Clinical characteristics and prognostic factors of cracked teeth: A retrospective cohort study.

Adjunctive pimavanserin in schizophrenia: A systematic review and meta-analysis with a focus on negative-symptom programmes.

Primary malignant bone tumors of the foot are rare, with limited and heterogeneous data on.characteristics, management, and outcomes. This study aims to provide an overview of the epidemiology, treatment, and prognosis of these tumors through a systematic review and cohort analysis. PubMed, Embase, and Web of Science were searched for studies on osteosarcoma, Ewing's sarcoma, and chondrosarcoma of the foot. Studies in English or German including≥10 patients with original data were eligible. Demographic, clinical, treatment, and outcome data were extracted. Additionally, a retrospective review was performed of all patients with foot malignancies (chondrosarcoma, Ewing sarcoma or osteosarcoma) treated at Amsterdam UMC (2013-2024). Data were pooled for analysis. Eighteen studies met the inclusion criteria, comprising 884 patients including the single center cohort. Osteosarcoma, Ewing's sarcoma, and chondrosarcoma were the most common malignancies, most frequently affecting the calcaneus, metatarsals, and phalanges, respectively. The median diagnostic delay was 9 (IQR 6-14) months, with pain and swelling as the predominant presenting symptoms. Below-knee amputation was the most common surgical procedure, particularly for hindfoot tumors. Local recurrence rates were highest in osteosarcoma (19%), while Ewing's sarcoma had the highest incidence of metastatic disease (56%). Disease-specific mortality at last follow-up was 40% for osteosarcoma, 50% for Ewing's sarcoma, and 21% for chondrosarcoma. The single-centre cohort mirrored these findings, highlighting the challenges of delayed diagnosis and inadvertent surgery. Primary malignant bone tumors of the foot present significant diagnostic and therapeutic challenges, with high rates of recurrence and metastasis. Early recognition, referral to specialized centers, and multidisciplinary management are essential to improve outcomes. Future research should focus on prospective data collection, standardized reporting, and patient-reported outcomes to guide optimal care.

“Filariasis is a chronic, mosquito‐borne parasitic infection. Chronic infection can lead to swelling of extremities, hydroceles, and testicular masses.”PurposeThe study aimed to evaluate the frequency and distribution of filariasis in Somalia.MethodsPatients were assessed using clinical examination, cytology, peripheral blood smears, and Doppler ultrasonography. Data were analyzed with IBM SPSS V23. Results were presented as tables, graphs, and frequencies (%).ResultA total of 22 cases of lymphatic filariasis were assessed in our hospital’s infectious diseases department during follow‐up from March 2018 to December 2023. When the regions of residence of the cases were questioned, it was found that a high proportion of the cases were presented from the same region (Mog‐86%). To a lesser extent, there were applicants from different regions. When the occupations of the cases were questioned, the majority were retired or housewives. When the presenting complaints and physical examination findings were analyzed, it was observed that the right or left extremity, or both, was usually affected. Swelling was the predominant presenting symptom. Genital involvement was detected in about 41% of cases. More than half of them had a history of mosquito bites.ConclusionGiven LF’s effects on public health, it remains an important public health problem in Somalia.

To describe the demographic, clinical, laboratory, imaging, and surgical features of 15 histologically confirmed ovarian pregnancies (OP) and to contextualize these findings within a narrative literature overview in order to improve clinical recognition and facilitate earlier diagnosis. A retrospective multicenter case series was conducted across two university-affiliated hospitals between 2012 and 2024. Women with histologically confirmed OP were included. Demographic data, risk factors, presenting symptoms, β-hCG dynamics, ultrasound findings, operative details, and postoperative outcomes were collected and analyzed. Fifteen patients were identified. The mean age was 34.6 ± 4.2years; 46.7% used an intrauterine device, 33.3% had prior cesarean delivery, and 13.3% conceived through assisted reproduction. Abdominal pain was the predominant symptom (86.7%), whereas vaginal bleeding occurred in 26.7%. The mean preoperative β-hCG level was 6,436 ± 5,570 mIU/mL and serial measurements showed inappropriate rises. OP was suspected preoperatively in 53.3% of cases; identification appeared higher in cases with formal ultrasound (85.7%), although this observation is limited by differences in imaging setting and documentation.. Observed sonographic features included a hyperechoic peripheral ring and a Doppler pattern demonstrating a single dominant feeding vessel; A trilaminar endometrial pattern was not observed in evaluable cases. Rupture occurred in 73.3% of patients with a median blood loss of 300mL (IQR 10-2000mL). All patients were treated surgically with ovarian preservation, and postoperative day-1 β-hCG declined by 59 ± 12%. OP commonly presents with abdominal pain and minimal bleeding and carries a high rupture risk. The described sonographic patterns may represent hypothesis-generating observations that could support clinical suspicion and warranting further study.

