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Radiology Case Reports Aug 2024Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or...
Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or external compression from a tumor. We describe a rare case of chronic headache and hearing loss due to flow reversal in the left internal jugular vein and compensatory massive dilation of the right internal jugular vein. Flow reversal was caused by a prominent brachiocephalic trunk with subseqent compression of the vena brachiocephalica sinistra. Vascular anomalies and associated venous bypass circulation may be considered as a rare cause of non-specific malaise. Restoration of the physiological direction of blood flow should be discussed on an interdisciplinary basis given the unpredictable haemodynamic consequences.
PubMed: 38737176
DOI: 10.1016/j.radcr.2024.04.032 -
Journal of Family Medicine and Primary... Mar 2024Vaccination has been pivotal in eradicating numerous infectious diseases. Nonetheless, concerns about the safety and side effects of the COVID-19 vaccine persist. This...
BACKGROUND
Vaccination has been pivotal in eradicating numerous infectious diseases. Nonetheless, concerns about the safety and side effects of the COVID-19 vaccine persist. This study aimed to gauge the perceptions and experiences of the Indian population concerning COVID-19 vaccination.
METHODS
This study was a cross-sectional survey of 313 participants aged 18 and above from diverse regions in India. Data was sourced using an electronic questionnaire disseminated via Google Forms. The survey evaluated demographics, vaccine awareness, attitudes, and side effects post-vaccination with Covishield and Covaxin.
RESULTS
22.6% of participants exhibited vaccine hesitancy; however, 78.3% believed the advantages superseded the risks. Most participants (81.5%) were aware of vaccine side effects. Most of the Indian respondents (97.1%) accepted the COVID-19 vaccine. Post-vaccination, 27.9% experienced adverse effects such as fever, headache, malaise, dizziness, and pain at the local site. Only 1.3% necessitated hospitalization.
CONCLUSION
Our study underscores the dichotomy between vaccine apprehensions and real-world experiences. Although concerns surrounding vaccine safety were prevalent, the majority of the Indian respondents (97.1%) accepted the COVID-19 vaccine, with most experiencing only transient, mild side effects. While 22.6% initially exhibited hesitancy, primarily due to misinformation, the actual experience post-vaccination was largely positive. To further address hesitancy, streamlined vaccine awareness campaigns emphasizing the safety and efficacy of vaccination are essential.
PubMed: 38736779
DOI: 10.4103/jfmpc.jfmpc_1668_23 -
Fatigue : Biomedicine, Health & Behavior 2024In Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), post-exertional malaise (PEM) is associated with greater distress and symptoms. Cognitive Behavioral...
BACKGROUND
In Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), post-exertional malaise (PEM) is associated with greater distress and symptoms. Cognitive Behavioral Stress Management (CBSM) has demonstrated beneficial effects for ME/CFS and may mitigate stress-related triggers of PEM. We tested a virtual CBSM intervention to increase access, and we report on its effects on stress and symptoms in ME/CFS patients with severe PEM.
METHODS
Data were from a randomized controlled trial (NCT01650636) comparing 10-week videoconference-delivered group CBSM (V-CBSM, =75) to a 10-week Health Information active control (V-HI, =75) in Fukuda criteria ME/CFS patients (71 classified as highPEM, 79 lowPEM). Linear regression explored PEM-by-Treatment interactions on overall symptom frequency and intensity, perceived stress, and fatigue-specific interference and intensity, at 5-month follow-up. Logistic regression tested V-CBSM effects on 5-month PEM status. Analyses controlled for age, gender, race/ethnicity, mode of symptom onset, and time since diagnosis.
RESULTS
The sample was middle-aged (47.96±10.89 years), mostly women (87%) and non-Hispanic White (65%), with no group differences on these variables or baseline PEM. For highPEM patients, V-CBSM (versus V-HI) demonstrated medium to large effects on follow-up symptom frequency, symptom intensity, fatigue interference, and fatigue intensity ('s < .05) and trending to significant reductions in perceived stress ( =.07). Differences were not evident for lowPEM patients. Treatment predicted follow-up PEM status at a trend ( = .058), with patients receiving V-CBSM demonstrating half the risk of highPEM classification versus V-HI.
CONCLUSIONS
V-CBSM demonstrates benefits for ME/CFS patients presenting with severe PEM and may reduce the expression of PEM over time.
PubMed: 38736736
DOI: 10.1080/21641846.2024.2306801 -
Bilateral bartholin's gland abscesses in a 4-year-old girl with vitamin a deficiency: a case report.BMC Infectious Diseases May 2024A Bartholin's gland abscess is one of the most common infections in women of reproductive age. Although Bartholin's gland abscesses have been reported in prepubertal...
