Onset Of Symptoms Research Articles

Influence of Health-Seeking Behavior on Treatment Initiation of Cancer Patients at a Tertiary Care Hospital in Varanasi

Abstract Background: Cancer is one of the leading causes of death worldwide, and in order to prevent it, it is vital to understand cancer patients’ health-seeking behavior that contributes to patient delays in receiving cancer treatment globally; however, no similar studies have been conducted in India. Therefore, this study made an effort to know health-seeking behavior among delayed cancer patients receiving treatment at a tertiary care hospital, Varanasi. Methods: A cross-sectional study was conducted at the Department of Surgical Oncology OPD, Sir Sunder Lal Hospital, IMS, BHU, Varanasi. Randomly selected 440 registered patients were interviewed with the help of semi-structured questionnaire. Binary logistic regression analysis and 2-test were used in this study. Results: Out of total 440 patients included in this study, 207 (47.05%) were males and 233 (52.95%) were females. The majority (59.32%) of patients were more than 45 years of age group. Most (80%) of the patients had delay in cancer treatment of more than 60 days from onset of symptoms. Only 29.55% of patients were aware of any symptoms of Cancer. Those patients who were doing self-medication (P=0.03) and did not attend any cancer screening program (P=0.04) showed a statistically significant association with delayed initiation of treatment. Patients referred from another centre (P = 0.03) also show a significant association with delayed treatment initiation. Cancer patients who visited the screening program (AOR= 0.22, P=0.003) were significantly associated with a lower likelihood of delayed treatment initiation. Conclusion: The study showed that 80% of patients were delayed in seeking treatment for Cancer and highly influenced by low awareness, self-medication and visiting multiple health centres for diagnosis and treatment. Therefore, there is a strong need to address the reasons for the delay in seeking treatment.

Angioinvasive Rhino-Orbital-Cerebral Mucormycosis in a Patient with Type 2 Diabetes Mellitus: A Complex and Lethal Cause of Stroke

Rhino-orbital-cerebral mucormycosis is a rapidly progressive and often fatal fungal infection caused by molds of the order Mucorales, particularly affecting immunocompromised individuals. This infection is notorious for its angioinvasive properties, enabling the fungi to invade blood vessels and leading to tissue necrosis. We report the clinical course of a 59-year-old Caucasian man with poorly controlled type 2 diabetes (HbA1c 16.8%) who presented with unilateral headache, left-sided facial numbness, and incomplete left ocular motor paresis. Initial presentation raised suspicion of orbital phlegmon, leading to antibiotic and later corticosteroid pulse therapy, which worsened the patient’s condition. Subsequent imaging demonstrated extensive inflammatory changes, including wall irregularities of the left intracranial internal carotid artery, accompanied by ocular protrusion and periorbital enhancement. New palatal lesions indicated mucormycosis, which was confirmed by molecular analysis of a palatal biopsy, leading to Amphotericin B treatment. Pre-surgery imaging revealed a malignant middle cerebral artery infarction, and the patient died 16 days after symptom onset and 12 days after initial presentation under palliative care due to a poor prognosis. This case of angioinvasive mucormycosis underscores the severe and often fatal course of rhino-orbital-cerebral mucormycosis in an immunocompromised individual. The rapid progression from initially vague and unspecific symptoms to extensive vascular involvement and stroke highlights the critical need for early and accurate diagnosis, as well as prompt intervention to prevent further disease progression. Additionally, this case also illustrates the potential risks associated with corticosteroid therapy in the presence of undiagnosed fungal infections, which can exacerbate the condition and lead to serious complications. Clinicians should maintain a high index of suspicion for mucormycosis in similar clinical scenarios, prioritizing adequate antifungal treatment and careful monitoring to improve patient outcomes. Early interdisciplinary collaboration is essential for the effective management of such complex cases.

