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Polymyalgia Rheumatica Presenting as Nocturnal Pyrexia of Unknown Origin: A Case Report
Full text linkBackground. Polymyalgia rheumatica (PMR) is a rheumatic disorder characterized by musculoskeletal stiffness and pain, primarily affecting the shoulder, neck, and hip areas. It is more common in females, with the peak incidence usually after the age of 70.
Case Report. A 74-year-old man presented with a two-month history of low-grade nocturnal fever up to 100oF (37.7oC) which did not respond to multiple courses of antibiotics. There was unintentional weight loss of 5 kg and mild shoulder stiffness. The patient had a history of Type 2 diabetes mellitus treated with 34 units of insulin (Humulin 70/30) daily and active smoking of 40 pack-years. On examination, mild tenderness of both shoulder girdle muscles and discomfort on external rotation were noted. The initial blood work-up revealed raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Serologies for syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were negative. Given the negative results of infective and malignancy screening, along with raised inflammatory markers and mild shoulder stiffness, a diagnosis of PMR was made and a trial of prednisolone was initiated, resulting in the resolution of symptoms.
Conclusions. The present case report highlights the importance of thoroughly investigating all differential diagnoses of pyrexia of unknown origin, regardless of the patient’s ethnic origin, to facilitate timely diagnosis
Bugs and Brains: The Microbiome & Dementia
Full text linkInterest in the microbiome and its correlation with different neurological diseases has grown significantly over the past decade. The gut microbiome contains a vast array of diverse organisms living in the gastrointestinal (GI) tract. Predominantly composed of bacteria, the gut microbiome helps regulate homeostasis and metabolism in the host, aiding in immune system development as well as vitamin and nutrient absorption. Studies suggest that, in addition to providing humans with these physiological benefits, the gut microbiome is also linked to and communicates with the brain via the gut-brain axis (GBA). Long-standing research on the GBA has demonstrated that the GI tract and the central nervous system are interconnected through both neurological and immunological signaling pathways. Recent research is expanding our understanding of the microbiome and the GBA, revealing correlations between the microbiome impact on the GBA and neurological conditions such as Alzheimer’s dementia and Lewy body dementia, going as far as to identify and highlight specific microbial species that may serve as risk or protective factors for various forms of dementia. This letter aims to highlight the current findings and recommend the use of tools such as microbial cell-free DNA testing to gain a better understanding of the role of gut dysbiosis in dementia patients
In Vitro Evaluation of Cytotoxicity of Moringa oleifera Hydroalcoholic Leaf Extract on Human Gingival Fibroblasts
Full text linkBackground. The market for wound healing biomaterials is a rapidly growing industry globally. Moringa oleifera Lam. (MO) is a plant that has gained attention for its benefit in buccal mouthwashes and antiseptic products. This study aimed to assess the cytotoxic potential of MO hydroalcoholic extract on human primary gingival fibroblasts.
Methods. The gingival tissue was collected from a healthy adult male at Umm Al-Qura University Dental Teaching Hospital. Gingival fibroblasts were isolated and cultured in Dulbecco’s Modified Eagle Medium (DMEM). MO leaves were dried, powdered, and extracted with 80% ethanol. Various concentrations of MO alcohol extract were used to assess the cell viability of gingival fibroblasts using the MTT assay.
Results. The gingival fibroblasts treated with higher concentrations of MO hydroalcoholic extract (10, 5, and 2.5 mg/ml) showed significant morphological changes, including cytoplasm swelling, ruptured cells, nuclear changes, and apoptotic bodies. At these concentrations, cell viability decreased sharply. However, at a lower concentration of 2.5 mg/ml, the cells showed better viability. MO alcohol extract at concentrations of 1.25 mg/ml or lower did not have cytotoxic effects on fibroblasts, with cell viability comparable to that of the control.
Conclusions. MO alcohol extract at concentrations of 1.25 mg/ml or lower is not cytotoxic and does not induce dystrophic changes in morphology. Further research is needed to understand MO’s impact on oral health and to assess its potential use in oral care products in vivo
Effect of Sexual Dysfunction on Quality of Life in Men with Type 2 Diabetes Mellitus
Full text linkIntroduction. Sexual dysfunction is a significant complication of diabetes mellitus (DM). Men with DM may develop erectile dysfunction and a lack of sexual desire due to the nature of the disease and its complications.
