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Global trends and insights Into the Neurological Manifestations of Sjogren's Syndrome: a bibliometric review
No full textNeurological symptoms in Sjögren's syndrome (SS) present across a spectrum of severity, posing diagnostic and therapeutic challenges. This bibliometric review adopts a comprehensive approach to analyze the research landscape related to these symptoms. The data source utilized for this bibliometric review was the Web of Science Core Collection. The study selection encompassed English-language articles and reviews published between January 1, 2006, and June 30, 2023. Data extraction involved a systematic analysis of a total of 910 publications, which included 625 research articles and 285 reviews. The publication trends indicate a steady growth in research output, peaking with 122 papers in 2022. Geographic contributions primarily originate from the United States, followed by robust European contributions and increasing input from Asian countries, particularly China and Japan. Influential researchers such as Smith JM from Johns Hopkins University, Brown L from Harvard University, and Wang Q from Peking University have significantly shaped this field. Key institutions driving substantial publication volume and citation impact include Johns Hopkins University, Harvard University, and the University of Tokyo. Furthermore, journals such as Neurology, Journal of Autoimmunity, and Clinical Rheumatology play pivotal roles in disseminating advancements in SS-related neurological research. Future research priorities should focus on primary prevention, emphasizing the need for global cooperation and collaboration in neurological SS workup. There is a call for encouraging interdisciplinary, internationally focused investigative efforts specifically targeting SS neurologists. Key focus areas include potential preventive therapies aimed at significant neural dysfunctions (e.g., sensory neuropathy), mechanisms of microvascular dysfunction, and cognitive profiles/immunomodulation against autoantibodies. This analysis underscores the continued necessity for further research to optimize diagnosis and treatment in cases involving the complexities of neurological involvement with SS.https://www.cureus.com/articles/313678-global-trends-and-insights-into-the-neurological-manifestations-of-sjgrens-syndrome-a-bibliometric-review#!
Assessment and management of patients with a rash
No full textThis article explores how primary care nurses should approach the care of a patient with a rash. It outlines the main ways of examining a patient with a rash, along with effective management strategies. A thorough and systematic physical examination is essential for the accurate diagnosis and management of dermatological conditions. This process involves a comprehensive inspection, careful palpation and the use of specialised tools or techniques where necessary. Each component provides unique diagnostic insights, enabling clinicians to differentiate between various skin conditions and approach treatment accordingly. Although some of these assessment and treatment techniques will require referral to secondary care, it is useful for practice nurses to be aware of them and mindful of when to seek specialist input.https://www.practicenursing.com/content/clinical/assessment-and-management-of-patients-with-a-ras
Comparative Analysis of Lung Ultrasound, Computed Tomography, and X-ray in the Diagnosis of Common Pathologies among Critically Ill Mechanically Ventilated Patients-A Prospective Observational Study
Get PDFBackground and aims: Chest X-ray (CXR) and computed tomography (CT) are established imaging modalities for patients in respiratory distress, and lung ultrasound (LUS) has emerged as an efficient point-of-care alternative. This study aimed to evaluate the diagnostic performance of LUS and CXR in critically ill patients, utilizing CT thorax as the reference standard. Patient and methods: A prospective observational study was conducted in a tertiary care intensive care unit (ICU) involving mechanically ventilated adult patients requiring CT thorax. Before the CT, patients underwent portable CXR and LUS. Diagnostic performance metrics were calculated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and AUC-ROC for pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema for CXR and LUS compared to CT. Inter-rater agreement was assessed using Cohen's κ. Results: A total of 110 patients were included in this study. Overall, the performance of LUS was significantly superior to CXR for diagnosing various pathologies. Lung ultrasound exhibited 100% sensitivity and 97% specificity, outperforming CXR (66.7% sensitivity) for the detection of pneumothorax. For pleural effusion, LUS achieved 100% sensitivity and specificity, reflecting perfect concordance with CT, especially for moderate and severe pleural effusions, while CXR had an accuracy of only 68.18%. Lung consolidation and collapse were identified with 100% sensitivity and PPV by LUS. Furthermore, the accuracy of LUS in diagnosing pulmonary edema was 96.4%, with a specificity of 95.3% and an NPV of 100%. Conclusion: Across five pathologies that were evaluated in this study, LUS consistently outperformed CXR in diagnostic accuracy and concordance with CT thorax.https://www.ijccm.org/abstractArticleContentBrowse/IJCCM/64/29/10/42164/abstractArticle/Articl
Prevalence and factors associated with restraints in mental health in-patient wards
Get PDF© The Author(s), 2025. Published by
Cambridge University Press on behalf of
Royal College of Psychiatrists. This is an
Open Access article, distributed under
the terms of the Creative Commons
Attribution licence (https://
creativecommons.org/licenses/by/4.
