Prodromal Research Articles

Differential functional change in olfactory bulb and olfactory eloquent areas in Parkinson’s disease

Abstract Olfactory dysfunction, or hyposmia, frequently occurs as a prodromal symptom and ongoing sign of Parkinson’s disease. Functional MRI is a powerful tool for studying functional changes in the olfactory brain regions in patients with Parkinson’s disease. However, existing studies show inconsistent results and no study has measured olfactory functional MRI abnormalities in the human olfactory bulb directly. This is mainly due to the well-known susceptibility artifacts in conventional functional MRI images that affect several key olfactory-eloquent brain regions, and especially the olfactory bulb. In this study, olfactory functional MRI was performed using a recently developed functional MRI approach that can minimize susceptibility artifacts and measure robust functional MRI signals in the human olfactory bulb during olfactory stimulation. Experiments were performed on high magnetic field (7T) in 24 early (< 5 years of parkinsonian symptoms) Parkinson’s disease patients and 31 matched healthy controls. Our data showed increased functional MRI signal changes (ΔS/S) in the olfactory bulb in patients with early Parkinson’s disease, which correlated with behavioral olfactory measures. Temporally, functional MRI signals in the olfactory bulb returned to the pre-stimulus state earlier after reaching peak amplitude in patients with early Parkinson’s disease, implicating a faster olfactory habituation effect. The piriform cortex showed reduced numbers of activated voxels in patients with early Parkinson’s disease, which correlated with behavioral olfactory assessment. Several secondary olfactory regions including the orbitofrontal cortex, temporal pole, and amygdala exhibited reduced numbers of activated voxels and increased functional MRI signal changes in patients with early Parkinson’s disease. Our data also showed that functional MRI results are highly dependent on voxel selection in the functional analysis. In summary, we demonstrate differential spatial and temporal characteristics of olfactory functional MRI signals between the primary and secondary olfactory regions in patients with early Parkinson’s disease. These results may assist the development of novel quantitative biomarkers (especially in the early stages of Parkinson’s disease) to track and predict disease progression, as well as potential treatment targets for early intervention.

Analysis of components and related risk factors of urinary stones: a retrospective study of 1055 patients in southern China.

We conducted a retrospective study of 1055 patients with urinary stones who attended our single center from September 2017 to June 2024. Clinical data and laboratory indicators of patients were evaluated and compared with stone components. The most common type in our study was calcium oxalate (CaOx) stones (76.6%), followed by infection stones (13.2%) and uric acid (UA) stones (7.8%). Among the 1055 specimens, 899 (85.2%) cases were mixed component stones, of which calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) mixture were the most frequent (34.8%). There were only 156 cases (14.8%) of pure-component stones, of which anhydrous UA was the most frequent (7.0%). There were 738 males and 317 females, with a male-to-female ratio of 2.33:1. Male dominance was evident in CaOx stones (79.0 vs. 71.0%, P = 0.005). Female dominance was noted in infection stones (21.1 vs. 9.8%, P < 0.001). The multivariate analysis showed that higher serum albumin level was a risk factor for CaOx stone formation (OR = 2.959; 95% CI 1.470-5.953, P = 0.002). Women were more likely to develop infection stones than men (OR = 1.796; 95% CI 1.150-2.803, P = 0.010). As the urine pH increased, the risk of infection stones formation increased (OR = 2.521; 95% CI 1.809-3.513, P < 0.001). Moreover, a history of hypertension (OR = 2.339; 95% CI 1.409-3.881, P = 0.001), low urine pH (OR = 0.242; 95% CI 0.147-0.399, P < 0.001), and low serum albumin level (OR = 0.351; 95% CI 0.125-0.988, P = 0.047) were risk factors for the formation of UA stones.

Prodromal symptoms of a first manic episode: a qualitative study to the perspectives of patients with bipolar disorder and their caregivers'.

