Systemic Symptoms Research Articles

Health-related quality of life in non-alcoholic fatty liver disease: A cross-cultural study between Spain and the United Kingdom.

It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different nationalities. HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro. Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants. UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.

Frontal Sinus Displacement of Silicone Implant After Previous Rhinoplasty.

Rhinoplasty, a historic surgical procedure for facial esthetics, has been actively performed in Asia. The use of autologous tissues or artificial materials, such as silicone, Gore-Tex, and Medpore, is common in achieving cosmetic improvements. However, artificial material poses risks of inflammation and foreign body reactions, leading to complications like infection and necessitating material removal and antibiotic treatment. According to previous reports, various clinical aspects appear across inflammation, skin necrosis, and, in severe cases, systemic symptoms caused by implants. In this case study, the goal is to share a rare case of silicone implant migration into the frontal sinus after augmentation rhinoplasty. A 38-year-old female patient who had previously undergone rhinoplasty surgery visited the outpatient clinic complaining of headaches and a deviated nose. On computed tomography, the silicone implant moved upward, penetrating the nasoethmoid bone and invading the frontal sinus. Fortunately, there was no intracranial invasion. The authors planned the implant removal and performed the complete implant removal with capsulectomy. The patient has been undergoing follow-up without any complications after surgery. Augmentation rhinoplasty with implants, while common, carries long-term risks. This case highlights the severity of complications, emphasizing infection and migration into the frontal sinus and, in extreme cases, the brain cavity. Therefore, surgeons must continually refine operation techniques to minimize iatrogenic causes and consider modifying surgical procedures to prevent potential complications.

Erythema nodosum in northern Finland between 1996 and 2019: A register-based study.

Erythema nodosum (EN) is seen at any age with varying and often unidentified etiology. We studied the etiology and characteristics of EN in Northern Finland. Medical records of all patients with a diagnosis code for EN between 1996 and 2019 from Oulu University Hospital were retrieved and analyzed. There were in total 142 EN cases with a female predominance (n = 112, 72.9%). The mean age of the patients was 35.9 years. There were five cases diagnosed with EN in those younger than 2 years of age. Almost one third had EN nodules in multiple anatomical locations. In addition to skin findings, systemic symptoms were common (81.0%), and seen more often in men (p < 0.05). In children and adolescents, the most common etiological factors were gastroenteritis caused by 'Yersinia, Salmonella or Campylobacter', followed by inflammatory bowel diseases and hormonal contraception. Bacterial infections were the most common etiological factor among adults. In 28.2% of the cases there was no identified causative factor. In this study, EN was seen surprisingly often in small children. Etiological factors varied markedly among different age groups and symptoms differed between the sexes in adults. These aspects should be taken into account when diagnosing EN patients.

POEMS Syndrome

POEMS syndrome is a multisystem disorder associated with monoclonal plasma cell proliferation and the overproduction of vascular endothelial growth factors. The prognosis of POEMS syndrome has significantly improved owing to anti-myeloma treatments such as thalidomide and autologous stem cell transplantation. Therefore, early diagnosis and appropriate treatment are becoming increasingly important. A thorough and comprehensive evaluation of both systemic symptoms and laboratory abnormalities associated with the disease is essential for early diagnosis. The collaboration between neurology and hematology is indispensable to ensure proper treatment.

Targeted therapies in ameloblastomas and amelobastic carcinoma-A systematic review.

Targeted therapy has the potential to be used in the neoadjuvant setting for odontogenic tumors, reducing the morbidities associated with major surgery. In this regard, the aim of this study was to summarize the current evidence on the different forms of targeted therapy, effectiveness, and drawbacks of this course of treatment. Four databases were searched electronically without regard to publication date or language. Grey literature searches and manual searches were also undertaken. Publications with sufficient clinical data on targeted therapy for odontogenic tumors were required to meet the criteria for eligibility. The analysis of the data was descriptive. A total of 15 papers comprising 17 cases (15 ameloblastomas and 2 ameloblastic carcinomas) were included. Numerous mutations were found, with BRAF V600E being most common. Dabrafenib was the most utilized drug in targeted therapy. Except for one case, the treatment reduced the size of the lesion (16/17 cases), showing promise. Most of the adverse events recorded were mild, such as skin issues, voice changes, abnormal hair texture, dry eyes, and systemic symptoms (e.g., fatigue, joint pain, and nausea). It is possible to reach the conclusion that targeted therapy for ameloblastoma and ameloblastic carcinoma may be a useful treatment strategy, based on the findings of the included studies.

