Autoimmune diseases frequently present with ophthalmological manifestations,posing significant diagnostic and therapeutic challenges.This review delved into the complex interplay between autoimmunity and ocular health...Autoimmune diseases frequently present with ophthalmological manifestations,posing significant diagnostic and therapeutic challenges.This review delved into the complex interplay between autoimmunity and ocular health,highlighting common manifestations such as uveitis,keratitis,and optic neuritis.We explored advanced diagnostic tools and techniques to improve early detection and accurate diagnosis.Additionally,the review addressed current therapeutic strategies,emphasizing the need for tailored treatments to manage ocular symptoms effectively while minimizing systemic side effects.By overcoming these challenges we aimed to enhance patient outcomes and quality of life for those affected by autoimmune-related eye diseases.展开更多
Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous ma...Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.展开更多
BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptom...BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features.Thus,there are silent forms of the disease in which oral manifestations are the first sign.In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.AIM To assess the prevalence and types of oral manifestations in pediatric patients with CD.METHODS We performed a comprehensive literature search in PubMed,Scielo,Cochrane Library and Lilacs databases from 2014-2024.Three independent researchers screened and extracted the information,applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.RESULTS Of the initial 241 articles,14 studies fulfilled the proposed objectives and were included in the review.The main oral manifestations found were recurrent aphthous stomatitis and enamel defects.Additionally,delayed tooth eruption,angular cheilitis,glossodynia and xerostomia were also reported.CONCLUSION Assessing oral manifestations is crucial,especially in underdiagnosed cases of children with CD.Recognizing these signs helps pediatricians or general practitioners identify them during routine exams,enabling early diagnosis and treatment to prevent negative impacts on the child’s and family’s quality of life.展开更多
BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic...BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.展开更多
Objective The clinical features,disease course and visual outcomes of toxoplasmosis are less commonly reported in China than in other countries.To reduce misdiagnosis and improve visual function,the clinical character...Objective The clinical features,disease course and visual outcomes of toxoplasmosis are less commonly reported in China than in other countries.To reduce misdiagnosis and improve visual function,the clinical characteristics,management and visual outcomes of 13 cases of ocular toxoplasmosis(OT)were described.Methods This retrospective study included 14 eyes of 13 patients who were diagnosed with OT in Hubei,China.The clinical characteristics,course of treatment and outcomes are presented.There were 7 males and 6 females.Results The main form of OT was retinochoroiditis with vitritis or anterior uveitis.Next-generation sequencing was applied to 3 eyes,and positive results were found in those eyes.Thirteen patients were positive for Toxoplasma gondii IgG antibodies,and 3 of them were also positive for IgM T.gondii antibodies.One patient with acquired immune deficiency syndrome was diagnosed with coinfection with OT and cytomegalovirus,as evidenced by an aqueous humor etiological test.Three patients were misdiagnosed with noninfectious uveitis.Recurrence occurred in 3 eyes during the follow-up periods.One patient who received vitreous implantation of Ozurdex therapy at another hospital before referral relapsed.One patient who received sulfadiazine,azithromycin and glucocorticoid therapy relapsed.One patient who received sulfadiazine therapy experienced relapse.Patients who received clindamycin and sulfadiazine or who received clindamycin only did not experience recurrence during the follow-up period.The best corrected visual acuity was improved in 6 eyes after inflammation resolved.Conclusions Primary active retinochoroiditis is the main form of OT in Hubei,China.Timely correct diagnosis on the basis of ocular characteristics and aetiological test results and effective treatment should be adopted to prevent poor visual outcomes and recurrence.展开更多
Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment ...Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment response remains underexplored.Our review seeks to mainly delve into the effect of gender identity on ADHD,exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms,diagnostic assessment,and treatment,with the goal of supplying theoretical support and practical recommendations for future research and clinical practice.The primary content includes,specifically:(1)Symptom expression differences:Gender identity significantly affects ADHD symptoms;male-identified individuals commonly perform worse in task orientation and attention stability,while female-identified individuals may demonstrate more variability in attention control and executive functions;(2)Diagnosis and treatment:Clinical practice generally neglects the impact of gender identity on ADHD management,with personalized needs of gender-identified individuals frequently not adequately addressed,potentially,affecting treatment outcomes;and(3)Future research directions:Future studies should further assess how gender identity affects the specific mechanisms of ADHD,conduct researches in multicultural contexts,and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression.Besides,enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.展开更多
BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis an...BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.展开更多
BACKGROUND Ulcerative colitis(UC)is an idiopathic,chronic inflammatory bowel disease(IBD)most often located in the rectum,but may involve the entire colon.Extra intestinal manifestations(EIMs)occur with varying freque...BACKGROUND Ulcerative colitis(UC)is an idiopathic,chronic inflammatory bowel disease(IBD)most often located in the rectum,but may involve the entire colon.Extra intestinal manifestations(EIMs)occur with varying frequency depending on the affected organ.The most common ones are musculoskeletal EIMs,affecting up to 33%-40%of IBD patients.These include,among others,inflammatory back pain,tendinitis,plantar fasciitis and arthritis.Only a few case reports in literature discuss Achilles tendinitis.CASE SUMMARY This report describes a patient with UC and Achilles tendinitis in whom after many unsuccessful attempts of treatment with sulfasalazine,mesalazine,glucocorticosteroids,infliximab and tofacitinib,a complete UC remission and resolution of Achilles tendinitis were achieved with the use of dual biologic therapy(DBT)-ustekinumab and adalimumab(ADA).CONCLUSION This case mentions rare EIMs of UC and suggests that DBT may be an alternative for patient with ulcerative colitis and EIMs.展开更多
The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis ...The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .展开更多
Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that po...Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.展开更多
Background:The natural history of chronic HBV infection is typically characterized by four stages:the immune tolerance period,the immune clearance period,the immune control period,and the immune escape period.These st...Background:The natural history of chronic HBV infection is typically characterized by four stages:the immune tolerance period,the immune clearance period,the immune control period,and the immune escape period.These stages are associated with the distribution of HBcAg in liver cells;however,this relationship remains a topic of broad debate within the field of liver disease.To objectively and quantitatively measure the intracellular distribution of HBcAg,this paper aims to design a method referred to as the“layered evaluation method”and to examine its validation.Methods:The distribution of HBcAg in liver cells is assessed using Image Pro Plus image processing software,along with calculations of cytoplasmic and nuclear positive staining rates.Results:The findings indicate that the highest proportion of patients exhibited a positive cytoplasmic expression rate ranging from 0-2.5%.More than 40% of the total sample was categorized within the 0-2.5% positive nuclear expression range.The HBcAg cytoplasmic positive staining rates were classified into five levels:a cytoplasmic HBcAg positive staining rate of less than 0.05% is designated as level 0,indicating negative expression;a staining rate between 0.05% and 5% is classified as level 1;a rate from 5% to less than 10% is classified as level 2;a rate from 10% to less than 20% is classified as level 3;and a nuclear positivity rate exceeding 20% is classified as level 4.Conclusion:The inflammatory activity grade in these patients was positively correlated with the cytoplasmic distribution of HBcAg.Furthermore,the nuclear distribution rate of HBcAg was significantly higher in the G3 group compared to the other groups.展开更多
Introduction: Acute lymphoblastic leukemia (ALL) is a monoclonal hematological malignancy characterized by infiltration of the bone marrow by more than 20% of hematopoietic cells with blocked differentiation, called b...Introduction: Acute lymphoblastic leukemia (ALL) is a monoclonal hematological malignancy characterized by infiltration of the bone marrow by more than 20% of hematopoietic cells with blocked differentiation, called blasts, belonging to the lymphoblastic lineage of lymphoid nature (B or T lymphoblasts). Around 40% of childhood cancers are leukemias, and 85% of these are ALL. The first descriptions of osteoarticular involvement as an inaugural manifestation date back to 1913 with August Strauch. Our aim was to describe an isolated case of ALL with osteoarticular manifestations as an inaugural event supported by a review of the literature. Observation: A 14-year-old adolescent with no known pathological history was referred from pediatrics to investigate the etiology of a chronic peripheral polyarthritis that had been progressively evolving for about seven weeks. Clinically, he presented with chronic peripheral polyarthritis, polysynovitis, non-ankylosing deforming involving knees, shoulders, wrists, and proximal interphalangeals (PIP), and a leukemic facies (facial puffiness and periorbital erythema). Biological investigations revealed a non-specific inflammatory syndrome with a VS of 60 mm in the first hour and CRP increased to 45 mg/l (N ≤ 6 mg/l). The blood count showed hyperleukocytosis at 25,600/mm3 with lymphocyte predominance at 18,660/mm3, normocytic normochromic anemia with hemoglobin at 11 g/dl, and hyperplakettosis at 510,000/mm3. The blood smear showed 37% blasts confirmed on the medullogram, with more than 20% blastic invasion and a predominance of common B-type lymphocytes on immunophenotyping with negative Philadelphia. Immunological, renal, infectious, hepatic, lipid, and uricemia tests were normal. These clinical and paraclinical findings led to the diagnosis of B-type lymphocytic leukemia. The patient received multidrug therapy for induction, consolidation, and intensification. As part of the management of his osteoarticular disorders, infiltrations of the large painful joints were carried out with an adequate phosphocalcic intake. Conclusion: Leukemia is a diagnostic and therapeutic emergency, and osteoarticular damage may be the initial presentation.展开更多
AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.
Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurologica...Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurological disorders are the most common EHM associated with HEV.The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation.Patients can present with normal liver function tests,which can often be misleading for physicians.There is a paucity of data on HEV-related neurological manifestations;and these data are mostly described as case reports and case series.In this review,we analyzed data of 163 reported cases of HEV-related neurological disorders.The mechanisms of pathogenesis,clinico-demographic profile,and outcomes of the HEV-related neurological disorders are described in this article.Nerve root and plexus disorder were found to be the most commonly reported disease,followed by meningoencephalitis.展开更多
The coronavirus disease 2019(COVID-19)has caused one of the worst public health crises in modern history.Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract,gastrointest...The coronavirus disease 2019(COVID-19)has caused one of the worst public health crises in modern history.Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract,gastrointestinal manifestations are well described in literature.This review will discuss the epidemiology,virology,manifestations,immunosuppressant states,and lessons learned from COVID-19.Observations:At the time of writing,COVID-19 had infected more than 111 million people and caused over 2.5 million deaths worldwide.Multiple medical comorbidities including obesity,pre-existing liver condition and the use of proton pump inhibitor have been described as risk factor for severe COVID-19.COVID-19 most frequently causes diarrhea(12.4%),nausea/vomiting(9%)and elevation in liver enzymes(15%-20%).The current data does not suggest that patients on immunomodulators have a significantly increased risk of mortality from COVID-19.The current guidelines from American Gastroenterological Association and American Association for the Study of Liver Diseases do not recommend pre-emptive changes in patients on immunosuppression if the patients have not been infected with COVID-19.Conclusions and relevance:The COVID-19 pandemic has prompted a change in structure and shape of gastroenterology departmental activities.Endoscopy should be performed only when necessary and with strict protective measures.Online consultations in the form of telehealth services and home drug deliveries have revolutionized the field.展开更多
BACKGROUND Hepatitis C virus(HCV)is a disease with a significant global impact,affecting approximately 2%-2.5%of the world’s population.New direct-acting antivirals(DAAs)have been introduced over the past few years w...BACKGROUND Hepatitis C virus(HCV)is a disease with a significant global impact,affecting approximately 2%-2.5%of the world’s population.New direct-acting antivirals(DAAs)have been introduced over the past few years with great success in viral eradication.The association of chronic HCV infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature.AIM To assess the effect of treating HCV with DAAs on the extrahepatic cutaneous manifestations of HCV.METHODS This prospective observational study included 1039 HCV positive Egyptian patients who were eligible to receive DAAs.A total of 30 patients were diagnosed with extrahepatic cutaneous manifestations and fulfilled the inclusion criteria of the study.Of these patients,6 had classic lichen planus,8 were diagnosed with psoriasis vulgaris and 16 had pruritus.All patients received DAAs from October 2018 to July 2019 in the form of a three-month course of sofosbuvir/daclatasvir combination.Patients with lichen planus or psoriasis were dermoscopically evaluated before treatment and 6 mo after treatment,while patients with hepatic pruritus were assessed using the 12-Item Pruritus Severity Scale over the same period.RESULTS All patients with psoriasis showed significant improvement in all psoriatic plaques,and all patients with hepatic pruritus scored 0 on the 12-Item Pruritus Severity Scale indicating total improvement of pruritus.In addition,four of six patients with lichen planus showed complete improvement.CONCLUSION Treatment of HCV with DAAs was significantly effective in improving virusrelated extrahepatic cutaneous manifestations.展开更多
Chinglish often occurs in the process of English language acquisition.It’s necessary to clarify what Chinglish is and what the major features are.The paper elaborates five major manifestations of Chinglish in terms o...Chinglish often occurs in the process of English language acquisition.It’s necessary to clarify what Chinglish is and what the major features are.The paper elaborates five major manifestations of Chinglish in terms of phonological difference,lexical redundancy and word misuse,unreasonable sentence structure as well as semantic misuse,and then proposes solutions to Chinglish through improvement of linguistic competence,conversion of thinking modes and enhancement of the awareness of cultural factors.展开更多
