Clinics and Practice

Background: To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. Method: The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest–posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. Results: Exploratory factor analysis resulted in two factors that accounted for 57% of the variance—internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach’s α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. Conclusions: The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice. Full article

Background: Heart failure (HF) is a leading cause of mortality across the globe, prompting ongoing research into novel biomarkers for improved risk stratification and patient management. Methods: This cross-sectional study aimed to investigate the relationship between two promising biomarkers, tetranectin and paraoxonase 1, and the severity of heart failure in a cohort of 87 patients with cardiovascular risk factors. Participants were categorized into three groups based on their New York Heart Association (NYHA) classification: no HF (Control), NYHA class I (G1), and NYHA class II-IV (G2). Results: Our analysis revealed a stepwise decrease in both TETRA and PON1 levels with increasing HF severity, with the Control group exhibiting the highest levels and the G2 group the lowest. Interestingly, a significant positive correlation between TETRA and PON1 was observed only in the Control group, suggesting a potential interplay between these biomarkers in healthy individuals that may be disrupted with the onset of HF. Furthermore, both TETRA and PON1 were positively associated with left ventricular ejection fraction (LVEF) and negatively associated with diastolic dysfunction, indicating their potential involvement in both systolic and diastolic cardiac function. Conclusions: These findings suggest that TETRA and PON1 may serve as valuable biomarkers for assessing HF severity and prognosis. Further research is warranted to validate these findings in larger, prospective studies and to explore their clinical utility in guiding treatment decisions. Full article

Introduction: Post-tonsillectomy hemorrhage is a serious complication that varies according to the surgical technique used, potentially compromising patient safety and recovery. Even though several techniques were frequently used, including cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy, there were certain discrepancies in hemorrhage rates in the literature. This meta-analysis aims to compare the rates of primary and secondary hemorrhage among these surgical techniques, with a focus on guiding clinical decision-making. Methodology: A total of 12 studies, published between 2005 and 2024, were selected from the PubMed, Web of Science, Scopus, and Cochrane Library databases, comprising 1684 participants from both pediatric and adult groups. Primary and secondary hemorrhage rates, surgical techniques, and study characteristics were extracted as data. Therefore, the aim of performing this meta-analysis with random-effects models was to calculate pooled estimates for hemorrhage rates and the heterogeneity index (I²). The techniques studied included cold steel dissection, coblation, monopolar diathermy, and bipolar diathermy. Results: The pooled primary hemorrhage rate across all techniques was 1.0% (95% Cl: 0.5–1.4%), with insignificant heterogeneity (I² = 0.0%, p < 0.665). By contrast, pooled secondary hemorrhage occurred at a rate of 5.8% (95% CI: 3.9–7.6%). Cold steel tonsillectomy was associated with the lowest secondary hemorrhage rate of 3.7% (95% CI: 0.8–6.6%, I² = 43.558%, p = 0.115), while bipolar diathermy had the highest secondary hemorrhage rate of 8.6% (95% CI: 2.3–15.0%, I² = 86.448%, p < 0.001). Conclusions: This meta-analysis underscores the considerable variability in rates of post-tonsillectomy hemorrhage frequency among various surgical techniques. Cold steel dissection appears to be the safest regarding secondary hemorrhage, while coblation likely minimizes primary bleeding. Bipolar diathermy comes across as the technique with the highest risk for primary hemorrhage and requires special caution during its use. Such results emphasize the need for careful selection of the surgical technique concerning patients’ particular conditions and the need to enhance care periods to reduce the bearing of any hemorrhagic complications. Full article

