Neurological Disorders In Patients Research Articles

Neurological symptomatology features in patients with spine and spinal cord trauma at the thoracolumbar junction level

Background. Traumatic injuries to the thoracolumbar junction account for over 60 % of all injuries to the thoracolumbar spine. The neurological symptomatology accompanying injuries at this level is characterized by diverse patterns of both motor and sensory dysfunction, which are determined by the topographic-anatomical features of this area. Neurological deficit may be caused by conductive, segmental, and radicular disturbances. The aim of the study is to determine the nature and frequency of neurological disorders in patients with spine and spinal cord trauma at the level of the thoracolumbar junction, depending on the likely substrate of the traumatic impact. Materials and methods. An analysis of the neurological status assessment was conducted in 101 patients who suffered spine and spinal cord trauma at the level of the thoracolumbar junction. The average age of the patients was 41 years (95% confidence interval 36–44). Most patients were male (75.25 %). The number of motor segments with signs of upper and lower motor neuron lesion, and dermatomes with sensory impairment of radicular, segmental, or conductive types were determined. Results. It was found that 83.5 % of motor segments with dysfunction had clinical signs of lower motor neuron lesion, 41.3 % of dermatomes with sensory impairment had traumatic root damage, 57.9 % of dermatomes showed impairments of a segmental type, and 28.9 % were of a conductive type. Conclusions. The data obtained indicate a significant role of segmental disturbances in forming the symptoms in patients with spine and spinal cord trauma at the level of the thoracolumbar junction.

Genotype and phenotype correlation of PHACTR1-related neurological disorders

BackgroundPHACTR1 (phosphatase and actin regulators) plays a key role in cortical migration and synaptic activity by binding and regulating G-actin and PPP1CA. This study aimed to expand the genotype and...

Prevalence of SARS-CoV-2 antibodies and associated factors in the adult population of Belgium: a general population cohort study between March 2021 and April 2022

BackgroundThis study assessed seroprevalence trends of SARS-CoV-2 antibodies in the Belgian adult population between March 2021 and April 2022, and explored factors associated with seropositivity and seroreversion among the vaccinated and unvaccinated population.MethodsA prospective longitudinal surveillance study was conducted within a random sample of the general population (18 + years) in Belgium, selected from the national register through a multistage sampling design. Participants provided a saliva sample and completed a survey questionnaire on three occasions: at baseline and in two follow-up waves. Outcome variables included (1) seropositivity, defined as the presence of SARS-CoV-2 antibodies, assessed with a semi-quantitative measure of anti-RBD (Receptor Binding Domain) IgG ELISA and (2) seroreversion, defined as passing from a positive to a negative antibody test between two measurements. Trends in SARS-CoV-2 antibody prevalence were assessed using binary logistic regression with contrasts applying post-stratification. Potential determinants of seropositivity were assessed through multilevel logistic regressions.ResultsIn total 6,178 valid observations were obtained from 2,768 individuals. SARS-CoV-2 antibody prevalence increased from 25.1% in the beginning of the study period to 92.3% at the end. Among the vaccinated population, factors significantly associated with higher seropositivity rates were being younger, having a bachelor diploma, living with others, having had a vaccine in the last 3 months and having received a nucleic-acid vaccine or a combination. Lower seropositivity rates were observed among vaccinated people with a neurological disease and transplant patients. Factors significantly associated with higher seropositivity rates among the unvaccinated population were having non-O blood type and being non-smoker. Among vaccinated people, the seroreversion rate was much lower (0.3%) in those who had received their latest vaccine in the last 3 months compared to those who had received their latest vaccine more than 3 months ago (2.7%) (OR 0.13; 95%CI 0.04–0.42).ConclusionsThe rapid increase in antibody seropositivity in the general adult population in Belgium during the study period was driven by the vaccination campaign which ran at full speed during this period. Among vaccinated people, seropositivity varied in function of the time since last vaccine, the type of vaccine, sociodemographic features and health status.

Comparison of time to clinically meaningful improvement in quality of life in neurological disorders in patients treated with natalizumab versus ocrelizumab.