This study aimed to assess the effect of sexual dysfunction on the quality of life (QoL) in men with type 2 DM.
Methods. This study utilized a single-center, descriptive design and was carried out between November 15, 2021, and August 24, 2022. It included 378 male patients with type 2 DM treated at the internal medicine outpatient clinic at a university hospital in Turkey. The data were collected using the Personal Information Form developed by the researchers, the Arizona Sexual Experiences Scale (ASEX), and the Diabetes-Specific Quality of Life Scale (DSQOL). Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U test, Spearman correlation coefficient, and multiple regression analysis were used to assess the data.
Results. Among male patients with type 2 DM participating in the study, the mean ASEX score was 14.47 ± 3.37 and the DSQOL score was 2.92 ± 0.31. The relationship between the mean ASEX and DSQOL scores and various factors such as age, education status, employment status, regular health check-ups, duration of diagnosis, type of treatment, fasting blood glucose level, HbA1c level, and body mass index was found to be statistically significant (p < 0.05). A negative correlation was identified between the mean ASEX and DSQOL scores (p < 0.001). Additionally, multiple regression analysis revealed that QoL, duration of diagnosis, marital status, and education status were significant factors influencing the sexual dysfunction levels of the participants (p < 0.001).
Conclusions. This study found that as individuals’ levels of sexual dysfunction increased, their QoL decreased. Therefore, it is recommended to assess sexual dysfunction thoroughly and implement training programs aimed at improving sexual health to enhance individuals’ QoL
Knowledge and Opinions About Sustainable Nutrition and the Factors Associated With Sustainable and Healthy Eating Behaviors in Adults
Full text linkIntroduction.The aim of this study was to assess the knowledge and opinions about sustainable nutrition and the factors associated with sustainable and healthy eating behaviors among individuals aged 18 to 65 years.
Methods. An online cross-sectional survey-based study included analysis of demographic and anthropometric characteristics, participants’ knowledge and opinions about sustainable nutrition, and their scores on the Sustainable and Healthy Eating Behaviors (SHEB) Scale. The snowball sampling method was used.
Results. The study included 3,037 adults with a mean age of 25.62 ± 9.66 years. Participants scored highest on the factors of healthy and balanced nutrition and low fat, and lowest on the factors of local food and reducing meat consumption. The SHEB Scale scores for women (4.04 ± 1.12) were higher compared to men (3.83 ± 1.21) (p < 0.001). A significant association was identified between age and SHEB Scale scores (OR=1.01, 95% CI 1.01-1.03), with no association observed with body mass index. Women were more likely to display sustainable and healthy eating behaviors compared to men (OR=1.45 95% CI 1.23-1.71), as were married participants compared to single participants (OR=1.87 95% CI 1.54-2.27).
Conclusions. The results of this study indicate that sustainable nutrition is not well understood among adults. Advancing age, female gender, and being married were found to be associated with higher scores on the SHEB Scale
ДЕРМАТОГЛІФІЧНИЙ ФЕНОТИП ЛЮДИНИ ЯК ОДИН З КРИТЕРІЇВ ЇЇ ІДЕНТИФІКАЦІЇ
No full textIntroduction. One of the methods used to track the pattern of heredity and variability of human psychophenotypic traits is dermatoglyphic. It is used to study the hereditary patterns that form skin lines on the fingertips, palms, and soles of a person.
The aim of the study to develop expert criteria for the informativeness of dermatoglyphic fingerprints in the system of forensic medical identification of a person.
Materials and methods. The object of the study was fingerprint cards obtained from 460 people (200 women and 260 men) aged 18-59 years living in Ukraine. The dermatoglyphic method and the method of statistical analysis were used.
Results. It has been established that dermatoglyphic features can be congenitally unchanged (pattern type and its orientation, comb and delta count, rudiments and dysplasias);
congenital variables (altitude-latitude index, delta-interphalangeal fold distance, line density); acquired variables (white lines and scars).All these features have not only individual but also group variability.
