Principal Symptoms Research Articles

Perianal Mucinous Adenocarcinoma: A Case Report and a Systematic Review of the Literature.

Mucinous adenocarcinoma of anus is an uncommon neoplasm of the gastrointestinal tract. In most of the cases, early diagnosis of this disease is difficult since its symptoms frequently mimic benign inflammatory conditions. A systematic PubMed and Scopus search was conducted, a propos of a case report. One hundred fifty patients from 93 case reports were included. The mean age of the patients was 60.5years (range: 18-81). The majority of them were males (124 out of 150, 82.7%), while the main known risk factor was the history of chronic fistula (109 out of 150, 72.7%). Recurrent perianal sepsis and perianal pain were the principal symptoms at the time of presentation. No symptoms have been reported only in three patients (3 out of 150, 2%). Regarding the prior surgical history of the patients, multiple abscess drainage and perianal fistula's related interventions were present in 62 (41.3%) and 19 (12.7%) patients, respectively. Neoadjuvant chemoradiotherapy was administered in 53 out of 150 patients (35.3%), while the majority of them have been treated with combined treatment of chemotherapy and radiotherapy. APR and its variations were the most applied surgical treatment (68%). Adjuvant chemoradiotherapy was administered almost up to one-third of the included patients (34%). Recurrence of the disease was reported in 41 out of 150 patients (27.3%). Death was reported in 44 out of 150 patients (29.3%). Review of the available published literature suggests that perianal mucinous adenocarcinoma is an extremely rare neoplasia. Τhere is no consensus as far as the diagnosis and the treatment strategies, due to the rarity of this neoplasm. High degree of clinical suspicion as well as histopathological confirmation is the principal requisites for the diagnosis of mucinous adenocarcinoma, especially in the ground of chronic ulcero-proliferative perianal lesions.

Clinical and Psychological Implications of Genital Vitiligo in a Thai Population.

The understanding of genital vitiligo among Thai individuals is limited. This study evaluated the clinical presentation, quality of life, and sexual health consequences of genital vitiligo. This cross-sectional, questionnaire-based study involving vitiligo patients aged 18 years or older with past or present genital involvement was conducted at Siriraj Hospital. It also measured aspects of sexual health and quality of life. The mean age of the 41 participants was 48.2 years, and 24 (58.5%) were males. All participants presented with genital vitiligo. In males, the penile shaft (45.8%), scrotum (45.8%), and glans (33.3%) were predominantly affected. In females, the mons pubis (64.7%), labia majora (23.5%), and labia minora (23.5%) were frequently involved. Both sexes reported afflictions in the pubic area (41.5%), inguinal region (36.6%), buttocks (34.1%), and oral mucosa (34.1%). Itching was the principal symptom in 26.8% of the patients. The median Dermatology Life Quality Index scores were significantly different (females 6, males 3.5). Compared with their male counterparts, females exhibited lower self-esteem (41.2% vs 29.2%), greater apprehension about marriage (11.8% vs 8.3%), and embarrassment about sexual activities (23.5% vs 16.7%). Remarkably, 65.9% of patients had not discussed their genital vitiligo with their doctors, and 51.2% of physicians had not inquired about or examined for genital involvement. Genital vitiligo adversely impacts quality of life and self-esteem, particularly among female patients. The lack of discourse between patients and physicians highlights a need for increased awareness and proactive clinical investigations to enhance patient care and satisfaction.

Network structure of REM sleep behavior disorder symptoms in iRBD patients

ObjectiveEmploying the REM Sleep Behavior Disorder Questionnaire-Hong Kong (RBDQ-HK) to investigate symptoms and their severity in rapid eye movement (REM) sleep behavior disorder (RBD) patients, this study delves into the construct of RBD through the RBDQ-HK and its links to depression and sleep quality. MethodsData from the RBDQ-HK, the Geriatric Depression Scale (GDS), and the Pittsburgh Sleep Quality Index (PSQI) were compiled from individuals with isolated RBD (iRBD) confirmed by polysomnography. We constructed a network analysis of the RBDQ-HK, measured the centrality of each symptom (node), conducted Exploratory Graph Analysis (EGA) to unveil the dimension structure of the questionnaire, and calculated bridge expected influence (BEI) to identifying critical bridge. Multivariate linear regression was also employed to discover relationships between RBDQ-HK dimensions and variables such as PSQI and GDS. ResultsIn our cohort of 455 iRBD patients (299 males), the items in the RBDQ-HK were divided into three dimensions: dream, movement, and SRI/violence. The symptoms identified as most central to RBD were ‘shouting or yelling in sleep’, ‘dream-enacting movements’, and ‘talking during sleep’. The highest (BEI) was ‘violent and aggressive dreams’, which has the potential to bridge three dimensions within the symptom network. Depression was significantly correlated with the movement and dream dimensions of RBD, and sleep quality was predominantly related to the dream dimension score. ConclusionOur findings verify that the principal symptoms of the RBDQ-HK align with the established diagnostic criteria and reveal a three-dimensional structure within RBD symptoms. The relationships between the RBD symptoms, depression, and sleep quality need to be identified for the effective management of RBD patients.