Aim: To assess time to improvement in Quality of Life in Neurological Disorders (Neuro-QoL) domains for patients treated with natalizumab versus ocrelizumab. Methods: Patients enrolled in the MS PATHS network who initiated treatment with either natalizumab or ocrelizumab rated the Neuro-QoL domains of physical function, symptoms, emotional health, cognitive function and social ability. Results: Time to clinically meaningful improvement was significantly shorter with natalizumab versus ocrelizumab for cognitive function (event time ratio [95% CI]: 0.37 [0.24-0.57]; p<0.001), sleep disturbance (0.45 [0.28-0.72]; p=0.001), social role participation (0.37 [0.21-0.66]; p=0.001) and social role satisfaction (0.5 [0.31-0.8]; p=0.004). Conclusion: Natalizumab had shorter time to clinically meaningful improvement in cognitive, sleep, and social role Neuro-QoL domains versus ocrelizumab.

MiR-145a-5p/SIK1/cAMP-dependent alteration of synaptic structural plasticity drives cognitive impairment induced by coke oven emissions

Exposure to fine particulate matter (PM) is associated with the neurodegenerative diseases. Coke oven emissions (COEs) in occupational environment are important sources of PM. However, its neurotoxicity is still unclear. Therefore, evaluating the toxicological effects of COE on the nervous system is necessary. In the present study, we constructed mouse models of COE exposure by tracheal instillation. Mice exposed to COE showed signs of cognitive impairment. This was accompanied by a decrease in miR-145a-5p and an increase in SIK1 expression in the hippocampus, along with synaptic structural damage. Our results demonstrated that COE-induced miR-145a-5p downregulation could increase the expression of SIK1 and phosphorylated SIK1, inhibiting the cAMP/PKA/CREB pathway by activating PDE4D, which was associated with reduced synaptic structural plasticity. Furthermore, restoring of miR-145a-5p expression based on COE exposure in HT22 cells could partially reversed the negative effects of COE exposure through the SIK1/PDE4D/cAMP axis. Collectively, our findings link epigenetic regulation with COE-induced neurotoxicity and imply that miR-145a-5p could be an early diagnostic marker for neurological diseases in patients with COE occupational exposure.

CUL4B mutations impair human cortical neurogenesis through PP2A-dependent inhibition of AKT and ERK

Mutation in CUL4B gene is one of the most common causes for X-linked intellectual disability (XLID). CUL4B is the scaffold protein in CUL4B-RING ubiquitin ligase (CRL4B) complex. While the roles of CUL4B in cancer progression and some developmental processes like adipogenesis, osteogenesis, and spermatogenesis have been studied, the mechanisms underlying the neurological disorders in patients with CUL4B mutations are poorly understood. Here, using 2D neuronal culture and cerebral organoids generated from the patient-derived induced pluripotent stem cells and their isogenic controls, we demonstrate that CUL4B is required to prevent premature cell cycle exit and precocious neuronal differentiation of neural progenitor cells. Moreover, loss-of-function mutations of CUL4B lead to increased synapse formation and enhanced neuronal excitability. Mechanistically, CRL4B complex represses transcription of PPP2R2B and PPP2R2C genes, which encode two isoforms of the regulatory subunit of protein phosphatase 2 A (PP2A) complex, through catalyzing monoubiquitination of H2AK119 in their promoter regions. CUL4B mutations result in upregulated PP2A activity, which causes inhibition of AKT and ERK, leading to premature cell cycle exit. Activation of AKT and ERK or inhibition of PP2A activity in CUL4B mutant organoids rescues the neurogenesis defect. Our work unveils an essential role of CUL4B in human cortical development.

Myocardial involvement characteristics by cardiac MR imaging in neurological and non-neurological Wilson disease patients

