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Parvovirus B19 (B19V) is a significant pathogen responsible for a wide range of clinical manifestations, particularly in children and pregnant women. While B19V is most commonly recognized as the cause of Fifth disease, a mild erythematous illness in children, its clinical impact extends far beyond this condition. B19V can lead to severe complications, including transient aplastic crisis in individuals with chronic hemolytic anemias, arthralgia, and more severe joint diseases. During pregnancy, B19V infection poses serious risks, such as spontaneous abortion, non-immune hydrops fetalis, and fetal anemia, particularly when infection occurs between 9 and 20 weeks of gestation. Moreover, B19V is associated with a variety of organ system involvements, including cardiac, neurological, hepatic, and renal complications. These manifestations can range from mild to life-threatening, necessitating a broad spectrum of therapeutic approaches, including symptomatic care, immunoglobulins, corticosteroids, and supportive therapies. Despite the significant clinical burden posed by B19V, no specific antiviral treatment or vaccine is currently available, making early recognition and prompt management crucial for improving patient outcomes. This review provides a comprehensive overview of the diverse clinical presentations of B19V infection, with a focus on pediatric and pregnancy-related complications. It underscores the need for ongoing research into targeted therapies and highlights the importance of vigilant clinical management to mitigate the severe consequences of this pervasive virus. [ABSTRACT FROM AUTHOR]

A 51-year-old female sanitation worker in China developed bilateral neuroretinitis due to scrub typhus. Initially diagnosed with ‘scrub typhus infected pneumonia’, her symptoms subsided within seven days of chloramphenicol treatment. However, two weeks later, she experienced acute bilateral vision loss. Fundoscopy revealed swollen optic discs, exudates, and a small macular pigment epithelial detachment. Diagnosed with scrub typhus-related neuroretinitis, her vision improved after methylprednisolone treatment. This represents the first reported case of such in southern China, suggesting a delayed immune response to scrub typhus. Early diagnosis and proper treatment are crucial for vision prognosis. [ABSTRACT FROM AUTHOR]

Background: This study investigated the factors influencing the prognosis of children with steroid-resistant nephrotic syndrome (SRNS) in patients from the Guangxi region. Methods: We retrospectively analyzed clinical and pathological data of 279 patients with SRNS from six tertiary hospitals in Guangxi. Clinical data were compared between initial (I-SRNS) and secondary (S-SRNS) steroid resistance subgroups and Cox regression analysis was used to determine risk factors for chronic kidney disease (CKD) and CKD stage 5 (CKD5) in patients with SRNS. Results: The median age of onset was 54 months. Thirty-three patients had extra-kidney manifestations. Fifty-two, 24, 57, 33, and 41 patients had hypertension, acute kidney injury, vitamin D deficiency, high intraocular pressure, and dwarfism, respectively. One hundred eighty-two and 92 patients had I-SRNS and S-SRNS, respectively. There were significant differences in sex, ethnicity, family history, incidence of hematuria, clinical classification, efficacy of immune agents, and prognosis between groups (P < 0.05). Among the 279 cases of SRNS, 239 had normal kidney function, 37 developed CKD, and 16 had CKD5. An increase in serum creatinine level (HR = 1.003) was significantly associated with CKD in children with SRNS, and effective immunosuppressant therapy decreased the CKD risk (HR = 0.168). Patients with increased serum creatinine levels (HR = 1.003) and acute kidney injury (HR = 4.829) were more likely to progress to CKD5. Conclusions: Children with S-SRNS showed a higher response to immunosuppressants than those with I-SRNS. Effective immunosuppressant therapy was found to protect against CKD, whereas increased acute kidney injury was an independent risk factor for CKD5. [ABSTRACT FROM AUTHOR]

Background: To analyze the clinical manifestations, endoscopic features, pathological features, endoscopic resection, and prognosis of esophageal granular cell tumors (GCTs). Methods: The present study retrospectively analyzed and followed up the clinical data of 62 patients diagnosed with esophageal GCTs who underwent endoscopic resection at Zhongshan Hospital of Fudan University between July 2007 and March 2022. The clinicopathological features, endoscopic diagnosis, and treatment experience of esophageal GCT patients were summarized. Results: Among the 62 patients with esophageal GCT, there were 34 males and 28 females, with an average age of 49.3 ± 11.7 years. Only 11 patients had symptoms, such as epigastric discomfort, regurgitation or dysphagia. One patient had multiple lesions, and the rest had single lesions, totaling 63 lesions. Most lesions (53/63) were located in the median and lower esophagus, the diameters ranged from 3 to 22 mm. The endoscopic morphology of the GCTs was molar, flat, hemispherical, or irregular submucosal protuberance. Endoscopic ultrasound (EUS) was performed in 38 cases, most cases (31/38) were hypoechoic, and 32 cases were appeared as homogeneous lesions. There were no complications during or after the endoscopic operations, and the en bloc resection rate was 100%. The negative rate of microscopic incisional margin was 63.5% (40/63). No patients developed recurrence during the follow-up period. The follow-up duration was 21–197 months (100.5 months for average). Conclusion: Esophageal GCT is a rare disease with no obvious symptoms and a good prognosis. Endoscopic resection is a safe and effective method of diagnosis and treatment for esophageal GCTs. A microscopic positive tumor margin may not increase the rate of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the therapeutic efficacy of intravenous amoxicillin clavulanate potassium combined with nebulized budesonide and ambroxol hydrochloride in pediatric community-acquired pneumonia (CAP) and its impact across various microbial strains and clinical symptoms. The primary objective of this study is to evaluate the efficacy of intravenous amoxicillin-clavulanate combined with nebulized budesonide and ambroxol hydrochloride in the treatment of pediatric community-acquired pneumonia (CAP), and to analyze their impact on different microbial strains and clinical symptoms. Secondary objectives include assessing the treatment's effect on the improvement of clinical symptoms, hospital stay duration, and the levels of inflammatory markers. Design: Prospective, single-center study. Methods: Fifty-six children with CAP, aged under 6 years, from Affiliated Maternity and Child Health Care Hospital of Nantong University were included. Patients were treated with conventional therapy and the study medication. Clinical characteristics, microbiological data, symptom improvement, and hospitalization times were analyzed. Findings: Young children, particularly under 1 year, exhibited a higher incidence of multiple microbial infections and severe clinical manifestations. Treatment with budesonide and ambroxol hydrochloride led to significant clinical improvement across all age groups, with notable efficacy against various pathogens. Conclusions: Nebulized budesonide and ambroxol hydrochloride are effective in treating pediatric CAP, offering a promising therapeutic option, particularly for young children with severe presentations. [ABSTRACT FROM AUTHOR]

Introduction: Juvenile-onset systemic lupus erythematosus (jSLE) is a rare chronic autoimmune disease with multisystemic involvement that can cause significant damage, disability and death. jSLE has a more severe disease presentation than lupus in adults, with a higher incidence of major organ involvement. Aim of the study is to determine the presenting clinical and laboratory characteristics of jSLE patients and to compare symptoms at disease onset from our cohort through a review of the literature. Materials and methods: rretrospective review of medical records encompassing all juvenile systemic lupus erythematosus (jSLE) patients treated in department from July 2007 to July 2024. Upon disease presentation, we abstracted array of clinical and laboratory indices: constitutional symptoms, skin and mucosal changes, arthritis, renal and CNS involvement, CRP, ESR, WBC, platelet count, DCT, ANA, anti-DsDNA, anti-Sm, antiphospholipid antibodies, C3, C4, and RF. Results:. Nineteen children (15 girls and 4 boys) were diagnosed with jSLE. The mean age was 11 years. Arthralgia was the most common complaint (78%), followed by fever, (47%). The most common clinical manifestation was arthritis (62%), followed by renal disease (68%), leukopenia (57%), oral ulcers and thrombocytopenia (42%), malar rash (31%), serositis (21%), and CNS symptoms (16%). Four patients (21%) had stage 2 nephritis, one had stage 3 nephritis, and three (16%) had stage 4 nephritis. All exhibited elevated ESR and positive ANA. Majority of patients had elevated anti-DsDNA (83%), anti-Sm (52%), antiphospholipid antibodies(62%), and anti-ribonucleoprotein antibodies in 9 patients (47%). Low C3 levels were observed in 14 patients (73%) and low C4 levels in 17 patients (88%). Conclusion: (jSLE) is a challenging disease in terms of both diagnosis and treatment. Any case of fever of unknown origin, particularly when accompanied by joint pain, should prompt an evaluation for jSLE. In our cohort, the most common presenting symptoms were fever, arthritis, and arthralgia. [ABSTRACT FROM AUTHOR]

