Etiological Origins Research Articles

Neurosarcoidosis Associated with Psychiatric Symptoms: Case Report

Background Sarcoidosis is a granulomatous disease predominant in women and black men that has inflammatory origin of unknown etiology; neurosarcoidosis is a rare and critical presentation of the disease. Case description A 26-year-old black female presented frontal headache for 1 year, as well as behavioral and mood changes for 15 days. Skull tomography and nuclear magnetic imaging of the skull revealed damaged meninges, a right frontal bone lesion, and an intraparenchymal contrast-enhancing lesion. Screening with computed tomography (CT) scans was performed, and it showed signs of bronchiectasis in the lower third of the right lung, but it was asymptomatic. The biopsy showed signs of reactional lesion with the presence of non-caseating granulomas. After the treatment with corticosteroids, the patient presented progressive improvement. Conclusions Neurosarcoidosis is a rare and critical pathology of sarcoidosis that presents a lytic bone lesion and clinical psychiatric symptoms; neurosarcoidosis is also rare in the literature.

Non-CNS pathogenic origin of Parkinson's disease.

The gut with its variety of microbiota may serve as an etiological origin of diseases. Gut microbes may also play a role in the pathogenesis of diseases beyond their simple nutritional maintenance and support. For example, gut protein aggregation, possibly aided by microbes as well as nasal influences, might be linked to disease that may move to the brain through the vagus nerve. To this end, Braak has offered a "dual-hit" hypothesis that proposes a novel etiology for Parkinson's disease (PD). The hypothesis places the initial origin of the disease in the nose and the gastrointestinal tract (GI) after infection by an unknown pathogen that could aggregate in the gut and then eventually spread to the brain via the autonomic plexuses. Gut health functioning, therefore, may affect brain status and behavior. A protein known as alpha-synuclein accumulates in brains of people with Parkinson's disease that is also present in the GI before the onset of motor symptoms. Therefore, the stomach, previously thought to be a stable mechanism throughout life, might explain some etiological origins of disease. Finally, the vagus nerve of the autonomic system that extends from the brain to the abdomen and exercises both sympathetic and parasympathetic roles might be associated with PD diagnosis along with Lewy body influences.

Oral Manisfestations in HIV Patients

The main characteristic of a patient with Acquired Immunodeficiency Syndrome (AIDS) is the ineffectiveness of the individual's immune system. The high degree of immunological weakness in which these patients are found has a high impact on their quality of life and can be seen clinically in the oral cavity. Because of this, the present study sought to evidence the most frequent oral manifestations of the AIDS disease. It has been demonstrated in this literature review that there is no specific oral manifestation of AIDS, but rather opportunistic lesions that are related to a deficient immune system. Such lesions may be of bacterial, viral, fungal origin, neoplastic processes and lesions of unknown etiology, as well as periodontal manifestations, which may be aggravated by the use of tobacco, alcohol, antidepressants and inadequate oral hygiene. It was also presented the ineffectiveness of saliva as a form of contagion and the importance of good oral hygiene for regression and control of some lesions. For this reason, it is important to note the importance of the dentist to correct the clinical diagnosis of such lesions so that it is possible to refer the patient to an infectologist in order to perform immunological tests that confirm their diagnosis and allow the correct follow-up and treatment . Only treatment with highly active antiretroviral therapy (HAART) does not provide full recovery of the epithelial cells of the oral cavity; therefore, the rapid initial implementation of antiretroviral therapy combined with constant patient visits to the dentist, for correct plaque control and adequate oral hygiene, avoids the appearance of certain lesions and helps in the regression of others.

DSM-5'te obsesif kompulsif bozukluk

There have been some changes of the Obsessive Compulsive Disorder in DSM-5 in terms of its classification and description. First of all, it has been suggested that the disorder should be out of a lower cap of the anxiety disorders and with DSM-5 a new heading has become an issue like obsessive compulsive disorder and related disorders. The ones that suggest the obsessive compulsive spectrum disorders fundamentally assume that the obsessive compulsive disorder and the disorders defined as related with the OCD come from the same etiologic origin unlike the other anxiety disorders. The purpose of this compilation is to mention on how OCD has been defined all along the history and what kind of conceptual changes it went through until DSM-5.

