Prolonged Episodes Research Articles

Cardioesophageal Reflex. Should it trigger clinician's response?

Cardiologists and gastroenterologists often encounter the coexistence of symptoms and functional abnormalities, but determining causation is more difficult.​​ In 1962 Smith and Papp first coined the term "linked angina". Their statement was preceded by the experiment whereby increase in bile duct pressure elicited the typical chest pain in patients with ischemic heart disease.​ It was demonstrated that dysphagia can be associated with ventricular arrhythmia suggestive of possible cardioesophageal reflex involvement. A potential association between gastroesophageal reflux disease and atrial fibrillation development has been proposed due to the close anatomic vicinity of the esophagus and the left atrium. It has been demonstrated that the patients suffering from prolonged gastro-esophageal acid reflux episodes and coronary spasm may be at higher risk for the development of linked-angina and acute myocardial infarction.​ We believe cardioesophageal reflex is a probable mediator of the linked angina. We recommend early treatment of gastroesophageal disorders in patients with symptomatic coronary arterial disease to alleviate the associated ischemic and arrhythmic burden.

Young female with repeated chest and gastrointestinal infections

Common variable immunodeficiency disorder (CVID) is a primary immunodeficiency disorder characterised by reduced serum levels of immunoglobulin G (IgG), along with immunoglobulin A (IgA) and/or immunoglobulin M (IgM).1 The range of clinical manifestations is broad, including acute and chronic infections, inflammatory and autoimmune disease, and an increased incidence of cancer and lymphoma.2 We present a case of a young female with bronchial asthma, repeated chest infections, and a prolonged episode of gastroenteritis. After a detailed history, examination, and investigations, she was diagnosed with CVID. She was managed with IV fluids, antibiotics, and antiprotozoal medications. After one month of follow-up, she was doing well. Keywords: Immunodeficiency, Immunoglobulins, CVID, Respiratory tract infection, IgA, IgG, IgM, asthma, gastroenteritis

Cortical hemodynamics of electrographic status epilepticus in the critically ill.

The pathophysiological mechanisms of status epilepticus (SE) underlying potential brain injury remain largely unclear. This study aims to employ functional near-infrared spectroscopy (fNIRS) combined with video-electroencephalography (vEEG) to monitor brain hemodynamics continuously and non-invasively in critically ill adult patients experiencing electrographic SE. Our primary focus is to investigate neurovascular coupling and cerebrovascular changes associated with seizures, particularly during recurring and/or prolonged episodes. Eleven critically ill adult patients underwent simultaneous vEEG-fNIRS with large cortical coverage. Data from seven patients with identified electrographic SE were analyzed. The timing of recorded seizures was marked using standardized critical care EEG terminology. A general linear model was employed to extract the hemodynamic response to seizures from the fNIRS recordings. Linear mixed-effects models were utilized to correlate hemodynamic responses with seizure characteristics. A total of >200 h of monitoring and >1000 seizures were recorded. In most patients, an increase in oxyhemoglobin (HbO) and a decrease in deoxyhemoglobin (HbR) were observed during shorter-duration seizures. Although a similar response could also be seen initially for longer-duration seizures, this hemodynamic change was often followed by a progressive decline in HbO concentration and an increase in HbR. At the systemic level, no significant difference in peripheral oxygenation occurred during seizures, and only small changes in mean arterial blood pressure and heart rate occurred in four and two patients, respectively. We demonstrate the feasibility of using multichannel vEEG-fNIRS to measure the hemodynamic changes associated with electrographic seizures in critically ill adult patients. Our findings suggest that disrupted neurovascular coupling is more prevalent during prolonged seizures compared to recurrent short-duration seizures. This research provides valuable insights into the dynamic interplay between neuronal activity and hemodynamics during critical care seizures.

Revisiting marine heatwaves baselines in warming oceans under nonstationary condition.