Diagnosing bipolar disorder (BD) is challenging, and adequate treatment is of major importance to minimalize the consequences of the illness. Early recognition is one way to address this. Although in clinical research the prodromal phase of BD is gaining interest, the perspective of patients with BD and their caregivers on prodromal symptoms is still lacking. The aim of this study is to gain insights in prodromal symptoms of patients with BD and their caregivers before the onset of a first manic episode. A qualitative research method was used to investigate prodromal symptoms one year prior to a first manic episode. In-depth interviews were conducted with patients with BD type I and their caregivers. Only patients with a first manic episode in the previous five years were included. The prodromal symptoms from patients' and caregivers' perspectives could be clustered into seven themes, with underlying subthemes: behavior (increased activity, destructive behavior, disinhibited behavior, inadequate behavior, changes in appearance), physical changes (changes in sleep, physical signals, differences in facial expression), communication (reciprocity, process, changes in use of social media), thought (process and content), cognition (changes in attention and concentration, forgetfulness), emotions (positive emotions, more intense emotions, mood swings), and personality (more pronounced manifestation of existing personality traits). Patients with bipolar I disorder and their caregivers described subsyndromal manic features one year prior to a first manic episode. In addition, they recognized mood lability, physical changes and more pronounced manifestation of existing personality traits. The results of this study confirm the presence of a prodromal phase. In clinical practice, monitoring of prodromal symptoms of BD can be useful in patients with depression, especially those with a familial risk of BD.

ANALYSIS OF EARLY CHANGES IN OPTICAL COHERENCE TOMOGRAPHY AND OCULAR MANIFESTATIONS OF VOGT-KOYANAGI-HARADA DISEASE (CLINICAL CASES)

The difficulty of diagnosing Vogt-Koyanagi-Harada syndrome is due to the fact that in the prodromal stage, the inflammatory process develops in the vascular membrane without ocular manifestations, clinically, flu-like syndrome, meningism come out in the first place, mistakenly leading the patient to a doctor of another specialty.Objective: To analyze optical coherence tomography (OCT) data and clinical manifestations for early diagnosis and timely treatment of Vogt-Koyanagi-Harada syndrome.Methods: Data from two clinical cases are presented: patient T. with timely pathogenetic pulse therapy and patient B. with alternative treatment due to his refusal of the proposed therapy. Results: Against the background of treatment, both patients have an increase in visual acuity, but patient B. has a less favorable prognosis according to OCT data due to the lack of adequate therapy.Conclusion: OCT of the macular region makes it possible to make the correct diagnosis at an early date, which prevents the transition of the uveitic stage of Vogt-Koyanagi-Harada disease into a chronic one.

Association of Oral Manifestations with Iron Deficiency Anemia: A Case-Control Study

Insufficient iron levels cause oral signs of iron insufficiency. Iron is necessary for several biological activities, including oral tissue health. Low iron levels might alter oral tissues, causing particular symptoms. The aim of this study to detect the oral manifestations of iron deficiency anemia as well as to investigate the link between the severity of these manifestations and the degree of the iron deficiency. The study includes 100 patients with iron deficiency anemia at an Azadi Teaching Hospital, in Duhok City, North of Iraq, and 98 healthy persons. A full history was obtained, and complete blood count and serum ferritin were recorded. In terms of gender distribution, a clear dominance of females was observed, as they represented 94% of the total cases compared to only 6% for males. Regarding the severity of anemia, most patients had moderate to mild degrees, while severe anemia cases represented a smaller percentage (12%). The comparison between patients and healthy people showed highly significant statistical differences in all pathological changes of the oral mucosa. Complete absence of pathological changes was more common in healthy controls (85%) than in patients (34%). Some pathological changes were closely associated with iron deficiency anemia, such as atrophic glossitis and angular cheilitis. This study concludes by highlighting the strong correlation between iron deficiency anemia (IDA) and oral mucosal lesions, and the most common oral manifestations are present in patients with severe iron deficiency anemia.

Validation and psychometric properties of the bipolar prodrome symptom interview and scale-full prospective Chinese version to assess individuals at risk for bipolar disorder.

