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Background: Excessively high repair tension, especially tension ≥10 N, can lead to unsuccessful rotator cuff repair. Purpose/Hypothesis: The purpose of this study was to identify the preoperative risk factors for high repair tension in rotator cuff repair. It was hypothesized was that older age, longer symptom duration, nontraumatic (ie, degenerative) tear onset, progressive fatty degeneration, and larger tear size would be among the risk factors. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This retrospective study involved 80 patients (80 shoulders) diagnosed with rotator cuff tears by magnetic resonance imaging between July 2018 and August 2020. Repair tension was measured intraoperatively using a digital tension meter. Risk factors for high repair tension (≥10 N) were evaluated. The t test was used to assess the relationship of repair tension with patient characteristics and surgical parameters. Parameters with a P value of <.05 in the univariate analysis were entered into a multivariate logistic regression model to determine their relationship with repair tension ≥10 N. Results: Symptom duration of ≥4 months, nontraumatic tear onset, large/massive tears, mediolateral (ML) tear length of ≥20 mm, and anteroposterior (AP) tear length of ≥18 mm were associated with high odds of repair tension ≥10 N (P ≤.013 for all). Multivariate analysis showed that nontraumatic onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm were independent risk factors for repair tension ≥10 N (P ≤.035 for all). Conclusion: The independent risk factors for high repair tension (≥10 N) during rotator cuff repair were nontraumatic tear onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm. Symptom duration of ≥4 months and large/massive tears were associated with high odds of repair tension ≥10 N, although they were not considered independent risk factors. Prospective cohort studies with larger sample sizes are needed to confirm the clinical value of the risk factors identified in this study. [ABSTRACT FROM AUTHOR]

Vertebral compression fractures (VCFs) affect 1.4 million patients every year, especially among the globally aging population, leading to increased morbidity and mortality. Often characterized with symptoms of sudden onset back pain, decreased vertebral height, progressive kyphosis, and limited mobility, VCFs can significantly impact a patient's quality of life and are a significant public health concern. Imaging modalities in radiology, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) studies and bone scans, play crucial and evolving roles in the diagnosis, assessment, and management of VCFs. An understanding of anatomy, and the extent to which each imaging modality serves to elucidate that anatomy, is crucial in understanding and providing guidance on fracture severity, classification, associated soft tissue injuries, underlying pathologies, and bone mineral density, ultimately guiding treatment decisions, monitoring treatment response, and predicting prognosis and long-term outcomes. This article thus explores the important role of radiology in illuminating the underlying anatomy and pathophysiology, classification, diagnosis, treatment, and management of patients with VCFs. Continued research and advancements in imaging technologies will further enhance our understanding of VCFs and pave the way for personalized and effective management strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Uncemented acetabular components are widely used in modern total hip arthroplasty (THA). Modularity has numerous advantages including the ability to use supplementary screw fixation for the shell, and allow to switch from ceramic to polyethylene (PE) bearings and vice versa, and the use of lipped and face-changing liners. OBJECTIVE: Despite these advantages, a problem with modular PE liners is dissociation. This is a rare complication in modern implants. The rate of liner dissociation is reported to be very low between 0.17% and 0.8%. Typical symptoms are sudden onset of groin pain in a previously well-functioning hip joint, followed by grinding or clicking sensations during hip joint motions indicating, that the femoral head is articulating with the metal acetabular shell rather than with the PE liner. Any newly observed noise or squeaking from a THA should undergo radiographic investigation to exclude liner dissociation. CASE PRESENTATION: We present the case of an 88-yearold male patient who developed PE liner dissociation in a cementless THA with a Pinnacle acetabular component six years after the index operation. We recommended revision of the left hip, which was performed two days later. In the interim, the patient was advised to use a pair of crutches. During revision surgery, it was observed that the metal head made contact with the cementless cup shell without damaging it from a macroscopic standpoint. Consequently, a simple exchange of the PE liner was conducted, and a 36 mm metal head was implanted due to scratches on the original head. CONCLUSION: Early diagnosis facilitates a straightforward exchange of the liner along with the head, potentially preserving the osseous integrated cup shell and stem integrity. Routine radiologic follow-up allows to distinguish between PE liner dissociation and severe PE wear. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic stroke, involving bleeding within the brain or surrounding areas, presents a distinct profile of socio-demographic and clinical characteristics. Hemorrhagic strokes are more common in older adults. However, younger individuals with certain risk factors can also be affected. This study aimed to find out the socio-economic characteristics of hemorrhagic stroke patients. Methods: This prospective observational study was conducted in the Medicine In-patients Department of Dhaka Medical College Hospital, Dhaka, Bangladesh, from October 2009 to March 2010. A total of 60 cases of hemorrhagic stroke were enrolled using a purposive sampling technique. Data analysis was performed using MS Office tools. Results: The mean age of participants was 50.33 ± 8.93 years, with a male-to-female ratio of 3:1. 13.3% were illiterate, 60% had a monthly family income of over 10,000 BDT. Family history of stroke was reported by 13.3%, 28.3% experienced symptoms during sleep, 20% during work, and 15% during excitement. 58.3% experienced a sudden onset of symptoms. Frequent comorbidities included hypertension (40.0%) and diabetes mellitus (30.0%). Headache was the most common symptom (66.7%). Neurological exams showed normal consciousness in 66.7%, with varying grades in the remainder. Normal speech was noted in 70.0%, normal muscle bulk in 91.7%, and hypertonic muscle tone in 80.0%. Among hemorrhagic stroke patients, 51.7% had right-sided intracerebral hemorrhage on CT. Conclusion: Older adults are particularly susceptible to hemorrhagic stroke. Most patients experience a sudden onset of symptoms, with headaches being the most common. Typically, patients retain normal consciousness, speech, muscle tone, and muscle bulk in the majority of cases. [ABSTRACT FROM AUTHOR]