Marine Heatwaves (MHWs) are prolonged episodes of above- 'normal' Sea Surface Temperature (SST) which have imposed detrimental impacts on oceans and their dependent ecosystem services. The key question still remained unresolved or at least still not fully addressed in MHW science, is 'What is a valid normal or baseline?'. In other words, can the conventional 'normal' serve as a realistic valid baseline in today's oceans experiencing the impacts of contemporaneous climatic changes and global warming during anthropogenic era? To robustly address this issue, we attempted to propose a methodology for identifying MHW thresholds that accounts for SST warming. In this study, we developed a novel, consistent, flexible and as realistic as possible working framework that practically deals with the current actual climate conditions which mainly involves incorporating the nonstationarity concept into the MHW definition. We presented our proposed approach using an exemplification exhibiting potential global implications. The competency of our proposed framework was evaluated by characterizing MHWs in one of the world's warmest marine environments, the Persian Gulf and Oman Sea. Our findings from employing dynamic non-stationary thresholds revealed that, MHWs have been merely evolving into a new warmer routine representing no significant variations in MHWs metrics except for the maximum SSTs during the extreme events.

Prevalence of physical and mental health problems among internally displaced persons in White Nile state, Sudan 2023: a cross sectional study

BackgroundFollowing the latest war in 2023, over nine million people have been internally displaced, of which White Nile State received over 50,000. They lived in different camps and moved to big cities. This study assessed the scope of mental and physical concerns among the IDPs to identify important healthcare needs.MethodsThis is a cross-sectional survey of four localities of internally displaced persons in White Nile state, Sudan. Between December 4th and December 14th, 2023, 800 directly interviewed participants were randomly selected using a face-to-face semi-structured interview. Potential participants were determined using a stratified simple random method.ResultsThe findings revealed that 45% of IDPs experienced poor physical health, with prevalent ailments among adults including minor colds (67%), respiratory infections (43%), prolonged flu episodes (36%), insomnia (38%), headaches (42%), gastric upset (44%), nausea (35%), and gastrointestinal issues (40%). Depression, PTSD, and anxiety were prevalent among adults at rates of 18%, 20%, and 14% respectively. Moreover, a staggering 72% of children under five suffered from malnutrition, with males accounting for 44% and females 56%.ConclusionAlarming numbers of IDPs in White Nile State face significant physical and mental health problems, warranting urgent interventions from local and international relief agencies.

The debut of benign recurrent intrahepatic cholestasis in acute hepatitis A

Background. Benign recurrent intrahepatic cholestasis is a rare inherited disorder characterized by recurrent episodes of severe hyperbilirubinemia and pruritus that resolve spontaneously. However, attacks of cholestasis may persist for several months and in some cases be associated with frequent recurrences, which may be grounds for liver transplantation.Objective. To present a clinical case of debut benign recurrent intrahepatic cholestasis following acute hepatitis A.Results. A 30-year-old patient was admitted at the Liver Transplantation Center of Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy for a prolonged episode of intrahepatic cholestasis with severe coagulopathy after acute hepatitis A. Total bilirubin was elevated up to 835 µmol/L and INR was 3.6. The manifestations of vitamin K-associated coagulopathy were controlled after the first dose of parenteral menadione sodium bisulfite. Glucocorticosteroids, ursodeoxycholic acid and plasmapheresis turned ineffective in the treatment of hyperbilirubinemia. Due to long-persisting cholestasis resistant to conservative therapy, the patient was considered for inclusion to the liver transplant waiting list. However, spontaneous resolution of the cholestatic episode was achieved at 5 months after the onset of manifestations. Benign recurrent intrahepatic cholestasis type 2 was diagnosed on the basis of the specific clinical signs, laboratory blood tests and genetic testing.Conclusion. The present Case Report shows a long-lasting episode of cholestasis with severe coagulopathy in acute hepatitis A in a patient with benign recurrent intrahepatic cholestasis with subsequent spontaneous resolution of the clinical symptoms at 5 months after their manifestation onset. Therefore, the differential diagnosis of benign recurrent intrahepatic cholestasis should be considered prior to liver transplantation in patients with intrahepatic cholestasis.

Intestinal Microbiota Transplant Prior to Allogeneic Stem Cell Transplant (MAST) trial: study protocol for a multicentre, double-blinded, placebo-controlled, phase IIa trial

IntroductionLower diversity of the gut microbiome prior to allogeneic haematopoietic cell transplantation (HCT) correlates with reduced survival after the intervention. Most patients undergoing HCT for a haematological malignancy have previously...