Role of fundus autofluorescence imaging in the management of submacular hemorrhage

PurposeTo evaluate the baseline characteristics of fundus autofluorescence (FAF) in patients with submacular hemorrhage (SMH).MethodsThis retrospective study included patients diagnosed with treatment-naive, foveal-involving subretinal hemorrhage (size > 2-disc diameters) of any etiology, presenting between June 2017 and June 2023. Only cases with good-quality color fundus photographs, optical coherence tomography (OCT) scans, and blue-light FAF images at baseline were included. SMH imaging characteristics were documented and correlated with treatment outcomes. A successful treatment outcome was defined as the reduction, displacement or clearance of the SMH from beneath the fovea.ResultsNineteen cases of SMH (13 males, 6 females), ranging from 14 to 85 years, were analyzed. Neovascular age-related macular degeneration (nAMD) was the most common etiology (n = 11, 58%). Baseline visual acuity ranged from 6/9 to counting fingers at ½ meter, with a median presentation time of 7 days from symptom onset (range: 1–57 days). Treatment success was observed in 13 eyes (68%). Hypoautofluoroscence on FAF was significantly associated with SMH resolution (p = 0.021). However, no association was found between treatment success and clinical hemorrhage characteristics (p = 0.222), OCT findings (p = 0.222), or specific treatments (p > 0.05). Hypoautofluoroscence on FAF was the sole predictor of treatment success, as demonstrated by Spearman’s correlation (r = 0.637; p = 0.003) and linear regression analysis (p = 0.003).ConclusionFAF, in conjunction with color fundus photography and OCT, may provide valuable insights for clinicians in formulating treatment strategies for patients with SMH. Hypoautofluoroscence on FAF was a significant predictor of successful SMH resolution in this study.

Examining the complex Interplay between gut microbiota abundance and short-chain fatty acid production in amyotrophic lateral sclerosis patients shortly after onset of disease.

This study aimed to assess differences in the enteral microbiome of relatively recent-onset amyotrophic lateral sclerosis (ALS) patients (< 6-15 months since symptom onset) compared to healthy individuals, focusing on short-chain fatty acids (SCFAs) as potential mediators of host metabolism. We included 28 volunteers (16 ALS, 12 controls) with informed consent. No significant effect of ALS on alpha diversity (measuring the variety and abundance of species within a single sample, and indicating the health and complexity of the microbiome) was observed, but ALS patients had higher abundances of Fusobacteria and Acidobacteria. ALS subtypes influenced specific species, with increased Fusobacteria and Tenericutes in spinal ALS compared to bulbar ALS. ALS patients showed increased Enterobacter, Clostridium, Veillonella, Dialister, Turicibacter, and Acidaminococcus species and decreased Prevotella, Lactobacillus, and Butyricimonas. Correlations between species varied between ALS patients and healthy individuals and among ALS subtypes. No significant differences in SCFA concentrations were found, but spinal ALS samples showed a trend towards decreased propionate content. Relationships between SCFAs and phyla colonization differed by disease status. This study suggests distinct enteral microbiome characteristics in ALS patients, though the implications are unclear. Further research is needed to determine if these differences are causative or consequential and to explore their potential as diagnostic or therapeutic targets. The study also underscores the heterogeneity of microbiome constraints in ALS and the need for more research into ALS and SCFA metabolism.

Socioeconomic Factors Associated with ≥2-year Delayed Diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) in the United States.

The objective of this study is to explore the impact of socioeconomic factors on risk of ≥2-year delayed diagnosis of NMOSD. Consequences of delayed diagnosis in NMOSD could be as severe as complete blindness or quadriplegia. Female sex and African ancestry are risk factors for delayed diagnosis across many disease states in the US. Patients with NMOSD are disproportionately represented by women of African descent suggesting that there may be socioeconomic barriers to timely diagnosis. This retrospective cohort study of patients with NMOSD used a closed claims database linked with socioeconomic market research and American Community Survey data at the zip-9 level. Patients were included if they had at least 2 NMOSD claims ≥30 days apart between January 2018 and December 2021. Symptom onset was defined as the first claim of associated NMOSD symptoms up to 15 years prior to diagnosis. ≥2-year delayed diagnosis was defined as diagnosis at or after 2 years of symptom onset. The conceptual causal framework was illustrated with a directed acyclic graph. Multivariable regression models were used to estimate associations of patient characteristics and several socioeconomic variables with risk of ≥2-year delayed NMOSD diagnosis. In multivariable regression analysis, factors associated with ≥2-year delayed diagnosis were female sex (OR 1.44; 95%CI 1.07-1.95) and Managed Medicaid coverage (OR 1.45; 95%CI 1.11-1.89). Factors associated with diagnosis in <2 years included age≤45 (OR 1.43; 95%CI 1.06-1.94), moderate and severe comorbidity [(Moderate OR 1.62, 95%CI 1.13-2.33), (Severe OR 1.56; 95%CI 1.04-2.35)], and western US regions (OR 1.56; 95%CI 1.12-2.16). There was no impact of other socioeconomic factors on ≥2-year delayed diagnosis. However, patient-level data on race/ethnicity was not available. This study demonstrated that otherwise healthy, female, Managed Medicaid beneficiaries, age >45 years may be at highest risk for ≥2-year delayed diagnosis of NMOSD.