The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent cause...The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used in most transplant recipients.Therefore,there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirinresistant HEV.In this review article,a literature search using PubMed and MEDLINE databases was performed,up to March 2020.Only the articles published in English were reviewed.展开更多
Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of ...Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.展开更多
Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed...Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.展开更多
文摘Autoimmune diseases frequently present with ophthalmological manifestations,posing significant diagnostic and therapeutic challenges.This review delved into the complex interplay between autoimmunity and ocular health,highlighting common manifestations such as uveitis,keratitis,and optic neuritis.We explored advanced diagnostic tools and techniques to improve early detection and accurate diagnosis.Additionally,the review addressed current therapeutic strategies,emphasizing the need for tailored treatments to manage ocular symptoms effectively while minimizing systemic side effects.By overcoming these challenges we aimed to enhance patient outcomes and quality of life for those affected by autoimmune-related eye diseases.
文摘Bone marrow edema syndrome (BMES), is a rare and self-limiting condition characterized by localized bone pain and transient marrow edema visible on MRI. BMES has been increasingly associated with specific cutaneous manifestations that may hold diagnostic and prognostic significance. Patients with BMES have reported localized erythema, dermal thickening, and induration overlying the affected joints, which are hypothesized to reflect microvascular compromise and inflammatory processes within the bone and adjacent soft tissues. Dermatologic signs are likely linked to regional hyperemia, venous stasis, and cytokine-mediated inflammation, paralleling the pathophysiological mechanisms underlying intraosseous edema. Elevated intraosseous pressure in BMES may disrupt local perfusion, resulting in ischemia-reperfusion injury and subsequent vascular leakage, which manifests in visible cutaneous changes. Pro-inflammatory mediators, such as interleukin-1β and vascular endothelial growth factor (VEGF), central to BMES pathogenesis, may exacerbate endothelial activation, and dermal involvement. Histopathologic studies of affected skin have revealed perivascular lymphocytic infiltration and increased dermal vascularity, further supporting the theory of a shared ischemic and inflammatory pathway between bone and skin. Although MRI remains the gold standard for BMES diagnosis, recognition of these cutaneous manifestations could expedite orthopedic referral and intervention, especially in cases where imaging is delayed or symptoms are ambiguous. Current treatment options, including bisphosphonates, prostacyclin analogs, and offloading of weight bearing, may benefit from integration with dermatologic strategies to alleviate localized cutaneous symptoms and improve patient comfort. Evaluating the molecular and vascular links between BMES and its cutaneous manifestations provides an opportunity to refine diagnostic protocols and therapeutic approaches, offering a comprehensive understanding of the systemic interplay between dermal and skeletal pathophysiology, and optimizing clinical outcomes for patients affected by BMES.
文摘BACKGROUND Celiac disease(CD)is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals.It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features.Thus,there are silent forms of the disease in which oral manifestations are the first sign.In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.AIM To assess the prevalence and types of oral manifestations in pediatric patients with CD.METHODS We performed a comprehensive literature search in PubMed,Scielo,Cochrane Library and Lilacs databases from 2014-2024.Three independent researchers screened and extracted the information,applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.RESULTS Of the initial 241 articles,14 studies fulfilled the proposed objectives and were included in the review.The main oral manifestations found were recurrent aphthous stomatitis and enamel defects.Additionally,delayed tooth eruption,angular cheilitis,glossodynia and xerostomia were also reported.CONCLUSION Assessing oral manifestations is crucial,especially in underdiagnosed cases of children with CD.Recognizing these signs helps pediatricians or general practitioners identify them during routine exams,enabling early diagnosis and treatment to prevent negative impacts on the child’s and family’s quality of life.