Care Nursing in Immune Disorder Assessment among Adult Oncology Patients: A Scoping Review.

International guidelines recommend a pathway for preferable nursing handling in a specific cancer topic, like chemotherapy toxicity, low adhesion in toxicity reported with a consequential increase in adverse events (AEs) frequency, poorer QoL outcomes, and increased use of healthcare service until death. Unpredictability, postponed reports, and incapability to access healthcare services can compromise toxicity-related effects by including patients' safety. In this scenario, a more attentive nursing intervention can improve patients' outcomes and decrease costs for healthcare services, respectively. The present scoping review aims to describe and synthesize scientific care nursing evidence assessment in oncology patients. PubMed, Embase, Nursing & Allied Health Database, and British Nursing were the databases examined. Keywords used and associated with Boolean operators were assessment, care, nursing, immune disorder, oncology, and patient. Research articles considered were published between 2013-2023. All systematic processes were performed according to the PRISMA procedure in order to reach all manuscripts considered in the present scoping review. The Embase database showed a total of 25 articles, PubMed displayed 77, the Nursing & Allied Health Database evidenced a total of 74, and the British Nursing database showed 252 records. Then, after a first revision in each database by considering the inclusion criteria, the abovementioned titles and abstracts were selected and, 336 records were removed, and 92 studies remained. Of these, 65 manuscripts were excluded after verifying abstracts. Finally, a total of 7 articles were carefully analysed and selected for this scoping review. Specifically, 2 articles belonged to the British Nursing Database, 3 articles belonged to Embase, 1 to the Nursing & Allied Health Database and one related to PubMed. Oncology nursing should consider several aspects, such as therapy-related toxicity and its related morbidity and mortality, worsening levels of quality of life, and increasing duty by the healthcare organization or endorsements for the principal symptoms and signs which may anticipate few diseases and worst clinical conditions, too. Therefore, careful monitoring may allow prompt recognition and subsequent earlier management in the treatment efficacy.

Role of ncRNAs in the Pathogenesis of Sjögren's Syndrome.

Sjögren's syndrome is a multisystemic autoimmune disease that mainly affects the exocrine glands, causing dryness of the eyes and the mouth as the principal symptoms. Non-coding RNAs (ncRNAs), once regarded as genomic "junk", are now appreciated as important molecular regulators of gene expression, not least in Sjögren's syndrome and other autoimmune diseases. Here we review research into the causative roles of microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) on immunological responses, inflammation, and salivary gland epithelial cell function in Sjögren's syndrome patients. These ncRNAs represent promising new therapeutic targets for treating the disease and possibly as biomarkers for early diagnosis.

Clinico-Laboratory Profile and Outcome of Kawasaki Disease in Children in a Tertiary Care Hospital in Kathmandu

Introduction: Kawasaki disease (KD) is one of the most common vasculitis of childhood. It contributes significantly to acquired heart disease in children and results in coronary artery abnormalities including aneurysm in 25% of untreated children. This study aims to retrospectively assess the clinical course, laboratory results, and presenting symptoms of patients with complete and incomplete KD treated at tertiary care hospital in Kathmandu.Method: This retrospective study was conducted in the Department of Pediatrics. Data from January 2020 to December 2020 were retrieved from medical records department of the hospital and analyzed using Microsoft excel.Result: The total number of cases evaluated in our study was 9. The median age at the time of the diagnosis of KD was 24 months (median age for incomplete KD-21 months, complete KD-37 months). Male to female ratio was 1.2:1. The peak season of KD occurrence was Spring (March – May). Mean duration of stay in the hospital was 7 days. All children presented with fever, with an mean fever duration of 7 days at the time of presentation. Fever was present in every case. The most common principal symptom was a polymorphous skin rash, observed in 88% of the cases. Elevated CRP levels (≥3 mg/dl) were noted in all 9 cases. Cardiovascular complications were present in 88% of the patients, with coronary artery aneurysm (CAA) detected in 11%, coronary artery dilation in 22%, and mild pericardial effusion documented in 66% of the cases. Eight patients (88%) received IVIG, all 9 patients (100%) received aspirin, and 2 patients received steroids. There were no fatalities.Conclusion: KD is a common vasculitis in children which do not have significant sex predilection in oppose to most of the studies. Majority of cases occurred in spring season. The most common symptom was polymorphous rash. A high level of suspicion for diagnosing KD is essential, and early treatment is crucial to prevent complications and reduce the future economic burden on families and the nation.