An Outbreak of Shiga Toxin-Positive Enteroaggregative Escherichia coli 0104:H4 Related Hemolytic Uremic Syndrome in Turkey: A Multicenter Study.

Serious outbreaks related to Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) have been reported globally. In 2011, Germany experienced a significant outbreak of HUS caused by enteroaggregative Escherichia coli (EAEC) O104:H4 strain. Since then, no other outbreaks of this strain have been reported. This study aims to evaluate pediatric patients affected by the second documented worldwide outbreak of STEC-HUS (EAEC O104:H4 serotype) contaminating local drinking water. Medical records of patients hospitalized in five pediatric intensive care units (PICU) diagnosed with STEC-HUS between July and September 2022 were evaluated retrospectively. Eighteen patients (14 girls, and 4 boys) were enrolled in the study. The median age was 7.4 [Intetquartile range (IQ) 1.3-17] years. Abdominal pain was the most common symptom (100%). The mean duration between symptom onset and development of STEC-HUS was 3 days (IQ 1-9). EAEC O104:H4 serotype was detected in the stool samples of eight patients. Neurological involvement was observed in three patients, cardiac involvement in two patients, and both in one patient. Two patients required respiratory support and dialysis was performed in 16 (88.8%) patients. Plasmapheresis was administered to two patients, and eculizumab was given to four. No mortality was reported during follow-up; the mean durations of PICU and hospital stays were 11.3 and 31.6 days, respectively. Outbreaks of HUS can have severe implications on mortality and morbidity. However, timely diagnosis and implementation of appropriate supportive care, including dialysis, respiratory support, and suitable medical treatment for eligible patients, can lead to favorable outcomes.

Association of Resilience-Related Life Experiences on Variability on Age of Onset in Dominantly Inherited Alzheimer Disease.

It remains unknown whether the associations between protective lifestyles and sporadic dementia risk reported in observational studies also affect age at symptom onset (AAO) in autosomal dominant Alzheimer disease (ADAD) with predominant genetic influences. We investigated the associations between resilience-related life experiences and interindividual AAO variability in ADAD. We performed a longitudinal and confirmatory analysis of the Dominantly Inherited Alzheimer Network prospective observational cohort (January 2009-June 2018, follow-up duration 2.13 ± 2.22 years), involving clinical, CSF, and lifestyle/behavioral assessments. We performed a 2-pronged comprehensive resilience assessment in each cohort. Cohort 1, incorporating the general resilience definition (cognitive maintenance [Clinical Dementia Rating = 0] despite high pathology), included carriers during the periods of significant CSFp-tau181 variability and grouped into resilience/resistance outcome bins according to the dichotomous pathologic and cognitive statuses, subcategorized by the estimated years from expected symptom onset (EYO). Cohort 2, focused on ADAD-specific genetically determined time frame characterizing the onset predictability, included asymptomatic participants with available preclinical lifestyle data and AAO outcomes and grouped into delayed or earlier AAO relative to the parental AAO. Associations of cognitive, CSFp-tau181, and lifestyle/behavioral predictors with binary outcomes were investigated using logistic regression. Of 320 carriers (age 38.19 ± 10.94 years, female 56.25%), cohort 1 included 218 participants (39.00 ± 9.37 years, 57.34%) and cohort 2 included 28 participants (43.34 ± 7.40 years, 71.43%). In cohort 1, 218 carriers after -20 EYO, when the interindividual variability (SD) of CSFp-tau181 first became more than twice greater in carriers than in noncarriers, were grouped into low-risk control (asymptomatic, low pathology, n = 103), high-resilience (asymptomatic despite high pathology, n = 60), low-resilience (symptomatic despite low pathology, n = 15), and susceptible control (symptomatic, high pathology, n = 40) groups. Multivariable predictors of high resilience, controlling for age and depression, included higher conscientiousness (odds ratio 1.051 [95% CI 1.016-1.086], p = 0.004), openness to experience (1.068 [1.005-1.135], p = 0.03) (vs. susceptible controls), and agreeableness (1.082 [1.015-1.153], p = 0.02) (vs. low resilience). From 1 to 3 years before parental AAO (cohort 2), the multivariable predictor of delayed AAO, controlling for CSFp-tau181, was higher conscientiousness (0.916 [0.845-0.994], p = 0.036). Among the cognitively and socially integrated life experiences associated with resilience, measures of conscientiousness were useful indicators for evaluating resilience and predicting future dementia onset in late preclinical ADAD.