Conclusion. The proposed forensic classification of dermatoglyphic features does not include individual features of the structure of patterns (minutiae), the appearance of which is largely due to the action of random factors and therefore is valuable for forensic science (fingerprinting)
Diagnosis and Treatment of Chronic Urticaria: The Importance of Autoimmune Aspects and Comorbidity
Full text linkThe study aimed to conduct a comprehensive systematic review of the literature on the autoimmune mechanisms associated with chronic spontaneous urticaria (CSU) in adults, explore the association between chronic urticaria (CU) and autoimmune disorders, analyze two case reports, and develop a diagnostic algorithm considering the autoimmune pathogenesis.
Materials and Methods. The literature review was conducted to study the mechanisms underlying autoimmune CU. Two case reports were analyzed and a diagnostic algorithm for patients suspected of autoimmune urticaria was formulated.
Results. CU significantly impairs patients’ quality of life, posing problems in daily activities and is often associated with concomitant autoimmune diseases. Though the pathogenesis of CSU remains incompletely understood, in recent years, there has been significant progress in understanding the pathophysiology of this condition, prompting researchers to explore new agents, especially biological ones, in cases with severe refractory urticaria. We have developed a diagnostic algorithm aimed at improving the management tactics for CSU and autoimmune pathology, that involves a thorough collection of complaints, medical history, performing a series of basic laboratory tests for specific markers of autoimmune disorders, and expanding their spectrum with detailed differential diagnostics.
Conclusions. CU is an important medical and social issue that requires an interdisciplinary personalized approach to patients. The diagnosis of the condition involves a comprehensive approach, considering potential concomitant autoimmune disorders and detailed laboratory investigations, especially in cases refractory to standard second-generation antihistamine therapy. The treatment of CU, specifically the stepwise therapy protocol based on symptom severity and response to treatment and aimed at reducing symptoms, improving patients’ quality of life, and achieving CU remission, is outlined in various national and international guidelines, and is carried out gradually, involving three lines of therapy
Optimization of Diagnostics and Treatment of Nasopharyngeal Cysts
Full text linkNasopharyngeal cysts are typically benign, congenital lesions filled with fluid and encapsulated from surrounding tissues. Both children and adults may present with clinical signs.
The aim of the study was to improve the efficiency of diagnostics and treatment of nasopharyngeal cysts in adults based on the differential diagnosis.
Materials and Methods. The study was carried out at the Department of Otolaryngology with the Course of Head and Neck Surgery, Ivano-Frankivsk National Medical University, Ukraine, and encompassed both outpatient and inpatient-to-outpatient observations. Fifteen (9 females, 6 males) patients with nasopharyngeal cysts at the age of 28 to 51 years were examined. All patients underwent a comprehensive assessment, including a thorough evaluation of their medical history, a standard examination of the ears, nose, and throat (ENT) using conventional and optical techniques, alongside computed tomography (CT) of the nasopharynx and paranasal sinuses, complemented by a general physical examination.
Results. Fifteen patients with nasopharyngeal cysts were examined and treated. In nine (60%) cases, the cyst appeared as a round mass with a dense wall, partially or completely obstructed by the excretory duct and containing dense content, localized in the central region of the nasopharynx. In four (26.6%) cases, the cyst ruptured. Cysts were localized laterally, originating from the fossa of Rosenmüller in three (20%) cases. All patients underwent minimally invasive surgery.
Conclusions. Endoscopic examination, CT, and magnetic resonance imaging are the most informative diagnostic methods for nasopharyngeal cysts. A definitive diagnosis can be made based on pathomorphological examination. The treatment of choice for nasopharyngeal cysts is endoscopic endonasal surgery with a microdebrider and laser coagulation
Peculiarities of the Clinical Picture of Hirschsprung’s Disease in Children of the First Year of Life Taking Into Account the Extent of Aganglionosis
Full text linkThe aim of the work. To investigate the peculiarities of the clinical course of Hirschsprung’s disease in children of the first year of life and to determine the significance of symptoms in the verification of the disease.
Research materials and methods. Since 1980 up to 2021, at the pediatric surgery clinic of the National Medical University named after O.O. Bohomolets on the basis of the National Children’s Specialized Hospital “OKHMATDYT” and in the pediatric surgery clinic of the Ivano-Frankivsk National Medical University on the basis of the Ivano-Frankivsk Regional Children’s Clinical Hospital, there were examined and treated 483 children of the first year of life suffering from Hirschsprung’s disease.