Background and Objectives: Uveitis-masked syndromes or masquerade syndromes (UMSs) are a group of ocular conditions with several systemic underlying causes, malignant or nonmalignant, that mimic the inflammatory status of the uvea. They are often difficult to detect and diagnose with traditional techniques, such as ophthalmic exams. Ocular B (bidimensional)-ultrasound (OBU) is a non-invasive, repeatable, rapid ultrasound method effective in indirect signs that lead back to systemic diseases. It is comparable in effectiveness with other imaging tools. The cause of UMSs can often be serious, and therefore early diagnosis and prompt treatment are critical. This study aimed to identify the sonographic signs of these forms, which can help physicians discover the cause underlying UMS. Materials and Methods: This was a consecutive, retrospective, nonrandomized study. This study was conducted at the University Hospital Polyclinic of Bari, Italy, from January 2022 to December 2024. A total of 186 patients were included, from 10 to 85 years old. They all underwent B-scan ultrasonography (Quantel Medical ABSolu Ocular Ultrasound). Results: All patients reported blurred vision, which could be accompanied by visual reduction (<20/40, Snellen charts), photophobia, floaters, flashes, proptosis, and redness. In all cases, we noted peculiar ultrasonographic signs, which allowed us to discriminate the underlying systemic diagnosis, such as vitreous corpuscles, choroid thickening, and primitive or metastatic solid tumors. Finally, we identified different diseases, such as primary intraocular lymphoma (PIOL), other lymphoproliferative conditions, orbital plasmacytoma, uveal melanoma, metastasis, endogenous endophthalmitis, retinal detachment, central serous retinopathy, metallic foreign bodies, ocular amyloidosis, and drug-induced UMSs. The sensitivity and specificity of ocular ultrasound compared to multimodal ocular imaging in UMSs were as follows: for primary intraocular lymphoma (PIOL) and other lymphoproliferative conditions, 0.98 (95% CI, 0.80–1) and 0.68 (90% CI, 0.40–0.92), respectively; for orbital plasmacytoma, 0.64 (92% CI, 0.52–0.86) and 0.66 (93% CI, 0.48–0.89), respectively; uveal melanoma, 1.00 (98% CI, 0.88–1.00) and 0.98 (95% CI, 0.86–0.98), respectively; metastasis, 0.75 (95% CI, 0.53–0.85) and 0.85 (95% CI, 0.48–0.98), respectively; endogenous endophthalmitis, 1.00 (95% CI, 0.50–1.00) and 0.83 (95% CI, 0.48–0.98), respectively; retinal detachment, both were 1.00 (95% CI, 0.87–1.00 and 0.84–0.97, respectively); central serous retinopathy, 0.60 (80% CI, 0.41–0.88) and 0.85 (95% CI, 0.52–0.98), respectively; metallic foreign bodies, 1.00 (95% CI, 0.78–1.00) and 0.99 (95% CI, 0.99–1.00), respectively; ocular amyloidosis, 0.77 (82% CI, 0.52–0.90) and 0.83 (80% CI, 0.49–0.88), respectively; and drug-induced UMSs, 0.64 (95% CI, 0.49–0.88) and 0.85 (95% CI, 0.52–0.98), respectively. Conclusions: Diagnosing UMS accurately can be quite challenging, and many of its different types frequently go undetected. This complexity in identification often leads to underdiagnosis, meaning it is essential to improve awareness and understanding of the condition in order to achieve better recognition and treatment. Early detection of these forms is imperative. The use of OBU can help diagnose indirect signs of these forms early and treat them promptly. It compares well with other diagnostic imaging techniques, such as MRI, but this does not mean that it replaces them; it can offer added value in multimodal imaging. Full article

Background/Objectives: Cumulus cells have been proposed to be indicators of oocyte quality. In this study, oocyte cumulus cells were analyzed for SERPINE gene expression. High SERPINE gene expression in cumulus cells is associated with reduced oocyte maturity. However, high mRNA levels in granulosa cells are associated with follicles that result in pregnancy. This study aimed to evaluate SERPINE gene expression in cumulus cells across different ovarian stimulation protocols and its potential impact on follicle number, oocyte maturity, and embryo quality. Methods: The sample of the study consisted of 93 infertile women that underwent a five-day fixed antagonist protocol. Detection of SERPINE gene expression levels in cumulus cells was performed by extracting and isolating the total RNA produced in granulosa cells, and conducting cDNA synthesis and Real-Time Polymerase Chain Reaction. Results: The SERPINE gene expression in CCs was assessed in 71 samples. The SERPINE gene expression levels in CCs were categorized based on the ΔCp values. Most participants (65.9%) exhibited a high expression of the SERPINE gene, with ΔCp values greater than 2. Higher gene expression resulted in a higher number of follicles. However, no statistically significant results were observed regarding the number of follicles and the number of embryos. Conclusions: The study results provide insights into the expression patterns of the SERPINE gene in CCs and underscore the complexity of fertility-related biomarkers and the need for further investigation. SERPINE expression appears to be associated with follicle count, while its role in predicting oocyte quality and pregnancy success remains inconclusive. Full article

Background: Microsurgery is a demanding surgical field requiring precision and extensive training. There is a continued need for standardized training models to improve skill acquisition and efficiency in microvascular anastomosis. Objectives: This study aimed to assess whether a standardized microsurgery training protocol, focusing on technique-specific objectives, improves performance among beginner trainees. Material and Methods: A three-month, non-randomized cohort study was conducted with entry-level plastic surgery residents. Participants were assigned to either a control group, practicing without structured guidance, or a test group, using a predefined microsurgery curriculum. Skill performance was measured at baseline, three weeks, and three months using a modified University of Western Ontario Microsurgical Skills Assessment (UWOMSA) tool. Results: While both groups improved over time, the test group demonstrated significantly greater improvement at the three-month mark (mean score: 59 vs. 38; p = 0.00027). The structured training model promoted more consistent progress and superior microsurgical technique. Conclusions: A standardized training protocol significantly enhances microsurgical proficiency over time. These findings suggest value in structured, low-cost training models for microsurgical education. Limitations include the small sample size, use of non-living models, and a non-randomized design. Full article