Worldwide results from the RESTORE II on elective endografting of thoracic aneurysms and dissections

To assess safety, performance, and efficacy of the RELAY thoracic stent graft (Bolton Medical, Barcelona, Spain) in the treatment of patients who require elective thoracic endovascular aortic repair including aneurysms and dissections. The RELAY Endovascular Registry for Thoracic Disease II (RESTORE II) is a multicenter, prospective, international cohort study involving 21 centers in 12 countries worldwide. All consecutively included patients underwent elective thoracic endovascular aortic repair with a RELAY or RELAY NBS stent graft (including offtheshelf and custom-made devices) to repair thoracic aortic aneurysms or dissections. Demographic, clinical, andaortic parameters were Web-based registers. Safety and efficacy data were collected for a follow-up period of24months. RESTORE was a precedent registry involving European sites that used RELAY first-generation devices. A total of 173 patients were enrolled in the registry from October 2010 to September 2014 (aneurysm [n= 99]/dissection [n= 74]). Overall technical success of the intervention reached 97.1% irrespective of the etiology and geographic origin of patients. Baseline clinical heterogeneity was observed between devices concerning the etiology of the disease and certain comorbidities and/or risk factor distribution (diabetes, hypertension, myocardial infarction, angina pectoris). An average of 1.36 stent graft components were used per patient, with mean intended treatment length of 197.0± 87.7/188.7± 103.1mm and mean access site diameter of 10.3± 8.2/9.7± 1.7mm in aneurysms/dissections, respectively. The rate of all-cause 30-day mortality was lower than in the RESTORE registry (4.0% vs 7.2%). Perioperative neurologic complications were infrequent: paraplegia/paraparesis (2.9%) and stroke (0.6%) (vs 2.0% and 1.6% in the RESTORE registry). Freedom from all-cause mortality at 2years was 93.6%. At the final completion angiography, device-associated complications were detected in 4.6% of the patients (vs 5.3% in the RESTORE) and endoleak rate was 6.4% (type I 5.8% and type II 1.7%). The worldwide results of the RESTORE II registry show the safety and effectiveness of RELAY and RELAY NBS stent grafts for elective endovascular thoracic aortic repair. Compared with the RESTORE registry, the device presents a lower rate of perioperative complications.

Protective Effect of Soy Isoflavones (from Glycine max) on Adipose Tissue Oxidative Stress and Inflammatory Response in an Experimental Model of Post-menopausal Obesity: The Molecular Mechanisms

Obesity, adiposity mediated oxidative stress and inflammatory response has been identified to have an etiological origin for most of the complications associated with ageing populace. However, there are limited studies addressing the metabolic role of adipose tissue in the pathobiology of postmenopausal complications with respect to oxidative stress and inflammation. Numerous studies have reported the beneficial effects of soy isoflavones on postmenopausal complications; however, its efficacy these complications in postmenopausal model of obesity remain unclear. In the present study we found that the both ovariectomy and high fat diet (30 per cent fat) in isolation and in combination developed adipose tissue oxidative stress as evidenced by the reduced level of total antioxidant status (TAS) in association with elevated levels of adipose tissue malondialdehyde (MDA) and MDA/TAS ratio. These rats also displayed with inflammation as showed by increased levels of plasma tumor necrosis factor alpha (TNFα) and high sensitive C – reactive protein (hsCRP). The expression of adipose tissue inflammatory proteins; cyclo-oxygenase 2 (COX2), monocyte chemo attractant protein (MCP1) and protein kinase C alpha (PKCα) were heightened in response to both ovariectomy and high fat diet. All these metabolic changes were further augmented when ovariectomy was followed by high fat diet. This suggests that there was a synergism between the postmenopausal state and intake of fat rich diet in the development of adipose tissue oxidative stress and inflammatory response. Treatment with soy isoflavones significantly inhibited these metabolic changes improved adipose tissue oxidative stress and inflammatory response suggesting the use of this natural phytoestrogen as an anti-oxidant and anti-inflammatory agent for relieving metabolic consequences associated with postmenopausal women.

