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Neurological Sciences : Official... Jul 2023The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.
BACKGROUND
The role of central and/or peripheral nervous system dysfunction is basically fundamental in fibromyalgia.
AIM
The aim of this position statement on behalf of the Neuropathic Pain Study Group of the Italian Society of Neurology is to give practical guidelines for the clinical and instrumental assessment of fibromyalgia (FM) in the neurological clinical practice, taking into consideration recent studies.
METHODS
Criteria for study selection and consideration were original studies, case-controls design, use of standardized methodologies for clinical practice, and FM diagnosis with ACR criteria (2010, 2011, 2016).
RESULTS
ACR criteria were revised. For diagnostic procedure of small-fiber pathology, 47 studies were totally considered. Recent diagnostic criteria should be applied (ACR, 2016). A rheumatologic visit seems mandatory. The involvement of small fibers should request at least 2 among HRV + SSR and/or laser-evoked responses and/or skin biopsy and/or corneal confocal microscopy, eventually followed by monitoring of metabolic and/or immunological/ and or/paraneoplastic basis, to be repeated at 1-year follow-up.
CONCLUSIONS
The correct diagnostic approach to FM could promote the exclusion of the known causes of small-fiber impairment. The research toward common genetic factors would be useful to promote a more specific therapeutic approach.
Topics: Humans; Fibromyalgia; Neuralgia; Skin; Peripheral Nervous System; Neurology
PubMed: 37222872
DOI: 10.1007/s10072-023-06836-3 -
Missouri Medicine 2024Technologies in the 21st century provide increasingly detailed and accurate maps of brain structure and function. So why don't psychiatrists order brain imaging on all... (Review)
Review
Technologies in the 21st century provide increasingly detailed and accurate maps of brain structure and function. So why don't psychiatrists order brain imaging on all our patients? Here we briefly review major neuroimaging methods and some of their findings in psychiatry. As clinicians and neuroimaging researchers, we are eager to bring brain imaging into daily clinical practice. However, to be clinically useful, any test in medicine must demonstrate adequate test statistics, and show proven benefits that outweigh its risks and costs. In 2024, beyond certain limited circumstances, we have no imaging tests that can meet those standards to provide diagnosis or guide treatment. This cold fact explains why for most psychiatric patients, neuroimaging is not currently recommended by professional organizations or the National Institute of Mental Health.
Topics: Humans; Mental Disorders; Brain; Neuroimaging; Psychiatry; Psychiatrists
PubMed: 38404436
DOI: No ID Found -
Frontiers in Public Health 2023This study aimed to investigate the etiology, clinical features, and outcomes of community-acquired pneumonia (CAP) in adults. Understanding the causative pathogens is...
OBJECTIVES
This study aimed to investigate the etiology, clinical features, and outcomes of community-acquired pneumonia (CAP) in adults. Understanding the causative pathogens is essential for effective treatment and prevention.
DESIGN
Between 2016-2018, 518 hospitalized adults with CAP and 241 controls without symptoms were prospectively enrolled. Urine samples were collected for pneumococcal urinary antigen tests and nasopharyngeal swabs for viral and bacterial analysis, combined with routine diagnostic care.
RESULTS
Among the included CAP patients, was the most common pathogen, detected in 28% of patients, followed by in 16%. Viruses were identified in 28%, and concurrent viruses and bacteria were detected in 15%. There was no difference in mortality, length of stay, or symptoms at hospitalization when comparing patients with bacterial, viral, or mixed etiologies. Among the control subjects without respiratory symptoms, , , or were detected in 5-7%, and viruses in 7%.
CONCLUSION
emerged as the predominant cause of CAP, followed closely by viruses and . Intriguingly, symptoms and outcome were similar regardless of etiology. These findings highlight the complexity of this respiratory infection and emphasize the importance of comprehensive diagnostic and treatment strategies.: ClinicalTrials.gov, identifier [NCT03606135].