Getting up for brain health: Association of sedentary behavior breaks with cognition and mental health in children

Children spend most of their waking hours sedentary and reducing this behavior has been challenging. Interrupting prolonged episodes of sedentary behavior with active breaks can provide mental and cognitive health benefits. Considering the multifactorial nature of these health aspects, this study aimed to verify the role of body mass index (BMI), cardiorespiratory fitness (CRF), and moderate to vigorous physical activity (MVPA) in the relationship between the break in sedentary time with cognitive and mental health in children. This is a cross-sectional study with 129 children (62 boys), aged between 6 and 11 years (mean 8.73 ± 1.53) from a public school in southern Brazil. For the assessment of fluid intelligence, psychologists applied Raven’s Colored Progressive Matrices test. Mental health was measured using the Strengths and Difficulties Questionnaire. Sedentary breaks were measured using accelerometers, and CRF was determined using the 6-min walk test. Generalized linear regression analyses were used to verify associations of sedentary breaks with fluid intelligence and mental health, according to children’s BMI, CRF, and MVPA. All models were adjusted for sex, age, somatic maturation, and total time of accelerometer use. Our results indicated that sedentary breaks were associated with fluid intelligence in overweight/obese (β = 0.108; p = 0.021) and physically inactive children (β = 0.083; p = 0.010). Regarding mental health, no association was identified with sedentary breaks. In conclusion, sedentary breaks should be encouraged for the benefits of fluid intelligence, especially in children who do not meet physical activity recommendations and are overweight.

The California collaborative network to promote data driven care and improve outcomes in early psychosis (EPI-CAL) project: rationale, background, design and methodology

BackgroundA prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based “coordinated specialty care” (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California’s CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL’s LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive.Methods and objectivesEPI-CAL’s LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL’s network will contribute data to the Early Psychosis Intervention Network (EPINET) program.DiscussionThe current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users.Clinical trials registrationwww.ClinicalTrials.gov, identifier NCT04007510; registered 07/05/2019.

Interleukin-12 modulates sleep–wake activity and improves performance in a memory task

BackgroundCytokines, known for their pro- and anti-inflammatory roles, are also key regulators of sleep–wake cycles. Classical pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), are associated with increased sleep, particularly slow-wave sleep (SWS), while anti-inflammatory cytokines, like interleukin-10 (IL-10), generally reduce sleep duration. Given the essential role of sleep in memory consolidation, this study aimed to investigate whether interleukin-12 (IL-12), a pro-inflammatory cytokine, could increase sleep duration following a memory acquisition task and subsequently improve memory performance. Male Swiss mice were surgically implanted with electrodes for electrocorticogram (ECoG) and electromyogram (EMG) recordings to track their sleep–wake cycles. After a recovery period, baseline sleep–wake activity was recorded. The mice were then randomly assigned to two groups and treated with either IL-12 (0.5 µg, i.p.) or a phosphate-buffered saline (PBS, i.p.) control, administered immediately before the multiple-trial inhibitory avoidance (MTIA) task, a behavioral test used to assess memory performance. Following the memory acquisition session, sleep–wake activity was immediately recorded for a continuous 24-h period.ResultsMice treated with IL-12 exhibited longer latency to cross into the dark compartment during the MTIA test, indicating improved memory retention compared to the control group. Interestingly, this improved performance was associated with prolonged wakefulness, particularly in the first three hours after task acquisition.ConclusionThe study shows that IL-12 can improve memory retention through prolonged wake episodes rather than increased sleep. This finding challenges the conventional understanding that sleep is the primary state for memory consolidation, suggesting that under specific conditions, wakefulness may also play a key role in supporting memory processes. Further research is needed to explore the underlying mechanisms of IL-12's cognitive effects.

CYP2C19 Genetic Variants and Major Depressive Disorder: A Systematic Review.

Major depressive disorder (MDD) affects over 300 million people globally and has a multifactorial etiology. The CYP2C19 enzyme, involved in metabolizing certain antidepressants, can influence treatment response. Following the PRISMA protocol and PECOS strategy, this systematic review assessed the variation in common CYP2C19 gene variants' frequencies across populations with MDD, evaluating their impact on clinical characteristics and treatment response. We comprehensively searched five databases, identifying 240 articles, of which only nine within the last decade met our inclusion criteria. Except for one study that achieved 74.28% of STROPS items, the rest met at least 75% of GRIPS and STROPS guidelines for quality and bias risk assessment. The CYP2C19's *1 allele, the *1/*1 genotype, and the NM phenotype, considered as references, were generally more frequent. Other CYP2C19 polymorphism frequencies exhibit significant variability across different populations. Some studies associated variants with MDD development, a more extended history of depression, prolonged depressive episodes, and symptom severity, while others reported no such association. Some studies confirmed variants' effects on escitalopram and citalopram metabolism but not that of other drugs, such as sertraline, venlafaxine, and bupropion. Treatment tolerability and symptom improvement also varied between studies. Despite some common findings, inconsistencies highlight the need for further research to clarify the role of these polymorphisms in MDD and optimize treatment strategies.