Each year, more than 20,000 people sustain a traumatic brain injury in Switzerland. The vast majority of these are mild, with severe complications being rare and outcomes generally favorable. However, a minority of patients experience persistent, heterogeneous, and nonspecific symptoms that may be disabling. Management relies on a patient-centered approach combining information, reassurance, management of the predominant symptoms, and gradual return to activities. Early identification of risk factors for chronicity helps to identify patients at risk for an unfavorable course. Appropriate clinical follow-up may limit the progression to severe forms requiring interdisciplinary and specialized care, thereby improving prognosis while reducing the risk of overmedicalization.

This study aims to assess whether single-agent pharmacotherapy directed at the patient-prioritised, highest-scoring PERSONS symptom (target symptom) produces concurrent improvements in both the target symptom and overall symptom burden in advanced-cancer patients. Consecutive adults receiving palliative care specialist between April 2023 and February 2024 were enrolled if ≥1 PERSONS item scored ≥ 7/10. At baseline (T0), clinicians identified the target symptom and initiated one guideline-concordant drug for its control. Follow-up (T1) occurred after 14 days (median). Outcomes were change in target-symptom severity and change in total PERSONS score. Paired t-tests compared T0 and T1; Pearson's r examined correlations. 81 patients (median age 71years; 55.6% female; 81.5% metastatic disease) completed both assessments. Target-symptom severity fell from 7.63 ± 1.02 to 3.78 ± 1.35 (mean reduction 3.85 points; 95% CI 3.45 to 4.25; p<0.0001). The total PERSONS score decreased from 21.94 ± 4.56 to 13.46 ± 5.12 (mean reduction 8.48 points; 95% CI 7.54 to 9.42; p<0.0001). Target-symptom severity correlated moderately with non-target PERSONS score at T0 (r = 0.55) and strongly at T1 (r = 0.65; both p<0.0001). Pain was the predominant target symptom (45.7 %). Focusing on a single, evidence-based drug on the patient-defined dominant symptom halved target-symptom intensity and reduced global symptom burden by 39% within 2 weeks. These findings support a pragmatic 'less-is-more' paradigm that may minimise polypharmacy while delivering broad symptomatic benefit in advanced cancer.

Objective:To investigate the clinical and imaging characteristics of intralabyrinthine and internal auditory canal（IAC） lipomas so as to improve diagnostic accuracy. Methods:A retrospective analysis was conducted on the clinical follow-up data of 8 patients diagnosed with intralabyrinthine or IAC lipomas at our hospital from January 2017 to September 2024. The diagnostic key points and diagnosis and treatment strategies were discussed with reference to the literature. Results:The cohort comprised 4 males and 4 females, all with unilateral involvement（left: 3; right: 5）, aged 7-61 years. The predominant symptoms were unilateral sensorineural hearing loss（SNHL） with tinnitus（progressive in 5 cases, sudden in 3）. Two patients experienced vertigo. Imaging features: Temporal bone HRCT revealed fat-density lesions（HU: -30 to -100）; MRI demonstrated T1WI hyperintensity, T2WI heterogeneous signals, no contrast enhancement, and signal attenuation on fat-suppressed sequences. Lesion size ranged from 2 to 8 mm. All cases were confirmed by imaging and without surgical intervention. Follow-up duration spanned 6 months to 9 years（mean: 59.3 months）. No tumor growth was observed during follow-up; one patient exhibited worsened hearing loss and tinnitus, while the other 7 had stable symptoms. Conclusion:Imaging is definitive for diagnosing intralabyrinthine and IAC lipomas. These lipomas exhibit indolent growth, making follow-up observation the optimal clinical strategy.

