Uncategorized

Pruritus is a cross-disciplinary leading symptom of numerous diseases and represents an interdisciplinary diagnostic and therapeutic challenge. In contrast to acute pruritus, chronic pruritus (CP) is a symptom of various diseases that is usually difficult to treat. Scratching and the development of scratch-associated skin lesions can alter the original skin status. In the presence of an itch-scratch-cycle, even secondary diseases such as chronic prurigo can develop. Chronic pruritus leads to considerable subjective suffering of those affected, which can result in restrictions on the health-related quality of life such as sleep disturbances, anxiety, depressiveness, experience of stigmatization and/or social withdrawal up to clinically relevant psychic comorbidities. Medical care of patients should therefore include (a) interdisciplinary diagnosis and therapy of the triggering underlying disease, (b) therapy of the secondary symptoms of pruritus (dermatological therapy, sleep promotion, in the case of an accompanying or underlying psychological or psychosomatic disease an appropriate psychological-psychotherapeutic treatment) and (c) symptomatic antipruritic therapy. The aim of this interdisciplinary guideline is to define and standardize the therapeutic procedure as well as the interdisciplinary diagnosis of CP. This is the short version of the updated S2k-guideline for chronic pruritus. The long version can be found at www.awmf.org.

Urticaria is an immune-mediated allergic disease. This study explored the effect of Jingfang Mixture on spleen T lymphocyte subsets of urticaria mice. A total of 50 Kunming mice were randomized into normal group(C), model group(V), and low-(JF-L, 0.5 g·kg~(-1)), medium-(JF-M, 1 g·kg~(-1)) and high-dose(JF-H, 2 g·kg~(-1)) Jingfang Mixture groups, with 10 mice in each group. The mixture of ovalbumin and aluminum hydroxide(0.1 mg + 0.1 mL) was used(intraperitoneal injection) to induce urticaria in mice. The administration began 6 days after the first immunization, and the second immunization was carried out 10 days after the first immunization. The pruritus index was detected within 30 min after the second immunization. The administration lasted 21 days. After 21 days, the serum was taken to detect the total IgE level. Based on hematoxylin and eosin(HE) staining, the pathological changes of skin tissue were observed, and Western blot was used to detect the levels of p-Janus kinase 2(JAK2)/JAK2 and p-signal transducer and activator of transcription 3(STAT3)/STAT3 in skin tissue. The spleen was taken to detect the spleen index, and flow cytometry was employed to determine the expression of lymphocyte subsets. The results showed that group V had obvious pathological changes in skin tissue compared with group C. Moreover, group V showed more scratches, higher spleen index, and higher level of total serum IgE than group C. In addition, higher levels of p-JAK2 and p-STAT3, lower proportions of CD4~+T, Th1, and Treg, higher proportions of CD8~+T, Th2, and Th17, and lower ratios of CD4~+/CD8~+, Th1/Th2, and Terg/Th17 were observed in group V than in group C. Compared with group V, each administration group showed alleviation of the pathological morphology of skin tissue, obvious epidermal thickening, relatively intact collagen fiber structure of dermal reticular layer, alleviated edema, and relief of vasodilation and peripheral inflammatory cell infiltration. Moreover, less scratching, lower spleen index, lower p-JAK2/JAK2 and p-STAT3/STAT3 were observed in the administration groups than in group V. JF-M group and JF-H group demonstrated lower levels of total IgE, larger proportions of CD4~+T, Th1, and Treg, smaller proportions of CD8~+ T, Th2, and Th17, and higher ratios of CD4~+/CD8~+, Th1/Th2, and Terg/Th17. In conclusion, Jingfang Mixture may improve the symptoms of urticaria mice by regulating the balance of spleen T lymphocyte subsets through JAK2-STAT3 signaling pathway.

Ankle fracture surgery is a common procedure with many patients receiving opioid medications for postoperative pain control. Whether there are factors associated with higher medication quantities or patient-reported outcomes, however, remains largely unknown.

The presence of ectopic (supernumerary) teeth is common odontogenic problem in clinical practice. Its presence in dentate region is common but rare in the non dentate areas such as nose and maxillary sinus. The intranasal teeth generally remain asymptomatic but can get misdiagnosed for foreign body, or may present as complications like headache, epistaxis, nasal obstruction, rhinolith formation, oroantral fistula and sinusitis. Here, we discuss a case of intranasal tooth as a rare cause of profuse and recurrent epistaxis. The clinical, radiological findings and surgical treatment via endoscopic approach of this rare entity has been discussed. This interesting case report highlights the need to look beyond nose as cause for epistaxis. Endoscopic removal for this entity can be a preferred option to help minimize complications.