基金Supported by National Natural Science Foundation of China,No.82360120Ten Thousand Doctor Plan in Yunnan Province,No.YNWRMY-2018-020Yunnan Provincial Key Laboratory of Clinical Virology,No.202205AG070053-07.
文摘BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.
基金Hubei Natural Science Foundation of China(No.2022CFB296).
文摘Objective The clinical features,disease course and visual outcomes of toxoplasmosis are less commonly reported in China than in other countries.To reduce misdiagnosis and improve visual function,the clinical characteristics,management and visual outcomes of 13 cases of ocular toxoplasmosis(OT)were described.Methods This retrospective study included 14 eyes of 13 patients who were diagnosed with OT in Hubei,China.The clinical characteristics,course of treatment and outcomes are presented.There were 7 males and 6 females.Results The main form of OT was retinochoroiditis with vitritis or anterior uveitis.Next-generation sequencing was applied to 3 eyes,and positive results were found in those eyes.Thirteen patients were positive for Toxoplasma gondii IgG antibodies,and 3 of them were also positive for IgM T.gondii antibodies.One patient with acquired immune deficiency syndrome was diagnosed with coinfection with OT and cytomegalovirus,as evidenced by an aqueous humor etiological test.Three patients were misdiagnosed with noninfectious uveitis.Recurrence occurred in 3 eyes during the follow-up periods.One patient who received vitreous implantation of Ozurdex therapy at another hospital before referral relapsed.One patient who received sulfadiazine,azithromycin and glucocorticoid therapy relapsed.One patient who received sulfadiazine therapy experienced relapse.Patients who received clindamycin and sulfadiazine or who received clindamycin only did not experience recurrence during the follow-up period.The best corrected visual acuity was improved in 6 eyes after inflammation resolved.Conclusions Primary active retinochoroiditis is the main form of OT in Hubei,China.Timely correct diagnosis on the basis of ocular characteristics and aetiological test results and effective treatment should be adopted to prevent poor visual outcomes and recurrence.
基金Supported by the Central Guiding Local Science and Technology Development Fund Project,No.YDZX2022091。
文摘Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment response remains underexplored.Our review seeks to mainly delve into the effect of gender identity on ADHD,exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms,diagnostic assessment,and treatment,with the goal of supplying theoretical support and practical recommendations for future research and clinical practice.The primary content includes,specifically:(1)Symptom expression differences:Gender identity significantly affects ADHD symptoms;male-identified individuals commonly perform worse in task orientation and attention stability,while female-identified individuals may demonstrate more variability in attention control and executive functions;(2)Diagnosis and treatment:Clinical practice generally neglects the impact of gender identity on ADHD management,with personalized needs of gender-identified individuals frequently not adequately addressed,potentially,affecting treatment outcomes;and(3)Future research directions:Future studies should further assess how gender identity affects the specific mechanisms of ADHD,conduct researches in multicultural contexts,and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression.Besides,enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-022 and No.2022-PUMCH-D-002CAMS Innovation Fund for Medical Sciences,No.2021-1-I2M-003+1 种基金Undergraduate Innovation Program,No.2023-zglc-06034National Key Clinical Specialty Construction Project,No.ZK108000。
文摘BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.
文摘BACKGROUND Ulcerative colitis(UC)is an idiopathic,chronic inflammatory bowel disease(IBD)most often located in the rectum,but may involve the entire colon.Extra intestinal manifestations(EIMs)occur with varying frequency depending on the affected organ.The most common ones are musculoskeletal EIMs,affecting up to 33%-40%of IBD patients.These include,among others,inflammatory back pain,tendinitis,plantar fasciitis and arthritis.Only a few case reports in literature discuss Achilles tendinitis.CASE SUMMARY This report describes a patient with UC and Achilles tendinitis in whom after many unsuccessful attempts of treatment with sulfasalazine,mesalazine,glucocorticosteroids,infliximab and tofacitinib,a complete UC remission and resolution of Achilles tendinitis were achieved with the use of dual biologic therapy(DBT)-ustekinumab and adalimumab(ADA).CONCLUSION This case mentions rare EIMs of UC and suggests that DBT may be an alternative for patient with ulcerative colitis and EIMs.