Objective: This study compared the clinical presentations and disease severity between influenza A and B (FLUA and FLUB). Materials and Methods: The study included children hospitalized with virologically confirmed influenza between 2010 and 2020. The severity of the disease was evaluated based on admission to the pediatric intensive care unit (PICU), mechanical ventilation requirement, length of hospital stay, length of stay in the PICU, and death. Influenza viruses were compared within predefined age groups (0-2, 3-9, and 10-18 years) and in all age groups. Results: Of 343 patients, FLUA and FLUB were detected in 75.8% and 24.2% of children, respectively. FLUB was associated with a higher incidence of headache and abdominal pain (P < .001 and P = .01). Children with FLUB were prescribed antibiotics and antivirals 0.56 and 0.58- fold fewer than those with FLUA. Headache and abdominal pain rates were higher in patients between 3 and 9 years with FLUB. Children between 0 and 2 years with FLUA were more frequently admitted to the PICU than those with FLUB (23.6% vs. 4.0%; P < .004). Eight patients with FLUA died, while only 1 with FLUB died (P = .69). Conclusion: The clinical presentation of FLUA and FLUB appeared similar, except for headache and abdominal pain, which were more prevalent in older patients with FLUB. Our study revealed that children between 0 and 2 years with FLUA were at a significantly higher risk for admission to the PICU. As a result, greater attention and awareness should be paid to children under 2 years old with FLUA. [ABSTRACT FROM AUTHOR]

Elevated immunoglobulin E (IgE) levels are commonly associated with allergies. However, high IgE levels are also found in several other infectious and non-infectious disorders. Elevated IgE levels typically suggest allergies, eczema, or recurrent skin infections. Hyperimmunoglobulin E (hyper-IgE) levels typically reflect a monogenic atopic condition or inborn immune defects with an atopic phenotype. The aim of our research is to investigate and observe the clinical characteristics of children with increased IgE levels who have previously manifested infectious diseases. Furthermore, the retrospective study considers other factors, such as demographic characteristics (sex, area/environment, and age), and their effect on IgE serum levels. To answer this question, we conducted a one-year hospital-based retrospective study that included 200 hospitalized children who had at least two viral or bacterial infections in the six months preceding hospitalization. Measurements of IgE and allergen panels (respiratory and digestive) using blood samples revealed that individuals who tested positive for the body's synthesis of hyper-IgE were not observably allergic to any potential allergens despite having higher total serum IgE. According to the results, there was a strong correlation between elevated IgE serum levels and a history of infectious diseases among the patients. [ABSTRACT FROM AUTHOR]

A twig-like middle cerebral artery (MCA) is an uncommon lesion in which a plexiform network of small vessels replaces the M1 segment of the MCA. Currently, we have insufficient information for twig-like MCAs. Therefore, a review of the literature using PubMed was conducted. In this review of twig-like MCAs, the following were discussed: the definition, pathogenesis, hemodynamics, associated aneurysm, clinical manifestations, imaging examinations, therapeutic strategies, therapeutic complications and prognosis. In addition, we proposed a reasonable grading system for twig-like MCAs, which is significant. For a twig-like MCA, the pathogenesis is unclear, and congenital and acquired factors can be involved. A twig-like MCA disturbed cerebral hemodynamics. An associated aneurysm can occur in patients with twig-like MCAs. Twig-like MCAs can present subclinically and without clinical symptoms, hemorrhage, or ischemic strokes. Of all the available imaging examinations, digital subtracted angiography is the gold standard. When treating a twig-like MCA, it is feasible to target the associated aneurysm, and extracranial-intracranial bypass can be effective in reducing the risk of strokes, but more evidence is needed. Now, the decision to perform surgery for twig-like MCAs should be made on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Retinitis pigmentosa (RP) is a heterogeneous inherited retinal disorder. Mutations in KIZ cause autosomal recessive (AR) RP. We aimed to characterize the genotype, expression pattern, and phenotype in a large cohort of KIZ cases. Sanger and whole exome sequencing were used to identify the KIZ variants. Medical records were reviewed and analyzed. Thirty-one patients with biallelic KIZ mutations were identified: 28 homozygous for c.226C>T (p.R76*), 2 compound heterozygous for p.R76* and c.3G>A (p.M1?), and one homozygous for c.247C>T (p.R83*). c.226C>T is a founder mutation among patients of Jewish descent. The clinical parameters were less severe in KIZ compared to DHDDS and FAM161A cases. RT-PCR analysis in fibroblast cells revealed the presence of four different transcripts in both WT and mutant samples with a lower percentage of the WT transcript in patients. Sequence analysis identified an exonic sequence enhancer (ESE) that includes the c.226 position which is affected by the mutation. KIZ mutations are an uncommon cause of IRD worldwide but are not rare among Ashkenazi Jews. Our data indicate that p.R76* affect an ESE which in turn results in the pronounced skipping of exon 3. Therefore, RNA-based therapies might show low efficacy since the mutant transcripts are spliced. [ABSTRACT FROM AUTHOR]

Nasal glial heterotopia (NGH), formerly known as nasal glioma, is a rare congenital developmental abnormality. A two-year-old female infant with intranasal NGH was admitted to Affiliated Hospital of Yangzhou University in 2023. The patient treated in the Department of Otorhinolaryngology Head and Neck Surgery in our hospital due to bilateral runny nose. Finding a nasal space occupying lesion in the left nasal cavity, she was hospitalized as “nasal space occupying lesion (left)”. Consequently, she underwent surgical treatment after completing the relevant examinations. The postoperative pathological examination results showed it was glioma, and then she was diagnosed with intranasal type of nasal glial heterotopia finally. After half a year of postoperative follow-up, there was no recurrence and complications such as meningitis and cerebrospinal fluid rhinorrhea. The incidence of NGH is very low, and it is easy to miss diagnosis. For congenital nasal midline tumors in children, NGH should be considered when CT results suggest the tumor is not communicated with the skull, which has a good prognosis after surgical treatment. [ABSTRACT FROM AUTHOR]