Immunization against Medically Important Human Coronaviruses of Public Health Concern.

SARS-CoV-2 is a virus that affects the human immune system. It was observed to be on the rise since the beginning of 2020 and turned into a life-threatening pandemic. Scientists have tried to develop a possible preventive and therapeutic drug against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other related coronaviruses by assessing COVID-19-recovered persons' immunity. This study aims to review immunization against SARS-CoV-2, along with exploring the interventions that have been developed for the prevention of SARS-CoV-2. This study also highlighted the role of phototherapy in treating SARS-CoV infection. The study adopted a review approach to gathering the information available and the progress that has been made in the treatment and prevention of COVID-19. Various vaccinations, including nucleotide, subunit, and vector-based vaccines, as well as attenuated and inactivated forms that have already been shown to have prophylactic efficacy against the Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV, have been summarized. Neutralizing and non-neutralizing antibodies are all associated with viral infections. Because there is no specific antiviral vaccine or therapies for coronaviruses, the main treatment strategy is supportive care, which is reinforced by combining broad-spectrum antivirals, convalescent plasma, and corticosteroids. COVID-19 has been a challenge to keep reconsidering the usual approaches to regulatory evaluation as a result of getting mixed and complicated findings on the vaccines, as well as licensing procedures. However, it is observed that medicinal herbs also play an important role in treating infection of the upper respiratory tract, the principal symptom of SARS-CoV due to their natural bioactive composite. However, some Traditional Chinese Medicines contain mutagens and nephrotoxins and the toxicological properties of the majority of Chinese herbal remedies are unknown. Therefore, to treat the COVID-19 infection along with conventional treatment, it is recommended that herb-drug interaction be examined thoroughly.

Needling Method of Acupoint GB30: Based on Neuroanatomical Approach to the Principal Symptoms of GB30

Needling Method of Acupoint GB30: Based on Neuroanatomical Approach to the Principal Symptoms of GB30

Sustainable fluorescence derivatization approach for spectrofluorimetric quantification of methylphenidate hydrochloride in pharmaceutical formulation and spiked human plasma

Autistic children commonly experience symptoms that overlap with those of attention deficit hyperactivity disorder, such as inattention and hyperactivity. Methylphenidate hydrochloride is a brain stimulant drug used to treat the principal symptoms of attention deficit hyperactivity disorder in autistic individuals. A sustained spectrofluorimetric approach for quantifying methylphenidate hydrochloride in tablets and spiked plasma was developed in this study. At 75°C in a borate buffer pH 9, methylphenidate hydrochloride was derivatized by 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) into a fluorescent derivative detectable at 538 nm following excitation at 475 nm. The approach has been validated using ICH criteria, and it proved a sufficient linear response curve with the studied drug concentrations ranging from 2 to 100 ng/mL. The described approach was selectively used to quantify methylphenidate hydrochloride in tablets and plasma without the impact of the matrix components. In addition, the approach's sustainability was investigated and compared to the published work using two greenness assessment metrics termed analytical eco-scale and Analytical GREEnness (AGREE). The findings suggest that the recommended approach is sustainable compared to the published work.

Long-term prognosis of fatty-acid oxidation disorders in adults: Optimism despite the limited effective therapies available.