Bipolar disorder (BD) is a chronic, severe mental illness with a significant socio-economic burden. The early recognition of BD requires reliable and valid instruments. We evaluated the psychometric attributes of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP)-Chinese version. Altogether, 129 participants, aged 16-35 years meeting DSM-5 criteria for major depressive disorder (MDD, n = 27) or BD (n = 76), and 26 healthy controls were recruited. Subjects were evaluated with the BPSS-FP Chinese version, Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Cyclothymic-Hypersensitive Temperament questionnaire (CHT). Internal consistency, interrater reliability, criterion validity, and discriminant validity of the BPSS-FP-Chinese version were assessed. Cronbach alpha indices were 0.87, 0.86, and 0.66 for the manic, depressive, and general subscales of BPSS-FP-Chinese version, respectively. Interrater correlation was high, with total agreements of 0.94, 0.95, and 0.94 for the manic, depressive, and general index, respectively. Significant correlations (r ≥ 0.50) were noted between the BPSS-FP manic subscale and both the YMRS and CHT, the depressive subscale and the MADRS, and the general symptom subscale and the CHT. Moderate correlations were detected between the BPSS-FP general symptoms and both the YMRS and CHT (r = 0.40 ~ <0.50). Furthermore, the BPSS-FP mania index demonstrated a moderate correlation with the MADRS, while the depression index had a small correlation with the YMRS (r = 0.10 ~ <0.40). The BPSS-FP-Chinese version has good psychometric properties and can be applied in both clinical and research settings for screening subjects with a risk for BD.

Abstract 4125719: Efficacy of Prodromal Symptom Assessment in Prognostic Stratification of Acute Myocarditis

Introduction: The outcomes of acute myocarditis are heterogeneous and can lead to clinically significant consequences. However, the patient characteristics associated with adverse outcomes at presentation are not fully understood. Objection: To investigate the association between the presence or absence of prodromal symptoms and in-hospital mortality in patients admitted with acute myocarditis. Methods: We analyzed multicenter data registry (Tokyo CCU Network Database, comprising 76 institutions in the Tokyo metropolitan area). The study included 261 cases with acute myocarditis from January 2017 to December 2020, among which 260 required hospitalization from the emergency department. Patients were grouped based on the presence or absence of prodromal symptoms prior to hospitalization. Prodromal symptoms include the following: (a) chest pain; (b) dyspnea; (c) fever; (d) ful-like symptoms; and (e) others.The primary outcome was in-hospital death. Results: Among the 261 patients with acute myocarditis, 187 patients (71.6%) exhibited prodromal symptoms, and 74 patients (28.3%) did not. The primary outcome occurred in 19 patients (25.6%) without prodromal symptoms and in 20 patients (10.6%) with prodromal symptoms (hazard ratio, 2.87; 95% CI, 1.34 to 6.13; P=0.004, Figure 1A). A multivariable-adjusted Cox regression analysis confirmed that the absence of prodromal symptoms was an independent predictor of poor prognosis, even after adjusting for age, sex and the history of diabetes and hypertension. Notably, this trend was pronounced among patients with Killip classes 2-4, revealing higher in-hospital mortality rate in the patients without prodromal symptoms compared to those with prodromal symptoms (48.6% vs 11.7%; P &lt; 0.001, Figure 1B). Conclusions: This study demonstrates that the absence of prodromal symptoms in patients with acute myocarditis is an independent predictor of poor prognosis, especially for patients presented with Killip classes 2-4.

Abstract 4126987: A Case of Recurrent Neurocardiogenic Syncope in a COVID-19 Patient

Background: COVID-19 infection has been associated with a broad range of clinical manifestations. There are very few reported cases of COVID-19 patients presenting with syncope as an initial symptom. We present an extraordinary case of recurrent neurocardiogenic syncope in a COVID-19 patient. Case: A 66-year-old male presented after experiencing two episodes of syncope. He denied any prodromal or anginal symptoms. His medications included propranolol 10 mg twice daily for essential tremors. He had no family history of unexplained syncope or sudden cardiac death. He was hemodynamically stable and had one episode of fever at 102°F. Telemetry recording showed vagal-mediated sinus arrest and pauses without escape. Blood work showed normal cell counts, electrolytes, thyroid-stimulating hormone, and erythrocyte sedimentation rate, with a slightly elevated C-reactive protein of 22.2 mg/L. He tested positive for COVID-19 and had negative Lyme and Ehrlichia serologies. Decision Making: Due to symptomatic long sinus pauses, propranolol was discontinued, and he received a temporary pacemaker set at 50 beats per minute (bpm). He had another syncopal episode while being paced at 50 bpm, suggesting a neurocardiogenic mechanism, so the pacing rate was increased to 70 bpm. An echocardiogram showed a normal ejection fraction without any significant valvular disease. The syncope was determined to be vasovagal due to autonomic dysfunction in the setting of COVID-19. After 72 hours without further syncope, the temporary pacemaker was removed, and he was discharged home with an implantable loop recorder (ILR). A one-month follow-up showed no syncope, and ILR interrogation showed no bradycardia or pauses. Conclusion: Neurocardiogenic syncope with prolonged asystole and sinus pauses is an uncommon presentation of COVID-19 infection. The clinical course of autonomic dysfunction following COVID-19 is not very clear, and monitoring with an ILR is reasonable before considering permanent pacemaker implantation.