Investigation of Hemorheological Parameters in Ischemic Stroke Patients.

The aim of this study is to determine whether there are any changes in hemorheological parameters, including whole blood viscosity (WBV), plasma viscosity, erythrocyte aggregation, and erythrocyte deformability, in acute ischemic stroke patients, and to establish their relationship with stroke etiology. The study also aims to observe the changes in these parameters, if any, over time and after treatment, and to assess the correlation between risk factors for ischemic stroke and neuroimaging findings. This was a prospective observational study including 70 patients diagnosed with acute ischemic stroke within the first 3 days of the onset of symptoms and 96 healthy controls. Stroke patients were categorized based on TOAST criteria, and hemorheological parameters were measured at admission and on the fifth day post-treatment. Erythrocyte aggregation and deformability were measured using a laser ektacytometer, and viscosity assessment was conducted with a rotational viscometer. Stroke patients exhibited significant differences from the control group in aggregation amplitude, aggregation index, and aggregation half-time (p = 0.001, p = 0.013, p = 0.009, respectively) and showed elevated maximum value of elongation index (p = 0.000). No significant differences in WBV and plasma viscosity were observed between the groups. Post-treatment, the small vessel occlusion subgroup demonstrated a notable reduction in WBV. Additionally, homocysteine levels showed a positive correlation with scattered white matter lesions in basal ganglia and infratentorial regions (p = 0.002, p = 0.039, respectively). Increased predisposition to erythrocyte aggregation may contribute to the occurrence of acute ischemic stroke. Moreover, gaining the ability of erythrocytes to deform and increase blood flow may serve as a compensatory mechanism in the chronic vascular disease process. The risk factors for ischemic stroke may exhibit connections to specific areas within the brain.

Cerebrovascular implications of takayasu arteritis: a review.

Takayasu arteritis (TA) is a rare, chronic, inflammatory large-vessel vasculitis that affects the aorta and its main branches, including the cerebrovascular system. This review analyzes current knowledge and patient outcomes concerning the cerebrovascular implications of TA. A literature search, with publications from 1994 to 2024, identified pertinent studies through PubMed. An illustrative case report details a 19-year-old female with Type 1 TA, illustrating the complex decision required in the absence of surgical or endovascular options. Our results offer a demographic analysis of 1,698 TA patients, highlighting a female predominance of 89.99% and a mean symptom onset at 33 years. The clinical spectrum of cerebrovascular involvement presented varied symptoms, most notably dizziness, with significant incidences of ischemic events and bilateral stenosis primarily affecting the carotid and subclavian arteries. The most common type of TA was Type V, affecting 40% of patients studied. Endovascular treatment had a 95% initial success rate, with a 67% restenosis rate. Surgical treatment was successful in 84% of cases, but 21% had notable post-operative complications. Similar to the endovascular population, those treated with stand-alone conservative therapy saw a 93% initial remission rate with 52% having relapsed. Assessing the disease activity of TA is crucial when planning vascular intervention due to its significant impact on treatment outcomes. Despite its greater initial invasiveness, surgical interventions showed lower restenosis rates compared to either endovascular interventions or standalone conservative management. We emphasize advancements in TA management and the pressing need for continued research into diagnostic and treatment protocols for improved patient outcomes.