The present study aims to explore the effect of COVID-19 infection on pregnant women in plateau regions. Data from 381 pregnant women infected with COVID-19 who underwent prenatal examination or treatment at Women and Children's Hospital of Tibet Autonomous Region between January 2020 and December 2022 and 314 pregnant women not infected with COVID-19 were retrospectively collected. The study participants were divided into an infected and non-infected group according to whether they were infected with COVID-19. Basic information (ethnicity, age, body mass index and gestational age [GA]), vaccination status, intensive care unit (ICU) admission and delivery outcomes were compared. Binary logistic regression was used to analyse the influencing factors of ICU admission. The results revealed significant differences in the GA, vaccination rate, blood pressure, partial pressure of oxygen, white blood cell (WBC) count, ICU admission rate, preeclampsia rate, forearm presentation rate, thrombocytopenia rate, syphilis infection rate and placental abruption rate between the two groups (P < 0.05). A univariate analysis showed that COVID-19 infection, hepatitis B virus infection, the WBC count and hypoproteinaemia were risk factors for ICU admission. The results of the multivariate analysis of the ICU admission of pregnant women showed that COVID-19 infection (odds ratio [OR] = 4.271, 95 % confidence interval [CI]: 3.572–5.820, P < 0.05) was a risk factor for ICU admission and the WBC count (OR = 0.935, 95 % CI: 0.874–0.947, P < 0.05) was a protective factor for ICU admission. Pregnant women are vulnerable to the adverse consequences of COVID-19 infection, and public health measures such as vaccination are needed to protect this population subgroup. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. CVT is estimated to account for <1% of all strokes. Unlike arterial strokes, CVT tends to affect young patients with a female predominance, is often nonapoplectic in onset, and has a wide spectrum of clinical presentations. These and other features make CVT a challenging disease to diagnose without an understanding of its evolving epidemiology, clinical features, associated conditions, and the neuroimaging findings typically needed to confirm the diagnosis. Methods: This descriptive study retrospectively collected 39 CVT cases in Dr. Wahidin Sudirohusodo General Hospital Makassar. Data were taken from patients' medical records, radiological records, and catheter lab data records. The clinical manifestation and angiographic findings variables of consecutive CVT cases that had digital subtraction angiography (DSA) between January 2017 and December 2023 were analyzed. Results: This study was conducted on a total of 39 CVT patients with a mean age of 42.26 ± 12.98 years, mostly female 53.84%. The most clinical manifestation was vascular headache (87.2%). Presentation of hemiparesis was 30.8%, diplopia was 20.5%, and seizure 10.3%. Based on angiographic findings, most thrombosis is located in the cavernous sinus, as many as 41%, followed by superior sinus sagitalis (SSS), as many as 30.8%, and tranversus sinus (25.6%). The patient with the manifestation of vascular headache was female and located in the cavernous sinus. All patients presented with diplopia were located in the cavernous sinus. Conclusion: Most of CVT's patients were female and of productive age, with the most clinical presentation was vascular headache followed by focal neurological deficits like hemiparesis and diplopia. Based on angiographic findings, mostly thrombosis is located in the cavernous sinus, followed with the superior sagitalis sinus (SSS). The characteristics of patient CVT with vascular headaches mostly were female with thrombosis located in the cavernous sinus. [ABSTRACT FROM AUTHOR]

Objectives Anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5+) DM complicated by rapidly progressive interstitial lung disease (RP-ILD) has a high incidence and poor prognosis. The objective of this study was to establish a model for the prediction and early diagnosis of anti-MDA5+ DM-associated RP-ILD based on clinical manifestations and imaging features. Methods A total of 103 patients with anti-MDA5+ DM were included. The patients were randomly split into training and testing sets of 72 and 31 patients, respectively. After image analysis, we collected clinical, imaging and radiomics features from each patient. Feature selection was performed first with the minimum redundancy and maximum relevance algorithm and then with the best subset selection method. The final remaining features comprised the radscore. A clinical model and imaging model were then constructed with the selected independent risk factors for the prediction of non-RP-ILD and RP-ILD. We also combined these models in different ways and compared their predictive abilities. A nomogram was also established. The predictive performances of the models were assessed based on receiver operating characteristics curves, calibration curves, discriminability and clinical utility. Results The analyses showed that two clinical factors, dyspnoea (P  = 0.000) and duration of illness in months (P  = 0.001), and three radiomics features (P  = 0.001, 0.044 and 0.008, separately) were independent predictors of non-RP-ILD and RP-ILD. However, no imaging features were significantly different between the two groups. The radiomics model built with the three radiomics features performed worse than the clinical model and showed areas under the curve (AUCs) of 0.805 and 0.754 in the training and test sets, respectively. The clinical model demonstrated a good predictive ability for RP-ILD in MDA5+ DM patients, with an AUC, sensitivity, specificity and accuracy of 0.954, 0.931, 0.837 and 0.847 in the training set and 0.890, 0.875, 0.800 and 0.774 in the testing set, respectively. The combination model built with clinical and radiomics features performed slightly better than the clinical model, with an AUC, sensitivity, specificity and accuracy of 0.994, 0.966, 0.977 and 0.931 in the training set and 0.890, 0.812, 1.000 and 0.839 in the testing set, respectively. The calibration curve and decision curve analyses showed satisfactory consistency and clinical utility of the nomogram. Conclusion Our results suggest that the combination model built with clinical and radiomics features could reliably predict the occurrence of RP-ILD in MDA5+ DM patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective. METHODS: This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed. RESULTS: Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%). CONCLUSION: The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients. [ABSTRACT FROM AUTHOR]

Fusarium species are an emerging cause of onychomycosis, and the number of cases has dramatically increased in recent decades worldwide. This review presents an overview of the onychomycosis cases caused by Fusarium species and diagnosis and treatment that have been reported in the literature. The most common causative agent of onychomycosis is F. solani species complex, which accounts for 11.68% of the cases of Fusarium onychomycosis, followed by the F. oxysporum species complex (164 out of 1669), which is accounted for 9.83% of the total. F. fujikuroi species complex (42 out of 1669) and F. dimerum species complex (7 out of 1669) are responsible for 2.52% and 0.42 cases, respectively. Fusarium nail infections were reported in patients aged range 1-98, accounting for 5.55% (1669 out of 30082) of all cases. Asia has the highest species diversity of Fusarium onychomycosis (31.51%). South America accounts for 21.09%, and the most common causative agent is F. solani (19.32%), followed by F. oxysporum species complex (15.63%). Europe accounts for 4.90% of cases caused by F. oxysporum, followed by F. solani. Africa accounts for 23.87% of the cases due to the F. solani species complex, followed by F. oxysporum and F. fujikuroi. Distal and lateral subungual onychomycosis was the most common clinical symptom accounting for 58.7% (135 out of 230) of the cases. Data analysis relieved that terbinafine and itraconazole are active treatments for Fusarium onychomycosis. For a definitive diagnosis, combining of direct examination, culture and sequencing of the elongation factor of translation 1a are recommended. Accurate identification of the causative agents of onychomycosis due to Fusarium species and antifungal susceptibility testing is essential in patient management. [ABSTRACT FROM AUTHOR]

Graves' hyperthyroidism (GH) is often accompanied by mild to moderate liver injury, but severe hepatic dysfunction (SHD) is relatively rare. Whether patients with GH-related SHD can be treated with methimazole (MMI) remains controversial. This study aimed to determine the clinical characteristics and to evaluate the role of low-dose MMI for such patients. 33 patients with GH-related SHD were selected for this retrospective study in the Fifth Medical Center of Chinese PLA General Hospital from January 2017 to July 2022. The clinical manifestations, therapeutic responses, and effectiveness of MMI were evaluated. Systemic jaundice (100.0%), yellow urine (100.0%), fatigue (87.9%), and goiter (66.7%) were the main symptoms. Total bilirubin (TBIL) had no linear correlation with free triiodothyronine (FT3) (r = −0.023, p =.899), free thyroxine (FT4) (r = 0.111, p =.540), T3 (r = −0.144, p =.425), and T4 (r = 0.037, p =.837). On the 14th day after admission, FT3, FT4, T3, T4, TBIL, direct bilirubin (DBIL), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), and international normalized ratio (INR) decreased compared with the baseline (p <.05). The decrease rates of FT3, FT4, T3, T4, TBIL, and DBIL in the MMI group were higher than those in the non-MMI group (p <.05). The improvement rate of the MMI group (77.8%) was higher than that of the non-MMI group (9.5%, p =.001). MMI treatment is an independent predictor affecting the early improvement of patients (OR = 0.022, p =.010). The main clinical manifestations of patients with GH-related SHD were symptoms related to liver disease. Low-dose MMI was safe and effective for them. [ABSTRACT FROM AUTHOR]