Exploring the connection between AGN radiative feedback and massive black hole spin

We present a novel implementation for active galactic nucleus (AGN) feedback through ultrafast winds in the code GIZMO. Our feedback recipe accounts for the angular dependence of radiative feedback on black hole spin. We self-consistently evolve in time (i) the gas-accretion process from resolved scales to a smaller scale unresolved (subgrid) AGN disk, (ii) the evolution of the spin of the massive black hole (MBH), (iii) the injection of AGN-driven winds into the resolved scales, and (iv) the spin-induced anisotropy of the overall feedback process. We tested our implementation by following the propagation of the wind-driven outflow into an homogeneous medium, and here we present a comparison of the results against simple analytical models. We also considered an isolated galaxy setup, where the galaxy is thought to be formed from the collapse of a spinning gaseous halo, and there we studied the impact of the AGN feedback on the evolution of the MBH and of the host galaxy. We find that: (i) AGN feedback limits the gas inflow that powers the MBH, with a consequent weak impact on the host galaxy characterized by a suppression of star formation by about a factor of two in the nuclear (≲kpc) region; (ii) the impact of AGN feedback on the host galaxy and on MBH growth is primarily determined by the AGN luminosity rather than by its angular pattern set by the MBH spin (i.e., more luminous AGNs more efficiently suppress central star formation (SF), clearing wider central cavities and driving outflows with larger semiopening angles); (iii) the imprint of the angular pattern of AGN radiation emission is detected more clearly at high (i.e., Eddington) accretion rates. At such high rates, the more isotropic angular patterns, as occur for high spin values, sweep away gas in the nuclear region more easily, therefore causing a slower MBH mass and spin growths and a higher quenching of SF. We argue that the influence of spin-dependent anisotropy of AGN feedback on MBH and galaxy evolution is likely to be relevant in those scenarios characterized by high and prolonged MBH accretion episodes and by high AGN wind–galaxy coupling. Such conditions are more frequently met in galaxy mergers and/or high-redshift galaxies.

Investigative approach using smart insulin pens in a young person with type 1 diabetes and recurrent prolonged hypoglycemic episodes

Investigative approach using smart insulin pens in a young person with type 1 diabetes and recurrent prolonged hypoglycemic episodes

Randomised Placebo-Controlled Pilot Trial Evaluating the Anti-Anginal Efficacy of Ticagrelor in Patients with Angina with Nonobstructive Coronary Arteries and Coronary Slow Flow Phenomenon.

Background: The coronary slow flow phenomenon (CSFP) is an angiographic finding characterised by the delayed passage of contrast through the coronary arteries, despite the absence of obstructive coronary artery disease (defined as less than 50% narrowing of the vessel lumen). Patients with the CSFP experience recurrent angina, for which there are limited evidence-based therapies. Ticagrelor may serve as an effective anti-anginal therapy for these patients by increasing adenosine levels, which could alleviate coronary microvascular dysfunction and its associated angina due to its vasodilatory properties. This study aimed to determine the anti-anginal efficacy of ticagrelor 90 mg taken twice daily on spontaneous angina episodes in patients with refractory angina (i.e., episodes ≥3/week despite two anti-anginals) and documented CSFP. Methods: In a randomised, double-blind, placebo-controlled, cross-over trial, the anti-anginal efficacy of a 4-week ticagrelor therapy regimen was evaluated in 20 patients with refractory angina (mean age 61.5 ± 10.5 years; 40% women) who had documented slow coronary flow. The primary endpoint was the frequency of angina episodes, recorded using an angina diary. Secondary endpoints included the duration and severity of angina episodes, consumption of short-acting nitrates, and health status evaluations using the Seattle Angina Questionnaire (SAQ) and the Short Form-36 (SF-36) indices. Results: During the four weeks of therapy, ticagrelor did not significantly improve angina symptoms compared to the placebo (placebo 25.7 (16.7)) vs. ticagrelor 19.8 (18.1), p > 0.05). Furthermore, it did not impact other patient-related outcome measures, including angina severity, duration, frequency of prolonged angina episodes, nitrate consumption, or the SAQ/SF-36 health outcome indices. No serious adverse events related to the study drug were observed. Conclusions: In patients with documented CSFP who were unresponsive to standard anti-anginal therapy, ticagrelor did not reduce the frequency of spontaneous angina episodes or the consumption of nitrates. Further confirmation of the potential benefits of this therapy may be obtained through a larger clinical trial.