Leptospirosis is an infection caused by . Leptospirosis causes disease in humans mainly in developing countries and also in countries with poor housing and sanitation, due to animals (mainly rats) that are potential sources of contamination. The clinical manifestations and the severity of leptospirosis are highly variable. We present the case of a 56-year-old female that was admitted to the emergency department with a three-week history of fever (38.4ºC), headache, dyspnea, and cough. There was a worsening of the patient's clinical status with respiratory failure and the necessity of admission to the intensive care unit for respiratory support with mechanical ventilation. The treatment was initiated with piperacillin and tazobactam, azithromycin, and steroids. There was a favorable evolution, and the patient was transferred to the internal medicine ward after 12 days with a suspected diagnosis of small vessel vasculitis and pneumonia. In the medical ward, after a careful anamnesis, leptospirosis was suspected and confirmed. The aim of this case report is to highlight the importance of a good anamnesis and the fact that an elaborate clinical history helps to consider new diagnostic hypotheses. Also intends to alert to the existence of leptospirosis in developed countries, a disease underdiagnosed in these countries.

Anaplastic astrocytoma is a kind of astrocytoma (a type of brain cancer) that is classified as World Health Organization (WHO) grade III. Headaches, poor mental status, focal neurological impairments, and seizures are the most prevalent early signs and symptoms of anaplastic astrocytoma. Anaplastic astrocytomas have also been linked to earlier exposure to vinyl chloride and large doses of brain radiation treatment. Anaplastic astrocytomas are a form of astrocytoma that also falls under the umbrella term of gliomas, which are tumors that develop from glial cells. This is because astrocytes are a kind of glial cell. As a result, anaplastic astrocytomas (grade III) are also known as "grade III gliomas" or "high-grade gliomas. In this case study, we present a case of a 35-year-old male who presented to our cancer hospital with complaints of weakness in the right upper and lower limbs for two years. He was then diagnosed with anaplastic astrocytoma, grade III. But after tumor resection, he developed right hemiplegia with involvement of the right upper extremity and lower extremity. This case study demonstrates how the neuro-physiotherapy rehabilitation protocol in the case of hemiplegia after brain tumor resection aids in improving motor function and functional independence. Physiotherapy treatment that is modulated according to the patient's needs plays a vital role in improving the quality of life and helping to delay the worsening of symptoms, thereby helping to increase the life span of patients diagnosed with anaplastic astrocytoma grade III.

People who experience persistent pain often require help from a family member, partner, or friend. These caregivers frequently have pain but are often not included in interventions. Caregivers and care receivers who both experience pain are more likely to be socially isolated, and experience communication conflict and decreased quality of life. Interventions should target caregiving dyads to help them manage their pain together. However, there are few intervention manuals or research protocols developed to support the dyad.

Microscopic polyangiitis (MPA) is a type of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis linked to myeloperoxidase (MPO), usually accompanied by pulmonary and renal lesions. MPA sometimes causes central nervous system (CNS) involvement such as cerebral infarction. Herein, we report a case of a 72-year-old man with a headache. He had an unknown cause of the elevated inflammatory response. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions in the small vessel region in the right basal ganglia with multiple cerebral microbleeds (cMBs). After admission, his left hemiparesis and consciousness disturbance gradually deteriorated. A follow-up MRI on day 18 showed increased multiple cerebral infarctions in small vessel regions with increased cMBs. Additional blood tests revealed positive MPO-ANCA. Although there were no findings suggestive of active renal or pulmonary involvement or peripheral neuropathy, we diagnosed him as having MPA-associated CNS-restricted vasculitis. CNS involvement of MPA is relatively rare but is associated with a high small vessel disease (SVD) burden. In addition to the unknown cause of inflammatory response, the multiple cMBs increase and a short-term recurrence of cerebral infarctions in the bilateral thalamus and basal ganglia was the clue for the diagnosis of CNS-restricted vasculitis. It is difficult to diagnose MPA vasculitis when lesions are restricted to the CNS. In the absence of lesions other than SVD, MPA-associated CNS vasculitis should be suspected in patients with progressive SVD burden and elevated inflammatory response.

Endometriosis is a chronic disease with the presence of endometrium-like tissue containing endometrial glands and stroma outside the uterus. The incidence of episiotomy scar endometriosis after vaginal delivery is 0.06-0.7%.