ObjectivesTo explore the characteristics of myocardial involvement in Wilson Disease (WD) patients by cardiac magnetic resonance (CMR).MethodsWe prospectively included WD patients and age- and sex-matched healthy population. We applied CMR to analyze cardiac function, strain, T1 maps, T2 maps, extracellular volume fraction (ECV) maps, and LGE images. Subgroup analyzes were performed for patients with WD with predominantly neurologic manifestations (WD‐neuro +) or only hepatic manifestations (WD‐neuro −).ResultsForty-one WD patients (age 27.9 ± 8.0 years) and 40 healthy controls (age 25.4 ± 2.9 years) were included in this study. Compared to controls, the T1, T2, and ECV values were significantly increased in the WD group (T1 1085.1 ± 39.1 vs. 1046.5 ± 33.1 ms, T2 54.2 ± 3.3 ms vs. 51.5 ± 2.6 ms, ECV 31.8 ± 3.6% vs. 24.3 ± 3.7%) (all p < 0.001). LGE analysis revealed that LGE in WD patients was predominantly localized to the right ventricular insertion point and interventricular septum. Furthermore, the WD‐neuro + group showed more severe myocardial damage compared to WD‐neuro − group. The Unified Wilson Disease Rating Scale score was significantly correlated with ECV (Pearson’s r = 0.64, p < 0.001).ConclusionsCMR could detect early myocardial involvement in WD patients without overt cardiac function dysfunction. Furthermore, characteristics of myocardial involvement were different between WD‐neuro + and WD‐neuro − , and myocardial involvement might be more severe in WD‐neuro + patients.Critical relevance statementCardiac magnetic resonance enables early detection of myocardial involvement in Wilson disease patients, contributing to the understanding of distinct myocardial characteristics in different subgroups and potentially aiding in the assessment of disease severity.Key points• CMR detects WD myocardial involvement with increased T1, T2, ECV.• WD‐neuro + patients show more severe myocardial damage and correlation with ECV.• Differences of myocardial characteristics exist between WD‐neuro + and WD‐neuro − patients.Graphical

Systemic Lupus Erythematosus, Antiphospholipid Syndrome: Focus on Nervous System Lesions

Systemic lupus erythematosus and antiphospholipid syndrome are two rare and complex diseases that can affect various organs and systems of the human body. Systemic lupus erythematosus is the prototype of connective tissue diseases that can present with a full spectrum of neurological and mental disorders. It is quite difficult to establish an accurate etiological diagnosis of systemic lupus erythematosus with predominant neuropsychiatric symptoms. The exact timing of neurological manifestations remains controversial: either the central nervous system is the initial target of autoimmune disorders, or neurological symptoms are part of a multisystem lesion. Antiphospholipid syndrome is a prothrombotic systemic autoimmune disease with heterogeneous clinical and pathological manifestations and is a well-established cause of ischemic stroke and transient ischemic attack, especially in young patients. There is growing recognition of a broader spectrum of cerebrovascular lesions associated with antiphospholipid syndrome, including white matter hyperintensities, cortical atrophy, and lacunar infarcts, which may have clinically important neurocognitive consequences. The article provides a review of the literature examining the spectrum of neurological disorders in patients with antiphospholipid syndrome and the inflammatory and cytokine mechanisms that play an important role in the pathogenesis of nervous system damage in systemic lupus erythematosus.

Cerebrospinal fluid metabolomic and proteomic characterization of neurologic post-acute sequelae of SARS-CoV-2 infection

The mechanism by which SARS-CoV-2 causes neurological post-acute sequelae of SARS-CoV-2 (neuro-PASC) remains unclear. Herein, we conducted proteomic and metabolomic analyses of cerebrospinal fluid (CSF) samples from 21 neuro-PASC patients, 45 healthy volunteers, and 26 inflammatory neurological diseases patients. Our data showed 69 differentially expressed metabolites and six differentially expressed proteins between neuro-PASC patients and healthy individuals. Elevated sphinganine and ST1A1, sphingolipid metabolism disorder, and attenuated inflammatory responses may contribute to the occurrence of neuro-PASC, whereas decreased levels of 7,8-dihydropterin and activation of steroid hormone biosynthesis may play a role in the repair process. Additionally, a biomarker cohort consisting of sphinganine, 7,8-dihydroneopterin, and ST1A1 was preliminarily demonstrated to have high value in diagnosing neuro-PASC. In summary, our study represents the first attempt to integrate the diagnostic benefits of CSF with the methodological advantages of multi-omics, thereby offering valuable insights into the pathogenesis of neuro-PASC and facilitating the work of neuroscientists in disclosing different neurological dimensions associated with COVID-19.

Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes.

Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).