Amazonian rivers are leaky barriers to gene flow in forest understory birds.

Ever since Alfred Russel Wallace's nineteenth-century observation that related terrestrial species are often separated on opposing riverbanks, major Amazonian rivers have been recognized as key drivers of speciation. However, rivers are dynamic entities whose widths and courses may vary through time. It thus remains unknown how effective rivers are at reducing gene flow and promoting speciation over long timescales. We fit demographic models to genomic sequences to reconstruct the history of gene flow in three pairs of avian taxa fully separated by different Amazonian rivers, and whose geographic ranges do not make contact in headwater regions where rivers may cease to be barriers. Models with gene flow were best fit but still supported an initial period without any gene flow, which ranged from 187 000 to over 959 000 years, suggesting that rivers are capable of initiating speciation through long stretches of allopatric divergence. Allopatry was followed by either bursts or prolonged episodes of gene flow that retarded genomic differentiation but did not fully homogenize populations. Our results support Amazonian rivers as key barriers that promoted speciation and the build-up of species richness, but they also suggest that river barriers are often leaky, with genomic divergence accumulating slowly owing to episodes of substantial gene flow.

Priapism Presentations in a Saudi Arabian Emergency Department: A Retrospective Study at a Tertiary Care Hospital.

To examine the distribution, clinical characteristics, and management of priapism in a Saudi Arabian tertiary care setting to provide a regional perspective. This retrospective chart review included 29 male patients presenting with priapism at a tertiary care hospital in Riyadh, Saudi Arabia, from January 2011 to June 2023. Data were collected on patient demographics, clinical presentation, treatment modalities, and outcomes. The study found recurrent episodes of priapism in many patients, with a significant number associated with hematological diseases, notably sickle cell disease. Most treatments involved non-surgical methods. A notable finding was the correlation between the duration of priapism episodes and the likelihood of hospital admissions, suggesting that prolonged episodes often required more extensive medical attention. Priapism often presents as a chronic and recurrent condition requiring personalized management strategies. This study emphasizes the importance of recognizing regional occurrence patterns to enhance the management of priapism and suggests a need for further research in regions where this condition is less common.

(295) EARLY PLACEMENT OF INFLATABLE PENILE PROSTHESIS FOLLOWING PENOSCROTAL DECOMPRESSION

Abstract Introduction Ischemic priapism is the most common form of priapism which accounts for up to 95% of the cases. Prolonged ischemic priapism is associated with a higher risk of corpus spongiosum fibrosis and the development of erectile dysfunction. Studies have shown that treatment of ischemic priapism under 12 hours has an excellent prognosis and may prevent erectile dysfunction in 100% of cases. On the other end of the spectrum, ischemic priapism >36 hours may lead to permanent loss of erectile function in virtually all cases. Objective One of the newer procedures applied in cases of refractory priapism is the penoscrotal decompression approach which is technically similar to the inflatable penile prosthesis insertion technique. In cases of failed distal shunting, this procedure has proven to be useful in small-scale studies. In this method, a penoscrotal incision is made followed by corporotomy and and corporal dilation. It is suggested that penoscrotal decompression may be favorable to early IPP placement from an economical standpoint. Methods In our experience, a 42-year-old individual presented with a prolonged episode of ischemic priapism for approximately 36 hours which did not achieve detumescence by conservative management. A shared decision was made to proceed with penoscrotal decompression. However, the patient was unable to achieve detumescence after the procedure. We decided to insert a three-piece IPP approximately 48 hours after the penoscrotal decompression procedure. A separate inguinal counter-incision was made for reservoir placement according to the established protocols for IPP placement. Results Penoscrotal decompression may not always provide favorable outcomes and maintaining erectile function by IPP implantation may be considered afterwards. Conclusions The insertion of the prosthesis following penoscrotal decompression is more challenging than the normal setting as the primary priapism leads to more blood clot formation and intracavernosal adhesion and fibrosis. Disclosure No.