Valuing the importance of sex differences in prodromal Alzheimer's disease based on structural magnetic resonance imaging.

Alzheimer's disease (AD) can be optimally managed from a healthcare point of view if detected at a prodromal stage. Amnestic mild cognitive impairment (MCI) is known as prodromal AD, has attracted extensive attention and research. To identify the differences in cognitive function and structural magnetic resonance imaging (MRI) features between men and women with MCI on the basis of A/T/N classification system ("A" means amyloid-β biomarker, "T" means tau biomarker, and "N" means neurodegeneration biomarker as determined by clinical imaging (e.g., positron emission tomography, magnetic resonance imaging (MRI)) or by the measurement of total tau protein (T-tau) in the cerebrospinal fluid (CSF)) and to further explore the correlation between them. 406 MCI subjects were selected from the Alzheimer's Disease Neuroimaging Initiative database and divided into male and female MCI groups. Differences in demographic characteristics, biomarkers, cognitive assessment performance, and regions of interest (ROIs) of structural MRI were compared between the two groups. The correlations between brain structural changes quantified by MRI and cognitive abilities were investigated through linear regression models. Compared with male MCI subjects, females had significantly higher T-tau concentration in CSF. There were significant differences in ROIs between the sex groups. In the male MCI group, the average cortical thicknesses of the right posterior cingulate, right anterior cingulate and right supramarginal gyrus were more closely correlated with cognitive function. In the female MCI group, the volume of the right rostral anterior cingulate, and the surface area and average cortical thickness of the right isthmus of the cingulate gyrus were more closely correlated with cognitive function. Based on A/T/N classification system, the structural MRI data analysis was closely correlated with the difference of cognitive function from patients with prodromal AD in a sex-dependent manner.

Mild behavioral impairment in people with mild cognitive impairment: Are the two conditions related?

Mild cognitive impairment (MCI) and mild behavioral impairment (MBI) are both considered potential prodromal stages of dementia, especially Alzheimer's disease. Previous literature has lacked specific information about MBI in individuals with MCI and associations of several aspects of both, MBI and MCI. Our aim was to investigate whether associations exist between aspects of MBI and aspects of cognitive performance in certain dimensions of the Montreal Cognitive Assessment (MoCA). We used baseline data from the double-blind randomized controlled intervention MCI-CCT-study. Current cognitive performance of individuals with MCI was measured with the MoCA. MBI was assessed with the MBI Shortscale (MBI short), which was administered through a self-report interview. Associations were assessed with Pearson correlations. Sensitivity analyses were conducted for gender and cognition. Group differences were examined with independent samples t-tests or Welch test. Significant correlations were considered in binary logistic regressions under control of covariates. There was no significant correlation between the current MoCA and MBI short scores in the total sample or in the gender-related analysis. Using dichotomized cognitive performance, significant correlations between MCI and MBI were revealed for individuals with lower MoCA scores. On the task level, several significant associations were identified between MoCA dimensions and MBI dimensions in the total sample and in the sensitivity analyses, also under control of covariates. Our findings support the hypothesis that with increasing cognitive decline, the association between MCI and MBI becomes stronger. Furthermore, a certain cut-off on the MoCA must be reached to identify a correlation.

And Baby Makes Three: Postpartum Changes in Male-Female Affiliative Interactions in White-Faced Capuchins.