Fatty-acid oxidation disorders (FAODs) are recessive genetic diseases. We report here clinical and paraclinical data from a retrospective study of 44 adults with muscular FAODs from six French reference centers for neuromuscular or metabolic diseases. The study cohort consisted of 44 adult patients: 14 with carnitine palmitoyl transferase 2 deficiency (32%), nine with multiple acyl-CoA deficiency (20%), 13 with very long-chain acyl-CoA dehydrogenase deficiency (30%), three with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (7%), and five with short-chain acyl-CoA dehydrogenase deficiency (11%). Disease onset occurred during childhood in the majority of patients (59%), with a mean age at onset of 15 years (range = 0.5-35) and a mean of 12.6 years (range = 0-58) from disease onset to diagnosis. The principal symptoms were acute muscle manifestations (rhabdomyolysis, exercise intolerance, myalgia), sometimes associated with permanent muscle weakness. Episodes of rhabdomyolysis were frequent (84%), with a mean creatinine kinase level of 68,958 U/L (range = 660-300,000). General metabolic complications were observed in 58% of patients, respiratory manifestations in 18% of cases, and cardiological manifestations in 9% of cases. Fasting acylcarnitine profile was used to orient genetic explorations in 65% of cases. After a mean follow-up of 10 years, 33% of patients were asymptomatic and 56% continued to display symptoms after exercise. The frequency of rhabdomyolysis decreased after diagnosis in 64% of cases. A standardized register would complete this cohort description of muscular forms of FAODs with exhaustive data, making it possible to assess the efficacy of therapeutic protocols in real-life conditions and during the long-term follow-up of patients.

A 7-Year Survey (2015-2021) in One Pediatric Hospital (Brasov, Romania) on Rotavirus Gastroenteritis Specified as Community- or Hospital-Acquired Infection in Young Children.

This project is an observational, descriptive study evaluating frequencies of rotavirus disease in hospitalized children aged less than 5 years old between 2015 and 2021 in the Pediatric Hospital of Brasov, Central Romania. The study compares socio-demographic (age, sex, place of living and ethnicity), clinical, and treatment aspects between community-acquired rotavirus gastroenteritis (CARG) and hospital-acquired rotavirus gastroenteritis (HARG). During that period, 1913 hospitalized children had a rapid positive immunichromatographic rotavirus test from stool specimens. Among them, 1620 (84.6%) were CARG and 293 (15.4%) were HARG. CARG conditions represented 28.5% of all acute hospitalized gastroenteritis (n = 5673) whereas HARG represented 5.2%. Around the same percentage of urban children were seen in CARG as in HARG (58.5% (n = 948) for CARG and 56.3% (n = 164) for HARG). About 64.9% (n = 1052) of CARG cases were from Roma population, and 66.5% (n = 195) in HARG. The age group with the highest frequency of the disease was 12 to 24 months old for both CARG and HARG. The average hospital duration was 5.09 days for CARG and 7.62 days for HARG. Diarrhea was the principal symptom in both CARG and HARG (92.6% (n = 1500) for CARG and 93.9% (n = 275) for HARG). Most CARG patients (61% (n = 989)) were treated for symptomatic management with iv fluids. Most HARG (60.4% (n = 177)) were treated for symptomatic management with iv fluids and antibiotics. A significant seasonal shift to a later period in the year was observed during the last registration year of 2021, possibly due to the COVID-19 epidemic. The seasonal disease burden of rotavirus infection in children remains high in hospital care in Romania, which may justify the systematic introduction of rotavirus vaccination across the whole country.

The Mystery of Tomato Flu in India

Introduction: While the globe fights against monkeypox and the coronavirus, a new virus known as "Tomato flu" threatens. This virus's recognized target is children. In May 2022, the virus was found for the first time in Kerala, India. Due to its principal symptom, tomato-shaped blisters all over the body, the ailment was given the term "Tomato Flu." Recent reports described it as type of hand, foot and mouth disease (HFMD). It is easily diagnosed by a history and physical examination. It is an infectious condition, but there are still a lot of unanswered questions. To shed light on this topic, we decided to collect and summarize the information on this novel viral pathogen. Materials and Methods: To accomplish this, we undertook a thorough literature assessment of the Tomato Flu research that has already been done. We analyzed data from various sources such as medical journals, government reports and news articles to gain a better understanding of this emerging disease. In addition, we conducted interviews with healthcare professionals who have treated patients with Tomato Flu to gain insights into their experiences. Results: Survey of literature showed that Tomato Flu is a self-limiting disease. Children under the age of 5 and immunocompromised individuals are more susceptible to this disease. There is no diagnostic test for the disease, differential diagnosis involves typical symptoms and the absence of other known viral agents. There is no treatment, supportive care brings relief. Conclusion: Overall, this review provides a better understanding of Tomato Flu and its potential impact on public health. By shedding light on this emerging virus, we hope to contribute to ongoing efforts to prevent and treat of this infectious disease. Medicine Today 2023 Vol.35(2): 129-133

Association between RS3763040 polymorphism of the AQP4 and idiopathic intracranial hypertension in a Spanish Caucasian population.

Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure of unknown aetiology. Principal symptoms are headache, visual disturbances, and obesity, together with elevated intracranial pressure. Unspecified MRI, despite normal ventricle size, suggests alterations in the water flux cellular mediated by the brain water channel aquaporin-4 (AQP4). The association among IIH, cerebral spinal fluid malfunction, reabsorption, and functional or regulatory modifications of AQP4 is a hypothesis not confirmed. Blood samples were collected from 72 Spanish Caucasian patients with IIH. A genetic association study was performed with bi-allelic SNPs rs1049305 and rs10244884 in AQ1 and rs2075575, rs3763043, and rs3763040 in AQ4. Genetic data were compared with 94 healthy Caucasian control. Statistics studies were assessed by Pearson's χ 2 tests for 2 × 2 (alleles) or 3 × 2 (genotypes) contingency tables. A P value < 0.05 was considered to be statistically significant. Statistically significant differences were found when comparing the results of the rs3763040 polymorphism of the AQ4 locus of IIH patients with controls, in genotypic frequencies (P = 0.0442) and allele frequencies (P = 0.0171). Furthermore, a statistically significant difference (P = 0.0207) was found in individuals carrying and not carrying the minor allele (GG + GA individuals vs GG homozygotes). No statistically significant differences were found when comparing allele and genotypic frequencies for SNPs rs1049305 and rs10244884 of AQ1 and rs2075575 and rs3763043 of AQ4. The association of AQP4 and specifically of its polymorphic variant rs3763040 with IIH should be validated in other ethnic groups in order to assess more precisely the role of AQP4 in the etiopathogenesis of IIH.

Antiglycation, antifibrillation and antioxidative effects of para coumaric acid and vitamin D; an in-vitro and in-silico comparative-cum-synergistic approach

Diabetes Mellitus is a metabolic disorder that results in impaired utilization of carbohydrates, lipids, and proteins. Severe hyperglycemia is its principal clinical symptom. Human serum albumin (HSA) is used as a model protein since it is viewed as a sign of glycaemic management because it is more likely to get glycated in diabetic people than other proteins. Para-coumaric acid (pCA), a phenolic acid, and Vitamin D (vit-D) are used as protective agents. In the present work, we deduce a synergistic-cum-comparative effect of pCA and vit-D, expecting some improvement in the efficacy of pCA when combined with vit-D. Methods employed are DPPH radical scavenging activity, In-vitro glycation of HSA, UV–vis spectroscopy, fluorescence analysis, and circular dichroism measurement. After treatment, increasein the absorbance and fluorescence intensity were reduced along with normalization of CD value. . The glycation-mediated fibrillation assessed by Congo-Red and Thioflavin T (ThT) were found to be diminishedwhen HSA was treated with equimolar concentration of p-CA and vit-D- treatment. Fructosamine adduct formation and lysine modificationwas also decreased, while inhibition to hemolysis and lipid peroxidation was found to increase upon treatment. The reactive oxygen species generation detection was also performed in lymphocytes treated with various protein samples. Docking results further confirmed theblocking some glycation-prone amino acids by both compounds. The study shows that the combination in the ratio of 1:1 has provided higher overall protection comparable to aminoguanidine (AG), the molecule which is utilized as a positive control.

Are paranoid ideation and hallucination spectrum experiences differently associated with affect dynamics? A continuous-time modeling approach.

Psychotic experiences have been associated with distortions in affective functioning, including aberrancies in affect dynamics. However, it remains unclear whether the two principal symptom dimensions of psychosis, namely paranoid ideation and hallucination spectrum experiences, are differently associated with affect dynamics, and whether associations hold after statistically controlling for depressive symptoms. We investigate this by using a novel statistical approach, the hierarchical Ornstein-Uhlenbeck (OU) process model. This is a continuous-time stochastic differential equations model in a Bayesian framework that describes dynamics in affective valence and arousal via three core parameters: attractor point, variability, and attractor strength. In a community sample with varying levels of psychotic experiences (n = 116), we measured affective valence and arousal 10 times per day for 7 days, using the experience-sampling method. We found-while statistically controlling for depressive symptoms-credible between-subjects associations between paranoid ideation and attractor points of negative valence and high arousal. We also found a credible positive association between hallucination spectrum experiences and arousal variability. Limited evidence emerged for small associations between paranoid ideation and high valence variability as well as between paranoid ideation and high attractor strengths of valence and arousal. Hallucination spectrum experiences showed some evidence for a small association with high arousal attractor points. The detailed picture of affect dynamics provided by the OU model reveals different cross-sectional affective profiles associated with paranoid ideation versus hallucination spectrum experiences that suggest different affective mechanisms of their formation and maintenance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Levels and clinical significance of the m6A methyltransferase METTL14 in patients with coronary heart disease.