Objectives To explore differences in axial spondyloarthritis (axSpA) clinical phenotype around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS). Method IMAS was a cross-sectional online survey (2017–2022) of 5557 unselected axSpA patients from 27 countries. We analysed across five geographic regions the age at symptom onset, diagnostic delay, gender, HLA-B27, family history, extra-musculoskeletal manifestations, presence of comorbidities, disease activity (BASDAI), level of spinal stiffness and treatments. Results Of 5557 IMAS participants, 3493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America and 146 from South Africa. Age at symptom onset ranged between 25 and 30 years and was higher in Latin America. Diagnostic delay was longest in South Africa and lowest in Asia. The lowest HLA-B27 positivity was observed in Latin America and the highest in Asia. Extra-musculoskeletal manifestations were the lowest in Europe. Mean disease activity (BASDAI) was 5.4, with highest values in South Africa and lowest in Asia. Most of the patients had used NSAIDs for their condition and less than half had ever taken conventional synthetic DMARDS; both were more frequent in Latin America and South Africa. Almost half of the patients had ever taken biologic DMARDs, more frequent use being in the Americas. Conclusion There is great heterogeneity of axSpA clinical phenotype presentation around the world. AxSpA manifests differently in different regions, so further understanding of these differences of phenotypes is needed to achieve early diagnosis and initiation of optimal disease treatment in axSpA in the different regions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of cerebrovascular MRI markers in unselected patients hospitalized for COVID-19 (Coronavirus disease 2019), we compared these with healthy controls without previous SARS-CoV-2 infection or hospitalization and subsequently, investigated longitudinal (incidental) lesions in patients after three months. Methods: CORONIS (CORONavirus and Ischemic Stroke) was an observational cohort study in adult hospitalized patients for COVID-19 and controls without COVID-19, conducted between April 2021 and September 2022. Brain MRI was performed shortly after discharge and after 3 months. Outcomes included recent ischemic (DWI-positive) lesions, previous infarction, microbleeds, white matter hyperintensities (WMH) and intracerebral hemorrhage and were analysed with logistic regression to adjust for confounders. Results: 125 patients with COVID-19 and 47 controls underwent brain MRI a median of 41.5 days after symptom onset. DWI-positive lesions were found in one patient (1%) and in one (2%) control, both clinically silent. WMH were more prevalent in patients (78%) than in controls (62%) (adjusted OR: 2.95 [95% CI: 1.07–8.57]), other cerebrovascular MRI markers did not differ. Prevalence of markers in ICU vs. non-ICU patients was similar. After three months, five patients (5%) had new cerebrovascular lesions, including DWI-positive lesions (1 patient, 1.0%), cerebral infarction (2 patients, 2.0%) and microbleeds (3 patients, 3.1%). Conclusion: Overall, we found no higher prevalence of cerebrovascular markers in unselected hospitalized COVID-19 patients compared to controls. The few incident DWI-lesions were most likely to be explained by risk-factors of small vessel disease. In the general hospitalized COVID-19 population, COVID-19 shows limited impact on cerebrovascular MRI markers shortly after hospitalization. [ABSTRACT FROM AUTHOR]

Bifurcations are a common site for saccular aneurysms, but rarely can be a site for dissecting aneurysms. Identification of these aneurysms is extremely important because the management plan depends on it. We describe a rare case of a ruptured dissecting aneurysm at the right ICA bifurcation in a pre-teen child which posed a diagnostic dilemma but ultimately was successfully managed with flow diversion. [ABSTRACT FROM AUTHOR]

Background: COVID-19 developed a sudden onset of smelling disorders. Researchers used self-reported or special tests to study this issue. We aimed to investigate whether quantitative-test smell disorders have a considerable difference from self-reported or not. Methods: We searched 554 studies published between December 2019 to September 2020 by the PICO model. Our search strategies were based on MeSH terms in the electronic databases Web of Science (136 articles), Scopus (84 articles), and PubMed (334 articles). The duplicated articles were excluded, then the preferred reporting items for systematic reviews and meta-analysis guidance were utilized. Finally, we divided the studies into two (self-report (33 articles) and specific-test (9 articles)) groups. Results: 33 (80%) articles expressed olfactory dysfunction by self-report of patients and 9(20%) studies were conducted by a specific test. Only three studies, one in self-report; ((internal reliability, Cronbach α = 0.84) and validity (r = -0.60, p < 0.001)) and two in specific-test groups; ((test-retest r=0.94) and another study (test-retest r >0.7)) conducted validity and reliability. Self-reported studies published a various range of prevalence (20% _97%) in patients with COVID-19. COVID-19 patients with a specific-test group were found to have a primary incidence of anosmia of over 65%, even reaching 98% depending on the types of tests. Conclusion: Self-reporting of COVID-19 detection can be affected by sociodemographic factors. Although self-reported questionnaires are economical and easy to use, standardized tests provide more reliable comparisons and professional assessments. Therefore, standardized tests are recommended for more accurate screening over self-reporting. [ABSTRACT FROM AUTHOR]

This article provides an overview of dermatological disorders that can lead to varioliform scars, which resemble smallpox scars. The disorders are divided into two categories: those that cause generalized skin lesions and those that cause localized skin lesions. The article discusses various disorders in each category, including chickenpox, smallpox, papulonecrotic tuberculid, secondary syphilis, acne necrotica, and lupus miliaris disseminatus faciei. The goal of the article is to classify these disorders, explain their causes, and offer a clinical approach for patients with varioliform scars. It is a valuable resource for library patrons researching skin disorders and their potential to cause varioliform scars. [Extracted from the article]

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic disease presenting with severe fatigue, post‐exertional malaise, and cognitive disturbances—among a spectrum of symptoms—that collectively render the patient housebound or bedbound. Epigenetic studies in ME/CFS collectively confirm alterations and/or malfunctions in cellular and organismal physiology associated with immune responses, cellular metabolism, cell death and proliferation, and neuronal and endothelial cell function. The sudden onset of ME/CFS follows a major stress factor that, in approximately 70% of cases, involves viral infection, and ME/CFS symptoms overlap with those of long COVID. Viruses primarily linked to ME/CFS pathology are the symbiotic herpesviruses, which follow a bivalent latent–lytic lifecycle. The complex interaction between viruses and hosts involves strategies from both sides: immune evasion and persistence by the viruses, and immune activation and viral clearance by the host. This dynamic interaction is imperative for herpesviruses that facilitate their persistence through epigenetic regulation of their own and the host genome. In the current article, we provide an overview of the epigenetic signatures demonstrated in ME/CFS and focus on the potential strategies that latent viruses—particularly Epstein–Barr virus—may employ in long‐term epigenetic reprograming in ME/CFS. Epigenetic studies could aid in elucidating relevant biological pathways impacted in ME/CFS and reflect the physiological variations among the patients that stem from environmental triggers, including exogenous viruses and/or altered viral activity. [ABSTRACT FROM AUTHOR]

We discuss two people with Parkinson's disease (PD), in whom tremor manifested directly following a severely stressful event. Both were initially misdiagnosed with a functional neurological disorder. These stories highlight that stress can trigger the onset of clinical manifestations of PD, by unveiling an underlying disease that had been unfolding for many years. Thus, the sudden symptom onset after a stressful event is not unique to functional disorders, and may lead to avoidable feelings of guilt if people wrongly attribute PD to this event. It remains unclear what mechanism explains this phenomenon, and why symptoms persist after the stressful event has passed. [ABSTRACT FROM AUTHOR]