In group-living primates, male investment in infants is highly variable. Previous research on polygynandrous primates found that male care of infants, whether direct or indirect, may be a means to increase offspring survival, increase social status, invest in future mating opportunities, and/or invest in future social or coalition partners, any of which may increase fitness outcomes. Relationships between male white-faced capuchins (Cebus imitator) and infants are highly variable, ranging from neutral to highly affiliative during periods of group stability to lethal during times of instability. We used genetic paternity analysis and behavioral observations to investigate the impact of paternity status, female dominance rank, male dominance rank, and infant sex on changes in rates of affiliation (contact and proximity) between capuchin males and females following the birth of an infant (n = 92 dyads). We used generalized linear mixed models and an information theory approach to select models for averaging. We found that overall rates of male-female affiliation increased following the birth of an infant (contact change: +1.09 ± 2.55%; proximity change: +1.16 ± 3.08%). Infant sex was the only significant explanatory variable; dyads that included males and females who gave birth to male infants experienced a significant increase in their time in contact and proximity in comparison to dyads with females who gave birth to female infants (contact change: p < 0.05 in 2/3 models; proximity change: p < 0.001 in 3/3 models). These findings add to previous data indicating that male capuchins do not recognize their offspring or have the motivation to preferentially invest in their care. We suggest that the observed sex bias may be a form of sex-specific socialization connected to the importance of forming long-term cooperative male bonds that are maintained via male parallel dispersal in this species.

Clinical characteristics and functional outcomes of pediatric Guillain-Barré syndrome admitted to the Neuro-intensive care unit: a decade-long retrospective observational study.

Guillain-Barré Syndrome (GBS) remains a significant contributor to acute flaccid paralysis in pediatric patients worldwide. Despite its impact, studies focusing on pediatric GBS requiring intensive care unit (ICU) management are limited. This study aimed to address this gap by exploring the clinical and outcome characteristics of pediatric GBS necessitating ICU care. This retrospective observational study, spanning a decade, analyzed the records of 75 pediatric GBS patients admitted to the Neuro-ICU of a tertiary care center in South India. Data included demographics, prodromal symptoms, clinical features, investigations, treatment modalities, and outcomes. The majority (55/75) of patients were male, with a median age of 12 years. The highest incidence of GBS requiring ICU admission was in the monsoon season. Prodromal symptoms were observed in 56%. Most patients (93.33%) presented with typical GBS symptoms, and 40% had respiratory distress on ICU admission. Acute motor axonal neuropathy (AMAN) was the most common subtype. Approximately 80% required mechanical ventilation, with a median duration of 22.5 days. No in-hospital mortality was recorded. At discharge, most patients had a GBS disability score of 4, improving to 2 at a median follow -up of 228 days. Pediatric GBS patients requiring ICU care exhibit distinctive characteristics, including a higher prevalence of AMAN subtype, seasonal clustering, and favorable outcomes with intensive treatment. The absence of in-hospital mortality underscores the effectiveness of prompt ICU admission and dedicated Neuro-intensive care.

Internal Validation of the Latvian Version of 16-Item Prodromal Questionnaire in A Help-Seeking Adolescent Population: Psychometric Analysis and Associated Factors.