0/), which permits unrestricted re-use,
distribution and reproduction, provided
the original article is properly cited.AIMS AND METHOD: Restraints in mental health in-patient settings can negatively affect recovery. This study aimed to examine the prevalence and associated factors of restraint use. A retrospective cohort study was conducted in a rural NHS mental health trust in the UK, covering all adult in-patients from July 2020 to July 2021. RESULTS: The prevalence of restraint was 34%. Factors associated with restraint included age 18-25 or ≥65 years, female gender, disability, long-term sickness benefits, detention under the Mental Health Act, frequent admissions and a diagnosis of depressive or severe mental illness. Statistically significant associations were found for age ≥65 years (odds ratio 3.920), Section 2 detention (odds ratio 5.72), more than ten previous admissions (odds ratio 5.672) and depressive disorders (odds ratio 3.478). CLINICAL IMPLICATIONS: Restraint use remains common and is linked to identifiable risk factors. These findings support the need for targeted interventions to reduce restraint, particularly for high-risk patient groups.https://www.cambridge.org/core/journals/bjpsych-bulletin/article/prevalence-and-factors-associated-with-restraints-in-mental-health-inpatient-wards/074C94348720B2D09DAD5D97286D86D
Recognizing haemophagocytic lymphohistiocytosis in an HIV patient with disseminated tuberculosis: not every fever is sepsis
No full textHaemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition that causes hyperinflammation, extensive tissue destruction, multi-organ failure (MOF) and death due to uncontrolled activation and proliferation of T cells and macrophages. HLH can be primary (genetic) and secondary (acquired). Primary HLH occurs due to genetic mutations, and secondary HLH is often triggered by autoimmune diseases, infections (commonly viral, bacterial and parasites) and malignancies, such as lymphoma. We report a case of secondary HLH in a 43-year-old man with an untreated human immunodeficiency virus (HIV) infection and newly diagnosed disseminated tuberculosis who was admitted to the acute medicine ward with some non-specific gastrointestinal symptoms. Nevertheless, he was treated with guideline-directed antibiotics, but his condition failed to improve with persistent high-grade fever, haemodynamic instability, splenomegaly, pancytopenia, transaminitis and hyperferritinaemia (ferritin: >18,000 μg/L). Hence, the multidisciplinary team (MDT) initiated a workup including the Haemophagocytic Lymphohistiocytosis Diagnostic Score (HScore) and bone marrow biopsy, along with viral screening, tuberculosis (TB) tests and computed tomography (CT) of the chest, abdomen and pelvis, followed by bronchoscopy. The clinical diagnosis of HLH was established based on the highly supportive clinical and laboratory criteria, as reflected by an extremely high HScore (272), despite the absence of haemophagocytosis on bone marrow biopsy. Later, the bronchial washing confirmed the detection of Mycobacterium tuberculosis. Our rheumatology, haematology and acute medicine team consensually agreed to start intravenous (IV) pulse methylprednisolone for three days, followed by antiretroviral and anti-tubercular regimens. This case underscores the diagnostic challenge of HLH in untreated patients with HIV and disseminated TB, where the clinical manifestations can resemble sepsis, cytokine storm or systemic inflammatory response syndrome (SIRS). Ultimately, early identification and timely intervention with immunosuppressive therapy are crucial for the favourable outcome of patients with HLH.https://www.cureus.com/articles/376377-recognizing-haemophagocytic-lymphohistiocytosis-in-an-hiv-patient-with-disseminated-tuberculosis-not-every-fever-is-sepsis#!