Acquired diaphragmatic hernia (DH) is a rare yet serious complication following liver transplantation (LT) in pediatric patients. We aimed to describe six pediatric cases who developed DH following LT, characterize their clinical presentation and management, and provide an updated review of the existing literature. This retrospective case series of pediatric patients who developed DH following LT and were followed up at Makassed Hospital, a tertiary referral center in East Jerusalem, between January 2015 and March 2025. Demographic characteristics, transplant details, clinical presentation, surgical management, and outcomes were extracted from medical records. In addition, a comprehensive literature review was conducted to identify previously reported cases of DH following pediatric LT. Six cases were identified. Based on the Ministry of Health referral records, indicating approximately 58 pediatric LTs from our region during the same period, this corresponds to an estimated incidence of about 10%. Median age at LT was 43 months, with DH developing after a median interval of 5.5 months. All patients received a left lateral segment graft, except for one who had a left lobe graft. Respiratory distress and abdominal pain were the predominant symptoms. Prompt primary surgical repair was performed in all patients. There was one case complicated by bowel ischemia, which required bowel resection. Recurrence was detected in one patient. DH following LT is rare but well recognized. Increased awareness and early recognition are essential to ensure timely surgical management and favorable outcomes.

The heterogeneity of insomnia presentations has long challenged research and clinical practice, motivating efforts to identify reliable disorder phenotypes. Person-centered, data-driven approaches such as latent class analysis (LCA) have provided new insights, suggesting that insomnia subtypes may differ not only in nocturnal symptoms but also in perceived impact and daytime distress. Despite this progress, LCA solutions often remain confined to the original datasets, limiting replication and applied use. To address this gap, we developed the insomnia-LCA classifier, an open-source web application that assigns new Insomnia Severity Index (ISI) response profiles to one of four subtypes identified in a previously published LCA of Italian university students: no insomnia (NI), subthreshold insomnia (SI), high insomnia risk (HI), and predominant daytime symptoms (DS). Using the original model's class priors and item-level conditional response probabilities, the app computes posterior class probabilities from user-entered ISI responses, individually or in batch mode. Outputs include class probabilities and modal assignment, ISI total and subscale scores, and a visual comparison between the individual profile and subtype mean patterns. Reclassification of the original dataset showed near-perfect agreement with the latent class model (accuracy=0.999; Cohen's kappa=0.999), and synthetic profiles behaved as expected. The insomnia-LCA classifier provides a practical, reproducible tool for deploying and testing LCA-derived phenotypes in clinical research.

Acute myocarditis is an inflammatory cardiac condition with a variable prognosis, ranging from complete recovery to progressive heart failure (HF) or death. Advances in diagnostics, such as high-sensitivity troponins and cardiac magnetic resonance (CMR), have improved detection, but prognostic insights in unselected, real-world populations remain limited. We retrospectively studied 471 consecutive patients hospitalized with acute myocarditis between 2009 and 2019, based on clinical diagnosis. Baseline features, laboratory results, and imaging data were systematically reviewed. The primary composite outcome included all-cause mortality, heart transplantation, mechanical circulatory support, new-onset HF, ventricular arrhythmias, and cardiac device implantation. The median patient age was 34 years and 32% were female. Chest pain was the predominant presenting symptom (87%), and ST-segment elevation was observed in 48%. At admission, 24% showed hypokinesia on echocardiography, and 12% had a left ventricular ejection fraction of <50%. Within 1 year, 41 patients (8.7%) experienced the composite outcome. Older age, dyspnea, and elevated biomarkers were associated with early events. Over a median follow-up of 8.2 years, independent predictors of adverse outcomes were age (hazard ratio [HR] 1.05 per year, 95% confidence interval [CI] 1.03-1.07), signs/symptoms of HF (HR 3.27, 95% CI 1.25-8.52), and hypokinesia on echocardiography (HR 19.77, 95% CI 4.10-95.36). No sex-based differences in outcomes were found despite different clinical presentations (HR 0.78, 95% CI 0.31-1.96). In this decade-long cohort, most patients had favorable outcomes. Early risk stratification and targeted management may improve prognosis in high-risk individuals.