Purpose of review: New daily persistent headache (NDPH) is a primary headache disorder characterized by the sudden onset of continuous pain and its intractability to treatment. It is more prevalent in the pediatric population than the adult population, but remains understudied and underdiagnosed. The purpose of the current article is to provide a current overview of new daily persistent headache in the pediatric and adolescent population, including history, pathophysiology, clinical findings, current and emerging treatment options, and the results of recent studies and meta-analyses. Recent findings: Despite recent studies and meta-analyses showing significant phenotypic overlap between chronic migraine and NDPH in the pediatric population, multiple recent studies have come to conflicting conclusions about the overlap of medication overuse in headache and pediatric NDPH. Recent studies reveal alterations in neuroimaging, particularly in functional connectivity, in patients with NDPH. Patients frequently remain treatment-refractory even to medications that have historically proven helpful in this population; however, new treatment options, including calcitonin gene-related peptide (CGRP) monoclonal antibodies, may be more effective. Summary: NPDH remains a perplexing and difficult-to-manage condition for both children and adults. Despite a higher prevalence in the pediatric population, there are relatively few studies to guide the evaluation and treatment of NDPH in pediatric and adolescent patients. Early treatment, both pharmacological and non-pharmacological, should be employed to reduce disability. Overall, further studies are needed to better understand pathogenesis and to identify more effective therapeutic strategies, both pharmacological and non-pharmacological. [ABSTRACT FROM AUTHOR]

The article discusses the long-term outcomes of deep brain stimulation (DBS) in a 10-year-old boy with Glutaric Aciduria Type 1 (GA1), a rare neurometabolic disorder. The boy experienced significant improvement in choreodystonic movements after DBS surgery, with some persistent symptoms in the left lower limb. DBS has shown effectiveness in treating drug-resistant movement disorders, but outcomes in pediatric patients with GA1 are still being studied due to limited evidence and heterogeneous results. Further research with larger patient cohorts is needed to better understand the impact of DBS on GA1 patients. [Extracted from the article]

Breathlessness is an aversive bodily sensation impacting millions of people worldwide. It is often highly detrimental for patients and can lead to profound distress and suffering. Notably, unpredictable breathlessness episodes are often reported as being more severe and unpleasant than predictable episodes, but the underlying reasons have not yet been firmly established in experimental studies. This review aimed to summarize the available empirical evidence about the perception of unpredictable breathlessness in the adult population. Specifically, we examined: (1) effects of unpredictable relative to predictable episodes of breathlessness on their perceived intensity and unpleasantness, (2) potentially associated neural and psychophysiological correlates, (3) potentially related factors such as state and trait negative affectivity. Nine studies were identified and integrated in this review, all of them conducted in healthy adult participants. The main finding across studies suggested that unpredictable compared to predictable, breathlessness elicits more frequently states of high fear and distress, which may contribute to amplify the perception of unpredictable breathlessness, especially its unpleasantness. Trait negative affectivity did not seem to directly affect the perception of unpredictable breathlessness. However, it seemed to reinforce state fear and anxiety, hence possible indirect modulatory pathways through these affective states. Studies investigating neural correlates of breathlessness perception and psychophysiological measures did not show clear associations with unpredictability. We discuss the implication of these results for future research and clinical applications, which necessitate further investigations, especially in clinical samples suffering from breathlessness. [ABSTRACT FROM AUTHOR]

• Different traffic conditions generate driver stress variably. • Driver behavior, physiology, and psychology state reflect their stress effects. • For the influencing factors, stress alleviation solutions are provided. • More research is required for driver stress in Complex scene and i-Drive. High-intensity driver stress (DS) is not only an important cause of vehicle collision accidents, but also a risk factor for cardiovascular disease and the sudden onset of illness in drivers. This article presented a systematic review to explore the key factors and influencing mechanisms that cause or affect the fluctuation of the DS level in the traffic situation, road conditions, and driving environment. We reviewed the research on DS since 2013 and identified 61 peer-reviewed articles published. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide the literature search and quality assessments after categorizing and commenting on the studies, the experimental design methodologies, research scope, and research topics are further reviewed, and suggestions are put forward. The traffic density (n = 6), traffic behavior(n = 6), and traffic control (n = 4) are the main traffic situation factors; the road type (n = 14) and geometric design (n = 6) are the main road condition factors; weather, light, and landscape conditions (n = 6) are the external driving environment factors; and the air quality, in-vehicle devices (n = 7), and trust and takeover problems caused by human–machine interaction (n = 16) are the internal environment factors. These impacts on DS are reflected in the behavior of drivers, as well as their physiological and psychological states. The future experiments must be conducted with multi-dimensional tasks, and multi-modal fusion methods; more abundant research is needed to explore the impacts of the high complexity of urban traffic and landscapes, the interactions between drivers and assisted driving systems, as well as the mixed driving mode of autonomous and manual vehicles on DS. Based on the different generation mechanisms of DS under different conditions, strategies, and suggestions for the alleviation of DS are proposed from the perspectives of driving assistance, traffic control, and landscape construction. [ABSTRACT FROM AUTHOR]

Investigating the causes of Sudden cardiac death (SCD) is always difficult; in fact, genetic cardiac conditions associated with SCD could be "silent" even during autopsy investigation. In these cases, it is important to exclude other aetiology and assist to ask for genetic investigations. Herein, the purpose of this review is to collect the most-implicated genes in SCD and generate a panel with indications for first line and second line investigations. A systematic review of genetic disorders that may cause SCD in the general population was carried out according to the Preferred Reporting Item for Systematic Review (PRISMA) standards. We subsequently listed the genes that may be tested in the case of sudden cardiac death when the autopsy results are negative or with no evidence of acquired cardiac conditions. To make genetic tests more specific and efficient, it is useful and demanded to corroborate autopsy findings with the molecular investigation as evident in the panel proposed. The genes for first line investigations are HCM, MYBPC3, MYH7, TNNT2, TNNI3, while in case of DCM, the most implicated genes are LMNA and TTN, and in second line for these CDM, ACTN2, TPM1, C1QPB could be investigated. In cases of ACM/ARVC, the molecular investigation includes DSP, DSG2, DSC2, RYR2, PKP2. The channelopathies are associated with the following genes: SCN5A, KCNQ1, KCNH2, KCNE1, RYR2. Our work underlines the importance of genetic tests in forensic medicine and clinical pathology; moreover, it could be helpful not only to assist the pathologists to reach a diagnosis, but also to prevent other cases of SCD in the family of the descendant and to standardise the type of analysis performed in similar cases worldwide. [ABSTRACT FROM AUTHOR]

The article discusses the timeless study evaluating the use of tenecteplase 4.5 to 24 hours post-stroke, concluding it doesn't improve outcomes compared to placebo, despite advancements in imaging for patient selection.