Post-traumatic Central or Axial atlantoaxial dislocation (CAAD) presenting with ‘atypical’ symptoms- Analysing the role of dynamic imaging on the basis of experience with 14 patients treated by atlantoaxial fixation surgery

This is a report of a series of 14 patients who presented with a range of 'atypical' cranial, spinal and systemic symptoms that started after they suffered relatively severe injury to the head and/or neck several months or years prior to the surgical treatment. Implications of diagnosing and treating central or axial atlantoaxial instability (CAAD) is discussed. Role of dynamic rotatory and lateral head tilt imaging in the diagnosis and treatment is analysed. There were 7 males and 7 females and their ages ranged from 21 to 64 years (average 42 years). Due to the severity of presenting neurological and non-neurological symptoms, all patients lost their occupation and were heavily dependent on painkillers and/or antidepressant drugs. In addition to other tell-tale clinical and radiological evidence, diagnosis of CAAD was made based on facetal alignments on lateral profile imaging in neutral head position. Dynamic head flexion-extension, lateral head tilt and neck rotation imaging confirmed and subclassified CAAD. All patients underwent atlantoaxial fixation surgery. A personalized self-assessment clinical scoring parameter and the WHODAS 2.0 was used to evaluate the outcome. One patient did not follow-up after surgery. At a minimum follow-up of 6 months after atlantoaxial fixation surgery, there was relief from all major symptoms in the rest of 13 patients. Diagnosing and treating CAAD can have 'major' therapeutic implications in patients presenting with progressively worsening disabling clinical symptoms following relatively severe head/neck trauma.

Safety and immunogenicity of a polyvalent DNA–protein HIV vaccine with matched Env immunogens delivered as a prime–boost regimen or coadministered in HIV-uninfected adults in the USA (HVTN 124): a phase 1, placebo-controlled, double-blind randomised controlled trial

An effective HIV vaccine will most likely need to have potent immunogenicity and broad cross-subtype coverage. The aim of the HIV Vaccine Trials Network (HVTN) 124 was to evaluate safety and immunogenicity of a unique polyvalent DNA-protein HIV vaccine with matching envelope (Env) immunogens. HVTN 124 was a randomised, phase 1, placebo-controlled, double-blind study, including participants who were HIV seronegative and aged 18-50 years at low risk for infection. The DNA vaccine comprised five plasmids: four copies expressing Env gp120 (clades A, B, C, and AE) and one gag p55 (clade C). The protein vaccine included four DNA vaccine-matched GLA-SE-adjuvanted recombinant gp120 proteins. Participants were enrolled across six clinical sites in the USA and were randomly assigned to placebo or one of two vaccine groups (ie, prime-boost or coadministration) in a 5:1 ratio in part A and a 7:1 ratio in part B. Vaccines were delivered via intramuscular needle injection. The primary outcomes were safety and tolerability, assessed via frequency, severity, and attributability of local and systemic reactogenicity and adverse events, laboratory safety measures, and early discontinuations. Part A evaluated safety. Part B evaluated safety and immunogenicity of two regimens: DNA prime (administered at months 0, 1, and 3) with protein boost (months 6 and 8), and DNA-protein coadministration (months 0, 1, 3, 6, and 8). All randomly assigned participants who received at least one dose were included in the safety analysis. The study is registered with ClinicalTrials.gov (NCT03409276) and is closed to new participants. Between April 19, 2018 and Feb 13, 2019, 60 participants (12 in part A [five men and seven women] and 48 in part B [21 men and 27 women]) were enrolled. All 60 participants received at least one dose, and 14 did not complete follow-up (six of 21 in the prime-boost group and eight of 21 in the coadminstration group). 11 clinical adverse events deemed by investigators as study-related occurred in seven of 48 participants in part B (eight of 21 in the prime-boost group and three of 21 in the coadministration group). Local reactogenicity in the vaccine groups was common, but the frequency and severity of reactogenicity signs or symptoms did not differ between the prime-boost and coadministration groups (eg, 20 [95%] of 21 in the prime-boost group vs 21 [100%] of 21 in the coadministration group had either local pain or tenderness of any severity [p=1·00], and seven [33%] vs nine [43%] had either erythema or induration [p=0·97]), nor did laboratory safety measures. There were no delayed-type hypersensitivity reactions or vasculitis or any severe clinical adverse events related to vaccination. The most frequently reported systemic reactogenicity symptoms in the active vaccine groups were malaise or fatigue (five [50%] of ten in part A and 17 [81%] of 21 in the prime-boost group vs 15 [71%] of 21 in the coadministration group in part B), headache (five [50%] and 18 [86%] vs 12 [57%]), and myalgia (four [40%] and 13 [62%] vs ten [48%]), mostly of mild or moderate severity. Both vaccine regimens were safe, warranting evaluation in larger trials. US National Institutes of Health and US National Institute of Allergy and Infectious Diseases.

