OBJECTIVE: Our study aimed to investigate the distinct clinical patterns of seronegative IgG4-related disease (IgG4-RD) patients.
METHODS: We retrospectively enrolled 698 treatment-naïve IgG4-RD patients in this study. Patients were divided into four different subgroups according to their baseline serum IgG4 levels. The distinct clinical patterns of seronegative IgG4-RD patients were revealed through the comparison of baseline clinical data and disease prognosis among the different subgroups. COX regression analyses were used to investigate the risk factors for disease relapse and to construct the nomogram model.
RESULTS: Seronegative IgG4-RD patients account for a minority of IgG4-RD patients (49/698, 7.02%). The proportions of seronegative IgG-RD patients in our study and several Asian cohorts were significantly lower than those of the European and American cohorts. Seronegative IgG4-RD patients got lower serum IgG levels (p < 0.0001), lower eosinophil count (p < 0.0001), lower serum IgE levels (p < 0.0001)), lower IgG4-RD responder index (RI) scores (p < 0.0001), and fewer affected organ numbers (p < 0.0001) compared with other subgroups, whereas they were more likely to manifest fibrotic type with some special organ involvement. Younger age at onset, GCs monotherapy, elevated C-reactive protein level, and elevated erythrocyte sedimentation rate level are the risk factors for the disease relapse of seronegative IgG4-RD patients. An effective nomogram model predicting disease relapse of seronegative IgG4-RD patients was constructed. Seronegative IgG4-RD patients with scores >84.65 at baseline were susceptible to suffering from disease relapse.
CONCLUSIONS: Distinct clinical features and multiple risk factors for disease relapse of seronegative IgG4-RD patients have been revealed in this study. A nomogram model was constructed to effectively predict disease relapse during the follow-up period.

Systemic lupus erythematosus (SLE) is a complex disease with an insidious clinical presentation. In up to half of the cases, SLE onset is characterized by clinical and serological manifestations that, although specific, are insufficient to fulfill the classification criteria. This condition, called incomplete SLE, could be as challenging as the definite and classifiable SLE and requires to be treated according to the severity of clinical manifestations. In addition, an early SLE diagnosis and therapeutic intervention can positively influence the disease outcome, including remission rate and damage accrual. After diagnosis, the disease course is relapsing-remitting for most patients. Time in remission and cumulative glucocorticoid exposure are the most important factors for prognosis. Therefore, timely identification of SLE clinical patterns may help tailor the therapeutic intervention to the disease course. Late-onset SLE is rare but more often associated with delayed diagnosis and a higher incidence of comorbidities, including Sjogren\'s syndrome. This review focuses on the SLE disease course, providing actionable strategies for early diagnosis, an overview of the possible clinical patterns of SLE, and the clinical variation associated with the different age-at-onset SLE groups.

暂无摘要。

Pediatric facial fractures have different clinical patterns and require different therapeutic approaches in comparison with those of facial fractures that occur among adults. The aim of this study was to describe the main clinical characteristics of pediatric facial fractures (such as fracture location, fracture pattern, treatment, complications and evolution) in a group of pediatric patients from NW Romania. This research was a retrospective study that was conducted for 10 years in a tertiary hospital for oral and maxillofacial surgery from NW Romania. A total of 142 pediatric patients were included in this study, with ages between 0 and 18 years. Mandibular (66.2%), midface (25.4%) and combined fractures (8.5%) were identified, and patients from the 13-18 years age group were more frequently affected by facial fractures (78.9%). Most of the diagnosed fractures among all three types of fractures were total fractures, and most mandibular (92.6%) and midface (80.6%) fractures were without displacement. Hematomas, lacerations and abrasions were identified as associated lesions. Patients with associated lesions were more frequently associated with combined fractures or midface fractures than mandibular fractures. The instituted treatment was, in general, orthopedic, for all three types of fractures (mandibular-86.2%; midface-91.7%; combined-66.7%). Most fractures, mandibular (96.8%), midface (100%) and combined (91.7%) fractures, had a favorable evolution. Most fractures did not present any complications at the follow-up. Pediatric facial fractures have unique patterns and must be treated with caution, considering the particularities of pediatric facial anatomy.