Background: For most acute conditions, the phase prior to emergency department (ED) arrival is largely unexplored. However, this prehospital phase has proven an important part of the acute care chain (ACC) for specific time-sensitive conditions, such as stroke and myocardial infarction. For patients with undifferentiated complaints, exploration of the prehospital phase of the ACC may also offer a window of opportunity for improvement of care. This study aims to explore the ACC of ED patients with undifferentiated complaints, with specific emphasis on time in ACC and patient experience. Methods: This Dutch prospective observational study, included all adult (≥ 18 years) ED patients with undifferentiated complaints over a 4-week period. We investigated the patients' journey through the ACC, focusing on time in ACC and patient experience. Additionally, a multivariable linear regression analysis was employed to identify factors independently associated with time in ACC. Results: Among the 286 ED patients with undifferentiated complaints, the median symptom duration prior to ED visit was 6 days (IQR 2–10), during which 58.6% of patients had contact with a healthcare provider before referral. General Practitioners (GPs) referred 80.4% of the patients, with the predominant patient journey (51.7%) involving GP referral followed by self-transportation to the ED. The median time in ACC was 5.5 (IQR 4.0-8.4) hours of which 40% was spent before the ED visit. GP referral and referral to pulmonology were associated with a longer time in ACC, while referral during evenings was associated with a shorter time in ACC. Patients scored both quality and duration of the provided care an 8/10. Conclusion: Dutch ED patients with undifferentiated complaints consulted a healthcare provider in over half of the cases before their ED visit. The median time in ACC is 5.5 h of which 40% is spent in the prehospital phase. Those referred by a GP and to pulmonology had a longer, and those in the evening a shorter time in ACC. The acute care journey starts hours before patients arrive at the ED and 6 days of complaints precede this journey. This timeframe could serve as a window of opportunity to optimise care. [ABSTRACT FROM AUTHOR]

Background: Diabetic Striatopathy (DS) is a rare complication of a poor‐controlled Diabetes Mellitus consisting of sudden onset of movement disorders. To date, there is still poor knowledge about the pathogenesis. Case: We describe a 79 year old men affected by sudden onset hemichoreic movements whose cause was a non‐ketotic hyperglycaemia diagnosed despite the normal blood glucose levels thanks to brain CT and magnetic resonance imaging. Then, we introduce a new magnetic resonance spectroscopy (MRS) finding never described until today which allowed us to produce a new pathogenetic theory of a phenomenon still without definitive explanations. Literature Review: We performed a review of DS cases using the Medline database and we extracted main data regarding imaging findings. Conclusions: Thanks to our MRS we show new imaging findings never described until today, with a new pathogenetic explanation, since all the causative hypotheses produced during the past years have never found evidence. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The rare co‐occurrence of takayasu arteritis (TAK) and ulcerative colitis (UC), presenting with asymptomatic onset and neurological complications, highlights the importance of an integrated diagnostic approach for overlapping autoimmune conditions. We present a rare case of a 44‐year‐old female diagnosed with both UC and TAK, characterized by an unusual acute asymptomatic onset accompanied by neurological manifestations. The patient exhibited symptoms of acute ischemic stroke along with vascular abnormalities, as well as colon inflammation associated with UC. The patient's asymptomatic presentation at the onset differs from previously reported cases. The presence of additional complications, such as hepatocellular adenoma and primary sclerosing cholangitis, further complicated the diagnostic challenges. The patient's treatment involved a combination of methylprednisolone, azathioprine, and prednisolone leading to improved clinical outcomes. This case emphasizes the complexity involved in diagnosing overlapping conditions and highlights the significance of TAK in presenting atypical manifestations in relation to UC. Furthermore, this case contributes to the limited literature, underscoring the need for early detection and comprehensive treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal (strep) infections (PANDAS) are a recognized medical entity among children. But evidence for strep-mediated sudden-onset obsessive–compulsive disorder (OCD) in young adults is very limited. Delayed strep assessment and treatment may negatively impact clinical outcomes. Methods: We describe a young adult with acute sudden-onset OCD (age 24), treated unsuccessfully with medication and therapy for 3 years. At age 27, antistreptolysin-O (ASO) was tested, based on extensive pediatric history of strep infections. Antibiotic treatment was initiated. Results: Magnetic resonance imaging (MRI) identified a new temporal lobe hyperintensity at OCD onset (age 24), which persisted at ages 25 and 30. ASO titers were elevated from age 27 through 29. Following Amoxicillin treatment, ASO initially increased. Subsequent Amoxicillin + Clavulin treatment produced improved OCD symptoms and treatment response, with no adverse effects. Conclusion: These results strongly suggest an association among strep infection, neuro-inflammation and sudden-onset OCD in this young adult whose response to medication and therapy was successful only after high-dose antibiotic intervention. Greater OCD remission potential may be possible with earlier identification and antibiotic treatment than 3 years post OCD onset. These findings add to the limited literature on strep as an etiology of the sudden-onset of OCD in young adults. They also lend urgency to increased frontline awareness for early strep and ASO assessment in sudden-onset acute OCD among young adults. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) has been known for many years to be associated with poor cardiovascular prognosis. Due to the sensitive neuropathy, the coronary artery disease in diabetic patients is frequently asymptomatic, until the onset of myocardial infarction or sudden cardiac death. Coronary artery disease is the leading cause of morbidity and mortality in patients with diabetes. Aims and Objectives: To reduce patient mortality and morbidity, the current analysis was performed on diabetes patients to look for ECG alterations. Materials and Methods: The present study include Electrocardiogram of 550 cases with non-insulin dependent diabetes mellitus (NIDDM) who were followed up prospectively for three consecutive years. The study has been conducted in MNR Medical College and Sangareddy, Telangana. Result & Conclusion: Left axis deviation (LAD) 16%, Left anterior hemiblock (LAHB) 5.5% Right bundle branch block (RBBB) with or without LAHB 4.2% respectively were the commonest ECG abnormalities observed. Repolarization abnormalities (6.1%) were also observed in these patient with non-insulin dependent diabetes mellitus. Prevalence of silent ischaemia and / or infarction (2.7%) were similar to that reported from west. Follow up revealed further appearance of bundle branch block, silent ischaemia / infarction, and repolarization defects at the end of 12, 24 & 36 months of study. These defects suggest primary involvement of myocardium which progress irrespective of metabolic status in patients with NIDDM. [ABSTRACT FROM AUTHOR]

Background. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is a rare pediatric disorder consisting of a sudden onset of obsessive–compulsive disorder (OCD) and/or tics after a group A Streptococcus (GAS) infection. Methods. In the period between 2013 and 2023, 61 children presented to our Pediatric Rheumatology unit with a suspicion of PANDAS syndrome. Among these, a retrospective analysis was conducted, and 19 fulfilled the current classification criteria and were included in this study. Results. The male-to-female ratio was 14:5, the median age at onset was 7.0 (2.0–9.5) years, and the median age at diagnosis was 8.0 (3.0–10.4) years. The median follow-up period was 16.0 (6.0–72.0) months. Family and personal history were relevant in 7/19 and 6/19 patients. Tics were present in all patients. Details for motor tics were retrospectively available in 18/19 patients, with the eyes (11/18) and neck/head (10/18) being most often involved. Vocal tics were documented in 8/19, behavioral changes in 10/19, and OCD in 2/19. Regarding the therapeutic response, all patients responded to amoxicillin, 12/13 to benzathine benzylpenicillin, and 7/9 to azithromycin. Conclusions. Our findings partially overlap with previous reports. Larger prospective studies are needed to improve treatment strategies and classification criteria. [ABSTRACT FROM AUTHOR]