BACKGROUND
A Bartholin's gland abscess is one of the most common infections in women of reproductive age. Although Bartholin's gland abscesses have been reported in prepubertal children, they are rarer in prepubertal children than in adults. Herein, we report a case of bilateral Bartholin's gland abscesses in a 4-year-old girl with vitamin A deficiency.
CASE PRESENTATION
A 4-year-old girl diagnosed with autism spectrum disorder was admitted to the hospital for close examination and treatment because of persistent fever and malaise. The child was a marked fussy eater and was diagnosed with corneal ulceration and night blindness secondary to vitamin A deficiency. Both of the patient's labia were swollen, and a diagnosis of a bilateral Bartholin's gland abscess was made using computed tomography. Incisional drainage was performed under general anesthesia. The patient's postoperative course was uneventful, and she was discharged from the hospital on day 8 after the surgery. During hospitalization, attempts were made to correct the vitamin deficiency by adding nutritional supplements to the diet. Three months after the surgery, no recurrence of abscesses was noted.
CONCLUSIONS
Decreased immunocompetence and mucosal barrier function due to vitamin A deficiency is thought to be the underlying cause of Bartholin's gland abscesses. Although prepubertal Bartholin's gland abscesses have been reported, they are rare. To the best of our knowledge, no reports of bilateral Bartholin's gland abscesses potentially caused by vitamin A deficiency have been reported. When prepubertal girls present with Bartholin's gland abscesses, the presence of immunodeficiency due to vitamin or trace element deficiency should also be considered.
Topics: Humans; Female; Child, Preschool; Abscess; Bartholin's Glands; Vitamin A Deficiency; Tomography, X-Ray Computed; Vulvar Diseases
PubMed: 38734601
DOI: 10.1186/s12879-024-09382-1 -
Biomedical Journal May 2024Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the... (Review)
Review
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
PubMed: 38734408
DOI: 10.1016/j.bj.2024.100746 -
Diagnostics (Basel, Switzerland) Apr 2024Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75-95%, and primary... (Review)
Review
Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75-95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of immunostaining and genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35-81; woman mean age of 55.5 years, range: 34-70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection ( = 2/23; specifically, brain and intestinal) or during follow-up ( = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific / assays ( = 35 patients with PCISs); among the provided data, we mention that one cohort ( = 20) identified a rate of 55% with regard to amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort ( = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, amplification and co-amplification, for example, with , CDK4, , , , , , , and , might improve the diagnosis of PCIS in addition to immunostaining since 10-20% of these tumours are MDM2-negative. Further studies are necessary to highlight applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy.
PubMed: 38732333
DOI: 10.3390/diagnostics14090919 -
Journal of Medical Case Reports May 2024An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with...
BACKGROUND
An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first case of a patient with lung cancer who developed an ascending aortic thrombus without structural risk factors or chemotherapy use.
CASE
A 60-year-old white female with significant smoking history presented with several weeks of malaise. A chest computed tomography scan revealed a 2.2-cm right upper lobe mass. As an outpatient, right hilar lymph node immunohistochemistry (IHC) samples via endobronchial ultrasound confirmed thyroid transcription factor-1 adenocarcinoma. After the procedure, the patient endorsed dyspnea and was advised to go to the emergency department. A chest computed tomography angiography identified a new 2.4 × 1.1 × 1.1 cm thrombus within the proximal aortic arch. No pulmonary emboli or intrapulmonary shunts were identified. A hypercoagulable workup was negative. Transthoracic echocardiogram was without left ventricular thrombus, akinesis or hypokinesis, left atrial dilation, or intracardiac shunts. A lower extremity ultrasound was negative for deep vein thrombosis. Given the procedural risk, thrombectomy was deferred. The patient was transitioned to enoxaparin, and a repeat computed tomography for resolution is in process.
CONCLUSION
To our knowledge, this is the only case detailing an in situ ascending aortic thrombus in the setting of lung cancer, without structural risk factors, chemotherapy use, or other hypercoagulable comorbidities. Optimal management for an aortic thrombus and malignant disease is less clear. Clinicians should be vigilant for unusual arterial thromboses in patients with high metastatic burden.
Topics: Humans; Female; Middle Aged; Lung Neoplasms; Cisplatin; Thrombosis; Adenocarcinoma of Lung; Aortic Diseases; Anticoagulants; Adenocarcinoma; Enoxaparin; Antineoplastic Agents; Computed Tomography Angiography; Aorta
PubMed: 38730499
DOI: 10.1186/s13256-024-04515-1 -
Cureus Apr 2024Pituitary apoplexy is a rare and severe complication of pituitary adenoma that may present with new-onset headache, ocular palsy, visual disturbances, life-threatening...