Preauricular pilonidal sinus: The first reported case

Introduction: Pilonidal sinus is a chronic inflammatory condition associated with the penetration of hair fragments into the skin. the incidence of pilonidal sinus is 0.07%. We present the first reported case of pilonidal sinus occurring in preauricular area in a 22-year- old male. case report: A 22-year-old male presented with pain and pus discharge from the right preauricular area since two years. On local examination, a scar measuring 2 cm at right preauricular area was found with one external opening. routine investigations were within normal limits. complete excision of the scar with the tract was performed. Primary closure of the wound was done. Histopathological examination confirmed pilonidal sinus. conclusion: Pilonidal disease is a complex condition that causes both discomfort and embarrassment to sufferers. the etiological origin of a pilonidal sinus is controversial. Although reported in several rare areas of the body other than sacrococcygeal area, to our knowledge, this is the first reported case in which pilonidal sinus occurs in preauricular

Expressive and receptive vocabulary learning in children with diverse disability typologies

A combined storybook and play vocabulary intervention was implemented as a single-subject study of 23 children of diverse typologies, including 10 with autism spectrum disorder (ASD), three with developmental disability (DD), five with Down Syndrome, and five with specific language impairment (SLI), who were currently receiving speech-language services and had an individual education plan (IEP) goal targeting language. Participants' ages ranged from 3 years-1 month to 7 years-4 months. A parallel treatment design was used to identify changes at (a) word level, (b) child level, and (c) in children of similar typological and developmental profiles. All children learned vocabulary words to criterion in both expressive and receptive modalities. Children of different etiological origin did not vary in the trajectory of their receptive or expressive word learning. These results suggest that the trajectory of word learning may be remarkably consistent across disability typologies. The theoretical and clinical ramifications of these findings are discussed.

Identification of new respiratory viruses in the new millennium.

The rapid advancement of molecular tools in the past 15 years has allowed for the retrospective discovery of several new respiratory viruses as well as the characterization of novel emergent strains. The inability to characterize the etiological origins of respiratory conditions, particularly in children, led several researchers to pursue the discovery of the underlying etiology of disease. In 2001, this led to the discovery of human metapneumovirus (hMPV) and soon following that the outbreak of Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) promoted an increased interest in coronavirology and the latter discovery of human coronavirus (HCoV) NL63 and HCoV-HKU1. Human bocavirus, with its four separate lineages, discovered in 2005, has been linked to acute respiratory tract infections and gastrointestinal complications. Middle East Respiratory Syndrome coronavirus (MERS-CoV) represents the most recent outbreak of a completely novel respiratory virus, which occurred in Saudi Arabia in 2012 and presents a significant threat to human health. This review will detail the most current clinical and epidemiological findings to all respiratory viruses discovered since 2001.

Suicidal Behavior in Psychiatric Population

Introduction Suicidal behavior includes attempted suicide and completed suicide, both generally preceded by suicidal ideation. Whereas suicidal ideation corresponds to the thoughts and cognitions about the end of life itself, the suicide attempt may culminate in suicide. Analysis Suicide is associated with frustrated needs, feelings of hopelessness and helplessness, ambivalent conflict between survival and unbearable stress, with a gradual taper of options and a perceived need for increased escape. However, 90% of all those who commit or attempt suicide suffer from mental disorder. Suicide risk in psychiatric patients is 3-12 times higher than in mentally healthy individuals. There is an increased risk in depressive disorder. This stresses the need to be alert for other diseases, such as psychotic and anxiety disorders, substance dependence and some personality disorders (borderline, histrionic and antisocial type). Prevention Suicidal behaviors can be reduced through knowledge about the issue, namely prevention. Different groups (family, social, cultural and professional) can play in a synergy of preventative efforts. Global Action Plan for Mental Health 2013 – 2020 the World Health Assembly, requires all 194 Member States to reduce their rates of suicide by 10% by 2020. Conclusions Suicidal behaviors include in its etiologic origins a set of sociological, psychological, biological and genetic factors in an explosive cocktail. Characterization of this problem will make it possible to detect specific interventions, to help with the lines of preventive orientation. Awareness and careful information of the population is imperative to the success of adequate and targeted prevention.