Objective: Systemic administration of glucocorticoid steroids is the most common initial treatment for idiopathic sudden sensorineural hearing loss (ISSNHL); however, due to the prevalence of coronavirus disease, the indications for this treatment must be carefully determined. The aim of this study was to investigate the efficacy of intratympanic steroid therapy as an initial treatment for idiopathic SSNHL. Methods: Sixty-eight patients with idiopathic ISSNHL who were treated with intravenous or intratympanic steroids were included in this study. Patients were retrospectively evaluated regarding preoperative grade, type of additional treatment, outcome of treatment, and side effects of each treatment. Results: In 46 cases, patients received intravenous steroid therapy as the initial treatment, while 22 patients received intratympanic steroid therapy; 10 patients underwent salvage treatment due to inadequate improvement of symptoms. Regarding additional treatment, intravenous steroid monotherapy was used in 37 patients. The outcomes were similar after both treatments; 16 (43%) and 11 (52%) patients treated exclusively with intravenous and intratympanic steroids, respectively, were completely cured. There were no significant differences in the effects between the 2 treatments, indicating that they were almost equally effective. The side effects observed in patients treated with intravenous steroid therapy were increased blood pressure, acute gastric mucosal disorder, and insomnia. None of these side effects were observed in any of the patients treated with intratympanic steroids; however, 1 case of perforation of the tympanic membrane occurred due to the procedure. Conclusion: There were no significant differences in posttreatment outcomes between patients treated with either intratympanic or intravenous steroids. The therapeutic effects were comparable, and no severe side effects were observed; therefore, intratympanic steroid therapy may be considered useful as an initial treatment for ISSNHL in the context of widespread coronavirus disease. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement is one possible cause for groin pain and can lead to long periods of absence for football players. In cam impingement, the end-grade position of the leg at kicking makes the hip particularly prone to faulty contact between the acetabulum and the femoral head. Studies suggest that the resting position of the pelvis in the sagittal plane may have an important role in the biomechanics of movement in the presence of cam impingement. Methods: A 19-year-old male competitive footballer complained of sudden groin pain during a period of low athletic load. Biomechanical tests (3D posture and isometric strength analyses) showed that unbalanced individual strength training had resulted in an increased forward tilt of the pelvis. At the same time, cam impingement was confirmed radiologically, which obviously contributed to the sudden onset of the symptoms. The kicking technique of the athlete showed increased hip and trunk flexion, which also indicated a muscular imbalance. Targeted strength and stretching exercises three times a week improved the pelvic position in terms of reduced anteversion. At the same time, the patient performed strength exercises to improve his kicking technique. Results: After 8 weeks, improvements in his pelvic position and global posture and increased muscle strength could be verified. At the same time, the athlete was free of complaints again. Conclusions: When groin pain occurs in football players with cam impingement, special attention should be paid to the resting position of the pelvis in the sagittal plane. Correcting increased pelvic anteversion can prevent unfavourable end-grade collisions of the acetabulum and femoral head during kicking with strong hip flexion and adduction. Possible changes in the pelvic position due to adverse individual strength training performed by young athletes should always be kept in mind. [ABSTRACT FROM AUTHOR]

Dear Sirs, Orofacial movement disorders are one of the many possible manifestations of a functional neurological disorder (FND). FNDs are highly prevalent disorders that encompass 5-20% of patients seen in a movement disorder clinic [[12]]. In this case report, we present a novel presentation of a functional movement disorder with bilateral orofacial jerks and demonstrate how surface polymyography can be used to objectively measure distractibility in functional movement disorders. Sharing the possible manifestations of functional movement disorders contributes to a better recognition of these disorders and will eventually improve patient management. [Extracted from the article]

Polymyalgia rheumatica (PMR) is a systemic inflammatory disease of the elderly population that increases in incidence as age advances. It is characterised by the sudden or sub-acute onset of symptoms affecting the shoulder and pelvic girdles, often accompanied by constitutional symptoms. Due to the lack of consensual diagnostic criteria and specific laboratory or radiological investigations for PMR, its diagnosis can be very challenging, particularly because it can be mimicked or masked by other geriatric syndromes. PMR responds well to glucocorticoid treatment, but if left untreated, can lead to morbidity and poor quality of life. We present the case of an 87-year-old male who presented with a one-week history of localised pain in the left hip joint, later involving the contralateral hip. Previously able to ambulate unaided, his mobility was now severely impaired. Due to his Alzheimer's dementia and multiple comorbid geriatric conditions, extensive investigations were undertaken before a diagnosis of atypical PMR was reached. Treatment with a low dose of prednisolone led to a full recovery. This case highlights the inconsistency between an atypical presentation and the classic presentation of PMR and draws attention to the possibility of missed diagnosis in older, frail patients. Atypical symptomatology on top of cognitive impairment and language barriers can be easily overlooked and left untreated and could lead to severe adverse outcomes. Accurate diagnosis is crucial, as PMR is readily diagnosed, but the treatment with glucocorticoids, though generally straightforward, can pose challenges, particularly when dealing with polypharmacy and multiple coexisting health conditions. [ABSTRACT FROM AUTHOR]

Spinal Anaesthesia (SA) with hyperbaric bupivacaine and opioids is a preferred technique for lower limb surgeries in many centres. Among the various complications of such anaesthesia, postprocedural voice loss is relatively uncommon and has been reported very rarely in cases other than parturient patients. The sudden onset of such symptoms after anaesthesia and various other attributable causes may have implications for the subsequent surgery. The authors reported here a case of postprocedural voice loss in a 24-year old male patient prepared for open reduction and internal fixation surgery for a femur fracture. The patient developed immediate dysphonia along with tingling of the face and itching of the nasal alae after the administration of a subarachnoid block. The patient had a normal heart rate, blood pressure, and respiratory pattern. There was no history of any previous episode or possible attributable psychological condition. The authors carefully monitored the patient, assessed various causes of such a presentation, and noticed it to be transient and without any serious implications. They attributed the cause to the rostral spread of fentanyl, and the surgery was resumed. The authors concluded that immediate and transient voice loss after SA is an unexpected and unavoidable complication for lower limb surgery and may occur in non obstetric cases as well. However, if hypovolemia and respiratory abnormalities had been excluded, reassurance and close observation may be appropriate. [ABSTRACT FROM AUTHOR]

