serious, risk of ONFH associated with long-term topical corticosteroid use. It underscores the importance of monitoring systemic side effects in dermatological therapies and educating patients on proper corticosteroid use. Alternative treatments, such as upadacitinib, should be considered in young male patients to prevent severe complications.

High prevalence of HLA-B51 and ocular involvement in Behçet's disease: a multicenter cross-sectional study.

Behçet's disease (BD) is a rare multisystem vasculitis. Globally, BD exhibits a unique geographic distribution, with the highest prevalence along the historic Silk Road. To study the demographics, clinical characteristics, and outcomes of BD in the United Arab Emirates (UAE). A multicenter retrospective chart review study was conducted at hospitals in the UAE from 2008 to 2024. All adult and pediatric patients who were diagnosed with BD by a rheumatologist and treated within the timeframe were included in the study while those who received any alternative final diagnosis were excluded. The results were analyzed using descriptive and inferential statistics. One hundred and twenty-three patients were treated and monitored for BD. Most were female (n = 70, 57%). Their median age was 32years (24-41), and approximately two-thirds were Emirati (n = 82, 67%). Twelve patients (10%) had a family history of BD, including 7 (6%) with first-degree BD. The time from the initial symptoms to diagnosis was 11.9months (2.3-31.0). The most common clinical manifestations were oral ulcers (n = 99, 81%), arthralgia (n = 63, 51%), genital ulcers (n = 62, 50%), and ocular involvement (n = 37, 30%). Most of the patients were HLA-B51 positive (n = 92, 84%). At diagnosis, 36 (29%) met the ISG criteria, 73 (59%) met the ICBD criteria, and 50 (41%) met neither criteria. The male patients exhibited more major organ involvement (ocular, neurological, vascular, and cardiac), greater use of corticosteroids and anti-TNFa medications, and greater disease activity than the female patients. Among the patients with isolated ocular manifestations (n = 9) who met neither classification criteria, most were female (56%), with a median age of 37years (26.5-3.5). None had a family history of autoimmune conditions, and all were HLA-B51 positive. Most of these patients (n = 8, 89%) received corticosteroids, 5 (56%) received azathioprine, and 2 (22%) received anti-TNFa therapies. These findings provide insights into the clinical profile of BD in the UAE. Notably, we found a high proportion of patients with positive HLA-B51 and ocular manifestation. Further research with larger sample sizes is needed to better understand these associations.

Comparison of the effects of microdiscectomy and interlaminar endoscopic lumbar discectomy on sexual activity.

The aim of this study was to compare the clinical outcomes and sexual function of male and female patients who underwent IELD and MD due to LDH. The retrospective study included 72 sexually active patients aged 24-50 years. Patients were divided into four groups based on genders and surgical techniques. Visual Analogue Scale (VAS) (leg pain/LBP) and Oswestry Disability Index (ODI) tests were performed. International Index of Erectile Function-5 (IIEF-5) to evaluate the sexual functions of male patients; Female sexual function tests (FSFI) were used to evaluate the sexual functions of female patients, and the Hospital Anxiety Depression Score (HADS) test was used to evaluate the hospital anxiety and depression levels of all patients. Mean age of the patients 39.8 ± 5.6. In all patients, a statistically significant improvement in three parameters (VAS-Leg, VAS-LBP, ODI) was observed in the post-operative period. However of note, the MD group had a statistically higher post-operative VAS-LBP pain score when compared with the IELD group (p = 0.001; p < 0.01). Both surgical interventions proved effective in increasing IIEF-5 scores, with the IELD group having statistically higher scores in the postoperative period. However, there was no such difference in FSFI scores in female patients with either procedure. The results showed that both IELD and MD improved sexual function in patients with LDH, but IELD had a greater positive effect in male patients compared to MD. It was also found that IELD caused less LBP and more improvement in anxiety levels compared to MD.

Utilization of NKX3.1 and P501S to distinguish primary breast carcinoma from metastatic prostatic adenocarcinoma in male patients.

NKX3.1 is an androgen-regulated tumor suppressor gene, and NKX3.1 protein expression is present mainly in prostatic epithelium. P501S is expressed in prostatic epithelium and is also regulated by androgens. Immunohistochemistry (IHC) for NKX3.1 and P501S is commonly used for the diagnosis of metastatic prostate carcinoma in pathology practice. Male breast cancer is rare, and most of the tumors are androgen-receptor positive. Thus, we investigated NKX3.1 and P501S expression in male breast carcinoma to determine its role in distinguishing primary breast carcinoma from metastatic prostatic adenocarcinoma. IHC for NKX3.1 and P501S was performed on primary invasive breast carcinomas in 25 male patients, 5 of whom had prior history of prostatic adenocarcinoma. Immunoreactivity was classified as negative or positive staining. Expression of NKX3.1 and P501S was identified in 8 (32%) and 7 (28%) cases of invasive breast carcinomas, 42% and 20% of in situ breast carcinomas, and 8% and 46% of normal terminal ductal lobular unit (TDLU), respectively. Among the five patients with prior history of prostate carcinoma, four had NKX3.1 or P501S expression in their primary invasive breast carcinomas. Their diagnosis of primary invasive breast carcinomas was confirmed by GATA3 and estrogen receptor (ER) IHC. This is the first study to report NKX3.1 and P501S expression in primary breast carcinomas in male patients. The positive rates are higher than those reported in female patients with ductal carcinoma. When considering the use of IHC markers to confirm the diagnosis of primary breast carcinoma in male patients, breast-specific markers or hormonal receptors should be considered in the diagnostic panel.

The association between cannabis use and suicidal intensity in psychiatric inpatients.

Over the past 15 years, most states have legalized the medical use of cannabis. Since then, daily use nearly tripled while the number of adults dying by suicide increased by 31%. Key studies found a greater suicidal intensity associated with cannabis use (CU) in adolescents. Adult associations have been understudied. The purpose of this study was to evaluate associations between CU and suicidal ideation intensity (SII) in adults. We examined 530 psychiatric inpatients ages 18 and above using the Columbia-Suicide Severity Rating Scale and the Alcohol, Smoking and Substance Involvement Screening Test for CU. We conducted a path analysis model of moderating and mediating factors, including psychiatric comorbidity, emotional regulation, psychological flexibility, and polygenic risk scores for externalization, CU, and suicide. Sixteen percent of the participants had no suicidality, 34.3% reported suicidal ideation, and 49.6% reported a prior suicide attempt. CU was found to be associated with lower risk of SII for females (p = .026) but not for males (p = .525), and increased CU was associated with greater risk of SII with lower psychological flexibility in males (p = .049) but not females (p = .628). CU was associated with increased SII among psychiatric inpatients, with sex-specific patterns and potential mediation by psychological flexibility. Further studies exploring specific amounts, duration of use, and time frames of CU during adolescence and adulthood may provide insights into its associated risks, especially as legalization expands. Patterns of past and current CU may increase understanding of mechanisms predicting increased SII in adult male psychiatric inpatients.