The authors have diagnosed and treated patients with May-Thurner syndrome who presented with recurrent edema and redness in the left lower leg and foot. Although May--Thurner syndrome is a rare vascular disease, its primary symptoms manifest as edema and redness in the left lower leg and foot, leading the patients to seek foot and ankle surgery. Suspicion should be directed towards May-Thurner syndrome if an obese individual who spends prolonged periods sitting repeatedly complains of edema and redness in the left lower leg and foot area, in which a blood clot forms due to compression of the left common iliac vein within the pelvis. [ABSTRACT FROM AUTHOR]

Diquat (DQ) is another widely used and harmful herbicide in addition to paraquat (PQ). Due to the lack of specific antidote, the case fatality rate is extremely high. At present, the toxicological mechanism has not been fully elucidated, and it is generally believed that oxidative stress causes cascade reactions, resulting in multiple organ dysfunction caused by damage to various tissues and organs. The early manifestations of DQ poisoning vary, and it is difficult to accurately capture the timing of treatment due to the lack of standardized or accurate evaluation system. How to implement accurate individualized medical treatment to reduce mortality and disability rate remains a medical challenge. Therefore, this review summarizes the pathogenesis and prognosis evaluation of acute DQ poisoning to provide reference for improving clinical treatment, decision-making, and prognosis evaluation. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical characteristics of erosive Eikenella corrodens, and to provide basis for clinical diagnosis and empirical treatment. Methods The clinical characteristics of 15 patients diagnosed with erosive Escherichia coli infection in the hospital from January 2015 to October 2021 were retrospectively analyzed. Results The main clinical manifestations of fifteen patients were local swelling and pain in the maxillofacial and cervical regions, abdominal abscess, and brain abscess. Fifteen strains of Erective Escherichia coli were mainly isolated from self draining fluids. Escherichia coli was resistant to penicillin. ceftriax one, and levofloxacin, with sensitivity rates of 53. 3%.93.3%, and 80.0%, respectively. The sensitivity rates to imipenem, meropenem, ampicillin, amoxicillin clavulanic acid, and trimethoprim sulfamethoxazole were all 100.0%. Conclusion Erective Escherichia coli mainly causes acute suppurative infections and forms local abscesses. Imipenem and meropenem can be used as empirical drugs for the treatment of erosive Escherichia coli infection. and timely and continuous debridement and flushing surgery can be performed on patients, with good results. [ABSTRACT FROM AUTHOR]

The common human coronaviruses (HCoVs) HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1 which are members of the coronavirus family are long co-existed with humans and widely distributed globally. Common HCoVs usually cause mild, self-limited upper respiratory tract infections (URTI), and also associated with lower respiratory tract infections (LRTI), especially in children. However, there are little multicentre studies have been conducted in children of several different areas in China, and the epidemic potential of common HCoVs remains unclear. Understanding of the common HCoVs is valuable for clinical and public health. Herein, we retrospectively analysed the medical records of children with acute lower respiratory tract infection admitted to 9 hospitals from different regions in China from 2014 to 2019. Of the 124 patients who tested positive for coronaviruses, OC43 was the predominant type, accounting for 36.3% (45/124) of the detections. Children aged ≤ 6 months and 12–23 months had the highest detection rate of common HCoVs, and the detection rate gradually declined after 2 years old. These four HCoVs could be detected all year round. Among the areas of our study, the overall positive rate was higher in southern China, especially in Guangzhou (29/124, 23.4%). Moreover, common HCoV-positive patients were codetected with 9 other common respiratory pathogens. 229E (11/13, 84.6%) was the most frequently associated with codetection, with EV/RhV was the most frequently codetected virus. Cough (113/124, 91.1%) and fever (73/124, 58.9%) were the most common symptoms of common HCoVs infection. [ABSTRACT FROM AUTHOR]

Background: Dengue is an arboviral disease caused by dengue virus; single positive stranded RNA virus of the family Flaviviridae. Symptomatic dengue infection causes a wide range of clinical manifestations; from mild dengue fever (DF) to potentially fatal disease, such as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Dengue is endemic in Bangladesh with recurrent outbreak and is one of the major public health concerns in current period. Therefore; we conducted a literature review to analyze demography, epidemiology, pathogenesis, clinical feature and diagnosis of dengue virus infection. Methods: According to the PRISMA guidelines, the references were selected from PubMed, Web of Science and Google Scholar database using search strings containing a combination of terms that included "dengue", "Bangladesh", "epidemiology", "outbreak"," pathogenesis", "clinical manifestation", "demography "and "diagnosis". Quality of references was evaluated by independent contributors. Results: About 167,700 confirmed dengue cases were reported at 16'september'2023 in Bangladesh. Although dengue is endemic in Bangladesh, the current dengue surge is unusual in terms of seasonality and the early sharp increase in comparison to previous years, where the surge started around -late June. Plasma leakages are the main pathophysiological hallmark that distinguishes DHF from DF. Severe plasma leakage can result in hypovolemic shock. Various factors are thought to impact disease presentation and severity. Virus segregation in cell cultures, nucleic acid demonstration by polymerase chain reaction (PCR), and serological detection of viral antigens (such as NS1) or particular antibodies are the preferred microbiological assays for dengue detection. Currently, no specific drugs and licensed vaccines are available to treat dengue disease in any of its clinical presentations for all age group. Conclusion: Understanding the clinical manifestation of dengue infection, prompt diagnosis, appropriate treatment, active and continuous surveillance of cases and vectors are the essential determinants for dengue prevention, control and reducing fatality rate. [ABSTRACT FROM AUTHOR]

Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is papillary thyroid microcarcinoma (PTMC), which includes tumors smaller than 10 mm in diameter. Due to the advancements in diagnostic techniques, the incidence of this type of cancer is on the rise. In this study, we aimed to analyze the factors worsening the PTMC prognosis. Methods: In the first step, we searched various databases for the factors affecting this tumor. The relevant articles were collected and different outcomes of this tumor and its associated factors which were studied in more than one article, were classified. Finally, we conducted a meta-analysis of these outcomes and their related factors. Results: In the meta-analysis, a significantly association was found between the following factors: recurrence with gender (P<0.001) lymph node metastasis (LNM) (P= 0.003), and extrathyroidal invasion (P<0.001); lymph node metastasis with extrathyroidal invasion (P<0.001), and multifocality (P<0.001); central lymph node metastasis (CLNM) with gender (P=0.001), tumor size (P<0.001), extracapsular invasion (P<0.001), lateral cervical lymph node metastasis (P<0.001), and extrathyroidal invasion (P<0.001); lymph node metastasis resulted in poor outcomes (P<0.001); and finally tumor size with BRAFV600E mutation (P<0.001). Conclusion: In conclusion, it is essential to note that greater awareness and understanding of this tumor characteristics and special and separate attention to PTMC can significantly improve the society overall health. [ABSTRACT FROM AUTHOR]

Purine nucleoside phosphorylase deficient severe combined immunodeficiency (PNP SCID) is one of the rare autosomal recessive primary immunodeficiency disease, and the data on epidemiology and outcome are limited. We report the successful management of a child with PNP SCID and present a systematic literature review of published case reports, case series, and cohort studies on PNP SCID listed in PubMed, Web of Science, and Scopus from 1975 until March 2022. Forty-one articles were included from the 2432 articles retrieved and included 100 PNP SCID patients worldwide. Most patients presented with recurrent infections, hypogammaglobulinaemia, autoimmune manifestations, and neurological deficits. There were six reported cases of associated malignancies, mainly lymphomas. Twenty-two patients had undergone allogeneic hematopoietic stem cell transplantation with full donor chimerism seen mainly in those receiving matched sibling donors and/or conditioning chemotherapy before the transplant. This research provides a contemporary, comprehensive overview on clinical manifestations, epidemiology, genotype mutations, and transplant outcome of PNP SCID. These data highlight the importance of screening for PNP SCID in cases presented with recurrent infections, hypogammaglobulinaemia, and neurological deficits. [ABSTRACT FROM AUTHOR]