Plasmodium cynomolgi (Pcy), a simian malaria parasite, is a recent perfect example of emerging zoonotic transfer in human. This review summarizes the current knowledge on the epidemiology of natural Pcy infections in humans, mosquitoes and monkeys, along with its biological, clinical and drug sensitivity patterns. Knowledge gaps and further studies on Pcy in humans are also discussed. This parasite currently seems to be geographically limited in South-East Asia (SEA) with a global prevalence in human ranging from 0 to 1.4%. The Pcy infections were reported in local SEA populations and European travelers, and range from asymptomatic carriage to mild/moderate attacks with no evidence of pathognomonic clinical and laboratory patterns but with Pcy strain-shaped clinical differences. Geographical distribution and competence of suitable mosquito vectors and non-primate hosts, globalization, climate change, and increased intrusion of humans into the habitat of monkeys are key determinants to emergence of Pcy parasites in humans, along with its expansion outside SEA. Sensitization/information campaigns coupled with training and assessment sessions of microscopists and clinicians on Pcy are greatly needed to improve data on the epidemiology and management of human Pcy infection. There is a need for development of sensitive and specific molecular tools for individual diagnosis and epidemiological studies. The development of safe and efficient anti-hypnozoite drugs is the main therapeutic challenge for controlling human relapsing malaria parasites. Experience gained from P. knowlesi malaria, development of integrated measures and strategies-ideally with components related to human, monkeys, mosquito vectors, and environment-could be very helpful to prevent emergence of Pcy malaria in humans through disruption of transmission chain from monkeys to humans and ultimately contain its expansion in SEA and potential outbreaks in a context of malaria elimination.

UNASSIGNED: Pediatric skin disorders are different from the adult type in their presentations, types, treatment and prognosis. Their presentation varies from place to place.
UNASSIGNED: To study the different clinical pattern and seasonal variation of dermatoses in children attending a multispecialty hospital in Uttar Pradesh.
UNASSIGNED: This study was conducted among 640 children who attended the OPD of multispecialty hospital over a period of one year. All children up to 10 years of age with cutaneous presentations were included in the study.
UNASSIGNED: Study showed that there was a male preponderance among the study participants. According to the age group, school-aged children (6-10 years) constituted the highest percentage (53%) followed by toddlers or pre-school children (41%). The most common skin conditions were infections (47%) followed by eczematous group (31%) of disorders. Among the infections, the most common infections were fungal - 35.64% (107) followed by parasitic infection (31%), viral infections (20%) and then bacterial infections (12.5%). Out of total eczematous dermatoses, Atopic dermatosis was maximum in number (61; 30%). This was followed by pityriasis Alba (47; 23.15%), and acute eczemas (32; 15.76%). Third most common dermatosis was Appendageal disorder (33; 5.15%). It included 15 cases of miliaria i.e. approximately 45.45%. Seventeen (2.65%) children reported for treatment of different kind of nevi. Pigmentary disorders were seen in 16 cases (2.5%). Three nutritional disorders were also seen. Season wise, most of the cases were seen in monsoons (June to October).
UNASSIGNED: Dermatoses is very common in children in the western region of Uttar Pradesh. The largest group was formed by infections followed by eczemas. Few cases increased in number depending upon the weather like fungal and bacterial infections, acne, miliaria in summers and xerosis, scabies in winters. This variation strongly suggests that weather has a very important role. Thus various measures including health education programs to be initiated to control and prevent the sudden spread of the diseases. Thus, Primary care providers and family physicians being the first responders should always keep in mind the seasonal variations while dealing with dermatosis in children.