The case report describes an 11-year old boy with sudden onset lower right limb thrombosis, hypertension and nephritic syndrome. Laboratory findings revealed positive results of anti-ANA, anti-dsDNA, lupus anticoagulant and COVID-19 IgG antibodies. Vascular ultrasound and computed tomography detected active thrombosis of the right popliteal vein. Kidney biopsy confirmed fourth class lupus nephritis. The patient responded well to a combination of steroids, cyclophosphamide, hydroxychloroquine, rituximab, alteplase, heparin and amlodipine, with the resolution of thrombosis and nephritic syndrome, stabilization of blood pressure and improvement in laboratory findings. The case highlights the importance of prompt diagnosis and appropriate treatment of systematic lupus erythematosus with vein thrombosis and lupus nephritis in children, particularly in male patients. Overall, this case emphasizes the possibility of virus triggering factors in systematic lupus erythematosus and the importance of regular check-ups, monitoring of symptoms in preventing complications and improving the long-term outlook for patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease is usually associated with optic neuritis, acute disseminated encephalomyelitis or transverse myelitis. We are presenting a rare case report wherein myelin oligodendrocyte glycoprotein antibody seropositivity was associated with hemorrhagic longitudinally extensive transverse myelitis. To our knowledge, no such cases were found to be published. Case presentation: A 15-year-old female came with complaints of sudden onset paraparesis. MRI was performed within 48 h from the episode of paraparesis, which revealed a long-segment, intramedullary, expansile and heterogeneously enhancing spinal cord lesion extending from T1 vertebral level up to conus medullaris. Few foci of blooming were also noted within the spinal cord on gradient sequences. Laboratory evaluation of cerebrospinal fluid analysis revealed no significant abnormality. Neuromyelitis optica antibodies were negative, and myelin oligodendrocyte glycoprotein antibodies (MOG) showed seropositivity. The patient was started on methylprednisolone and plasmapheresis for the same after which the patient gradually improved and regained her ability to walk. Follow-up MRI was performed after 4 weeks, which revealed significant reduction in the extent of the intramedullary lesion described earlier. Conclusions: Hemorrhagic longitudinally extensive transverse myelitis without any involvement of optic nerves and brain may show MOG seropositivity, and it should be considered as one of the differential diagnosis in acute myelopathy. [ABSTRACT FROM AUTHOR]

Sudden death, or unexpected natural death of a healthy individual, is a serious problem in all nations. Sudden cardiac death (SCD) mainly due to ischemic heart diseases is the top cause of sudden death. However, there are pathophysiological conditions, referred to as sudden arrhythmic death syndrome, in which no apparent lesion can be identified even after complete conventional or ordinary autopsy. While postmortem genetic analyses have accumulated evidence about underlying genetic abnormality in such cases, the precise relationships between genetic background and the phenotype have been largely elusive. In this study, a retrospective investigation of 17 autopsy cases in which lethal arrhythmia was suspected to be the cause of death was carried out. Genetic analysis focusing on 72 genes reported to be associated with cardiac dysfunctions was performed, in combination with detailed histopathological and postmortem imaging examination, and a family study. As a result, in two cases of suspected arrhythmogenic cardiomyopathy (ACM), we found a nonsense variant in PKP2 and frameshift variant in TRPM4 gene. In contrast, the other 15 cases showed no morphological changes in the heart despite the presence of a frameshift variant and several missense variants, leaving the clinical significance of these variants obscure. The findings of the present study suggest that nonsense and frameshift variants could be involved in the morphological abnormality in cases of SCD due to ACM, while missense variants alone rarely contribute to massive structural changes in the heart. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) might have an inherited cardiac condition background. Genetic testing supports post-mortem diagnosis and screening of relatives at risk. Our aim is to determine the feasibility of a Czech national collaboration group and to establish the clinical importance of molecular autopsy and family screening. From 2016 to 2021, we have evaluated 100 unrelated SCD cases (71.0% males, age: 33.3 (12.8) years). Genetic testing was performed by next-generation sequencing utilizing a panel of 100 genes related to inherited cardiac/aortic conditions and/or whole exome sequencing. According to autopsy, cases were divided into cardiomyopathies, sudden arrhythmic death syndrome, sudden unexplained death syndrome, and sudden aortic death. We identified pathogenic/likely pathogenic variants following ACMG/AMP recommendations in 22/100 (22.0%) of cases. Since poor DNA quality, we have performed indirect DNA testing in affected relatives or in healthy parents reaching a diagnostic genetic yield of 11/24 (45.8%) and 1/10 (10.0%), respectively. Cardiological and genetic screening disclose 83/301 (27.6%) relatives at risk of SCD. Genetic testing in affected relatives as starting material leads to a high diagnostic yield offering a valuable alternative when suitable material is not available. This is the first multidisciplinary/multicenter molecular autopsy study in the Czech Republic which supports the establishment of this type of diagnostic tests. A central coordinator and proper communication among centers are crucial for the success of a collaboration at a national level. [ABSTRACT FROM AUTHOR]

Objective: Children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) experience sudden onset neuropsychiatric symptoms after infection or other triggers. Symptoms range from mild to severe, potentially lasting days, weeks, months, or longer. Exacerbation-related functional decline presents in many aspects of daily life, generally accompanied by family stress and caregiver burden. We sought to investigate the relationship between severity of PANS symptoms and caregiver burden/stress and the relationship between severity of PANS symptoms and degree of caregiver/child cohesion. Methods: This cross-sectional online study surveyed caregivers recruited from PANS-related social media support sites. The Pediatric Acute Neuropsychiatric Symptom Scale - Parent Version (PNSS) measured current severity. Caregiver Burden Inventory (CBI) and Caregiver Self-Assessment Questionnaire (CSAQ) assessed caregiver burden/stress. Inclusion of Other in the Self (IOS) scale determined caregiver-perceived current and desired cohesion with their child(ren) with PANS. Results: Of the 216 respondents 79.6% exceeded CBI threshold indicating need for respite in adult care receiver populations. On the CSAQ, 72.9% expressed high distress, 80.5% reported feeling overwhelmed, and 58.1% reported crying spells, meeting cutoffs for support/respite used in adult care receiver populations. Most caregivers reported not having the desired degree of cohesion with their child on the IOS (85.5%). Parents of children with more severe PNSS symptoms fared significantly worse on all measures (CBI: H = 57.83; CSAQ: F = 29.26; IOS: H = 38.04; p < 0.001 for all). Content analysis of comments revealed five themes: (1) severe caregiver and/or family emotional distress and trauma; (2) caregivers wondering what happened to their child; (3) lack of awareness and support among health and education professionals; (4) relationship strain with family, friends, and significant others; and (5) financial and/or legal struggles because of their child's diagnosis. Conclusion: There is strong need for support and respite for children with PANS and their families. Long-term effects including posttraumatic stress symptoms among family members should be studied. [ABSTRACT FROM AUTHOR]