Results of the study. The clinical manifestation and course of aganglionosis varied in length at the time of hospitalization and depended on the time after birth. During the first month of life, 97 (20.08%) patients were hospitalized; of them 39 (8.07%) patients had an atypical clinical picture due to: colonic atresia in 15 (3.10%), colonic atresia + gastroschisis in 3 ( 0.62%), ileal atresia in 9 (1.86%), esophageal atresia in 3 (0.62%), cleft of the hard and soft palate in 9 (1.86%) patients. Depending on the age, there were 280 (57.97%) patients under 6 months, and 203 (42.03%) patients between 6 months and 1 year. The classic typical clinical picture was in 444 (91.93%) patients, which was characterized by the absence of meconium excretion, abdominal distension in 444 (91.93%) patients, delayed physiological weight gain against the background of nutritional insufficiency with the development of hypotrophy in 327 (67.70%) patients, vomiting of stagnant gastric and intestinal contents in 417 (86.34%) patients. On the other hand, there occurred enterocolitis in 315 (65.22%) patients, toxic megacolon in 16 (3.31%) patients, and anemia of various degrees in 241 (49.89%) patients, among the complications that arose during the examination of patients with Hirschsprung’s disease. According to the results of a comprehensive examination, the following extent of aganglionosis was determined: rectal form in 100 (20.70%) patients, rectosigmoid form – in 192 (39.75%), subtotal – in 150 (31.06%) and total in 41 (8.49%) patients. Concomitant malformations were found in 98 (20.29%) patients: renal malformations were diagnosed in 7 (1.45%) patients, concomitant heart malformations in 18 (3.73%) patients. Associated intraoperative findings were: Meckel’s diverticulum in 5 (1.03%) patients, and congenital cyst of the right ovary in 1 (0.21%) patient. The clinical course was affected by the concomitant malformations: incomplete bowel rotation in 10 (2.07%) patients and internal abdominal hernia in 2 (0.42%) patients.
Conclusions. Clinical manifestations and course of HD primarily depend on the presence of accompanying developmental defects, which may prevail during the examination due to vital disorders. In the clinical course of Hirschsprung’s disease, it is necessary to distinguish between typical and atypical forms. Typical clinical symptoms were in 444 (91.93%), and atypical in 39 (8.07%) patients
Effect of Spaced and Massed Learning Approaches on the Performance of Faculty Members in Medical Education
Full text linkIntroduction. The effectiveness of spaced and massed strategies can be evaluated by examining how educational experts (faculty members) transfer their learning skills to real-life educational contexts, such as with their undergraduate students in Saudi Arabia. It is necessary to consider the respective benefits of these strategies for faculty members to maintain standards and capabilities, fulfilling their learning and development needs.
Aim. This study aimed to compare the effectiveness of spaced and massed practice programs for faculty members in transferring their acquired assessment skills to their students. To achieve this goal, we used a mixed methodological approach, integrating both qualitative and quantitative methods into the study design.
Methods. This study was carried out at the Faculty of Medicine, King Abdul-Aziz University (KAU), Jeddah, Saudi Arabia. Focus group discussions were employed for the qualitative approach, while the paired-sample t-test and Chi-square test of independence were used for the quantitative approach.
Results. The results of the focus group discussion indicated that participants from both groups preferred the spaced learning approach, considering the busy schedules of medical doctors and students. In terms of cost effectivity, both group participants preferred the massed learning technique. Two (25%) participants from the spaced technique group and five (62.5%) participants from the massed technique group succeeded in applying all parts of the assessment cycle without significant help from other experts. Three (37.5%) participants in the spaced groups agreed that the pathway of applying the standards was confusing and entailed extra work requirements, while five (62.5%) participants in the massed group responded that it increased the feeling of being overwhelmed. Furthermore, the statistical results did not provide a clear indication of which program faculty members should adopt to facilitate their students in a better way. The lack of statistically significant differences between the findings of both programs suggests that the results do not confirm the superiority of spaced or massed practice, as is often assumed in medical education.
Conclusions. Both spaced and massed learning strategies were found to be broadly effective in transferring assessment skills, with no significant qualitative and qualitative differences. Their effectiveness depended on the specification of modules