Clinical manifestations and mechanisms of formation of neurological disorders in patients with vibration disease

The review presents an analysis of literature sources devoted to the study of changes in the nervous system in patients with vibration disease. Vibration-mediated cellular hypoxia, which occurs as a result of spastic changes in blood vessels, phase fluctuations in intravascular pressure, impaired blood and lymph outflow, causes suppression of energy metabolism, contributes to disorders at the level of receptor (glutamate, GABA-ergic, dopamine and cholinergic) and synaptic structures, conductors of pain and temperature sensitivity (demyelinization), analyzing neurons in the parietal region of the brain, regulatory proteins of the nervous tissue (NF-200, GFAP S-100). A low-amplitude, irregular, disorganized and sometimes deformed EEG spectrum with a predominance of the alpha wave and a shift of the alpha rhythm to the left reflects changes in the spontaneous electrical activity of brain structures in patients. With an increase in the experience dose of vibration-noise exposure, the dominant alpha activity changes to slow-wave or polyrhythmic. Mild and moderate diffuse changes in the brain become focal in nature, cortical-subcortical relationships are disrupted at the diencephalic level, creating a pathophysiological basis for sensorineural (sensory-neural) hearing loss, especially in patients with a genetic predisposition mediated by genes encoding proteins of the heat shock system. The psycho-emotional status of patients is characterized by a hypochondriacal focus on the state of health, mental disadaptation, psycho-emotional disorders in the form of anxiety, depressive mood. The analysis of literature sources on the mechanisms of the formation of neurological disorders in patients with vibration disease revealed the lack of data on the state of the multicomponent ghrelin system interacting with GHSR-1A and GHSR-1B receptors, which determines a new vector in further experimental and clinical studies.

The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms.

Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.

Neuroprognostication value of serum neurofilament light chain for out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Neurofilament light chain (NfL) is a novel biomarker for the assessment of neurological function after cardiac arrest (CA). Although meta-analysis has confirmed its predictive value, it has not conducted a more detailed analysis of its research. We conducted a meta-analysis to evaluate the relationship between serum NfL level and neurological prognosis in patients with spontaneous circulation recovery after CA, and subgroup analysis was conducted according to sample collection time, time to assess neurological function, study design, whether TTM was received, the method of specimen determination, and the presence of neurological disease in patients. To analyze the influence of these factors on the predictive value of serum NfL. Published Cochrane reviews and an updated, extended search of MEDLINE, Cochrane Library, Embase, Scopus, ClinicalKey, CINAHL, and Web of Science for relevant studies until March 2022 were assessed through inclusion and exclusion criteria. The standard mean difference and 95% confidence interval were calculated using the random-effects model or fixed-effects model to assess the association between one variable factor NfL level and the outcome of CA patients. Subgroup analysis according to sample collection time was performed. The prognosis analysis and publication bias were also assessed using Egger's and Begg's tests. Among 1209 related articles for screening, 6 studies (1360 patients) met the inclusion criteria and were selected for meta-analysis. The level of serum NfL in the good prognosis group (CPC1-2, CPC: cerebral performance category score) was significantly lower than that in the poor prognosis group (CPC3-5)SMD(standardized mean difference) = 0.553, 95%CI(confidence interval) = 0.418-0.687, I2 = 65.5% P<0.05). And this relationship also exists at each sampling time point (NfL specimens were collected on admission: SMD:0.48,95%CI:0.24-0.73; Samples were collected 24 hours after CA: SMD:0.60,95%CI:0.32-0.88;Specimens were obtained 48 hours after CA: SMD:0.51, 95%CI:0.18-0.85;Specimens were obtained 72 hours after CA: SMD:0.59, 95%CI:0.38-0.81). NfL may play a potential neuroprognostication role in postcardiac arrest patients with spontaneous circulation, regardless of when the sample was collected after CA.

Migraine and Risk of Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Background. Migraine is a frequently observed neurological disease in patients with systemic lupus erythematosus. However, the relationship between these two conditions is still a subject of controversy. Objectives. Our aim was to investigate the association between migraine and the risk of developing systemic lupus erythematosus through a meta-analysis of case-control studies. Methods. Following the Preferred Reporting Project for Systematic Reviews and Meta-Analysis statement, we conducted a comprehensive search of the following literature databases, including PubMed, Embase, and Web of Science, to identify relevant articles published up to June 2022 using the keywords “migraine” and “systemic lupus erythematosus” as subject headings. If heterogeneity was expected to be low ( I 2 ≤ 50 %), the pooled analysis was performed using a fixed-effects model calculated by the Mantel-Haenszel method. Analysis in this study was conducted using R software (http://www.r-project.org). Results. Six case-control experimental studies involving 908 participants were included in the meta-analysis. The overall combined relative risk of developing systemic lupus erythematosus in patients with migraine, compared to the control group, was 1.69 (95% confidence interval (CI): 1.26 to 2.27). The analysis revealed minimal evidence of heterogeneity and publication bias. Conclusions. Based on our meta-analysis, there is suggestive evidence that patients with migraine may have an elevated risk of developing systemic lupus erythematosus attacks.