Objective: This paper reports a case of balloon Eustachian tuboplasty with delayed presentation of extensive surgical emphysema. Methods: This is a clinical case report with a review of literature. Results: Eustachian tube dysfunction is a functional disorder that results in inadequate middle-ear ventilation, causing aural fullness and tinnitus. A 36-year-old male presented with the sudden onset of an isolated, painful, left-sided neck swelling. The patient underwent balloon Eustachian tuboplasty, which was uneventful, but subsequently developed a sudden onset of isolated left-sided neck swelling on the 5th post-operative day during Valsalva manoeuvre. Neck examination revealed extensive crepitus on the left side of the neck. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home. Conclusion: Balloon Eustachian tuboplasty is a safe procedure; however, extra care must be taken to avoid possible complications. Patients should be counselled against Valsalva manoeuvre and heavy weightlifting. They also should be instructed to sneeze with an open mouth and consider the use of stool softeners. [ABSTRACT FROM AUTHOR]

Background: Sudden sensorineural hearing loss (SSNHL) refers to rapid and often unexplained decline in auditory acuity. Reported recovery rates for SSNHL vary across studies; however, these are usually within the range of 40% to 60%. Although numerous studies have investigated factors that affect auditory restoration, prediction of patients' hearing recovery remains challenging. Current Concepts: Natural recovery rates for SSNHL range between 32.0% and 65.0%, and treatments commonly include systemic steroid therapy and intratympanic dexamethasone injections. Adjunctive treatments, such as antiviral agents, vasodilators, anticoagulants, hyperbaric oxygen therapy, and stellate ganglion block therapy are also utilized. Recovery typically occurs within 2 weeks, and approximately 66.0% of patients have complete or partial hearing restoration. Recovery predominantly occurs early; approximately 78.2% to 90.0% patients recover within 1 month and >98.0% within 3 months. Age is an important factor associated with recovery; patients aged ≥40 years show low recovery rates. Coexisting dizziness is generally associated with unfavorable outcomes. Hearing loss severity and types (based on the frequency-specific pattern of hearing impairment) are associated with poor prognosis. Additionally, systemic conditions like hypertension and diabetes are implicated as etiopathogenetic contributors. In addition to a variety of audiological assessments to evaluate cochlear function, environmental factors, including particulate matter and air pollution affect outcomes. Discussion and Conclusion: During SSNHL treatment, evaluation of factors known to affect recovery is important to determine patients' hearing restoration potential. Proactive patient counseling is necessary to guide treatment decision-making, particularly for initiation of auditory rehabilitation following incomplete or lack of recovery. Significant variables that affect hearing recovery are useful prognostic indicators. These studies are expected to provide better understanding of the pathophysiology of SSNHL and offer an evidence-based foundation for therapeutic interventions. [ABSTRACT FROM AUTHOR]

Acquired Hemophilia A (AHA) is a rare autoimmune disorder characterized by the onset of a sudden and unexpected bleeding episode in a patient with no personal or family history of bleeding diathesis, and with a typical laboratory feature, i.e., a prolonged activated partial thromboplastin time that is not otherwise explained. This bleeding disorder is caused by autoantibodies directed against the coagulation factor VIII (FVIII). AHA is idiopathic in 50% of cases and is secondary to well-defined diseases in the remaining 50%. AHA affects elderly patients although it has also been observed in the post-partum period. Bleeding manifestations are heterogeneous, ranging from mild to life-threatening bleeds involving limbs and organs. Severe bleeding with a significant decrease in hemoglobin levels must be promptly and adequately treated in order to avoid a worsening of the hemorrhages and their complications. According to international recommendations, the bypass agents (i.e., activated prothrombin complex concentrate and activated recombinant factor VII) and the replacement therapy with recombinant porcine FVIII are considered as the first-line therapy for bleeding control, due to their proven clinical efficacy. Plasma-derived or recombinant FVIII concentrates could be used as second-line treatments. Emicizumab may represent a valid and interesting therapeutic option for prophylaxis of bleeding recurrences. [ABSTRACT FROM AUTHOR]

Headache is one of the most common pain syndromes in the paediatric population. Headaches are classified as primary (migraine, tension-type headaches, trigeminal autonomic cephalalgia and other primary headaches) or secondary (e.g. post-traumatic). Non-febrile, non-traumatic headaches represent 1% of all paediatric emergency departments (PED) visits. Many patients present with an acute, moderate to severe pain, sometimes with a sudden onset. Sudden onset headache can be the main symptom of life-threatening neurological conditions as well as a sign of primary headaches such as thunderclap or stabbing headaches. This review aims to describe the presentation of sudden primary headaches in children, in order to help the physician to provide effective management in the emergency setting. [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (SCI) causes a sudden onset multi-system disease, permanently altering homeostasis with multiple complications. Consequences include aberrant neuronal circuits, multiple organ system dysfunctions, and chronic phenotypes such as neuropathic pain and metabolic syndrome. Reductionist approaches are used to classify SCI patients based on residual neurological function. Still, recovery varies due to interacting variables, including individual biology, comorbidities, complications, therapeutic side effects, and socioeconomic influences for which data integration methods are lacking. Infections, pressure sores, and heterotopic ossification are known recovery modifiers. However, the molecular pathobiology of the disease-modifying factors altering the neurological recovery-chronic syndrome trajectory is mainly unknown, with significant data gaps between intensive early treatment and chronic phases. Changes in organ function such as gut dysbiosis, adrenal dysregulation, fatty liver, muscle loss, and autonomic dysregulation disrupt homeostasis, generating progression-driving allostatic load. Interactions between interdependent systems produce emergent effects, such as resilience, that preclude single mechanism interpretations. Due to many interacting variables in individuals, substantiating the effects of treatments to improve neurological outcomes is difficult. Acute injury outcome predictors, including blood and cerebrospinal fluid biomarkers, neuroimaging signal changes, and autonomic system abnormalities, often do not predict chronic SCI syndrome phenotypes. In systems medicine, network analysis of bioinformatics data is used to derive molecular control modules. To better understand the evolution from acute SCI to chronic SCI multi-system states, we propose a topological phenotype framework integrating bioinformatics, physiological data, and allostatic load tested against accepted established recovery metrics. This form of correlational phenotyping may reveal critical nodal points for intervention to improve recovery trajectories. This study examines the limitations of current classifications of SCI and how these can evolve through systems medicine. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 76-year-old woman experiencing sudden-onset, painless ptosis in the right eye as an early symptom of a thalamic stroke, with no other neurological deficits. Topics discussed include the vascular territories of the thalamus and how infarcts in these regions can lead to varied neuro-ophthalmological symptoms, diagnostic imaging approaches, and the patient's positive response to dual antiplatelet therapy.