Use of incentive spirometry to prevent acute chest syndrome (ACS) in patients with sickle cell disease (SCD): a systematic review
No full textSickle cell disease (SCD) is a genetic hematological disorder that causes the production of sickle-shaped red blood cells. These abnormal cells reduce the oxygen-carrying ability around the body and obstruct blood flow, potentially resulting in devastating complications such as acute chest syndrome (ACS). The objective of this systematic review is to assess whether incentive spirometry is effective in reducing the incidence of ACS in patients with SCD. This review searched databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to August 17, 2025. Randomized controlled trials (RCTs) that used incentive spirometry in patients with SCD were included in the review. Inclusion criteria for this review include patients diagnosed with SCD who have received incentive spirometry, with outcomes compared against standard prevention for ACS or other alternative interventions aimed at preventing or managing lung pathology. Studies must report on at least one of the following outcomes: incidence of ACS, pulmonary function, hospital stay duration, hospitalization rates, or adverse effects. This study found that three RCTs (29 patients, 38 patients, and 20 patients with a total of 124 hospitalizations) were included in this review. Two studies compared incentive spirometry to standard care, while only one compared incentive spirometry to positive expiratory pressure (PEP). A meta-analysis was conducted between two studies, with one trial suggesting that incentive spirometry successfully reduced the incidence of ACS and the other trial suggesting that it could not successfully reduce it. A meta-analysis of both studies found that incentive spirometry did not successfully reduce the incidence of ACS in patients with SCD (RR=0.51; 95% CI (0.21, 1.33)). The quality of this evidence was very low, due to the wide confidence interval, high risk of bias, and substantial heterogeneity. This review concluded that incentive spirometry could not successfully reduce the incidence of ACS in patients with SCD. Limitations of the studies used included small sample sizes and heterogeneity between study populations (i.e., children vs. adults). Therefore, further research is required to assess this, including larger, well-designed RCTs to be conducted focusing on core outcome sets (COS).https://www.cureus.com/articles/406867-use-of-incentive-spirometry-to-prevent-acute-chest-syndrome-acs-in-patients-with-sickle-cell-disease-scd-a-systematic-review#!
Supportive bandage, removable splint, or walking casts for low-risk ankle fractures in children: A feasibility randomized controlled trial
Get PDFAims: It is unclear if a supportive bandage, removable splint, or walking cast offers the best outcome following low-risk ankle fractures in children. The aim of this study was to evaluate the feasibility of a randomized controlled trial to compare these treatments., Methods: Children aged five to 15 years with low-risk ankle fractures were recruited to this feasibility trial from 1 February 2020 to 30 March 2023. Children were randomized to supportive bandage, removable splint, or walking cast for two weeks. Follow-up at two, six, and 12 weeks was undertaken to determine feasibility for a definitive trial. Outcomes collected included complications, the Patient-Reported Outcomes Measurement Information System (PROMIS) mobility score, Paediatric Quality of Life Inventory, youth version of the EuroQol five-dimension health questionnaire, and Activities Scale for Kids - Performance., Results: A total of 87 children from six hospitals were randomized at a rate of 0.9 participants per site per month. Two children in the supportive bandage group crossed over to an alternative device. Complications were reported in six children. One child in the cast group developed skin blisters. One child in cast and one in bandage sustained a reinjury during the 12-week follow-up, and two children (one splint and one cast) required additional immobilization after the two-week treatment for persistent pain. Of the 84 participants who remained in the study at six weeks, 43 (51.2%) returned follow-up questionnaires at six weeks. Of the patient-reported outcome measures (PROMs), proxy-reported PROMIS mobility showed good responsiveness, low ceiling effects, and low missing item rates. In an exploratory analysis, small differences were observed between groups, with no evidence that any of the treatments were superior., Conclusion: This feasibility study showed acceptable recruitment and retention rates. There remains equipoise regarding the best treatment of these injuries. All three treatments appear well tolerated with similar complication rates. A primary outcome of complications or treatment failure would provide the highest study retention with secondary PROMs and economic analysis. Copyright © 2025 Marson et al.https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-0354.R
Clinical and socio-demographic characteristics of people with multiple sclerosis at the time of diagnosis: Influences on outcome trajectories