Giant mesenteric lipoma: A case report and a review of the literature

Abstract Mesenteric lipoma is a rare benign tumor of mature fat cells. Although generally asymptomatic, it occasionally causes abdominal pain, ileus, and small bowel volvulus, depending on its location and size. A definitive diagnosis can be made by pathological examination. Ultrasonography and abdominal computed tomography show this lesion as a well-defined, homogenous mass with fat density surrounded by a thin capsule. Because of its rare etiologic origin, we report the case of a 2-year-old male presented with progressive abdominal distension and failure to thrive, found to be caused by a mesenteric lipoma.

Segmental ileal dilatation with supernumerary intestinal muscle coat in a neonate.

Segmental intestinal dilatation (SID) is a rare developmental anomaly of the midgut, characterized by sharply demarcated dilatation of a gastrointestinal segment with clinical findings of intestinal obstruction. Although morphologic criteria for SID are clearly delineated, etiological origin of dilated intestine is unknown. Histology of the resected segment is usually reported to have normal presence of ganglion cells in the myenteric and submucosal plexuses. Intestinal muscle is hypertrophied, and heterotopic gastric mucosa may also be encountered. A 3-day-old male infant presenting with clinical findings of intestinal obstruction was diagnosed to have SID and had supernumerary intestinal muscle coat (SIMC) in the dilated segment, without any evidence of neurological abnormality. Histopathological findings of the resected ileal segment are reported to discuss the role of architectural malformation of muscularis propria as a cause of SID.

Effective Reassurance in Primary Care of Low Back Pain

Effective reassurance of patients reporting symptoms, for which no clear etiological origin is available, is one of the most important challenges in the early phases of nonspecific back pain. However, there is a lack of empirical studies on the effects of reassurance and, also, the effects shown were small. Improvements are needed with respect to the process of physician-patient interaction and to the methods used by the physician. We provide a short narrative review of the literature with special reference to affective and cognitive communication, based on a systematic review of 16 studies. We further consider recent evidence in the prognosis of low back pain, the role of physical activity, and subgroups-based individual differences in pain coping, questioning the information basis of reassurance. A 2-process model of affective and cognitive reassurance was supported. Recovery improved in a combination of communication of empathy with cognitive reassurance, giving concrete information and instructions. In terms of information, recent research indicate that a substantial percentage of patients do not recover within the first year after onset of back pain. Further, very low and high levels of physical activity are associated with pain and disability, associated with cognitive and behavioral pain coping. Reassurance of patients in early phases of persistent back pain might improve from affective and cognitive parts of communication and individually tailored information. Subgroup differences with respect to different prognosis, associated patterns of adaptive or maladaptive pain coping, and levels of health-promoting versus harmful physical activity should be considered more carefully.

Genetic features of metachronous esophageal cancer developed in Hodgkin's lymphoma or breast cancer long-term survivors: an exploratory study.