文摘The authors report a case of deficient sensory neuropathy secondary to vitamin B12 deficiency, diagnosed in the neurology department of the Sino-Central African Friendship University Hospital in Bangui. The diagnosis was made possible by electroneuromyography which showed subclinical neurological damage associated with hematological damage (anemia). Through this observation, we recall the diagnostic criteria of the disease in a context of difficult medical practice. .
文摘Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.
文摘Background:The natural history of chronic HBV infection is typically characterized by four stages:the immune tolerance period,the immune clearance period,the immune control period,and the immune escape period.These stages are associated with the distribution of HBcAg in liver cells;however,this relationship remains a topic of broad debate within the field of liver disease.To objectively and quantitatively measure the intracellular distribution of HBcAg,this paper aims to design a method referred to as the“layered evaluation method”and to examine its validation.Methods:The distribution of HBcAg in liver cells is assessed using Image Pro Plus image processing software,along with calculations of cytoplasmic and nuclear positive staining rates.Results:The findings indicate that the highest proportion of patients exhibited a positive cytoplasmic expression rate ranging from 0-2.5%.More than 40% of the total sample was categorized within the 0-2.5% positive nuclear expression range.The HBcAg cytoplasmic positive staining rates were classified into five levels:a cytoplasmic HBcAg positive staining rate of less than 0.05% is designated as level 0,indicating negative expression;a staining rate between 0.05% and 5% is classified as level 1;a rate from 5% to less than 10% is classified as level 2;a rate from 10% to less than 20% is classified as level 3;and a nuclear positivity rate exceeding 20% is classified as level 4.Conclusion:The inflammatory activity grade in these patients was positively correlated with the cytoplasmic distribution of HBcAg.Furthermore,the nuclear distribution rate of HBcAg was significantly higher in the G3 group compared to the other groups.
文摘Introduction: Acute lymphoblastic leukemia (ALL) is a monoclonal hematological malignancy characterized by infiltration of the bone marrow by more than 20% of hematopoietic cells with blocked differentiation, called blasts, belonging to the lymphoblastic lineage of lymphoid nature (B or T lymphoblasts). Around 40% of childhood cancers are leukemias, and 85% of these are ALL. The first descriptions of osteoarticular involvement as an inaugural manifestation date back to 1913 with August Strauch. Our aim was to describe an isolated case of ALL with osteoarticular manifestations as an inaugural event supported by a review of the literature. Observation: A 14-year-old adolescent with no known pathological history was referred from pediatrics to investigate the etiology of a chronic peripheral polyarthritis that had been progressively evolving for about seven weeks. Clinically, he presented with chronic peripheral polyarthritis, polysynovitis, non-ankylosing deforming involving knees, shoulders, wrists, and proximal interphalangeals (PIP), and a leukemic facies (facial puffiness and periorbital erythema). Biological investigations revealed a non-specific inflammatory syndrome with a VS of 60 mm in the first hour and CRP increased to 45 mg/l (N ≤ 6 mg/l). The blood count showed hyperleukocytosis at 25,600/mm3 with lymphocyte predominance at 18,660/mm3, normocytic normochromic anemia with hemoglobin at 11 g/dl, and hyperplakettosis at 510,000/mm3. The blood smear showed 37% blasts confirmed on the medullogram, with more than 20% blastic invasion and a predominance of common B-type lymphocytes on immunophenotyping with negative Philadelphia. Immunological, renal, infectious, hepatic, lipid, and uricemia tests were normal. These clinical and paraclinical findings led to the diagnosis of B-type lymphocytic leukemia. The patient received multidrug therapy for induction, consolidation, and intensification. As part of the management of his osteoarticular disorders, infiltrations of the large painful joints were carried out with an adequate phosphocalcic intake. Conclusion: Leukemia is a diagnostic and therapeutic emergency, and osteoarticular damage may be the initial presentation.