Get PDFBackground: It has long been accepted that multiple sclerosis (MS) is heterogenous regarding presentation and disease course, so that outcomes are diverse; however, there is less data on variation in the immediate period after diagnosis. Method(s): Our objective was to identify the clinical and demographic factors present at diagnosis. Two cohorts were compared from the Trajectories of Outcome in Neurological Conditions-MS study: those joining within one year of diagnosis (inception cohort) compared to 9-11 years following diagnosis (decade cohort). Patient reported outcome data were fitted to the Rasch model to yield interval estimates, longitudinal data were analysed by group-based trajectory models. Result(s): The inception cohort (n = 813) showed impact on fatigue, disability, health status and quality of life (QOL), although as expected, less than the decade cohort (n = 679), who also had more depressive symptoms. The average trajectory of health status was deceptive, as analysis showed two distinct groups, 13.8 % having much poorer health status, sustained for at least 3 years from diagnosis. Similarly, there were distinct groups with different trajectories identified for disability and QOL. These groups varied for depression, anxiety, sleep problems, employment, comorbidities, smoking history, and deprivation indices, highlighting influences prior to diagnosis. Conclusion(s): MS care must be personalised from diagnosis; service design should account for those people with MS experiencing poor health status from diagnosis. Basing capacity planning on average trajectories would be misleading. Furthermore, this evidence shows that service provision to support symptom management and disability clearly needs to be resourced from the diagnostic year.Copyright © 2025 The Authorshttps://doi.org/10.1016/j.jns.2025.12340
Cerebral cortical encephalitis in adults with myelin oligodendrocyte glycoprotein antibody-associated disease: A national case series
Get PDFBackground and purpose: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a relatively recently described disease, most commonly presenting with optic neuritis and longitudinally extensive transverse myelitis. Cerebral cortical encephalitis is a rare manifestation of MOGAD. Method(s): We identified patients presenting with cerebral cortical encephalitis with positive MOG antibodies in serum across a large specialized service. Demographic and clinical information were collected. We describe clinical and laboratory characteristics, treatment response, and subsequent relapse risk in adults presenting with this phenotype. Result(s): We identified eight patients meeting clinical criteria for cerebral cortical encephalitis with MOG antibodies. All had seizures; four had focal onset seizures with or without secondary generalization. Two patients exhibited encephalopathy, and six demonstrated focal neurological deficits at presentation. All had fluid-attenuated inversion recovery hyperintensities. Five of eight displayed cerebral swelling, and two of eight displayed leptomeningeal enhancement. Where cerebrospinal fluid (CSF) results were available, five of seven had CSF pleocytosis, protein was raised in two of seven, and one patient had oligoclonal bands unique to CSF. Median time to seizure control was 1.25 months, and all clinical features and magnetic resonance imaging abnormalities resolved. Four of eight patients (50%) had a clinical relapse, with a median time to relapse of 6.4 months. Conclusion(s): Cerebral cortical encephalitis appears to share similar CSF findings, steroid responsiveness, and risk of relapse with other clinical manifestations of MOGAD. This informs treatment decisions and patient counselling.Copyright © 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.https://doi.org/10.1111/ene.1655
Endovascular treatment of stroke due to medium-vessel occlusion
No full textBACKGROUND: Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear. METHOD(S): In a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 no symptoms] to 6 death]) at 90 days, reported as the percentage of patients with a score of 0 or 1. RESULT(S): A total of 530 patients from five countries were enrolled between April 2022 and June 2024, with 255 patients assigned to the EVT group and 275 to the usual-care group. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin scale score of 0 or 1 at 90 days occurred in 106 of 255 patients (41.6%) in the EVT group and in 118 of 274 (43.1%) in the usual-care group (adjusted rate ratio, 0.95; 95% confidence interval CI], 0.79 to 1.15; P = 0.61). Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group (adjusted hazard ratio, 1.82; 95% CI, 1.06 to 3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) in the EVT group and in 6 of 272 (2.2%) in the usual-care group. CONCLUSION(S): Endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care. (Funded by the Canadian Institutes for Health Research and Medtronic; ESCAPE-MeVO ClinicalTrials.gov number, NCT05151172.).Copyright © 2025 Massachusetts Medical Society.https://doi.org/10.1056/nejmoa241166