Genome Mining Leads to Diverse Sesquiterpenes with Anti-inflammatory Activity from an Arctic-Derived Fungus.

With the advancement of bioinformatics, the integration of genome mining with efficient separation technology enables the discovery of a greater number of novel bioactive compounds. The deletion of the key gene responsible for triterpene cyclase biosynthesis in the polar strain Eutypella sp. D-1 instigated metabolic shunting, resulting in the activation of dormant genes and the subsequent production of detectable, new compounds. Fifteen sesquiterpenes were isolated from the mutant strain, with eight being new compounds. The structural elucidation of these compounds was obtained through a combination of HRESIMS, NMR spectroscopy, and ECD calculations, revealing six distinct skeleton types. Compound 7 possessed a unique skeleton of 5/10 macrocyclic ether structure. Based on the gene functions and newly acquired secondary metabolites, the metabolic shunting pathway in the mutant strain was inferred. Compounds 6, 8, 11, 14, and 15 exhibited anti-inflammatory effects without cytotoxicity through the release of nitric oxide from lipopolysaccharide-stimulated RAW264.7 cells. Notably, acorane-type sesquiterpene 8 inhibited nitric oxide production and modulated the MAPK and NLRP3/caspase-1 signaling pathways. Compound 8 also alleviated the CuSO4-induced systemic neurological inflammation symptoms in a transgenic fluorescent zebrafish model.

A propensity score matched analysis of COVID-19 ongoing symptoms in primary medical staff members with different levels of stress in Jiangsu Province, China

ObjectiveOngoing symptoms which originated from coronavirus disease 2019 (COVID-19) infections threaten the health of a broad population of patients. With recent changes in COVID-19 control measures in China, medical staff members are currently experiencing a high level of stress. This study aimed to investigate the prevalence of ongoing symptomatic COVID-19 and explore the potential association between stress and ongoing COVID symptoms. MethodsFrom January 17th to February 2, 2023, primary medical staff members in Jiangsu Province were surveyed using a self-designed questionnaire. Univariate multinomial logistic analysis was used to illustrate the relationship between stress and ongoing symptoms after matching the low- and high-stress groups in a 1:1 ratio based on propensity scores. ResultsAnalysis revealed that 14.83 % (3785/25,516) of primary medical staff members infected with COVID-19 experienced ongoing symptoms, the most common of which included cough (9.51 %), dyspnea (9.51 %), sleep problems (4.40 %), anxiety (2.29 %), and reproductive system symptoms (1.89 %). In matched patients, higher stress levels were associated with a greater risk of ongoing symptoms than in patients without ongoing symptoms for 14 of the 15 reported symptoms in this study (odds ratios [ORs] > 1 and P < 0.05). Moreover, higher levels of stress were associated with a greater risk of more ongoing symptoms, and the overall ORs increased with the number of symptoms (ORs >1 and P < 0.05). ConclusionTo mitigate the possibility of experiencing ongoing symptoms, healthcare organizations and local authority agencies should institute helpful measures to decrease stress levels such as medical staff augmentation and enabling all staff to have a reasonable work-life balance.

Ischemic stroke due to stylocarotid artery syndrome: a case report and review.

Stylocarotid artery syndrome (SAS) is a rare variant of Eagle's syndrome that may lead to transient ischemic attack or stroke. The underlying pathophysiological mechanism involves compression of the internal carotid artery by an elongated styloid process (ESP), potentially resulting in vascular occlusion or dissection. An ESP exceeding 2.5 cm is deemed elongated, with a length of 3.0 cm considered clinically significant. Although the prevalence of ESP ranges from 4.0% to 7.3%, symptomatic cases are rare; symptoms are present in only approximately 4.0% of individuals with an ESP. Unlike the typical symptoms of Eagle's syndrome, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms as well as the development of central nervous system symptoms often leads patients to seek care from neurologists instead of otolaryngologists, increasing the likelihood of misdiagnosis or underdiagnosis. We herein report a unique case of ischemic stroke caused by SAS and present a literature review on cases of SAS-associated ischemic stroke published in the past decade. The reporting of this study conforms to the CARE guidelines.