Pituitary apoplexy is a rare and severe complication of pituitary adenoma that may present with new-onset headache, ocular palsy, visual disturbances, life-threatening electrolyte imbalance, and endocrinological disturbances due to pituitary hemorrhage and/or infarction. We report the case of a 58-year-old previously healthy patient who developed isolated mild oculomotor nerve palsy of the left eye following osteosynthesis of a traumatic right distal radius fracture. Initial cerebral magnetic resonance imaging showed a pituitary macroadenoma without characteristic signs of pituitary infarction or hemorrhage. The patient presented to the neurology department on the fifth postoperative day with malaise and fatigue due to pituitary insufficiency, deteriorated rapidly and required intensive care monitoring. Clinical stabilization was achieved through the administration of hydrocortisone, and transsphenoidal resection of the pituitary lesion was performed on the 10th day after acute symptom onset. Histological examination revealed a necrotic pituitary adenoma. Pituitary apoplexy may occur after minor surgery in patients with pituitary adenoma. Clinicians should pay particular attention to laboratory signs of pituitary insufficiency in new-onset oculomotor nerve palsy associated with sellar lesions, as cerebral imaging may miss pituitary apoplexy and therefore delay diagnosis and treatment. In our case, delayed decompressive transsphenoidal resection resulted in the normalization of the oculomotor nerve palsy while the pituitary insufficiency persisted. The potential impact of an earlier surgical intervention on the outcome of pituitary function remains uncertain.
PubMed: 38725789
DOI: 10.7759/cureus.57912 -
Access Microbiology 2024Brucellosis, a globally distributed zoonotic disease, is caused by the Gram-negative bacteria known as . Humans acquire infection through direct contact with the blood,...
Brucellosis, a globally distributed zoonotic disease, is caused by the Gram-negative bacteria known as . Humans acquire infection through direct contact with the blood, urine and placenta of animals, inhalation of dust or aerosols at infected animal farms, and raw milk and meat intake. This study aimed to assess the prevalence of brucellosis in dairy farmers in and around the Aligarh region of North India, to document various clinical signs and symptoms in positive individuals, and to create awareness in dairy farmers concerning brucellosis and ways to prevent it. This was an observational study that included 125 dairy farmers in and around the Aligarh region. Serum samples were taken from this high-risk group after obtaining informed consent. Further, a pre-designed proforma was used to collect information about their knowledge, attitude and practices (KAP) concerning brucellosis and assess the risk factors for the disease. The Rose Bengal test (RBT), serum agglutination test (SAT) and enzyme-linked immunosorbent assay (ELISA) were performed to detect the seroprevalence of brucellosis. infection was diagnosed in 64 (51.20 %) cases by indirect ELISA (IgM+IgG), 41 (32.8 %) by RBT and 4 (3.2 %) by SAT. Significant clustering of patients was seen in the 20-55 years age group. The most common symptoms in ELISA IgM-positive patients were joint pain (16.07 %), fatigue (14.28 %), anorexia (12.50 %), weight loss (8.92 %), malaise (5.35 %), undulant fever (3.57 %), night sweats (3.57 %) and headache (1.78 %). The findings of this study indicate that ELISA (IgM+IgG) exhibits great sensitivity as compared to SAT and RBT. KAP was very poor among dairy farmers. In India, is a frequent but severely underreported illness. ELISA is the most sensitive serological test for diagnosing brucellosis. No potential vaccine has yet been introduced for humans against brucellosis. Thus, it is necessary to impart awareness and sensitize high-risk groups concerning brucellosis.
PubMed: 38725590
DOI: 10.1099/acmi.0.000648.v3 -
Communications Biology May 2024Global biodiversity gradients are generally expected to reflect greater species replacement closer to the equator. However, empirical validation of global biodiversity...
Global biodiversity gradients are generally expected to reflect greater species replacement closer to the equator. However, empirical validation of global biodiversity gradients largely relies on vertebrates, plants, and other less diverse taxa. Here we assess the temporal and spatial dynamics of global arthropod biodiversity dynamics using a beta-diversity framework. Sampling includes 129 sampling sites whereby malaise traps are deployed to monitor temporal changes in arthropod communities. Overall, we encountered more than 150,000 unique barcode index numbers (BINs) (i.e. species proxies). We assess between site differences in community diversity using beta-diversity and the partitioned components of species replacement and richness difference. Global total beta-diversity (dissimilarity) increases with decreasing latitude, greater spatial distance and greater temporal distance. Species replacement and richness difference patterns vary across biogeographic regions. Our findings support long-standing, general expectations of global biodiversity patterns. However, we also show that the underlying processes driving patterns may be regionally linked.
Topics: Animals; Biodiversity; Arthropods; Geography; Spatio-Temporal Analysis
PubMed: 38720028
DOI: 10.1038/s42003-024-06199-1