The prodromal phase of a psychotic disorder is a period of altered functioning before the onset of the acute state; several interviews have been developed to determine whether individuals present with prodromal symptoms. The 16-item Prodromal Questionnaire (PQ-16) is a screening tool for evaluating those at risk of developing a psychotic disorder. The study aimed to evaluate the psychometric properties of the Latvian version of the PQ-16 in a sample of help-seeking adolescents referred for diagnostic assessment and look for possible associated socio-demographic and health-related factors. A cross-sectional study included patients admitted for evaluation between November 2022 and February 2023 in Riga's Children's Clinical University Hospital Child Psychiatry clinic. The data were collected during outpatient consultations by mental health professionals. We used the Latvian translation of PQ-16 and the socio-demographic and health-related factors questionnaire. Data were analysed with IBM SPSS 28; the scale's diagnostic accuracy and internal validity were examined. The study involved 107 adolescents aged 12% to 17%, 80.5% female, with a mean age of 14.98 (CI 14.70-15.26). Socio-demographic data and health-related variables did not significantly differ between the sexes (p > 0.05). The Latvian PQ-16 demonstrated excellent internal reliability with a Cronbach's alpha of 0.890. All 16 items were found to be valid with p < 0.001. A significant number of participants (73.8%) scored above the current cut-off of ≥ 6 with a mean of 9.17 (95% CI 8.41-9.93). Certain socio-demographic factors, such as female gender (p < 0.001), fair school performance (p = 0.048) and recent changes in school performance (p < 0.001), demonstrated a significant association with higher scores. Additionally, there were found significant associations between positive screening and health-related factors such as obstetric complications (p = 0.044), smoking (p = 0.002), alcohol consumption (p = 0.021), history of bullying in school (p < 0.001) and emotional abuse at home (p = 0.011). Latvian translation of PQ-16 showed high internal reliability and validity levels. Positive PQ-16 screening was associated with female gender, worsened school performance, obstetric complications, substance abuse and experienced emotional violence. The average score of 9.17 positive answers and 73.8% of participants screening positive for attenuated psychotic symptoms is significantly higher than in recent studies under similar conditions.

An exploratory study of metabolomics in endogenous and cannabis-use-associated psychotic-like experiences in adolescence

In adolescence, psychotic-like experiences (PLE) may indicate potential prodromal symptoms preceding the onset of psychosis. Metabolomic studies have shown promise in providing valuable insights into predicting psychosis with enhanced precision compared to conventional clinical features. This study investigated metabolomic alterations associated with PLE in 76 depressed adolescents aged 14–20 years. Serum concentrations of 92 metabolites were analyzed with liquid chromatography–mass spectrometry. PLE were assessed using the Youth Experiences and Health (YEAH) questionnaire. The associations between PLE symptom dimensions (delusions, paranoia, hallucinations, negative symptoms, thought disorder, and dissociation) and metabolite concentrations were analyzed in linear regression models adjusted for different covariates. The symptom dimensions consistently correlated with the metabolome in different models, except those adjusted for cannabis use. Specifically, the hallucination dimension was associated with 13 metabolites (acetoacetic acid, allantoin, asparagine, decanoylcarnitine, D-glucuronic acid, guanidinoacetic acid, hexanoylcarnitine, homogentisic acid, leucine, NAD+, octanoylcarnitine, trimethylamine-N-oxide, and valine) in the various linear models. However, when adjusting for cannabis use, eight metabolites were associated with hallucinations (adenine, AMP, cAMP, chenodeoxycholic acid, cholic acid, L-kynurenine, neopterin, and D-ribose-5-phosphate). The results suggest diverse mechanisms underlying PLE in adolescence; hallucinatory experiences may be linked to inflammatory functions, while cannabis use may engage an alternative metabolic pathway related to increased energy demand and ketogenesis in inducing PLE. The limited sample of individuals with depression restricts the generalizability of these findings. Future research should explore whether various experiences and related metabolomic changes jointly predict the onset of psychoses and related disorders.

Nadezhda Dobychina (1884–1950)

Abstract The opening of the first commercial art gallery in Russia by Nadezhda Dobychina (1884–1950) heralded surprising female dominance in the national art business sector, which appears even more remarkable considering that up until the early 1910s art dealers were virtually absent from the archaically pre-capitalistic Russian art market. On that account Dobychina’s Art Bureau, which opened in St. Petersburg in October 1911 was an entirely pioneering business project. Dobychina laid the groundwork for several innovative approaches which foreshadowed many aspects of modern gallery practice. Exhibitions in her Art Bureau were accompanied by talks, disputes, concerts and performances, bringing artists and public in a close contact with each other and thus providing a useful forum for the exchange of views and ideas. Dobychina’s Art Bureau aimed at showcasing the most original and distinctive artistic trends in Russia and abroad, ranging from realism, symbolism and post- impressionism to provocatively cutting-edge avant-garde. In a short span of less than a decade she organised the first exhibitions in Russia of Wassily Kandinsky and Marc Chagall and famously exhibited Malevich’s Black Square in the ground-breaking 0.10 exhibition, which was held at the Bureau in 1915. Over the years Dobychina has also assembled an important collection which included works of the World of Art and Avant-garde artists. The Art Bureau emerged as the most influential and ideologically independent centre of the contemporary art in Russia, which in turn secured artistic dialogue between Russia and Western Europe.