Duration of Benefit and Risk of Dual Antiplatelet Therapy up to 72 Hours After Mild Ischemic Stroke and Transient Ischemic Attack.

Clopidogrel-aspirin initiated within 72 hours of symptom onset is effective in patients with mild ischemic stroke or transient ischemic attack (TIA) in the Intensive Statin and Antiplatelet Therapy for Acute High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial. Uncertainties remain about the duration of the treatment effect. This study aimed to assess duration of benefit and risk of clopidogrel-aspirin in these patients. The INSPIRES trial was a 2*2 factorial placebo-controlled randomized trial conducted in 222 hospitals in China. The 2 treatments did not interact and were evaluated separately. In this study, we performed secondary analyses based on antiplatelet treatment. All patients with mild stroke or TIA of presumed atherosclerotic cause within 72 hours of symptom onset enrolled in the trial were included. Patients were randomly assigned to receive clopidogrel-aspirin on days 1-21 followed by clopidogrel on days 22-90 or aspirin alone for 90 days. The primary efficacy outcome was major ischemic event which included the composite of ischemic stroke and nonhemorrhagic death. The primary safety outcome was moderate-to-severe bleeding. We estimated the risk difference between the 2 treatments for each stratified week. All 6,100 patients in the trial were included (3,050 in each group). The mean age was 65 years, and 3,915 patients (64.2%) were men. Compared with aspirin alone, the reduction of major ischemic events by clopidogrel-aspirin mainly occurred in the first week (absolute risk reduction [ARR] 1.42%, 95% CI 0.53%-2.32%) and remained in the second week (ARR 0.49%, 95% CI 0.09%-0.90%) and the third week (ARR 0.29%, 95% CI -0.05% to 0.62%). Numerical higher risk of moderate-to-severe bleedings in the clopidogrel-aspirin group was observed in the first 3 weeks (absolute risk increase 0.05% [95% CI -0.10% to 0.20%], 0.10% [95% CI -0.09% to 0.29%], and 0.18% [95% CI -0.03% to 0.40%] in the first, second, and third weeks, respectively). Among patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, the net benefit of clopidogrel-aspirin initiated within 72 hours of symptom onset was pronounced in the first week and continued to a lesser degree in the following 2 weeks, outweighing the low, but ongoing hemorrhagic risk. ClinicalTrials.gov Identifier: NCT03635749. This study provides Class II evidence that among patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, the net benefit of clopidogrel-aspirin initiated within 72 hours of symptom onset was pronounced in the first week and continued to a lesser degree in the following 2 weeks, outweighing the low but ongoing hemorrhagic risk.

Quantification of blood and CSF volume to predict outcome after aneurysmal subarachnoid hemorrhage

This study aimed to describe the relationship between blood and CSF volumes in different compartments on baseline CT after aSAH, assess if they independently predict long-term outcome, and explore their interaction with age. CT scans from patients participating in a prospective multicenter randomized controlled trial of patients with aSAH were segmented for blood and CSF volumes. The primary outcomes were the mRS, and the Subarachnoid Hemorrhage Outcome Tool (SAHOT) at day 28 and 180. Univariate regressions were conducted to identify significant predictors of poor outcomes, followed by principal component analysis to explore correlations between imaging variables and WFNS. A multivariate predictive model was then developed and optimized using stepwise regression. CT scans from 97 patients with a median delay from symptom onset of 271 min (131–547) were analyzed. Univariate analysis showed only WFNS, and total blood volume (TBV) were significant predictors of both short and long-term outcome with WFNS more predictive of mRS and TBV more predictive of SAHOT. Principal component analysis showed strong dependencies between the imaging predictors. Multivariate ordinal regression showed models with WFNS alone were most predictive of day 180 mRS and models with TBV alone were most predictive of SAHOT. TBV was the most significant measured imaging predictor of poor long-term outcome after aSAH. All these imaging predictors are correlated, however, and may have multiple complex interactions necessitating larger datasets to detect if they provide any additional predictive value for long-term outcome.