Objectives: This study aimed to determine the number needed to treat (NNT) of ketorolac in comparison to placebo after third molar surgery. Methods: Studies located in PubMed, Scopus, and Web of Science were evaluated with the Cochrane Risk of Bias assessment tool. Data on the onset of analgesia, the number of patients requiring rescue medication, the global or general evaluation of the study medication, and adverse effects were extracted. Data analysis was performed using Review Manager 5.3 software for Windows. Results: The qualitative assessment of the included studies showed that ketorolac was more effective than a placebo and the quantitative evaluation on the onset of analgesia (NNT = 1.6 (95%CIs = 1.4, 1.9), n = 301), the number of patients who took rescue analgesics (NNT = 3.6 (95%CIs = 2.8 to 4.9), n = 563), and the global evaluation of the treatments (NNT = 1.7 (95%CIs = 1.5 to 1.9), n = 475) showed estimates of analgesic efficacy with a statistical difference in favor of ketorolac when compared with a placebo. No statistical difference was observed in adverse effects between ketorolac and placebo (n = 739). Conclusions: There is scientific evidence of moderate quality that allows estimators of the analgesic efficacy of ketorolac to be calculated, which will significantly help the clinician who performs pharmacological treatment after third molar surgery. Full article

Background/Objectives: The diversity of the oral microbiota exerts its effects in maintaining dental and overall health. The unique genetic profile of each individual influences the composition of the oral microbiota, determining susceptibility to certain diseases. The aim is to observe its role by highlighting the pathogenic mechanisms involved in oral dysbiosis and identify genetic determinism’s influence in maintaining balance. Methods: This study was designed as a narrative review of the oral microbiota, utilizing some of the principles and guidelines of systematic review to increase methodological rigor. We examined 121 articles such as reviews, meta-analyses, editorials, and observational studies, which met the inclusion and exclusion criteria. The inclusion criteria for studies were as follows: (1) studies that evaluated the impact of the microbiota in oral or/and systemic diseases; (2) studies that observed pathogenic mechanisms in the oral microbiota; (3) studies that evaluated the interaction of the microbiota with the immune system (4); studies that evaluated genetic implications in the microbiota. Results: Host genes regulate inflammatory and immunological reactions that play a role in microbiological balance. This explains the increased resistance of some to diseases, including gingivitis or periodontitis. Also, the implications of oral dysbiosis are reflected not only locally, but also generally, being associated with various systemic conditions. Conclusions: Understanding the pathogenic mechanisms and genetic determinants involved in oral dysbiosis may help create individualized therapies for preventing and managing oral and systemic disorders. A healthy lifestyle and adequate oral hygiene can facilitate a diverse and balanced microbiome, crucial for overall health. Full article

Background/Objectives: Telemedicine (TM) has emerged as a promising tool for improving heart failure (HF) management by allowing non-invasive, remote patient monitoring. However, patient adherence to TM plays a critical role in its effectiveness. This systematic review aims to assess adherence levels to non-invasive TM interventions and explore factors influencing compliance. Methods: This systematic review followed the PRISMA guidelines. A literature search was conducted across the PubMed, Medline, Web of Science, and Google Scholar databases to identify prospective randomized controlled trials published between January 2010 and June 2024. The inclusion criteria included studies focused on non-invasive TM in HF patients with a follow-up period longer than three months. Adherence rates were categorized as high (≥80%), moderate (60–79%), or low (<60%). Results: Of the 136 identified studies, 6 met the inclusion criteria. Three studies reported high adherence (>80%), and three moderate adherence (60–79%). Older patients (≥65 years) showed higher adherence, with two studies exceeding 85% adherence. Studies with higher female participation (>30%) reported better adherence, with two exceeding 88%. Across studies, a lack of racial diversity was especially notable, apart from a study that included a population with 69% black and 31% Hispanic participants, where adherence was 50% for ≥10 uploads over a 90-day period. Seasonal variations affected adherence, with December being the lowest (47–69%) and August the highest (>85%). Monitoring multiple health parameters correlated with better adherence (>85%) compared to single-parameter tracking (50–74%). Conclusions: TM is a promising tool for HF management, but adherence differs by age, sex, and the complexity of monitoring. To optimize TM use, standardized adherence measures and tailored strategies are needed. Full article