Building a social identity theory of stigmatized sexual practice: Exploring BDSM practitioner identity formation within interviews from an Israeli sample

ABSTRACT Despite growing interest in the psychologies and social lives of those involved in BDSM, we know too little regarding BDSM identity formation. To address this, we integrate theories of group psychology and social interaction to explore BDSM identity formation and negotiation. Thematic analysis of 16 in-depth interviews with a convenience sample of Israeli BDSM practitioners, suggests three important aspects of BDSM personal and group identity development, including disclosure management, community discovery and involvement, and negotiating evolving personal identities within the group. Practitioners describe negotiating identity disclosure; successful, failed, or declined integration into BDSM communities; and negotiating shifting identities. BDSM practitioners must navigate whether and how personal identities fit with sexual norms within a larger societal context (e.g., Israel) and within BDSM communities, risking stigma when violating these standards. Yet, we find that, while groups constrain, they also provide support for those who challenge social constraints.

Erythema Infectiosum: A Narrative Review.

Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.

Involvement of inflammasomes in the pathogenesis of Alzheimer's disease.

Alzheimer's disease (AD) is a neurodegenerative disease with a long preclinical and prodromal stage near 20 years. The neuropathological hallmarks of AD include amyloid plaques, neurofibrillary tangles, and neuroinflammation, those lead to neuronal and synaptic loss. Important fact, oxidative stress participates in the AD development by promoting amyloid-β deposition, tau hyperphosphorylation. However, the inflammatory response and pyroptotic death are mediated by the aberrant expression of NLRP inflammasome activated caspase-1, which leads to cleavage pro-inflammatory cytokines such as pro-interleukin-1β and pro-IL-18. IL-1β, TNF-α, and IL-6 which amplify the neuroinflammation loop, are produce by activated microglia and astrocytes, that can serve as early diagnostic markers or therapeutic targets in AD. In this review, we summarize our current understanding of the role of inflammasome in the pathogenesis of AD, highlighting key issues that need to be addressed to improve the development of new therapies.

Herpes zoster in an immunocompetent adolescent – A case of rare occurrence

ABSTRACT Herpes zoster is an acute viral infection caused by the reactivation of the varicella zoster virus. It occurs commonly in immunocompromised adults. Odontalgia may be an early prodromal symptom when herpes zoster involves the oral and maxillofacial region, which lays significant emphasis on the role of a dentist in early diagnosis and treatment of the infection. Herpes zoster infection commonly affects adult and elderly patients and is very rare in children. This article shows cases of herpes zoster infection in a 14-year-old immunocompetent boy who presented with dental pain as a prodromal sign. Herpes zoster may occur in children and thus should be considered in the differential diagnosis of acute multiple ulcers occurring in that population.

Beyond anosmia: olfactory dysfunction as a common denominator in neurodegenerative and neurodevelopmental disorders.

Olfactory dysfunction has emerged as a hallmark feature shared among several neurological conditions, including both neurodevelopmental and neurodegenerative disorders. While diseases of both categories have been extensively studied for decades, their association with olfaction has only recently gained attention. Olfactory deficits often manifest already during prodromal stages of these diseases, yet it remains unclear whether common pathophysiological changes along olfactory pathways cause such impairments. Here we probe into the intricate relationship between olfactory dysfunction and neurodegenerative and neurodevelopmental disorders, shedding light on their commonalities and underlying mechanisms. We begin by providing a brief overview of the olfactory circuit and its connections to higher-associated brain areas. Additionally, we discuss olfactory deficits in these disorders, focusing on potential common mechanisms that may contribute to olfactory dysfunction across both types of disorders. We further debate whether olfactory deficits contribute to the disease propagation or are simply an epiphenomenon. We conclude by emphasizing the significance of olfactory function as a potential pre-clinical diagnostic tool to identify individuals with neurological disorders that offers the opportunity for preventive intervention before other symptoms manifest.