Yellow Fever Vaccine-Associated Neurotropic Disease: A Case Report Of A 9-Month Old Infant And Review Of Literature

Introduction Yellow fever vaccine-associated neurotropic disease (YEL-AND) is a rare and serious complication following vaccination with the 17D live attenuated yellow fever vaccine. Cases of YEL-AND present as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, and meningoencephalitis and encephalitis. To date, only a few cases have been reported in the literature in children. Methods/Subject We present the case of a 9-month-old male who developed YEL-AND. He suffered "3 episodes of unprovoked generalized tonicclonic seizure," the first occurring within 2 hours of receiving a dose of the Yellow Fever vaccine, Measles, and Meningococcal vaccines. He was lethargic for 28 hours and had intermittent inconsolable cries for 48 hours, low-grade fever, and loss of motor milestones (sitting and standing). Available laboratory investigations and neuroimaging ruled out other possible causes. He was treated with anticonvulsants and IV Methylprednisolone and made a significant recovery and was discharged on the sixth day and has remained stable on follow-up. His clinical presentation, neuroimaging, and challenges in his management are discussed in this case report. Conclusion The licensed Yellow fever vaccines are safe, effective for the prevention of Yellow fever, and highly recommended, however, it is not completely devoid of serious adverse reactions. This case highlights a possibility of a very early onset of YEL-AND in children and should be suspected in individuals with a temporal relationship of symptom onset to vaccination.

Modeling the Impact of Ensitrelvir on SARS-CoV-2 Dynamics and Its Application for Assessment of Transmission Mitigation of Patients with COVID-19.

Mathematical modeling can provide quantitative understanding of the viral dynamics and viral reduction effects of drugs and enable simulations of the dynamics in various scenarios. In this study, a drug effect model of ensitrelvir was developed to describe the viral reduction effect. Using the model, we also estimated the impact of treatment with ensitrelvir on the reduction in the number of infected patients at the population level in Japan. The drug effect model of ensitrelvir was developed based on a viral dynamic model for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a population pharmacokinetic model of ensitrelvir using 10,477 samples of viral load from 1447 patients with coronavirus disease 2019 (COVID-19) in a phase 2/3 study. It was assumed that the drug effect on SARS-CoV-2 promoted the viral clearance depending on the free plasma concentrations. We estimated the impact of ensitrelvir treatment on the reduction in the number of infected patients at the population level in Japan using the susceptible-infectious-recovered-susceptible (SIRS) model including transmission mitigation. The viral reduction effect of ensitrelvir was characterized as a promotion of viral clearance depending on the plasma ensitrelvir concentrations using the Emax model. The maximum reduction effect was considered to depend on the time from symptom onset to treatment. The maximum transmission mitigation effect was observed when treatment was initiated within 12-24h of symptom onset, and secondary infections could be reduced by administering ensitrelvir as soon as possible after symptom onset. The viral reduction by ensitrelvir could be characterized based on the viral dynamics, and the dynamics could be estimated using the drug effect model. Furthermore, the drug effect on population level transmission based on the dynamics could be estimated. Thus, the simulation could be conducted for various conditions.

Mysterious Allergy Caused by Tick Bite: Alpha-Gal Syndrome.