Guillain-Barré Syndrome Complicated by Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome.

Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases. A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved. We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the 'red flags'. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old). This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome. Guillain-Barré syndrome (GBS) alone rarely causes headaches; therefore, when GBS patients complain of severe headaches, especially when the headache is associated with 'red flags', other complications and differential diagnosis should be considered.Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) can be triggered by GBS.Hyponatraemia, age over 50 years and female gender may be risk factors for developing PRES and RCVS in GBS patients.

It's Time to Go Quantum in Medicine.

As the field of medicine grows and expands, new scientific developments hold great promise for improving quality of care, clinical research, and the diagnosis and treatment of diseases. Quantum physics is a promising field that intersects with medicine much more than originally understood. In terms of diagnosing different diseases, incorporating quantum mechanics into the study of medicine can allow for efficient diagnosis before symptoms even arise in a patient. Applying theory-based mathematical structures that describe neuron transmission throughout the brain and mind on a quantum scale can help us to better understand neurological diseases in patients. Quantum theory can even give plausible explanations for subtle DNA changes and even telomere reduction in patients who develop cancer. Utilizing quantum theory in the field of medicine can help in understanding and applying treatments for a multitude of different diseases, such as Alzheimer's disease or diverse types of cancer, and even expand upon efficient and reliable diagnosis in clinical settings. Quantum physics is a pertinent advancing field that may have a significant impact on expanding medical care and treatment in the near future. In this review, the application of quantum physics in medicine is discussed.

Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study.

Heterogeneous neurocognitive impairment remains an important issue, even in the era of combination antiretroviral therapy (cART), with an incidence ranging from 15% to 65%. Although ART drugs with higher penetration scores to the central nervous system (CNS) show better HIV replication control in the CNS, the association between CNS penetration effectiveness (CPE) scores and neurocognitive impairment remains inconclusive. To explore whether ART exposure is associated with the risk of neurological diseases among patients with HIV/AIDS, this study in Taiwan involved 2,571 patients with neurological diseases and 10,284 matched, randomly selected patients without neurological diseases between 2010 and 2017. A conditional logistic regression model was used in this study. The parameters for ART exposure included ART usage, timing of exposure, cumulative defined daily dose (DDD), adherence, and cumulative CPE score. Incident cases of neurological diseases, including CNS infections, cognitive disorders, vasculopathy, and peripheral neuropathy, were obtained from the National Health Insurance Research Database in Taiwan. Odds ratios (ORs) for the risk of neurological diseases were conducted using a multivariate conditional logistic regression model. Patients with a history of past exposure (OR: 1.68, 95% confidence interval [CI]:1.22-2.32), low cumulative DDDs (< 2,500) (OR: 1.28, 95% CI: 1.15-1.42), low adherence (0 < adherence (ADH) ≤ 0.8) (OR: 1.46, 95% CI: 1.30-1.64), or high cumulative CPE scores (>14) (OR: 1.34, 95% CI: 1.14-1.57) had a high risk of neurological diseases. When stratified by classes of ART drugs, patients with low cumulative DDDs or low adherence had a high risk of neurological diseases, including NRTIs, PIs, NNRTIs, INSTIs, and multi-drug tablets. Subgroup analyses also suggested that patients with low cumulative DDDs or low adherence had a high risk of neurological diseases when they had high cumulative CPE scores. Patients with high cumulative DDDs or medication adherence were protected against neurological diseases only when they had low cumulative CPE scores (≤ 14). Patients may be at risk for neurological diseases when they have low cumulative DDDs, low adherence, or usage with high cumulative CPE scores. Continuous usage and low cumulative CPE scores of ART drugs may benefit neurocognitive health in patients with HIV/AIDS.