The impact of evolving synoptic weather patterns on multi-scale transport and sources of persistent high-concentration ozone pollution event in the Yangtze River Delta, China

High-concentration ozone pollution pose threats to ecosystems and human health. However, there is limited research on the impact of the alternating evolution of synoptic weather patterns (SWPs) on the multi-scale transport processes and sources of ozone. From June 14 to 18, 2018, a rare consecutive ozone pollution plagued in Hefei and broader Yangtze River Delta region (YRD). This study investigates the meteorological factors and sources using in-situ observational data and WRF-Chem model simulations. Analysis reveals a northeastern low-pressure system moving from north to south generated a cold front. This moving cold front facilitated the vertical transport of warm air masses carrying high-concentration ozone originating from North China. Subsequently, Ozone-rich air masses (ORMs) were transported over the YRD, influenced by the eastward movement of the Mongolian high-pressure system. Based on WRF-Chem model with NOx tagging mechanisms and WRF-FLEXPART backward simulations, it is confirmed that a notable atmospheric transport originated from North China region (NCR) to Hefei, especially on June 15. As the Mongolian high-pressure weakens and shifts east-southward, it carried ORMs generated by NOx emissions from the YRD, accumulating over the sea within the range of 120°E to 126°E and 25°N to 30°N. Both WRF-chem model results and TRopospheric Ozone and Precursors from Earth System Sounding (TROPESS) Chemistry Reanalysis dataset Version 2 (TCR-2) revealed the existence of ORMs in this geographic range. Subsequently, the ORMs carried out to sea by the weakened high-pressure system were reintroduced inland, influenced by southeast winds brought about by the peripheral circulation of typhoon “Gaemi”. In summary, the alternating evolution of SWPs significantly influences multi-scale ozone transport from both the NCR and the YRD regions, making substantial contributions to this prolonged episode. These findings offer valuable insights for improving regional ozone pollution prevention and control mechanisms.

The role of stressful traumatic events, personality traits and psychiatric disorders in the formation of chronic pain syndromes

BACKGROUND: Chronic pain syndrome is a highly prevalent condition that negatively affects the ability to work and quality of life, as well as worsening the prognosis of the disease and increasing the risk of early death. One of the most important scientific and practical medical tasks is the identification of risk factors for the transition of acute pain to chronic pain, which in the future will allow to develop mechanisms for preventing the development of chronic pain. It has been established that various psychological and psychopathological factors, in particular, personality traits and mental disorders, psychotraumatic events, make a significant contribution to the perpetuation of pain, but these data require clarification. AIM: To determine the contribution of stressful events, personality profile and comorbid psychiatric disorders to the formation of chronic pain syndromes. MATERIALS AND METHODS: The study included 105 patients aged 18 to 70 years with unexplained somatic or neurological pain syndrome that existed for more than 6 months and served as a reason for hospitalization. All patients underwent clinical-anamnestic and psychometric examination, statistical processing of the results was performed using SPSS Statistics v22. RESULTS: In the course of the study, 4 groups of patients with psychiatric disorders comorbid with chronic pain were formed: 1 — chronic pain within the framework of prolonged reaction to stress\exhaustion disorder, 42 observations (12 men, 30 women); 2 — chronic pain within the framework of prolonged masked depressive episodes, 41 observations (6 men, 35 women); 3 — chronic pain as part of hypochondriacal spectrum disorders (limited hypochondria), 15 observations (8 men, 7 women); 4 — chronic pain as part of constitutional anomalies with a tendency to experience pain (pain prone personality), 7 observations (5 men, 2 women). CONCLUSION: A significant association of chronic pain syndromes with stressful events has been established.

The diagnostic work-up in a 2-year-old girl with persistent mouth opening and oral malfunctions of unknown aetiology – case report

This study presents possible causes of recurrent prolonged episodes of oral malfunctions manifesting as permanently open mouth, salivation, and deglutition disorders. We present the case study of a girl hospitalised in the paediatric ward and then diagnosed by a multidisciplinary approach due to the lack of active and passive ability of mouth closing. Despite the comprehensive diagnostic work-up performed, no typical causes or organic reasons were determined. The comparative analysis included infectious, neurological, laryngological, vascular and orthopaedic diseases, and psychological and psychiatric factors. The diagnosis was made by exclusion; the psychological and habitual background was approved as the most probable reason for the symptoms.