文摘AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.
文摘Hepatitis E virus(HEV)is an important cause of repeated waterborne outbreaks of acute hepatitis.Recently,several extrahepatic manifestations(EHMs)have been described in patients with HEV infection.Of these,neurological disorders are the most common EHM associated with HEV.The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation.Patients can present with normal liver function tests,which can often be misleading for physicians.There is a paucity of data on HEV-related neurological manifestations;and these data are mostly described as case reports and case series.In this review,we analyzed data of 163 reported cases of HEV-related neurological disorders.The mechanisms of pathogenesis,clinico-demographic profile,and outcomes of the HEV-related neurological disorders are described in this article.Nerve root and plexus disorder were found to be the most commonly reported disease,followed by meningoencephalitis.
文摘The coronavirus disease 2019(COVID-19)has caused one of the worst public health crises in modern history.Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract,gastrointestinal manifestations are well described in literature.This review will discuss the epidemiology,virology,manifestations,immunosuppressant states,and lessons learned from COVID-19.Observations:At the time of writing,COVID-19 had infected more than 111 million people and caused over 2.5 million deaths worldwide.Multiple medical comorbidities including obesity,pre-existing liver condition and the use of proton pump inhibitor have been described as risk factor for severe COVID-19.COVID-19 most frequently causes diarrhea(12.4%),nausea/vomiting(9%)and elevation in liver enzymes(15%-20%).The current data does not suggest that patients on immunomodulators have a significantly increased risk of mortality from COVID-19.The current guidelines from American Gastroenterological Association and American Association for the Study of Liver Diseases do not recommend pre-emptive changes in patients on immunosuppression if the patients have not been infected with COVID-19.Conclusions and relevance:The COVID-19 pandemic has prompted a change in structure and shape of gastroenterology departmental activities.Endoscopy should be performed only when necessary and with strict protective measures.Online consultations in the form of telehealth services and home drug deliveries have revolutionized the field.
文摘BACKGROUND Hepatitis C virus(HCV)is a disease with a significant global impact,affecting approximately 2%-2.5%of the world’s population.New direct-acting antivirals(DAAs)have been introduced over the past few years with great success in viral eradication.The association of chronic HCV infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature.AIM To assess the effect of treating HCV with DAAs on the extrahepatic cutaneous manifestations of HCV.METHODS This prospective observational study included 1039 HCV positive Egyptian patients who were eligible to receive DAAs.A total of 30 patients were diagnosed with extrahepatic cutaneous manifestations and fulfilled the inclusion criteria of the study.Of these patients,6 had classic lichen planus,8 were diagnosed with psoriasis vulgaris and 16 had pruritus.All patients received DAAs from October 2018 to July 2019 in the form of a three-month course of sofosbuvir/daclatasvir combination.Patients with lichen planus or psoriasis were dermoscopically evaluated before treatment and 6 mo after treatment,while patients with hepatic pruritus were assessed using the 12-Item Pruritus Severity Scale over the same period.RESULTS All patients with psoriasis showed significant improvement in all psoriatic plaques,and all patients with hepatic pruritus scored 0 on the 12-Item Pruritus Severity Scale indicating total improvement of pruritus.In addition,four of six patients with lichen planus showed complete improvement.CONCLUSION Treatment of HCV with DAAs was significantly effective in improving virusrelated extrahepatic cutaneous manifestations.
文摘Chinglish often occurs in the process of English language acquisition.It’s necessary to clarify what Chinglish is and what the major features are.The paper elaborates five major manifestations of Chinglish in terms of phonological difference,lexical redundancy and word misuse,unreasonable sentence structure as well as semantic misuse,and then proposes solutions to Chinglish through improvement of linguistic competence,conversion of thinking modes and enhancement of the awareness of cultural factors.
文摘The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used in most transplant recipients.Therefore,there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirinresistant HEV.In this review article,a literature search using PubMed and MEDLINE databases was performed,up to March 2020.Only the articles published in English were reviewed.
文摘Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.
文摘Crohn＇s disease （CD） and ulcerative colitis （UC） are chronic inflammatory bowel diseases （IBD） that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.