Topics: Adult; Humans; Bacteriophages; Community-Acquired Infections; Hospitalization; Pneumonia, Bacterial; Respiratory Tract Infections; Streptococcus pneumoniae; Treatment Outcome; Case-Control Studies
PubMed: 38152664
DOI: 10.3389/fpubh.2023.1258981 -
Mycopathologia Jun 2024The incidence of breakthrough mold infections (bIMI) has been increasing, due to routine administration of broad-spectrum antifungal prophylaxis and an increasing pool... (Review)
Review
The incidence of breakthrough mold infections (bIMI) has been increasing, due to routine administration of broad-spectrum antifungal prophylaxis and an increasing pool of high-risk patient populations, with fungi more challenging to treat, resulting in a sustained high mortality, despite progress in diagnostic and therapeutic options. Pharmacokinetics of antifungal drugs, fungal, and host, including genetic, factors play a role in the emergence of bIMI. Suggested therapeutic approaches have included change of antifungal class treatment, with amphotericin-B products predominating as first-line empirical treatment and switching from one broad-spectrum azole to another remaining the most frequently used treatment modalities. Future perspectives include determining individual susceptibility to IMI to tailor prophylaxis and treatment strategies, improved diagnostic tests, and the introduction of new antifungal agents that may reduce morbidity and mortality caused by bIMI.
Topics: Humans; Invasive Fungal Infections; Antifungal Agents; Fungi; Incidence; Drug Resistance, Fungal
PubMed: 38869662
DOI: 10.1007/s11046-024-00864-z -
Advanced Science (Weinheim,... Oct 2023Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by debilitating fatigue that profoundly impacts patients' lives. Diagnosis of ME/CFS remains...
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by debilitating fatigue that profoundly impacts patients' lives. Diagnosis of ME/CFS remains challenging, with most patients relying on self-report, questionnaires, and subjective measures to receive a diagnosis, and many never receiving a clear diagnosis at all. In this study, a single-cell Raman platform and artificial intelligence are utilized to analyze blood cells from 98 human subjects, including 61 ME/CFS patients of varying disease severity and 37 healthy and disease controls. These results demonstrate that Raman profiles of blood cells can distinguish between healthy individuals, disease controls, and ME/CFS patients with high accuracy (91%), and can further differentiate between mild, moderate, and severe ME/CFS patients (84%). Additionally, specific Raman peaks that correlate with ME/CFS phenotypes and have the potential to provide insights into biological changes and support the development of new therapeutics are identified. This study presents a promising approach for aiding in the diagnosis and management of ME/CFS and can be extended to other unexplained chronic diseases such as long COVID and post-treatment Lyme disease syndrome, which share many of the same symptoms as ME/CFS.
Topics: Humans; Fatigue Syndrome, Chronic; Leukocytes, Mononuclear; Artificial Intelligence; Post-Acute COVID-19 Syndrome; Diagnostic Tests, Routine
PubMed: 37653608
DOI: 10.1002/advs.202302146 -
Current Opinion in Pulmonary Medicine May 2024Tuberculous pleuritis (TBP) is one of the most common types of extrapulmonary tuberculosis. We highlight the latest epidemiology of TBP, the heterogeneity of its... (Review)
Review
PURPOSE OF REVIEW
Tuberculous pleuritis (TBP) is one of the most common types of extrapulmonary tuberculosis. We highlight the latest epidemiology of TBP, the heterogeneity of its presentation and the performance of different diagnostic strategies.
RECENT FINDINGS
There are differential trends in the incidences of TBP worldwide. Its incidence increased in China but decreased in the United States in the past decade. The presentation of TBP is heterogeneous regarding clinical symptoms, radiological findings and pleural fluid analysis results. Conventional microbiological tests have low sensitivities to diagnose TBP. Recent research focused on various diagnostic tools with better yield. The sensitivity of nucleic acid amplification tests (NAAT) in pleural fluid, including the latest generation of PCR and sequencing-based techniques for detecting tuberculosis, remains suboptimal. Various pleural fluid biomarkers have been explored, but there is a lack of consensus on their clinical utility and cutoff levels.
SUMMARY
The heterogeneity of clinical presentation poses obstacles to diagnosing TBP. Further development of diagnostic tools, including more robust NAAT and biomarkers with additional validation, is needed before incorporation into routine clinical practice.
Topics: Humans; Pleural Effusion; Tuberculosis, Pleural; Exudates and Transudates; Biomarkers; Pleurisy; Sensitivity and Specificity
PubMed: 38323466
DOI: 10.1097/MCP.0000000000001052 -
Journal of Clinical Medicine Nov 2023In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the... (Review)
Review
In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.
PubMed: 38068267
DOI: 10.3390/jcm12237216