Emphysematous pyelonephritis is a rare, life-threatening necrotizing infection that is typically characterized by classic urinary symptoms. However, it is exceptionally rare for emphysematous pyelonephritis to manifest with predominant gastrointestinal symptoms, a deceptive mimicry that often masks the underlying renal pathology and leads to significant diagnostic delays. We report the case of a woman in her 60s with type 2 diabetes whose initial presentation was limited to vomiting and diarrhea, suggesting acute gastroenteritis. In the absence of typical urological distress, her condition rapidly worsened, and she developed septic shock and altered mental status within 48 h. Computed tomography confirmed Huang-Tseng class 3B emphysematous pyelonephritis with extensive destruction of the right renal parenchyma. Recognizing the irreversible tissue necrosis and failure of medical therapy, a decisive transition to emergency nephrectomy was performed. This timely surgical intervention successfully arrested the fulminant progression, leading to hemodynamic stabilization and recovery. This case underscores that emphysematous pyelonephritis rarely masquerades as gastroenteritis; in diabetic patients, such atypical manifestations followed by rapid clinical deterioration necessitate immediate computed tomography evaluation. Furthermore, when imaging reveals extensive gas formation and clinical stability is lost, prompt and resolute surgical source control is a critical, life-saving measure for ensuring patient survival.

Background/Objectives: Identifying the factor most strongly associated with patients’ quality of life (QoL) is crucial for establishing treatment goals focused on improved recovery. This study aimed to determine whether sociodemographic factors, negative, or depressive symptoms have the strongest association with QoL. Methods: Inpatients diagnosed with schizophrenia were recruited. We collected data on sociodemographic factors, asked patients to rate their well-being on a subjective well-being scale, and evaluated their psychopathology using observer-rated psychometric scales (Positive and Negative Symptoms Scale (PANSS), Brief Negative Symptoms Scale (BNSS), and Calgary Depression Scale for Schizophrenia (CDSS) as well as self-rated scales (Self-evaluation Negative Symptoms Scale (SNS). QoL was evaluated using Short-Form 36 (SF-36). Patients were also divided into primary, prominent, and predominant negative symptom groups. We conducted correlation and linear regression analyses to identify which factors were most strongly associated with QoL. Results: In this study, 323 participants were included. The CDSS total score showed the strongest correlation with QoL scores, followed by negative symptoms assessed with the SNS. Positive and negative symptoms, assessed using either the PANSS or the BNSS, showed weak or insignificant correlations with QoL. Among sociodemographic factors, the subjective well-being score, previous history of hospitalization, or suicide attempts had the strongest correlation with QoL. CDSS scores were the variable with the strongest independent association with QoL in regression analysis. Conclusions: Depressive symptom severity showed the strongest and most consistent association with QoL across both correlation and multivariable analyses. These findings are hypothesis-generating and require longitudinal confirmation.

Building on our previous research, which classified Kikuchi disease into three subtypes based on predominant symptoms and fever status - febrile type, febrile lymphadenopathy (FebLAP), and afebrile lymphadenopathy (aLAP) - we further investigated the underlying mechanisms contributing to their distinct clinical differences. Using NanoString nCounter technology, we analyzed the gene expression profiles of 35 Kikuchi disease lymph node specimens and compared them across the subtypes. Compared with the febrile type, aLAP exhibited higher AICDA expression, a trend observed in both germinal center positive and negative cases. The aLAP specimens also showed higher expression of B-cell markers; however, CD20 immunohistochemical staining did not reveal an increased number of B cells in aLAP. We therefore hypothesize that aLAP contains a higher proportion of atypical memory B cells, characterized by elevated AICDA and B-cell marker expression compared with other B-cell subsets. Immunohistochemical staining demonstrated that IRTA1+ atypical memory B cells were present in 64% (23/36) of aLAP cases, significantly higher than in FebLAP (0/8, 0%) and the febrile type (2/11, 18%) (p < 0.001). This finding confirms that aLAP is more likely to contain atypical memory B cells compared with the other subtypes. Pathway analysis revealed that the febrile type upregulates pathways associated with TLR2 and TLR4 signaling and neutrophil degranulation, while aLAP upregulates the TNFR2 non-canonical NF-κB pathway. RNAscope in situ hybridization demonstrated higher TLR4 expression in the febrile type compared with the aLAP type. These findings suggest that the triggering microbes for each subtype may differ, leading to distinct immune responses and clinical presentations. Overall, these results provide new insights into the immunopathogenesis of Kikuchi disease and highlight the potential role of atypical memory B cells in shaping its distinct clinical presentations. © 2026 The Pathological Society of Great Britain and Ireland.