Developmental midline nasal masses including nasal dermoids (NDs), encephaloceles (EPHCs), and nasal glial heterotopias (NGHs) are a consequence of disrupted embryonal developmental processes in the frontonasal region. Surgery is the only method of treatment in order to prevent local and intracranial inflammatory complications as well as distant deformities of the facial skeleton. Due to their rarity, similar location, and clinical and radiological symptoms, meticulous preoperative differential diagnostics is mandatory. The aim of this thorough literature review was to present and discuss all clinical, histopathological, and radiological aspects of NDs, NGHs, and EPHCs that are crucial for their differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical characteristics and outcomes of localized pulmonary infection by Scedosporium apiospermum (S. apiospermum) in order to provide evidence for diagnosis and treatment. Methods We reviewed 8 patients diagnosed with S. apiospermum pulmonary infection from Jan 2018 to Dec 2021 at the department of infectious disease of Zhongshan Hospital, Fudan University. The clinical data, radiological findings, treatment and prognosis of the patients were analyzed retrospectively. Results Among the 8 patients, there were 3 males and 5 females, with an average age of 58（27-76) years. Identified by MALDI-TOF MS，6 cases were S. apiospermum and 2 cases were S. boydii. There was 1 case had systemic sclerosis with pulmonary interstitial disease and diabetes, treated with Prednisone 10 mg/qd and Mycophenolate Mofetil 0.5 g/qd，6 cases were accompanied by underlying pulmonary diseases, and 1 case had no underlying disease. The most common clinical symptoms were cough, followed by sputum production, haemoptysis, fever, dyspnea and weight loss. The mean BMI was 19.5（15.6-23.2) kg/m², and the BMI was less than 18.5 kg/m² in 4 cases. The white blood cell counts, neutrophil counts and procalcitonin (PCT) were normal in all patients. The average value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hs-CRP) were 32 mm/h (increased in 4 cases) and 24.8 mg/L (increased in 5 cases). G test and GM test were negative. The average CD4 lymphocyte count of patients was 512.8（226.0-943.0) /μL, and the counts of 5 cases were <500/μL. The chest CT findings were diverse： bronchiectasis (5 cases), nodules (3 cases), consolidation (3 cases), cavities (2 cases), pleural thickening (2 cases), and tree bud sign (2 cases), and various imaging findings often existed in combination. All the patients were treated with voriconazole, and 4 patients developed liver insufficient and visual hallucination after taking the medicine were stopped or adjusted to posaconazole. Follow up for 6 months after the start of treatment, the clinical symptoms of all patients were significantly improved. In imaging，5 cases were absorbed，2 cases were similar, and 1 case was deteriorated, which was considered to be caused by mycobacterium infection. Conclusion The clinical and imaging manifestations of localized pulmonary infection by S. apiospermum are non-specific, inflammation markers ESR and hs-CRP are only slightly elevated, and the positive rates of G test and GM test are low, which make early diagnosis difficult. All the patients were treated with voriconazole and the overall prognosis is good. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to a rise in confirmed cases, making epidemiological studies crucial for identifying the source of transmission and developing effective treatment methods. We conducted a study on the clinical characteristics of patients with asymptomatic and mild symptoms of COVID-19 at a rescue hospital in Indonesia. Methods: This is an epidemiological study involving 6102 patients who were admitted to the Indrapura forefront hospital in Surabaya from May 2020 to February 2021. We described demographic data, clinical signs and symptoms, laboratory data, therapy, and clinical outcomes. Results: A total of 6102 patients were involved in this study, with 3664 (60.04%) being male and 2438 (39.95%) being female. The age range of 21–30 years was the most prevalent, accounting for 31.1% (1898 patients). The population had 1476 patients (24.2%) with comorbid conditions. The most prevalent comorbidity observed among these patients was hypertension, affecting 1015 individuals (16.6%). Out of the total 6006 patients observed, 40.7% (n = 2486) were asymptomatic, 54.6% (n = 3329) had mild symptoms, and 3.1% (n = 191) had moderate symptoms. All patients were administered supportive therapy without the use of antiviral medication. Out of the 6102 patients included in the study, 5923 patients (97.1%) achieved a cure, 36 patients (0.6%) are currently undergoing treatment, 142 patients (2.3%) were referred for desaturation indications (SpO2 < 94%), and one patient died due to a suspected cardiovascular event. Out of the total number of patients, 74.5% (4529 patients) had an average length of stay (LOS) of less than 10 days, while 25.6% (1563 patients) had an average length of stay of more than 10 days. Conclusion: The clinical presentation of asymptomatic and mild COVID-19 patients at a rescue hospital varies significantly based on the age and sex of patients. Cough and hyposmia are commonly observed symptoms. Supportive therapy is effective, and strict implementation of social distancing is crucial in preventing the spread of this disease from individuals who are asymptomatic or have mild symptoms. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus-2（SARS-CoV-2） is a novel coronavirus, which is the cause of the outbreak of SARS-CoV-2 infection. At present, the pandemic of SARS-CoV-2 infection has become a challenging world problem. Although most patients with SARS-CoV-2 infection mainly develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with SARS-CoV-2 infection have been observed. This article elaborated on the neurotropic mechanisms and neurological symptoms and manifestations of SARS-CoV-2 infection reported in the relevant literature, including taste and olfactory dysfunction, myalgia, headache, mental state changes, confusion, delirium and dizziness. This article reviewd the neurological symptoms associated with SARS-CoV-2 infection and its possible mechanisms, hoping to contribute to subsequent related research and clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Lymphedema is a chronic, debilitating disease that often requires life-long management. Predicting clinical manifestations and prognosis is crucial in clinical practice because the treatment of lymphedema should be individualized for best clinical outcome. The aim of this study is to explore the location and severity of lymphedema secondary to inguinal and/or iliac lymph node dissection (LND) in patients with melanoma. Patients with melanoma who received LND at a single tertiary medical center between 1 January 2010 and 31 September 2022 were retrospectively reviewed. Patient who received inguinal LND only were designate as the inguinal group while those who received both ilioinguinal LND were included in the ilioinguinal group. Volumetric measurement was used to objectify the severity and location of lymphedema. Clinical data was acquired for 12–15 months of follow-up. Among 81 patients, 43 (53%) had developed lymphedema in the lower extremities at an average of 33 days after the surgery. Initially, patients manifested with medial thigh lymphedema in the inguinal group while patients were presented with whole leg lymphedema in the ilioinguinal group. Lower leg volume of the ilioinguinal group was significantly higher than the inguinal group. After more than 12 months of lymphedema treatment, upper leg volume was higher in the ilioinguinal group than the inguinal group (12.7% vs 5.4%, p < 0.05). Lymphedema developed in early post-op period. The ilioinguinal group presented with a larger volume of lymphedema in the distal area of the legs. Even after sufficient treatment, predominant lymphedema remained in the proximal leg for the ilioinguinal group. Patients with both inguinal and iliac LND were associated with more severe lymphedema. Based on the dissection sites, the clinical manifestations and prognosis of leg lymphedema can vary widely. Thus, clinicians should consider the dissection site when approaching melanoma patients with lymphedema. [ABSTRACT FROM AUTHOR]

