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Polymyalgia Rheumatica Presenting as Nocturnal Pyrexia of Unknown Origin: A Case Report
Get PDFBackground. 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
Get PDFInterest 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
Get PDFBackground. 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
Get PDFIntroduction. 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
Get PDFIntroduction.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
КОРЕКЦІЯ ІНФУЗІЙНОЇ ТЕРАПІЇ ПРИ ГОСТРОМУ АЛКОГОЛЬНОМУ ПАНКРЕАТИТІ
Get PDFAbstract. Acute alcoholic pancreatitis (AAP) represents a significant cause of hospitalizations in surgical departments, with severe cases leading to multi-organ failure and high mortality rates, up to 30%. Effective management of AAP requires accurate patient condition assessment, which directly influences treatment strategies, including fluid resuscitation, pain relief, nutritional support, and antibiotic use. A key factor in AAP outcomes is the development of hypovolemia, caused by fluid loss into the peritoneal and retroperitoneal spaces, exacerbating systemic and local hypoperfusion, tissue ischemia, and pancreatic necrosis. Proper fluid therapy is essential to prevent both hypovolemia-related complications and fluid overload, which may lead to pleural effusion, cerebral edema, and cardiovascular dysfunction. Current guidelines for fluid therapy in AAP focus on maintaining specific physiological parameters such as mean arterial pressure, heart rate, central venous pressure, urine output, and hematocrit levels. However, the use of non-invasive methods like bioimpedance analysis, which measures tissue resistance to determine fluid distribution, may offer more precise insights into the patient's fluid status, enabling better management of infusion therapy.
The aim to optimize fluid management in patients with moderate to severe AAP and reduce infectious complications through the use of bioimpedance analysis.
Materials and methods. A total of 110 patients were enrolled, including 101 men and 9 women. The patients were divided into two groups: one treated with standard fluid therapy using Ringer's lactate solution and the other receiving Sterofundin ISO solution, with infusion volumes adjusted according to bioimpedance measurements. Laboratory tests, including procalcitonin levels and the Limulus amebocyte lysate (LAL) test, were used to monitor inflammatory markers and endotoxin levels, while bioimpedance measurements were conducted on days 1, 3, 5, 8, 11, and 14 to dynamically assess fluid balance.
The results showed that patients treated with Sterofundin ISO and bioimpedance-guided fluid management experienced a significant reduction in extracellular fluid volume deviations and infectious complications compared to those receiving standard treatment. In the second group, the incidence of infectious complications in patients with moderate AAP decreased from 35.9% to 21.62%, and in severe cases, from 81.3% to 44.45%..
Key words: acute alcoholic pancreatitis, LAL-test, bioimpedance measurement, infusion, infectious complicationsАнотація
Гострий алкогольний панкреатит (ГАП) є однією із основних причин госпіталізацій у хірургічні відділення, причому тяжкі випадки призводять до поліорганної недостатності та високої смертності (до 30%). Ефективне лікування ГАП вимагає точної оцінки стану пацієнта, що безпосередньо впливає на стратегії лікування, включаючи регідратацію, знеболення, та застосування антибіотиків. Ключовим фактором у патогенезі ГАП є розвиток гіповолемії, викликаної втратою рідини, що посилює системну та локальну гіпоперфузію, ішемію тканин та панкреатичний некроз. Адекватна інфузійна терапія необхідна для запобігання ускладнень, пов'язаних з гіповолемією та перевантаженням рідиною, що може призвести до плеврального випоту, набряку мозку та поліорганної недостатності. Сучасні рекомендації щодо рідинної терапії при ГАП зосереджені на підтримці певних фізіологічних параметрів, таких як середній артеріальний тиск, частота серцевих скорочень, центральний венозний тиск, діурез та рівень гематокриту. Однак використання неінвазивних методів, таких як біоімпедансометрія, що вимірює опір тканин для визначення розподілу рідини, може надати більш точні дані про склад організму пацієнта, що дозволяє краще корегувати терапію.
Метою дослідження є оптимізація рідинної інфузії у пацієнтів із ГАП середнього та важкого перебігу, а також зменшення інфекційних ускладнень за допомогою біоімпедансометрії
Матеріали та методи. У дослідження включено 110 пацієнтів, серед яких 101 чоловік та 9 жінок. Пацієнтів було розподілено на дві групи: перша група отримувала стандартизоване лікування відповідно до міжнародних протоколів, друга група отримувала інфузію розчином Стерофундин ISO, об'єм інфузії регулювався відповідно до результатів біоімпедансометрії. Лабораторні аналізи, включаючи рівні прокальцитоніну та ЛАЛ-тест, використовувалися для моніторингу запальних маркерів та рівнів ендотоксину, тоді як біоімпедансометрія проводилися у 1, 3, 5, 8, 11 та 14 доби стаціонарного лікування.
Результати показали, що пацієнти, які лікувалися Стерофундин ISO та біоімпеданс-керованою рідинною терапією, мали значне зниження відхилень позаклітинного об'єму рідини та інфекційних ускладнень порівняно з тими, хто отримував стандартне лікування. У даних пацієнтів частота інфекційних ускладнень із помірним ГАП зменшилася з 35,9% до 21,62%, а у тяжких випадках - з 81,3% до 44,45%.
Ключові слова: гострий алкогольний панкреатит, ЛАЛ-тест, біоімпедансометрія, інфузія, інфекційні ускладнення
Prevalence of Isolated Idiopathic Teres Minor Atrophy: A Retrospective Study
Get PDFIntroduction. Isolated idiopathic teres minor atrophy is a relatively understudied condition characterized by selective atrophy of the teres minor muscle without any identifiable underlying pathology.
This study aimed to determine the prevalence of isolated idiopathic teres minor atrophy.
Methods. Data were collected retrospectively by examining magnetic resonance imaging scans of the right and left shoulders of individuals aged 18 years or older performed at the Medical Centre of Majmaah University, Al Majma’ah, Saudi Arabia, between February 2019 and October 2022. Teres minor atrophy was classified using the original Goutallier classification system to assess fatty infiltration. In addition, demographics, including age, gender, and nationality, were collected. Associated imaging-based factors, such as teres minor and deltoid muscle edema, rotator cuff muscle tears, and injuries to the labrum and quadrilateral space, were also documented.
Results. Among the 2, 194 patients studied, 59 (2.7%) were diagnosed with isolated idiopathic teres minor atrophy, aged 27 to 75 years. Females comprised 59.3% of the affected individuals, and the majority of cases were Saudi nationals (81.4%). The right side was affected in 61% of cases. Nearly half of the affected individuals (50.9%) were classified as grade 2, while 25.4% were classified as grade 4. Patients with grade 3 and grade 4 isolated idiopathic teres minor atrophy were significantly older than those with grade 2 (58.29 ± 7.12 and 57.93 ± 12.34 versus 49.96 ± 11.72, respectively (p=0.029). No statistically significant associations were found between the demographic characteristics of individuals (age and gender) and the pattern of teres minor fatty involvement.
Conclusions. The incidence of isolated idiopathic teres minor atrophy was found to be 2.7%. Age was the main statistically significant factor associated with isolated idiopathic teres minor atrophy and the grade of teres minor atrophy. Other evaluated factors, including gender and the pattern of involvement, did not demonstrate any statistically significant associations
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
Get PDFThe 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
Get PDFNasopharyngeal 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