Sulpiride (Eglonil), the progenitor of the substituted benzamide class, has retained its clinical relevance for over half a century thanks to its unique combination of a dose-dependent spectrum of action and a high safety profile. At low and medium doses (100–400 mg/day), the drug, alongside mild neuroleptic effects, exhibits a triple anxiolytic, stimulant and somatotropic effects due to selective blockade of presynaptic dopamine D2/D3 receptors, followed by an increase in dopaminergic transmission in the mesolimbic pathways. This pharmacological profile determines sulpiride's leading role in the treatment of somatoform disorders and generalised anxiety disorder with predominant somato-vegetative symptoms, where the primary complaints are cardialgia, dyspepsia, tachycardia, hyperhidrosis and polymorphic bodily sensations without an organic basis. Sulpiride (Eglonil) is the drug of choice for somatised forms of anxiety, comorbidity with somatic diseases, functional disorders of the gastrointestinal tract and somatoform disorders.

O. vulgatum (Ophioglossum vulgatum, commonly known as "Yi Zhi Jian") is a traditional herbal medicine and food ingredient widely used for its heat-clearing and detoxifying properties and generally considered safe. However, its potential for severe muscular toxicity, particularly rhabdomyolysis, has not been systematically reported. A retrospective case series analysis was conducted on 10 patients admitted to the First People's Hospital of Neijiang City from 2024 to 2025 with O. vulgatum poisoning complicated by rhabdomyolysis. All patients ingested O. vulgatum for the purpose of "stewing soup", with a median latency period of 7h. The predominant symptoms were severe myalgia (100%), fatigue (50%), and paresthesia (20%). The median peak creatine kinase (CK) level was 4099U/L (range 2,427-17250U/L). Acute kidney injury (AKI) complicated the course in one patient (10%). All patients immediately discontinued the herbal intake and received supportive treatment including aggressive hydration and urine alkalinization. The median hospital stay was 6 days. At the last follow-up, all patients survived, with complete resolution of muscular symptoms and recovery of renal function. The causal relationship between rhabdomyolysis and O. vulgatum was assessed as "probable" for all ten patients according to the WHO-UMC scale. This is the first case series indicating an association between O. vulgatum consumption and severe rhabdomyolysis. Clinicians and the public should be aware of this risk and should avoid excessive or unconventional use. A detailed history of herbal medicine use is recommended for patients presenting with unexplained myalgia and elevated CK levels.

Listeria monocytogenes is a Gram-positive rod responsible for listeriosis. It has emerged as a significant foodborne pathogen and has been implicated in numerous outbreaks worldwide often present with bacteremia and may progress to severe manifestations such as meningoencephalitis, particularly in immunocompromised individuals and the elderly. Maternofetal infection is associated with worse pregnancy outcomes. The objective of this study is to assess the risk factors, clinical features, and outcomes of patients admitted with Listeria monocytogenes infection at a tertiary care Centre in Karachi, Pakistan. A retrospective study was conducted over 7 years and included all patients with culture-proven listeriosis. Comorbid conditions, clinical presentation, treatment, and outcomes were recorded and analyzed. A total of 63 patients diagnosed with Listeria monocytogenes infection were included in the study. There was a female predominance (n = 44, 69.8%), with a median age of 53(32.0, 67.0) years. Diabetes mellitus was the most common comorbidity (n = 27, 42.9%). Among high-risk groups, 14 (22.6%) patients were pregnant, 10 (15.9%) were on immunosuppressive therapy, and another 10 (15.9%) were classified as elderly. The predominant presenting symptoms included fever (n = 47, 74.6%) and central nervous system involvement (n = 28, 44.4%), mainly meningoencephalitis. All patients received antibiotic therapy with either ampicillin or meropenem for a mean duration of 16.7 ± 8.4 days. The overall mortality rate was11.1%.(n = 7). Listeriosis was observed not only in the elderly but also in middle-aged individuals with underlying risk factors, as well as in pregnant women.Improved environmental hygeine, early diagnosis, and timely treatment are essential to improving outcomes, particularly in pregnancy-related cases. Public education, healthcare provider training, and community-level preventive strategies are critical for effective management and control of listeriosis.