Riga-Fede disease: a review of the literature and a description of clinical cases

Relevance. Riga-Fede disease (RFD) is a rare pathology that develops as a result of trauma to the mucous membrane of the tongue ventral surface with sharp edges of natal, neonatal or primary teeth erupting in time and manifests in the form of erosion or sublingual fibrous lesion with an ulcerated surface.Purpose. To analyze the literature and present our own RFD clinical cases.Material and methods. A search was performed of articles published in 2001-2023 on the research topic in the main scientific literature databases (PubMed, E-library, Google Scholar, etc.). We analyzed the data from 68 publications and presented three of our own clinical cases of RFD in children aged 5, 6 and 9 months.Results. Analysis of literature data revealed different approaches to the diagnosis and treatment of RFD in children. The diagnosis of RFD should rely on the clinical picture and exclude additional trauma to children by histological examination and lesion excision. Pronounced tooth mobility, ineffective infant feeding and the presence of neurological diseases in patients were the main indications for the extraction of teeth, which caused RFD development. In the absence of tooth mobility, non-surgical treatment methods should be preferable. In the presented clinical cases, erupted primary teeth caused BRF. In two cases, the treatment consisted of smoothing the sharp edges of the teeth and restoration with glass ionomer cement; in one case, a child with a neurological disease experienced extraction of lower central incisors. In all cases, recovery was within 3-4 weeks.Conclusion. Once clinically diagnosed with RFD, treatment method choice should consider tooth mobility and the child's overall health.

New insights into RAGE/Diaph1 interaction as a modulator of actin cytoskeleton dynamics in peripheral nervous system in long term hyperglycemia.

This review focuses on Receptor for Advanced Glycation Endproducts/Diaphonous related formin1 (RAGE/Diaph1) interaction as a modulator of actin cytoskeleton dynamics in peripheral nervous system (PNS) in diabetes. Deciphering the complex molecular interactions between RAGE and Diaph1 is crucial in expanding our understanding of diabetic length dependent neuropathy (DLDN). DLDN is a common neurological disorder in patients with diabetes. It is well known that actin cytoskeletal homeostasis is disturbed during DLDN. Thus, we review the current status of knowledge about RAGE/Diaph1 impact on actin cytoskeletal malfunctions in PNS and DLDN progression in diabetes. We also survey studies about small molecules that may block RAGE/Diaph1 axis and thus inhibit the progression of DLDN. Finally, we explore examples of cytoskeletal long-non coding RNAs (lncRNAs) currently unrelated to DLDN, to discuss their potential role in this disease. Most recent studies indicated that lncRNAs have a great potential in many research areas, including RAGE/Diaph1 axis as well as DLDN. Altogether, this review is aimed at giving us an insight into the involvement of cytoskeletal lncRNAs in DLDN.

Considerations in the Management of Functional Neurological Disorders in Patients with Hearing Loss.

Adam is a 14-year-old adolescent boy with hearing loss who presented to the pediatric neurology clinic accompanied by his father for evaluation of new-onset left hand tremor for a duration of 1 month. An American Sign Language interpreter was present and used throughout the visit.Adam has bilateral sensorineural hearing loss related to premature birth at 28 weeks' gestation. He uses sign language and attends a school for the hearing impaired. He has been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and a nonspecific learning disorder. His ADHD symptoms are well controlled with a stimulant medication. He is independent in activities of daily living, and there is no concern for intellectual disability. His father is concerned that Adam may have anxiety, but this has not been evaluated.After careful history, it is found that the tremor was first noted the day after burglars broke into his home and stole precious belongings. Current stressors include difficulties with schoolwork and a strained relationship with an extended family member. There is no family history of tremor.The tremor was intermittent initially, with episodes lasting around 30 minutes. Over time, the tremor became more persistent. Adam is left-handed, and the tremor is now interfering with handwriting, eating, and other fine motor skills. The tremor worsens when Adam is tired or stressed and improves with relaxation. No tremor has been noted in other body parts. Adam denies any other neurological symptoms, including headache, vision changes, or gait abnormalities.On examination, Adam seemed anxious but showed no significant distress and had normal vital signs. His general examination was unremarkable. His neurological examination showed intact cranial nerves, apart from the hearing impairment. He had normal muscle tone, intact strength and coordination, and a normal casual gait. Rhythmic shaking of the left upper extremity was present with action, while maintaining posture. Using specific examination techniques, the examiner was able to alter the rhythm of the tremor, and the tremor was noted to subside when the patient was engaged with the examiner. These findings in addition to signs of suggestibility and variable frequency/direction were consistent with a functional etiology.The diagnosis of a functional neurological disorder manifesting in the form of functional tremor was discussed with the patient and his father with assistance from the sign language interpreter. Counseling regarding management consisting mainly of cognitive behavioral therapy and evaluation of possible coexisting conditions, such as anxiety, was discussed.What factors would you consider in diagnosis and management of functional neurological disorder in a hearing-impaired child/adolescent?