According to the World Health Organization, approximately 20 million people worldwide are infected annually with the hepatitis E virus (HEV). There are four main genotypes of HEV. Genotype 1 and genotype 2 are common in developing countries and are transmitted by contaminated water from a fecal–oral route. Genotype 3 and genotype 4 are common in developed countries and can lead to occasional transmission to humans via undercooked meat. Hepatitis E virus 1 and HEV3 can lead to fulminant hepatitis, and HEV3 can lead to chronic hepatitis and cirrhosis in immunocompromised patients. The majority of patients with HEV infection are asymptomatic and usually have spontaneous viral clearance without treatment. However, infection in immunocompromised individuals can lead to chronic HEV infection. Both acute and chronic HEV infections can have extrahepatic manifestations. No specific treatment is required for acute HEV infection, no treatment has been approved in chronic infection, and no HEV vaccine has been approved by the (United States) Food and Drug Administration. This review focuses on the molecular virology (HEV life cycle, genotypes, model systems, zoonosis), pathogenesis, clinical manifestation, and treatment of chronic HEV infection, especially in immunocompromised patients, to provide clinicians a better understanding of the global distribution of these infections and the significant effect they can have on immunocompromised patients. [ABSTRACT FROM AUTHOR]

Severe fever with thrombocytopenia syndrome (SFTS) is a new infectious disease first discovered in Ta-pieh Mountains in central China in 2009. It is caused by a novel bunyavirus infection (SFTSV). Since the first discovery of SFTSV, there have been case reports and epidemiological studies on SFTS in several East Asian countries, such as South Korea, Japan, Vietnam and so on. With the rising incidence of SFTS and the rapid spread of the novel bunyavirus around the world, it is clear that the virus has a pandemic potential and may pose a threat to global public health in the future. Early studies have suggested that ticks are an important medium for the transmission of SFTSV to humans; in recent years, it has been reported that there is also human-to-human transmission. In endemic areas, potential hosts include a variety of livestock and wildlife. When people are infected with SFTV, the main clinical manifestations are high fever, thrombocytopenia, leukocytopenia, gastrointestinal symptoms, liver and kidney function damage, and even MODS, with a mortality rate of about 10–30%. This article reviews the latest progress of novel bunyavirus, including virus transmission vector, virus genotypic diversity and epidemiology, pathogenesis, clinical manifestation and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Intracranial germinoma is a rare tumour of the nervous system, primarily affecting children and young adults, causing neurological and endocrinological symptoms. In this study, we found that a delayed diagnosis (>6 months after initial symptoms) leads to worse overall survival rate despite smaller sizes of the primary tumours. The time to diagnosis was shorter in patients who exhibited neurological symptoms, and bifocal lesions were associated with a significantly worse prognosis. This study emphasizes the need for timely diagnosis of intracranial germinoma, and suggests the necessity of thorough differential diagnosis in patients presenting atypical neurological and endocrinological symptoms. Background: Intracranial germinoma is a rare malignant neoplasm of the central nervous system (CNS) that occurs in children and young adults. The aim of our study was to assess the initial manifestation of the disease, and to find differences in outcomes dependent on time of diagnosis. Methods: The study group consisted of 35 consecutive patients (adults and children) who were treated for intracranial germinoma with radiotherapy at a tertiary centre, and their data were retrospectively collected. We evaluated time from the first symptoms to diagnosis and divided patients into early and delayed diagnosis groups. Delayed diagnosis has been defined as the time from initial presentation to final diagnosis longer than six months. Results: A total of 17 (48.6%) of the patients had delayed diagnoses. Patient survival data spanned a median of six (interquartile range 3–12) years. At the time of the diagnosis, patients presented exclusively neurological symptoms in 16 (45.7%) cases, exclusively endocrinological symptoms in five (14.3%) cases, and mixed symptoms in the remaining cases (n = 14; 40.0%). Patients with neurological symptoms had shorter time (p < 0.001) from first symptoms to the final diagnosis (5.91 months) than in patients without them (19.44 months). The delayed diagnosis group presented significantly smaller tumour size (mean maximal dimension 2.35 cm) compared to early diagnosis group (3.1 cm). The 5-year and 10-year survival rates of our patients were 94.3% and 83.4%, respectively. Patients with a delayed diagnosis (n = 17) had a significantly worse (p = 0.02) 10-year OS (63%) compared to the early diagnosis group (n = 18; OS = 100%). Importantly, in five patients (14.29%), initial manifestation occurred before radiological signs of the disease. Conclusion: Our study stresses the need for timely diagnosis in intracranial germinoma, as a delay has a significant impact on the prognosis. In particular, if the tumour is small or causes exclusively endocrinological symptoms, the diagnosis may be difficult and delayed. [ABSTRACT FROM AUTHOR]

Background: Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and non necrotizing granulomas. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications. Aim: The present study aims to evaluate clinical manifestation and diagnosis of Cardiac sarcoidosis -terials and methods: This retrospective study was carried out in the department of medicine, cardiology and CTVS in a tertiary care hospital, India. A total of 140 patients age ranged from 18 to 70 years, with a sarcoidosis diagnosis were screened, and 35 patients were diagnosed with CS based on JCS 2016 Guidelines. All medical records contain socio-demographic and clinical data was evaluated. Results: The majority of the patients 37.2% were 41-60 years age group, median age was 45.9 years. 60% was male, 54.3% residing at rural areas and 42.8% belonged to lower socioeconomic class. Common clinical manifestations of CS were dyspnoea (71.4%), palpitation (48.6%), fatigue (34.3%), dizziness (31.4%) and chest pain in 25.7% of patients. Syncope (20%) and cardiac arrest (11.4%) were the common complication of CS Conclusion: As systemic sarcoidosis, CS remains a challenging issue in the matter of diagnostics. The evolution of clinical manifestation and diagnostic techniques in recent years has led to a significant improvement in the detection and classification of the severity of the disease. [ABSTRACT FROM AUTHOR]

Historically, Francisella tularensis (Ft) is endemic in Armenia. In Europe, specifically in Scandinavian countries (Finland and Sweden), therewereseveral outbreaks reported over the last 30 years. In these areas, the disease peaks are recorded between June and September, with more than 50 % of cases occurring during August, corresponding to mosquito emerging season. Although most of the recently reported (2017/23; 2018/5; 2019/4) cases inthree geographic clusters in Tavush marz without previously documented tularemia casesand with not detected source of infection and a mode of transmission. All patients with glandular and ulceroglandular forms of tularemia reported onset of symptoms between July and September.Тhe relationship between mosquito bites and tularemia is based on epidemiological and clinical data. [ABSTRACT FROM AUTHOR]

Inborn errors of immunity (IEI) comprise a group of about 490 genetic disorders that lead to aberrant functioning or the development of distinct immune system components. So far, a broad spectrum of IEI‐related manifestations has been noted in the literature. Due to overlapping signs and symptoms of IEI, physicians face challenges in appropriately diagnosing and managing affected individuals. The last decade has witnesses improving in the molecular diagnosis of IEI patients. As a result, it can be the mainstay of diagnostic algorithms, prognosis, and possibly therapeutic interventions in patients with IEI. Furthermore, reviewing IEI clinical complications demonstrates that the manifestations and severity of the symptoms depend on the involved gene that causes the disease and its penetrance. Although several diagnostic criteria have been used for IEI, not every patient can be explored in the same way. As a result of the failure to consider IEI diagnosis and the variety of diagnostic capabilities and laboratory facilities in different regions, undiagnosed patients are increasing. On the other hand, early diagnosis is an almost essential element in improving the quality of life in IEI patients. Since there is no appropriate guideline for IEI diagnosis in different organs, focusing on the clues in the patient's chief complaint and physical exams can help physicians narrow their differential diagnosis. This article aims to provide a practical guide for IEI diagnosis based on the involved organ. We hope to assist clinicians in keeping IEI diagnosis in mind and minimizing possible related complications due to delayed diagnosis. [ABSTRACT FROM AUTHOR]