Brunner syndrome is a rare X-linked neurogenetic disorder caused by mutations in the MAOA gene and deficiency of MAO-A; clinically, its presentation is heterogeneous and may include sleep disorders, neurodegenerative features, neurodevelopmental alterations, intellectual disability, behavioral symptoms, impulsivity, aggressiveness, non-specific affective symptoms, ADHD, and rarely, positive psychotic symptoms. We present the case of a 22-year-old male patient, born in eastern Colombia, with a confirmed diagnosis of Brunner syndrome and an atypical presentation characterized by predominant depressive symptoms and suicidal ideation. Based on these findings, it is important to consider genetic etiologies in patients with complex or treatment-resistant psychiatric disorders, as well as to adopt a comprehensive approach combining pharmacotherapy, psychosocial interventions, and close clinical follow-up.

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder with highly heterogeneous clinical manifestations, often leading to misdiagnosis. Urinary incontinence as the initial and predominant symptom of NIID has rarely been reported. A Chinese male in his early seventies presented with an 8-year history of nocturnal urinary incontinence and a 4-year history of progressive memory loss. Detailed clinical, neuroimaging, electrophysiological, and genetic assessments were performed. Magnetic resonance imaging (MRI) showed high-intensity signals along the corticomedullary junction on diffusion-weighted imaging (DWI). Electrophysiological studies indicated peripheral neuropathy in all four limbs. Genetic analysis via polymerase chain reaction (PCR) combined with capillary electrophoresis identified a GGC repeat expansion (115 repeats) in the 5' untranslated region (5' UTR) of the NOTCH2NLC gene, confirming the diagnosis of NOTCH2NLC-associated NIID. This case highlights the diagnostic challenges of NIID presenting primarily with overflow urinary incontinence. It emphasizes the importance of considering NIID in patients with unexplained urinary dysfunction accompanied by cognitive decline, and confirms that early genetic testing is essential for accurate diagnosis and differential identification from other neurodegenerative diseases.

Background: Primary bile reflux gastritis (PBRG) is a distinct clinicopathological entity caused by the retrograde flow of duodenal contents into the stomach, resulting in gastric mucosal injury. Its prevalence among patients presenting with chronic gastritis symptoms remains poorly characterised, especially in the Indian subcontinent. Objective: To determine the prevalence of PBRG among patients with chronic gastritis presenting to a tertiary care centre, and to evaluate associated clinical features, symptom profiles, and lifestyle risk factors. Methods: A retrospective cross-sectional study was conducted at a tertiary care centre. Data of 120 patients diagnosed with chronic gastritis on upper gastrointestinal endoscopy were retrieved. Demographic details, presenting symptoms (heartburn, reflux, nausea), and risk factor data (smoking, alcohol consumption, consumption of outside food) were recorded. Endoscopic diagnoses were categorised as pan gastritis, lax lower oesophageal sphincter (LOS), PBRG, antral gastritis, or oesophagitis. Results: Of 120 patients (mean age 43.0 ± 9.8 years; 78 males, 42 females), PBRG was the third most common diagnosis, identified in 26 patients (21.7%). Pan gastritis was most prevalent (48; 40.0%), followed by lax LOS (34; 28.3%), antral gastritis (8; 6.7%), and oesophagitis (4; 3.3%). Among PBRG patients, heartburn (88.5%) and regurgitation (73.1%) were the predominant symptoms. Smoking and alcohol were each documented in 69.2% of PBRG cases. Males constituted 73.1% of PBRG patients. Conclusion: PBRG accounts for approximately one in five patients presenting with chronic gastritis symptoms at our centre, with a male predominance and high association with tobacco and alcohol use. Heightened clinical suspicion and targeted endoscopic evaluation are warranted in these patients.