To investigate the association of methyltransferase-like protein 14 (METTL14) expression with coronary heart disease (CHD). Three hundred and sixteen patients who attended Henan Provincial People's Hospital between June 2019 and February 2021 with principal symptoms of pain or tightness in the chest and who underwent coronary angiography for definitive diagnosis were enrolled. The uric acid, TG, TC, LDL-C, HDL-C, apolipoprotein A1, free fatty acid, lipoprotein a, homocysteine, CRP, and SAA levels were examined. The levels of METTL14, TNF-α, MCP-1, VCAM-1, ICAM-1, and IL-6 were evaluated by ELISA. Patients with CHD had significantly higher m6A methyltransferase activity. In addition, the incidence of diabetes and hypertension, as well as the concentrations of TC, CRP, and SAA were higher in CHD patients. Patients with coronary lesion branches also had significantly increased TG, LDL-C, CRP, and SAA levels. TNF-α, MCP-1, VCAM-1, ICAM-1, and IL-6 expression was also markedly increased in the CHD group (P < 0.001) as was the expression of METTL14 (P < 0.001). The METTL14 expression levels also differed significantly in relation to the number of branches with lesions (P < 0.01) and were correlated with SAA, VCAM-1, ICAM-1, IL-6, and the Gensini score. ROC curve analyses of METTL14 in CHD indicated an AUC of 0.881 (0.679, 0.894) with a cut-off value of 342.37, a sensitivity of 77%, and a specificity of 84%. MCP-1, VCAM-1, IL-6, SAA, and METTL14 were found to independently predict CHD risk. METTL14 levels were found to be positively associated with inflammatory markers and to be an independent predictor of CHD risk.

Der Lichen planus des Ösophagus – Eine unterschätzte Erkrankung

An involvement of the esophagus in patients with lichen planus was described for the first time in 1982. Ever since, it has been seen as a rarity. However, studies over the last 10 years have shown a higher prevalence than expected. It may even be supposed that esophageal lichen planus (ELP) is more common than eosinophilic esophagitis. ELP mostly affects middleaged women. The principal symptom is dysphagia. Endoscopically, ELP is characterized by denudation and tearing of the mucosa, trachealization and hyperkeratosis and esophageal stenosis may occur in patients with long courses of the disease. Histologic findings including mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis (civatte bodies) and dyskeratosis are crucial. Direct immunofluorescence shows fibrinogen deposits along the basement membrane zone. So far, there is no well-established therapy but a treatment with topic steroids is effective in 2/3 of the patients. Common therapy of lichen planus of the skin seems to be ineffective for treatment of ELP. Symptomatic esophageal stenosis should be endoscopically dilated. ELP joins the group of "new" immunologic diseases of the esophagus.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic.

The global prevalence of PASC is estimated to be present in 0·43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well-defined. We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) phenotype. The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. The median duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS, majority were female, and obesity (BMI > 30 Kg/m2) (P = 0.00377895) and worse functional status (P = 0.0110474) were significantly associated with ME/CFS. Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype.

Trigeminal nerve sheath tumor presenting as trochlear nerve palsy

A 73-year-old woman presented with vertical diplopia which was diagnosed as a trigeminal nerve sheath tumor. This case was unusual because the principal symptom was a vertical diplopia due to involvement of the trochlear nerve. Trigeminal function was preserved on initial presentation. The patient was advised neuroimaging along with baseline blood investigations. On subsequent follow-ups she developed trigeminal symptoms in the form of tingling and numbness along her left cheek and below her left eye. Eventually, radiodiagnosis showed a dumbbell-shaped necrotic lesion originating from the trigeminal nerve sheath suggestive of a schwannoma. The case was then referred to a neurosurgeon for appropriate management.

The revolutionary evolution in carious lesion management.

Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.