Advanced human immunodeficiency virus (HIV) does not affect ability to utilize lymphadenopathy in assessment of drug reaction with eosinophilia and systemic symptoms syndrome in HIV and tuberculosis: Prospective comparative study

Advanced human immunodeficiency virus (HIV) does not affect ability to utilize lymphadenopathy in assessment of drug reaction with eosinophilia and systemic symptoms syndrome in HIV and tuberculosis: Prospective comparative study

Clinical analysis of cytomegalovirus infection-associated hemophagocytic lymphohistiocytosis in five patients without underlying diseases

The clinical data of five patients [one male and four female; median age: 31 (21-65) years] with cytomegalovirus (CMV)-induced hemophagocytic lymphohistiocytosis (HLH) diagnosed and treated in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed from January 2011 to December 2020. None of the patients had any underlying disease, and all were immunocompetent. The main clinical presentations were fever in all five patients, splenomegaly in four, enlarged lymph nodes in two, liver enlargement in one, and rash in three. Pulmonary infection was found in three patients, two of whom developed respiratory failure. Two patients had jaundice. Central nervous system symptoms and gastrointestinal bleeding were observed in one case. All patients received glucocorticoids and antiviral therapy. One patient was treated with the COP (cyclophosphamide+vincristine+prednisone) chemotherapy regimen after antiviral therapy failed and he developed central nervous system symptoms. After treatment, four patients achieved remission, but the fifth pregnant patient eventually died of disease progression after delivery. CMV-associated HLH in an immunocompetent individual without underlying diseases is extremely rare, and most patients have favorable prognosis. Antiviral therapy is the cornerstone of CMV-HLH treatment.

Vaccine adherence and adverse events of the SARS-COV vaccine in patients with inflammatory bowel disease

ObjectiveTo assess adherence to and the adverse effects of the SARS-COV vaccine in patients with inflammatory bowel disease (IBD). Patients and methodsThis is an observational, analytical, cross-sectional study. Sociodemographic and clinical data, SARS-COV vaccine data, medications for IBD with use during the vaccination period, and adverse events during the vaccination period were collected. Carried out logistic regressions with robust variance estimation to estimate the odds ratio with the respective 95% confidence intervals (95%CI) to assess the factors associated with non-serious adverse effects following vaccine doses as outcome variables. Results194 patients participated, with vaccine compliance of 78.3% for three doses of any vaccine (n=152). Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. The first dose of the SARS-COV vaccine with AstraZeneca had a higher percentage of patients with vaccine symptoms. AstraZeneca vaccine increased the chance of non-serious adverse effects in IBD patients by 2.65 times (95% CI: 1.38–5.08; p=0.003), regardless of age, gender, physical activity, excess weight, use of disease-modifying drugs, immunobiological and corticosteroids. CoronaVac vaccine was associated with asymptomatic patients at the first dose and reduced the chance of adverse effects by 0.28 times (OR: 0.284; 95%CI: 0.13–0.62; p=0.002). ConclusionLocal symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. Using CoronaVac in the first dose reduced the chances of adverse effects, while AstraZeneca increased the risk of adverse effects.

Drug Reaction with Eosinophilia and Systemic Symptoms Induced by Diosmin and Hesperidin: A Case Report

Drug Reaction with Eosinophilia and Systemic Symptoms Induced by Diosmin and Hesperidin: A Case Report

ALDRESS: A Retrospective Pilot Study to Develop a Pharmacological Causality Algorithm for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a severe form of drug hypersensitivity reaction characterized by significant morbidity, mortality, and long-term sequelae, coupled with limited therapeutic avenues. Accurate identification of the causative drug(s) is paramount for acute management, exploration of safe therapeutic alternatives, and prevention of future occurrences. However, the absence of a standardized diagnostic test and a specific causality algorithm tailored to DRESS poses a significant challenge in its clinical management. Methods: We conducted a retrospective case-control study involving 37 DRESS patients to validate a novel causality algorithm, the ALDRESS, designed explicitly for this syndrome, comparing it against the current standard algorithm, SEFV. Results: The ALDRESS algorithm showcased superior performance, exhibiting an 85.7% sensitivity and 93% specificity with comparable negative predictive values (80.6% vs. 97%). Notably, the ALDRESS algorithm yielded a substantially higher positive predictive value (75%) compared to SEFV (51.40%), achieving an overall accuracy rate of 92%. Conclusions: Our findings underscore the efficacy of the ALDRESS algorithm in accurately attributing causality to drugs implicated in DRESS syndrome. However, further validation studies involving larger, diverse cohorts are warranted to consolidate its clinical utility and broaden its applicability. This study lays the groundwork for a refined causality assessment tool, promising advancements in the diagnosis and management of DRESS syndrome.