Leucine-rich glioma inactivated 1 (LGI1); antibody-associated encephalitis is an autoimmune disease with complex and diverse clinical manifestations and is prone to misdiagnosis. In this article, one case of LGI1 antibody-associated encephalitis was reported. This patient presented with loss of consciousness and limb twitches as the first symptoms, which occured twice within a year. No obvious abnormal signal was found by MRI. Autoimmune encephalitis antibody test showed that both serum and cerebrospinal fluid samples were positive for LGI1 antibody, which confirmed the diagnosis. Relevant symptoms were significantly improved after glucocorticoid use and immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Guillain–Barre syndrome (GBS) is a complication that occurs in patients with Coronavirus Disease (COVID-19) infection. The spectrum of symptoms varies from mild to severe symptoms, even death. The study aimed to compare the clinical manifestations in GBS patients with and without COVID-19 comorbidity. Results: A systematic review and meta-analysis of cohort and cross-sectional studies was conducted comparing the characteristics and course of GBS disease in the COVID-19 positive and COVID-19 negative groups. Four articles were selected with a total sample of 61 COVID-19 positive and 110 COVID-19 negative GBS patients. Based on clinical manifestations, COVID-19 infection increased the likelihood of tetraparesis (OR: 2.54; 95% CI 1.12–5.74; p = 0.03) and the presence of facial nerve involvement (OR: 2.34; 95% CI 1.00–5.47; p = 0.05). Demyelinating type GBS or AIDP was more common in the COVID-19 positive group (OR: 2.32; 95% CI 1.16–4.61; p = 0.02). COVID-19 in GBS significantly increased the need for intensive care (OR: 3.32; 95% CI 1.48–7.46; p = 0.004) and the use of mechanical ventilation (OR: 2.42; 95% CI 1.00–5.86; p = 0.05). Conclusions: GBS following COVID-19 infection showed more severe variations in clinical characteristics compared to the group of GBS patients without COVID-19. Early detection of GBS, especially the typical manifestations post COVID-19 infection, is very important to carry out intensive monitoring and early management before the patient's condition worsens. [ABSTRACT FROM AUTHOR]

Background: Carotid cavernous fistula (CCF) is an abnormal arteriovenous shunt between the carotid artery or its branches, with the cavernous sinus. It is still common in developing countries, and is mostly due to traumatic origin. Endovascular treatment has emerged as the primary mode of treatment of CCF. This is the first study describing the clinical manifestation, angiographic characteristic, and the challenges we face in endovascular treatment of CCF cases in Makassar, Indonesia. Results: This descriptive study was conducted between January 2019 to March 2022. We reviewed medical records and angiograms of all patients diagnosed with CCF at the Wahidin General Hospital, Makassar. Clinical manifestations, angiogram results, treatment, and outcome data were analyzed. A total of 23 patients were included in this study, with 17 (73.9%) direct CCF (Barrow type A) and 6 (26.1%) indirect CCF (Barrow type B, C, D). The mean age of patients were 32 years old. The three most common clinical manifestations were proptosis (n = 21, 91.3%), headache (n = 14, 60.8%), and chemosis (n = 14, 60.8%). The three most common drainage routes were via the superior ophthalmic vein (n = 23, 100%), inferior petrosal sinus (n = 12, 52.1%), and superficial middle cerebral vein (n = 6, 26.0%). All patients with direct CCF (n = 17) had endovascular treatment, resulting in 13 cases with complete occlusion (76.5%), 3 cases with incomplete occlusion (17.6%), and 1 (5.9%) procedure cancelled due to difficult navigation. Occlusion of fistula was best achieved with detachable coil, with a technical success rate of 90%. In indirect CCF (n = 6), 4 patients were treated conservatively and 2 with endovascular treatment, with complete occlusion in 2 patients. Conclusions: Carotid cavernous fistula patients commonly presented with orbital symptoms, headache, or neuro-ophthalmologic signs. The most common drainage pattern is via anterior route. Posterior, superior and lateral drainage were not found in indirect CCF. Endovascular treatment is an effective method for fistula closure, especially in the case of direct fistula. Challenges in endovascular treatment are related to the anatomy of the fistula and cavernous sinus. [ABSTRACT FROM AUTHOR]

Background: India is a country known to the West as a country of snake charmers and snakes. Generation after generation, some families in our country continue to play and live with snakes (snake charmers), but we fail to protect the community from snake bites. Protection from this environmental and occupational hazard requires at least some education of the public with regard to how to protect them from snake bites, as well as what to do after the bite has occurred. Methods: The clinical profile of 88 patients who were admitted to the hospital with snake bites and gave informed consent were studied. Patients were treated with anti-snake venom (ASV) whenever required, the initial dose and total dose of ASV administered were also calculated. Results: Most patients were male (54.5%). The majority of the cases (39.8%) were farmers, followed by housewives (15.9%), daily-wage laborers (13.6%), students (11.4%), and shopkeepers (4.5%). The most common clinical manifestation was an extension of edema beyond the site of bite (29.5%) followed by neurological features (26.1%), pain abdomen (20.5%), vomiting (14.8%), and regional lymphadenitis (12.5%). Out of the 88 cases, 11 cases died and the remaining 77 cases recovered. Mortality was significantly higher among patients with complications such as wound infection (P < 0.0010.000), sepsis (P = 0.000), compartment syndrome (P = 0.028), and haematuria (P = 0.004). Conclusion: Snakebite is an occupational hazard, as more than half of the patients were farmers and labourers. The risk factors such as the time between bite and treatment, snake bite -related complications, and adequate doses of ASV determine the treatment outcome. [ABSTRACT FROM AUTHOR]

Dengue fever is a dengue virus infection, emerging rapidly and posing public health threat worldwide, primarily in tropical and subtropical countries. Nearly half of the world's population is now at risk of contracting the dengue virus, including new countries with no previous history-like Ethiopia. However, little is known about the epidemiology and impact of the disease in different countries. This is especially true in countries, where cases have recently begun to be reported. This review aims to summarize epidemiology, biology, pathogenesis, clinical manifestations, and diagnosis of dengue virus infection and its trend in Ethiopia. It may help countries, where dengue fever is not yet on the public health list-like Ethiopia to alert healthcare workers to consider the disease for diagnosis and treatment. The review retrieved and incorporated 139 published and organizational reports showing approximately 390 million new infections. About 100 million of these infections develop the clinical features of dengue, and thousands of people die annually from severe dengue fever in 129 countries. It is caused by being bitten by a dengue virus-infected female mosquito, primarily Aedes aegypti and, lesser, Ae. albopictus. Dengue virus is a member of the Flavivirus genus of the Flaviviridae family and has four independent but antigen-related single-stranded positive-sense RNA virus serotypes. The infection is usually asymptomatic but causes illnesses ranging from mild febrile illness to fatal dengue hemorrhagic fever or shock syndrome. Diagnosis can be by detecting the virus genome using nucleic acids amplification tests or testing NS1 antigen and/or anti-dengue antibodies from serum, plasma, circulating blood cells, or other tissues. Dengue cases and outbreaks have increased in recent decades, with a significant public health impact. Ethiopia has had nearly annual outbreaks since 2013, devastating an already fragmented health system and economy. Standardization of medication, population-level screening for early diagnosis and prompt treatment, and minimization of mosquito bites reduce overall infection and mortality rates. [ABSTRACT FROM AUTHOR]

Tardive syndrome (TS) refers to persistent hyperkinetic, hypokinetic, and sensory complaints appearing after chronic neuroleptics and other dopamine receptor-blocking agents (DRBAs). It is defined as involuntary movements, often rhythmic, choreiform, or athetoid, involving the tongue, face, extremities, and sensory urges such as akathisia and lasts for a few weeks. TS develops in association with neuroleptic medication usage for a few months at least. There is usually a delay between the initiation of the causative drug and the onset of abnormal movements. However, it was soon noted that TS can also develop early, even days or weeks after DRBAs begin. However, the longer the exposure, the greater the risk of developing TS. Tardive dyskinesia, dystonia, akathisia, tremor, and parkinsonism are frequent phenomenologies of this syndrome. [ABSTRACT FROM AUTHOR]