OBJECTIVE: To study the clinical features and the possibility of objectification of vestibular dysfunction in patients with vestibular migraine.
METHODS: The study included 46 patients (10 men and 36 women) aged 18 to 50 years, with vestibular migraine and control groups. A targeted collection of complaints was carried out with an assessment of vestibular symptoms; a detailed history; a study of neurological status, with an emphasis on the study of oculomotor reactions, vestibular tests. Functional computer stabilometric tests were used to objectify vestibular dysfunction.
RESULTS: Clinical features, as well as features of stabilometric parameters in patients with vestibular migraine have been identified, which can be used to obtain a quantitative assessment of vestibular dysfunction and objectification of vertigo in this category of patients.
CONCLUSIONS: A purposeful and complete collection of complaints and anamnesis detailing the features of the symptoms in patients with vestibular migraine helps to identify the clinical polymorphism of the pathology in question and contributes to the correct diagnosis. And the use of functional stabilometric tests contributes to the objectification of vestibular dysfunction in this category of patients, quantifying the distinctive features of the balance system in vestibular migraine.
UNASSIGNED: Изучение клинических особенностей и возможности объективизации вестибулярной дисфункции у пациентов с вестибулярной мигренью.
UNASSIGNED: В исследование были включены 46 пациентов (10 мужчин и 36 женщин в возрасте от 18 до 50 лет)с вестибулярной мигренью и группы контроля (с простой мигренью). Проводился целенаправленный сбор жалоб с оценкой вестибулярных пароксизмов; детализация анамнеза; исследование неврологического статуса, с акцентом на исследование глазодвигательных реакций, вестибулярных проб. Для объективизации вестибулярной дисфункции использовалась функциональная компьютерная стабилометрия.
UNASSIGNED: Выявлены клинические особенности, а также особенности стабилометрических параметров у пациентов с вестибулярной мигренью, которые можно использовать для получения количественной оценки вестибулярной дисфункции и объективизации головокружения у данной категории пациентов.
UNASSIGNED: Целенаправленный и полный сбор жалоб и анамнеза с детализацией особенностей приступов у пациентов с вестибулярной мигренью помогает выявить клинический полиморфизм рассматриваемой патологии и способствует точной постановке диагноза. При этом использование функциональных стабилометрических тестов способствует объективизации вестибулярной дисфункции у данной категории пациентов, количественно определяя важные отличия системы баланса при вестибулярной мигрени.

The COVID-19 pandemic has caused global changes that affect the daily life of the world\'s population, with a direct impact on individuals\' physical and mental health as well as on their social and recreational habits.
This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period.
A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p < 0.01); the ratio of men to women increased (2.0 vs. 1.4; p = 0.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p < 0.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p < 0.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p < 0.01) with a non-significant increase in 2021 (69.0%, p = 0.07).
The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

BACKGROUND: Asthma is significantly related to chronic rhinosinusitis (CRS) both in prevalence and severity. However, the clinical patterns of uncontrolled asthma with and without comorbid CRS are still unclear. This study aimed to explore the clinical characteristics and cytokine patterns of patients with uncontrolled asthma, with and without comorbid CRS.
METHODS: 22 parameters associated with demographic characteristics, CRS comorbidity, severity of airflow obstruction and airway inflammation, and inflammation type of asthma were collected and assessed in 143 patients with uncontrolled asthma. Different clusters were explored using two-step cluster analysis. Sputum samples were collected for assessment of Th1/Th2/Th17 and epithelium-derived cytokines.
RESULTS: Comorbid CRS was identified as the most important variable for prediction of different clusters, followed by pulmonary function parameters and blood eosinophil level. Three clusters of patients were determined: Cluster 1 (n = 46) characterized by non-atopic patients with non-eosinophilic asthma without CRS, demonstrating moderate airflow limitation; Cluster 2 (n = 54) characterized by asthma patients with mild airflow limitation and CRS, demonstrating higher levels of blood eosinophils and immunoglobulin E (IgE) than cluster 1; Cluster 3 (n = 43) characterized by eosinophilic asthma patients with severe airflow limitation and CRS (46.5% with nasal polyps), demonstrating worst lung function, lowest partial pressure of oxygen (PaO2), and highest levels of eosinophils, fraction of exhaled nitric oxide (FeNO) and IgE. Sputum samples from Cluster 3 showed significantly higher levels of Interleukin (IL)-5, IL-13, IL-33, and tumor necrosis factor (TNF)-α than the other two clusters; and remarkably elevated IL-4, IL-17 and interferon (IFN)-γ compared with cluster 2. The levels of IL-10 and IL-25 were not significantly different among the three clusters.
CONCLUSIONS: Uncontrolled asthma may be endotyped into three clusters characterized by CRS comorbidity and inflammatory cytokine patterns. Furthermore, a united-airways approach may be especially necessary for management of asthma patients with Type 2 features.

UNASSIGNED: The COVID-19 pandemic has caused global changes that affect the daily life of the world\'s population, with a direct impact on individuals\' physical and mental health as well as on their social and recreational habits.
UNASSIGNED: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period.
UNASSIGNED: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07).
UNASSIGNED: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.