Rational timepoint of medical rehabilitation in chronic tinnitus : Applying for rehabilitation options for achronic course

Chronic tinnitus is acommon symptom of the auditory system. Acausal therapy does not yet exist. The recommended treatment includes expert counseling, psychotherapeutic interventions, particularly cognitive behavioral therapy, and measures to improve hearing. The treatment modules are multimodal and can be combined individually. Depending on the severity of the different disease dimensions (tinnitus and comorbidities), arehabilitative approach may be useful for maintaining health and occupational ability. In addition to athorough and well-founded diagnosis and counseling, specific cognitive behavioral therapy and non-specific psychotherapeutic interventions (mindfulness/relaxation) on an individual or group basis, physiotherapy, and exercise, as well as auditory rehabilitation measures (hearing aids, auditory therapy) in the context of multimodal therapy approaches are necessary.

Juvenile xanthogranuloma manifesting with LCH-associated neurodegenerative disease-like radiological findings.

Here, we describe two patients with juvenile xanthogranuloma (JXG) manifesting with Langerhans cell histiocytosis (LCH)-associated neurodegenerative disease (ND)-like radiological findings. One patient showed typical radiological abnormalities at onset, which worsened with progressing central nervous system symptoms 7years after LCH-oriented chemotherapy. Another showed spontaneous regression of clinical symptoms, with a transient radiological change 1year after salvage chemotherapy for recurrence of JXG. These data regarding JXG-associated ND will facilitate future investigation of the disease, as well as development of therapeutic interventions.

Exposures and Health Effects of Diacetyl and 2,3-Pentanedione in a Coffee Processing Facility

Diacetyl and 2,3-pentanedione are alpha-diketones that are generated during the coffee roasting process and have been shown to be related to respiratory symptoms, abnormal lung function, and in rare cases, an irreversible disease called obliterative bronchiolitis. This study measured personal exposures in a coffee roastery in New Zealand using thermal desorption tubes and explored the prevalence of respiratory symptoms with a health questionnaire. Exposures from task samples were highest for grinding (Geometric Mean (GM): 22.5 ppb diacetyl; GM: 19.3 ppb 2,3-pentanedione), followed by packaging (GM: 10.8 ppb diacetyl; GM: 9.3 ppb 2,3-pentanedione) and then roasting (GM: 4.7 ppb diacetyl; GM: 4.1 ppb diacetyl). 8-h time-weighted average (TWA) diacetyl exposures exceeded the National Institute of Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) of 5 ppb for Roaster/Packager (GM: 6.6 ppb) and Grinder (GM: 5.3 ppb). 8-h TWA concentrations were below the NIOSH REL of 9.3 ppb for 2,3-pentanedione (Roaster/Packager, GM: 5.7 ppb; Grinder, GM: 4.6 ppb). Workers reported nose, eye symptoms and systemic symptoms (flu-like illness or achy joints, fever or chills, or unusual tiredness or fatigue). The results indicated that exposure was highest for tasks involving ground coffee beans and that coffee processing workers can be exposed to alpha-diketones above the NIOSH RELs. Further research into alpha-diketone exposure and health effects, and control measures to minimise exposure are recommended.

Surgical correction of 7 abdominal wall hernias using a hybrid technique

Incisional hernias are defects of the abdominal wall under previous scarring. They are an important epidemiological factor, as they account for 11% of laparotomy surgeries performed by surgeons. They have local and systemic symptoms, including pain, fullness, bulging, and edema, which can even lead to ischemia and tissue necrosis. Comorbidities are important aggravating factors and the surgical techniques used for correction, which consist of laparotomy and video-laparoscopy, both must be effective to avoid complications, including recurrences. The herniorrhaphy and hernioplasty techniques are constantly described in the literature, but using a mixed technique is something little seen that challenges the knowledge of the medical team and addresses the professional's judgment to encompass both prior knowledge and the patient's social and comorbid profile.

Meningococcal Disease Presenting with Acute Myopericarditis and Concurrent Acute Meningitis

Emergency department physicians uncommonly associate myopericarditis with bacterial infection and, even more rarely, encounter myopericarditis caused by meningococcal infection. This case report describes a 38-year-old man who presented with chest pain, electrocardiographic changes, and cardiac biomarkers consistent with acute myopericarditis and rapidly developed central nervous system symptoms that were concerning for acute bacterial meningitis. The diagnosis of Neisseria meningitidis infection was confirmed by blood cultures. Once identified, the patient made a full recovery following a course of intravenous antibiotic therapy. This case underscores the difficulty of diagnosing this rare, but potentially life-threatening, condition in the emergency department.