Alpha-Gal syndrome (AGS) manifests as an intricate allergic response characterised by the formation of specific immunoglobulin E (IgE) antibodies targeting a carbohydrate termed galactose-a-1.3-galactose (a-Gal). Alpha-Gal antigens, which play a role in AGS, have been detected in the salivary glands and saliva of various tick species, especially Amblyomma americanum. Identifying these antigens in tick saliva underlines the potential role of tick bites in sensitising individuals to a-Gal and contributes to the complex immunological processes associated with AGS. When people with a-Gal allergy eat beef, pork, lamb, or the flesh of other mammals, they experience an allergic reaction that causes various symptoms, including rash, nausea, vomiting, and diarrhoea. In some cases, AGS can be life-threatening requiring emergency medical attention. Moreover, these reactions do not occur only due to red meat; intake of medical drugs, vaccines, and antidotes containing a-Gal epitopes can also trigger allergies. The fact that the symptoms causing IgE antibodies are directed against a carbohydrate moiety the unusual delay between food consumption and the onset of symptoms, and the differences in the reactions shown by a-Gal allergy make a-Gal syndrome an unprecedented allergic disease and distinguish it from other food allergies. Interestingly, a-Gal antigens involved in the development of AGS have been discovered in salivary secretions of different tick species in several continents. However, the underlying causes of a-Gal-specific IgE production and immune responses to tick bites are not fully understood. This complex system is crucial for identifying and developing new therapies for the disease. This article reviews the evolution of a-Gal, the current understanding of AGS and its relationship to tick species.

"Sterile hypopyon following pars plana vitrectomy and silicone oil injection".

To report five cases of post-operative sterile endophthalmitis in patients who underwent pars plana vitrectomy with silicone oil injection for retinal detachment. Review of the medical records of five patients who underwent pars plana vitrectomy with silicone oil injection at Southend University Hospital and the Royal Eye Infirmary, Derriford Hospital for rhegmatogenous or tractional retinal detachment. All five patients presented with signs of anterior chamber inflammation exhibiting flare, fibrin and hypopyon in the early or late post-operative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was commenced, with rapid resolution of the anterior chamber inflammatory reaction and no further intervention required. The use of silicone oil as a tamponade agent for retinal detachment can rarely induce sterile anterior chamber inflammation with signs resembling infectious endophthalmitis. Onset of symptoms, absence of pain and good response to topical steroids can help differentiate between the two entities.

Time critical diagnoses and transfers of patients with acute type A aortic dissection in the UK: national audit of current practice*

SummaryBackgroundType A aortic dissection repair is one of the most common emergency cardiac surgical procedures undertaken in the UK and has a high mortality. Early diagnosis and prompt surgery by an expert cardiac surgical team is crucial. Little is known about the patient's journey from first symptoms until surgery.MethodsThe Association for Cardiothoracic Anaesthesia and Critical Care undertook a prospective national audit of the management of type A aortic dissection in the UK.ResultsThe details of 334 patients with type A aortic dissection were reported by 28 UK cardiac centres over 12 months. Median (IQR [range]) time from onset of symptoms until arrival in an emergency department was 2.3 (1.4–4.7 [0.1–491.6]) h. Median (IQR [range]) time between arrival in the emergency department and the start of surgery was 9.5 (6.1–18.2 [0.8–363.5]) h. Delays in diagnosis and transfers were reported in 158 (47.3%) patients. Fifty‐two patients (15.6%) had an initial misdiagnosis. The condition of 56 patients (16.8%) deteriorated clinically before arrival in the operating theatre. A medical doctor accompanied 50 patients (15.0%) during transfer. Sixty‐four patients (19.2%) died in hospital with 41 (12.3%) dying within the first 5 days after surgery.ConclusionsThis audit provides a snapshot of current practice for patients with type A aortic dissection in the UK. Our findings show the acuity, clinical severity and vulnerability of patients with type A aortic dissection, and the deficits in the process of diagnosis and the quality of transfer. This audit demonstrates the need for the implementation of comprehensive, regionally governed, interdisciplinary medical management for every patient with type A aortic dissection.

Replication-Competent Oropouche Virus in Semen of Traveler Returning to Italy from Cuba, 2024.

A febrile man in Italy who had traveled to Cuba in July 2024 was diagnosed with Oropouche fever. Reverse transcription PCR detected prolonged shedding of Oropouche virus RNA in whole blood, serum, urine, and semen. Sixteen days after symptom onset, replication-competent virus was detected in semen, suggesting risk for sexual transmission.