BackgroundDevelopment of novel therapeutic drugs and regimens for cancer treatment has led to improvements in patient long-term survival. This success has, however, been accompanied by the increased occurrence of second primary cancers. Indeed, patients who received regional radiotherapy for Hodgkin’s Lymphoma (HL) or breast cancer may develop, many years later, a solid metachronous tumor in the irradiated field. Despite extensive epidemiological studies, little information is available on the genetic changes involved in the pathogenesis of these solid therapy-related neoplasms.MethodsUsing microsatellite markers located in 7 chromosomal regions frequently deleted in sporadic esophageal cancer, we investigated loss of heterozygosity (LOH) and microsatellite instability (MSI) in 46 paired (normal and tumor) samples. Twenty samples were of esophageal carcinoma developed in HL or breast cancer long-term survivors: 14 squamous cell carcinomas (ESCC) and 6 adenocarcinomas (EADC), while 26 samples, used as control, were of sporadic esophageal cancer (15 ESCC and 11 EADC).ResultsWe found that, though the overall LOH frequency at the studied chromosomal regions was similar among metachronous and sporadic tumors, the latter exhibited a statistically different higher LOH frequency at 17q21.31 (p = 0.018). By stratifying for tumor histotype we observed that LOH at 3p24.1, 5q11.2 and 9p21.3 were more frequent in ESCC than in EADC suggesting a different role of the genetic determinants located nearby these regions in the development of the two esophageal cancer histotypes.ConclusionsAltogether, our results strengthen the genetic diversity among ESCC and EADC whether they occurred spontaneously or after therapeutic treatments. The presence of histotype-specific alterations in esophageal carcinoma arisen in HL or breast cancer long-term survivors suggests that their transformation process, though the putative different etiological origin, may retrace sporadic ESCC and EADC carcinogenesis.

Physiology of the neuromuscular junction and related disorders

The neuromuscular junction (NMJ) is a region of communication between the nerve and muscle cells. Non-anatomical functional contact occurs at this junction. The NMJ is divided into three regions: presynaptic, synaptic gap, and postsynaptic. When action potentials reach the terminal end of the nerve, acetylcholine (ACh) molecules in the presynaptic region are released into the synaptic gap. The released ACh stimulates nicotinic ACh receptors and depolarizes the motor endplate. This depolarization is transformed into actual action potential when a threshold value is surpassed. At this point, ACh in excess that required for neurotransmission is released. Subsequently, the ACh receptor is stimulated. The principal reason for excess production of ACh is to ensure a sufficient supply for neurotransmission. The NMJ is thought as a static structure. However, this structure has dynamic remodeling activity, which is significantly affected by drugs, toxins, aging, injury, and exercise. The net effect of pathologies involving the NMJ is to decrease the ability of neurotransmission. These pathologies can be congenital, acquired, or specific to presynaptic, synaptic, or postsynaptic regions. The etiological origins of NMJ pathologies include autoimmunity, congenital disease, pharmacological or toxic agents, and trauma. In this review, physiology and related disorders of the neuromuscular junction considered in the light of recent knowledge has been aimed. J. Exp. Clin. Med., 2014; 31:149-153

Stanley Milgram’s Obedience to Authority “Relationship” Condition: Some Methodological and Theoretical Implications

In May 1962, social psychologist, Stanley Milgram, ran what was arguably the most controversial variation of his Obedience to Authority (OTA) experiments: the Relationship Condition (RC). In the RC, participants were required to bring a friend, with one becoming the teacher and the other the learner. The learners were covertly informed that the experiment was actually exploring whether their friend would obey an experimenter’s orders to hurt them. Learners were quickly trained in how to react to the impending “shocks”. Only 15 percent of teachers completed the RC. In an article published in 1965, Milgram discussed most of the variations on his baseline experiment, but only named the RC in passing, promising a more detailed account in his forthcoming book. However, his 1974 book failed to mention the RC and it remained unpublished until François Rochat and Andre Modigliani discovered it in Milgram’s personal archive in 1997 at Yale University. Their overview of the RC’s procedure and results left a number of questions unanswered. For example, what were the etiological origins of the RC? Why did Milgram decide against publishing this experiment? And does the RC have any significant methodological or theoretical implications on the Obedience studies discourse? Based on documents obtained from Milgram’s personal archive, the aim of this article is to shed new light on these questions.