• Rising Dengue Incidence: Dengue cases in Saudi Arabia have sharply increased since the 1990s, influenced by climate change and global travel. • Impact of Pilgrimages and socio-environmental factors are likely contributing to the spread of novel dengue viral strains. • Emerging research Needs: Ongoing research is essential to address environmental factors in dengue virus transmission. Exacerbated by the rise of global warming due to climate change, as well as ease of international travel and mass migration, the dengue virus infection remains of particular economic and global concern. Of note, the emergence of the first case of dengue viral infection occurred in Saudi Arabia in the 1990s, and since then there has been a steady rise in the number of cases. Moreover, the arrival of imported dengue virus variants poses a significant challenge to dengue fever surveillance and control efforts within the region, especially as Saudi Arabia attracts millions of religious pilgrims throughout the year. Herein, we discuss the epidemiology of dengue viral infection in Saudi Arabia, dengue fever biology and clinical manifestation. Current management strategies, amongst other factors influencing dengue fever in Saudi Arabia are also deliberated upon. Future ongoing research and consistent monitoring of both established and emerging dengue viral strains within Saudi Arabia are needed, given the lack of current comprehensive studies. [ABSTRACT FROM AUTHOR]

This case-control study compared the clinical profile, parasite load, polymerase chain reaction positivity, and response to therapy in patients with recurrent cutaneous leishmaniasis (RCL) with primary cutaneous leishmaniasis (CL). The RCL patients had milder diseases with lower parasite loads, a lower number of lesions, and more self-healing diseases than primary CL patients. [ABSTRACT FROM AUTHOR]

Madelung's disease is a rare clinical disease with a low incidence. The main feature of the disease is lipodystrophy, which is more common in men between the ages of 30 and 60. At present, there is no standard and effective treatment for this disease in the world. Here, we reported a case of Madelung's disease with surgical treatment of the neck and reviewed relevant literature to improve the understanding of this disease. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical and CT features of spondylitis caused by non-tuberculous mycobacteria (NTM) and Mycobacterium tuberculosis (TB). Methods The clinical information and CT of 63 gender- and age-matched patients with microbiologically confirmed NTM (21) and TB (42) spondylitis in our hospital from 2009 to 2022 were retrospectively analyzed. Results The majority of NTM spondylitis was middle-aged to elderly women. The incidence of trauma (38.10%), disease severity (47.62%), extraspinal bone involvement (76.19%), skin and soft tissue abscess (61.90%), and CD4 +T cell reduction (38.10%) in NTM group was significantly higher (P=0.001, 0.036, <0.001, <0.001, 0.014) than those in TB group (4.76%, 19.05%, 19.05%, 4.76%, 9.52%). The number of infected vertebrae (5, 2.5-9), incidence of central (90.48%) or peripheral (23.81%) distribution of lesions within the vertebrae, more than 1 lesion in the same vertebrae (80.95%), predominant sclerotic mixed bone destruction (76.19%), nodular or patchy increased density (61.90%), and thick ring sign (38.10%) in NTM group were significantly higher (P=0.003, <0.001, 0.013, <0.001, 0.003, <0.001, <0.001) than that of TB group was (2, 2-4; 11.90%; 2.38%; 1.52%; 35.71%; 0; 0). The incidence of lesions involving only two adjacent vertebrae (52.38%), subligamentous lesions (95.24%), dead bone (64.29%), vertebral collapse (40.48%), spinal deformity (73.81%), intervertebral space stenosis (4.76%), calcification in paravertebral abscess (100%), peripheral muscle abscess (45.24%), the thickness of paravertebral soft tissue swelling/abscess (1.45 cm, 1-1.9 cm), and the number of vertebrae surrounded by paravertebral abscess (3, 2-4) in TB group were significantly higher (P=0.006, 0.006, 0.003, <0.001, 0.015, 0.003, <0.001, <0.001, 0.024, <0.001, <0.001) than that of NTM group (14.29%; 9.52%; 28.57%; 19.05%; 28.57%; 14.29%; 0.5 cm, 0.2-0.95 cm; 1, 1-2). Conclusion The clinical and CT features are helpful for differential diagnosis of NTM and TB spondylitis. [ABSTRACT FROM AUTHOR]

Granulomatous lobular mastitis (GLM) is a benign inflammatory disease of the mammary gland with unknown etiology. Erythema nodosum (EN) is a rare, extramammary symptom of GLM. The purpose of this article was to investigate the clinical features of EN associated with GLM. We recruited 102 GLM patients diagnosed between December 2018 and December 2021 at Renmin Hospital of Wuhan University. The clinical characteristics and laboratory indices of the EN group (n = 12) and the non-EN group (n = 90) were compared. The proportion of GLM patients with lesions involving ≥2 quadrants and high peripheral white blood cell count, absolute neutrophil count and neutrophil-to-lymphocyte ratio (NLR) was larger in the EN group than in the non-EN group (p = 0.002, 0.025, 0.014, 0.002, respectively). The duration of EN was longer in GLM patients with EN than in GLM patients without EN (p = 0.005). GLM patients with EN had more abscesses and sinus tracts than those without EN (p = 0.003, 0.038). Lesions involving ≥2 quadrants and the NLR were positively associated with the occurrence of EN (R = 0.304, 0.0302, p = 0.002, 0.002). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR was 0.770. When NLR > 5.73, the sensitivity and specificity of predicting EN were 66.67% and 87.78%, respectively. Our findings suggest that GLM concomitant with EN suggests the presence of a more severe condition and extensive lesions. [ABSTRACT FROM AUTHOR]

Prior to COVID-19, dengue was an important public health problem in Malaysia. Due to the movement control order imposed by the Malaysian government to curb the COVID-19 transmission, a study predicted that mosquito-borne diseases would increase during lockdown and partial lockdown seasons. Thus, this study aims to determine the current situation of dengue incidence during the pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020 and 2021). We compared the number of laboratory-confirmed cases in the pre-COVID19 year (2019) and during the COVID-19 pandemic (2020 and 2021). In addition to that, we characterized the clinical manifestation, dengue serotype and viremia levels of dengue patients that were admitted to the Hospital Cancelor Tuanku Muhriz. We found a significant decrease in the number of laboratory-confirmed cases between COVID-19 pandemic and the pre-covid period (p2020=0.064; p2021< 0.001). In this study, we found DENV 4 serotype was the most common serotype in dengue patients admitted to our hospital. There was no significant correlation between DENV serotype/viremia level with clinical manifestation of dengue fever and dengue with warning signs. However, patients infected with DENV4 had the highest viral load compared to patients infected with other serotypes. We also found high viremia levels were significantly associated with the febrile phase. [ABSTRACT FROM AUTHOR]

Background: Respiratory tract infections (RTIs) are considered as one of the most important causes of morbidity and mortality, worldwide. A wide variety of bacteria and viruses are responsible for the development of RTIs. Considering the importance of respiratory tract infections, this study aimed to provide an overview of the most important respiratory tract infections and inflammations of bacterial origin and their etiologies. Results: A literature review was conducted to find original studies associated with respiratory infections. Articles that provided evidence on respiratory tract infections as well as their clinical manifestations and etiologies were included in this research. Conclusion: Considering the importance and economic burden of respiratory tract infections as well as their diversity and widespread prevalence in different communities, it is necessary to implement preventive measures at the national level to control and deal with respiratory diseases with high prevalence in all age groups, in addition to observing the principles of health and hygiene. [ABSTRACT FROM AUTHOR]