Progression of TMJ disorders in patients with rheumatoid arthritis

Relevance. The literature highlights the significant impact of rheumatoid arthritis (RA) on the onset of musculoskeletal dysfunction symptoms in the temporomandibular joint (TMJ). However, the risk factors that influence the clinical manifestations of TMJ disorders in RA patients remain insufficiently explored.Objective: To examine the impact of rheumatoid arthritis on the onset and progression of TMJ disorders.Materials and methods. At the Dental Clinic of the Central Research Institute of Stomatology and Maxillofacial Surgery, 180 patients from St. Petersburg State Clinical Rheumatology Hospital No. 25, diagnosed with rheumatoid arthritis, were examined. Standard clinical assessments and detailed medical history collection were performed.Results. Patients with long-standing RA (over 5 years) were more likely to experience TMJ disorder symptoms, with a relative risk of 1.342 (95% CI) [1.106; 1.628]. No statistically significant correlation was found between RA activity and TMJ disorders. The symptom pattern varied by timing: prior to RA, patients predominantly experienced TMJ clicking and crepitus (66%); during RA onset, pain and restricted jaw movement were more common (80% and 72%, respectively). After RA manifestation, pain became the dominant symptom, though its intensity diminished over time (to 60%).Conclusions. The duration of RA has a notable impact on both the frequency and nature of TMJ disorder symptoms. While RA treatment reduces symptom intensity over time, their frequency remains high.

Large vessel occlusion mediated fluid attenuated inversion recovery signal intensity ratio is associated with stroke within 4.5 h.

The primary objective was to investigate the value of the fluid attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying stroke within 4.5 h. The secondary objective was to ascertain whether large vessel occlusion (LVO) mediated the relationship between the SIR and stroke within 4.5 h. We analyzed 633 acute stroke patients within 24 h of clear symptom onset. The SIR and DWI-FLAIR mismatch were evaluated. First, we determined whether demographic variables, vascular risk factors and LVO were related to stroke within 4.5 h with multivariate logistic regression analyses and stratified regression analysis. Next, we used mediation analysis to determine whether LVO explained the association between SIR and stroke within 4.5 h. Finally, we used receiver operating characteristic (ROC) analysis to assess the value of SIR, independent variable, and multiparameter models in identifying stroke within 4.5 h and compared with DWI-FLAIR mismatch. Hyperlipemia, LVO and SIR were associated with stroke within 4.5 h. Mediation analysis revealed that LVO partially mediated the relationship between SIR and stroke within 4.5 h (p < 0.001). The multiparameter model (hyperlipemia, LVO and SIR) showed significantly improved performance (AUC 0.869) in identifying stroke within 4.5 h over DWI-FLAIR mismatch (0.684), hyperlipemia (0.632), LVO (0.667) and SIR (0.773) models. SIR is associated with stroke within 4.5 h, and LVO partially mediates this relationship. A multiparameter model combining hyperlipemia, LVO and SIR can more accurately identify stroke within 4.5 h than individual parameter models.

Seasickness and partial peripheral vision obstruction with versus without an artificial horizon

Motion sickness (MS) is common when subjects are exposed to unfamiliar motion and affect individuals during travel. This study examines the immediate effect of two visual devices, in the form of glasses, on MS symptoms and associated physiological effects. The hypothesis is that peripheral vision obstruction reduces MS and that an additional beneficial effect could be observed when it is combined with an artificial horizon. Fifteen subjects with moderate to severe susceptibility to MS were exposed to a boat simulator in three conditions. Symptoms were assessed immediately after exposure. Time spent in the simulator, heart rate, and temperature were also recorded. The intensity of symptoms at the end of the experience did not differ, but time spent in the simulator before the onset of symptoms was significantly longer with peripheral vision obstruction (+36 %) and with both techniques combined (+40 %) than in the control condition. No difference was observed between the combined condition and peripheral vision obstruction alone. The glasses device used in this study (with or without an artificial horizon) delays the onset of symptoms. Further research is needed to confirm the mechanism that explains the benefits and to evaluate these effects during prolonged exposure to MS-inducing stimuli or after a period of familiarization with the device.