Chemotactic Chemokines Are Important in the Pathogenesis of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most frequently diagnosed disorders, affecting about 20% of the general population in Western countries. This syndrome poses an enormous socio-economic burden, impairs the quality of life substantially, and increases healthcare costs. IBS can be classified as either idiopathic (ID-IBS) with unknown etiology or post-infectious (PI-IBS), which develops after a bout of acute diarrhea or gastroenteritis. Little is known about the immunopathogenesis of these two forms of IBS. We evaluated various biomarkers in clinical samples of ID-IBS and PI-IBS patients with the goal to test the hypothesis that the immunologic presentations of these forms of IBS are similar, despite their apparent different etiologic origins. Sera and stool samples from PI-IBS, ID-IBS, and healthy volunteers were analyzed for relative amounts of 36 different biomarkers using the Proteome Profiler Human Cytokine Array Panel A Kit and quantitative ELISA. Our results demonstrated significantly high levels of chemotactic chemokines monocytes chemotactic protein-1 (CCL2) [p-value = 0.003], macrophage inflammatory protein-1β (CCL4) [p-value = 0.010], and CXCL16 (p-value 0.001) in the sera and stools of both ID-IBS and PI-IBS patients. Furthermore, pro-inflammatory cytokines (IFN-γ, IL-1β, and TNF-α) were significantly higher in IBS patients. Anti-inflammatory cytokines (IL-10, IL-4, and IL-13) were variable except IL-10, which was significantly higher in the healthy volunteers than the IBS patients. Remarkably, the amounts and expression pattern of these biomarkers were not significantly different between ID-IBS and PI-IBS. Thus, ID-IBS and PI-IBS present similar immunologic and clinical phenotypes, in spite of their different etiologic origins.

Refining the parent-reported Inventory of Callous–Unemotional Traits in boys with conduct problems.

Callous-unemotional (CU) traits have been shown to delineate a unique subgroup of children with severe and persistent conduct problems that seem to have unique etiological origins. However, commonly used measures of CU traits in children may not adequately capture the full range of these characteristics in a developmentally appropriate manner. As a result, the 24-item Inventory of Callous-Unemotional Traits (ICU; self-, parent-, and teacher-report versions; Frick, 2004) was recently developed as a more extensive assessment of CU traits. However, studies to date have focused almost exclusively on the self-report version ICU in adolescents and have identified problems with the factor structure of the measure. The current study is the 1st to examine the factor structure of the parent-report version ICU in a sample of 250 boys (ages 6-12 years) exhibiting significant conduct problems. Initial analyses indicated that factor models reported for the parent-report version of the ICU demonstrated a relatively poor fit to the data. Item response theory techniques were used to develop a more psychometrically sound and efficient short form of the ICU consisting of 2 factors (i.e., Callous and Uncaring) using 12 of the original 24 items. The revised version scores demonstrated high internal consistency, good discrimination across the continuum of the CU construct, and adequate short-term test-retest reliability. The revised measure total score also exhibited evidence of convergent and discriminant validity, although the subscales exhibited some differential correlations with theoretically meaningful constructs. Avenues for future measure refinement and use with children are discussed.

Genetic and Environmental Etiologies of Adolescent Dysfunctional Attitudes: A Twin Study

Despite the importance of dysfunctional attitudes in the development and maintenance of depression, little is known about the etiological origin of dysfunctional attitudes. The Dysfunctional Attitudes Scale for Children was administered to 674 adolescent twins derived from the Beijing Twin Study (BeTwiSt). Four hundred and thirty-nine monozygotic and 235 same-gender dizygotic twin pairs were included. Approximately 54% were females. The age range of the twins was 11-17 years. Model-fitting analyses were conducted. Biometric genetic model-fitting estimates indicated that additive genetic factors accounted for 31% (95% CI: 11%, 45%) of variance in adolescent dysfunctional attitude. The influence of shared environmental factors was small and negligible (9% [95% CI: 0%, 27%]). Non-shared environmental factors explained 60% (95% CI: 55%, 66%) of variance. Equating the estimate parameters across gender or age groups resulted in a non-significant difference of model fit, but there were trends suggesting higher heritability in females and older adolescents. Our results provide evidence for moderate heritability of dysfunctional attitudes in adolescents. Dysfunctional attitudes can be used as an endophenotype to identify risk genes for depression.

Unusual clinical presentations of cervical or lumbar dorsal ramus syndrome.

ObjectivePatients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS.MethodsThis study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy.ResultsThe number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment.ConclusionIt seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.