The special issue "A Wider Look at Pediatric Primary Headaches" in the journal "Life" highlights the challenges of diagnosing and treating pediatric headaches, emphasizing the unique aspects of various primary headaches in children and adolescents. The issue covers a range of conditions, from tension headaches to less common syndromes like trochlear migraine and red ear syndrome. The articles provide valuable insights into the clinical features, pathophysiology, and treatment options for these conditions, underscoring the need for further research to enhance diagnostic accuracy and therapeutic approaches in pediatric patients. [Extracted from the article]

Background: Acute necrotizing encephalopathy (ANE) is a devastating neurologic condition that can arise following a variety of systemic infections, including influenza and SARS-Cov-2. The clinical features of COVID-19-associated ANE in pediatric patients based on multi-case data have not yet been described and remain obscure. We reviewed 12 pediatric patients to better describe the clinical features of ANE with COVID-19. Methods: We retrospectively collected and summarized the clinical features of ANE in children with COVID-19. Clinical data were collected from 12 children, including their general status, clinical symptoms, laboratory tests, and neuroimaging features. Results: Among the subjects, 10 were over 5 years old and they accounted for 83.33%. A large percentage of those affected (66.67%) were females. The major manifestations included fever (100%), impaired consciousness (100%), and convulsions (75%). We determined that increased interleukin (IL)-6 and IL-10, and tumor necrosis factor-α and interferon gamma were not predictive of severe ANE and mortality in children with COVID-19 in this study. All children presented with abnormal neuroimaging with multiple and symmetrically distributed lesions, involving the thalamus, basal ganglia, cerebellum, and brain hemispheres. Eight of the 12 children died, resulting in a mortality rate of 66.67%, and 75% of these children were females. Importantly, we found the timely administration of mannitol after an acute onset of convulsions or disturbance of consciousness may be decreased the high mortality induced by ANE children with COVID-19. Conclusion: COVID-19 associated with ANE in children is characterized by sudden symptom onset, rapid disease progression, and high mortality. [ABSTRACT FROM AUTHOR]

• Tick-borne infection disease is difficult to diagnose. • Retinal biomarker: peripapillary ischemia has been found of tick-borne infection. • Early detection of the biomarker peripapillary ischemia can prevent misdiagnosis. The objective of this study was to determine whether an observed peripapillary ischemia is a potential biomarker of tick-borne infection (TI). An experimental design analyzing the optic nerve to demonstrate peripapillary ischemia and vessel density changes through ocular coherence tomography with angiography in subjects with TI. Glaucoma was ruled out and the study engaged subjects in the age range 8-40 years. All subjects in the experimental group experienced visual symptoms. Subjects in the control group were asymptomatic and not previously diagnosed with TI. The ocular coherence tomography with angiography scanned the vessel density of the pericapillary plexus surrounding the optic nerves; the images were rated by percentage of vessel density. A two-tail t -test analysis was used to analyze the results. The t -test for each measure comparing the difference-of-differences to a zero change at baseline returned statistically significant, demonstrating reduced vessel density for the subjects in the experimental group (P <0.0001; 95% confidence interval [32.37409-43.50091]). The appearance of peripapillary ischemia in persons below the age of 50 years represents a potential screening biomarker of TI. Primary care physicians, ophthalmologists, and optometrists who have patients presenting sudden onset of visual symptoms in addition to the appearance of peripapillary ischemia should be tested to rule out a TI. [ABSTRACT FROM AUTHOR]

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One of the most prevalent musculoskeletal problems is rotator cuff (RC) injury. The most frequent RC injury is a supraspinatus tear. A partial supraspinatus tear is a partial tear or rupture of the tendon of the supraspinatus muscle and usually presents with pain, weakness, and difficulty in raising affected arm. The aim of this study is to determine the effectiveness of RC and scapular strengthening exercises with low-level laser therapy on pain, range of motion (ROM), strength, and functional abilities of a 61-year-old patient presenting with partial supraspinatus tear. The treatment was given for 5 days/week for 6 weeks. Pain, ROM, strength, and functional abilities were assessed by the Shoulder Pain and Disability Index, goniometer, and handheld dynamometer. Interventions are found to be effective in improving pain, ROM, strength, and functional abilities in patient with partial supraspinatus tear. [ABSTRACT FROM AUTHOR]

Aim. To determine whether thyroid hormone levels are associated with a specific clinical phenotype in patients with first-episode psychosis (FEP). Methods. Ninety-eight inpatients experiencing FEP and with less than 6 weeks of antipsychotic treatment were included in the study and were followed up for one year. Baseline psychiatric evaluation included assessment of prodromal symptoms, positive and negative symptoms, depressive symptoms, stressful life events and cycloid psychosis criteria. Thyroid function (thyroid-stimulating hormone (TSH) and free thyroxin (FT4)) was determined at admission. Partial correlation analysis was conducted to analyse the correlation between levels of TSH/FT4 and symptoms. Logistic regression was performed to explore the association between psychopathological symptoms, 12-month diagnoses and thyroid hormones while adjusting for covariates. Results. Patients with prodromal symptomatology showed lower baseline FT4 levels (OR = 0.06; p = 0.018). The duration of untreated psychosis (DUP) was inversely associated with FT4 concentrations (r = -0.243; p = 0.039). FEP patients with sudden onset of psychotic symptoms (criteria B, cycloid psychosis) showed higher FT4 levels at admission (OR = 10.49; p = 0.040). Patients diagnosed with affective psychotic disorders (BD or MDD) at the 12-month follow-up showed higher FT4 levels at admission than patients diagnosed with nonaffective psychosis (schizophrenia, schizoaffective) (OR = 8.57; p = 0.042). Conclusions. Our study suggests that higher free-thyroxine levels are associated with a specific clinical phenotype of FEP patients (fewer prodromal symptoms, shorter DUP duration and sudden onset of psychosis) and with affective psychosis diagnoses at the 12-month follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Raising awareness of respiratory diphtheria and for the importance of early antitoxin administration. Methods: Report of a case of fulminant, imported respiratory diphtheria in an otherwise healthy 24-year-old Afghan refugee in Austria in May 2022. Result: This was the first case of respiratory diphtheria in Austria since 1993. Diphtheria antitoxin was administered at an already progressed disease stage. This delay contributed to a fulminant disease course with multiorgan failure and death. Conclusion: In high-income countries with low case numbers, awareness of respiratory diphtheria and for the importance of early antitoxin administration must be raised. [ABSTRACT FROM AUTHOR]

Context: Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life. Aims: To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute. Settings and Design: It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications. Materials and Methods: All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes. Results: Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases (n = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum (n = 17), followed by gallbladder (n = 6), appendix (n = 3), gastric (n = 1), jejunum (n = 1), esophagus (n = 1), ileocecal junction (n = 1), duodenum (n = 1), sigmoid (n = 1), and anal canal (n = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception (n = 6) was the most common, followed by intestinal atresia (n = 5), anorectal malformation (n = 3), abdominal wall defect (n = 3), hemorrhagic cyst (n = 1), Meckel's diverticulum (n = 1), and sacrococcygeal teratoma (n = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases. Conclusion: GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract. [ABSTRACT FROM AUTHOR]