Background: Chronic diseases require long-term and multidimensional care, but traditional medical education has emphasised acute care and episodic interventions. This gap limits the understanding of future clinicians about the complexity of managing chronic conditions over decades. This mix-methods quantitative–qualitative pilot study describes “Time Capsule Medicine”, an innovative educational framework in which medical students acted out the progressive challenges that patients with chronic illnesses might face over a continuous period of 20 years. This paper aims to report the outcomes of this innovative educational technique. Methods: Thirty final-year medical students were engaged in the three-phase programme which included preparation, immersive simulation, and reflection and evaluation. The preparation consisted of online workshops in chronic disease progression, age-related changes, and continuity of care, while the immersive simulation featured appropriate role-play exercises in small groups that simulated the chronic disease process across four five-year increments. The reflection and evaluation consisted of debriefing sessions and reflective journals, while pre- and post-simulation questionnaires tested learning outcomes. The physical constraints included weighted garments with visual impairments simulating the age-related limitations. Results: A gender- and ethnically diverse cohort of thirty final-year medical students from three medical schools in North London participated in the programme. The simulation significantly enhanced students’ confidence in managing long-term disease trajectories (pre-simulation score: 2.8 ± 0.9; post-simulation score: 4.3 ± 0.6; p < 0.01) and understanding of age-related challenges (from 3.1 ± 1.0 to 4.5 ± 0.5; p < 0.01). Empathy scores increased from 3.0 ± 0.9 to 4.7 ± 0.5 p < 0.01. The qualitative analysis showed an increased appreciation of the continuity of care, recognition of systemic barriers, and insights into the emotional burdens of chronic conditions. For many students, the simulation was transformative, changing the way they approached holistic, patient-centred care. Conclusions: This experiential learning approach has succeeded in effectively addressing one of the most important gaps known in traditional medical education in developing empathy, understanding, and confidence in the long-term management of chronic diseases. The integration of similar simulations into medical curricula may adequately arm future clinicians with the complexities of continuity of care and patient management. Further studies need to be performed exploring scalability and its impact on long-term clinical practice. Full article

Cutaneous leishmaniasis (CL) is a vector-borne infection caused by protozoan parasites belonging to the genus Leishmania. CL is an emerging global health concern due to increasing migration, travel, and climate change. Traditionally, it was confined to endemic regions such as the Americas, the Middle East, and Central Asia; however, it is now spreading to non-endemic areas. Climate change has further contributed to the expansion of sandfly habitats, increasing CL transmission risk in previously unaffected areas. Healthcare providers in non-endemic regions often misdiagnose CL, delaying treatment and morbidity. Diagnosis remains challenging due to the need for species-specific identification, while treatment is limited by cost, availability, and personnel expertise. This review explores the epidemiology, clinical presentation, diagnostic challenges, and management of CL in the context of global mobility. It highlights rising CL cases in refugee settlements, particularly in Lebanon and Jordan, due to poor living conditions, inadequate vector control, and healthcare barriers. While there have been advances in systemic and topical therapies, access in refugee and resource-poor settings remains a barrier. Addressing the global burden of CL requires improved surveillance, healthcare provider training, and increased awareness. By enhancing global collaboration and policy changes, public health efforts can mitigate the expanding impact of CL. Full article

Objectives: This cohort study examines the relationship between quality of life and oral health in adolescents and young adults in the Zagreb area. Methods: The research involved 250 participants aged 14 to 25 from Zagreb. Each participant was examined by an oral medicine doctor using a probe and mirror in a dental unit, and their DMFT (Decayed, Missing, and Filled Teeth) status was determined. Participants also completed questionnaires on their socio-economic status (SES) and the impact of their oral health on quality of life (OHIP-14, Oral Health Impact Profile). Results: Caries was the most common dental issue among adolescents (2.23 ± 2.58), with restoration being the most frequent treatment (54%). Endodontic treatment and tooth extraction were more prevalent among individuals with lower SES (24.1%), who also had worse DMFT scores (8.09 ± 5.56). Prophylaxis was equally distributed across SES and gender. Male patients had more carious teeth (2.75 ± 3.07) than female patients (1.85 ± 2.08), while female patients scored worse on the OHIP-14 scale (10.97 ± 8.77) compared to males (8.81 ± 8.11). Age positively correlated with both OHIP-14 and DMFT scores. Conclusions: Adolescents and young adults in Zagreb, Croatia, exhibited high DMFT and OHIP-14 scores, reflecting significant oral health issues and reduced quality of life, particularly among older individuals and those with lower SES. The association between invasive treatments (e.g., endodontic procedures and extractions) and diminished quality of life underscores the necessity for early preventive measures, including regular dental check-ups and targeted oral health education. Full article

Background/Objectives: Renal cell cancer is a rare occurrence in patients with ulcerative colitis (UC), with no clearly demonstrated association between UC and an increased risk of renal malignancies. In this article, a case report concerning this relationship is presented. Methods: Our research group presented a case of clear cell renal carcinoma in a 56-year-old male with UC who had previously undergone ileorectal anastomosis and subtotal colectomy. Results: The patient developed a complex renal cyst that progressed to malignancy within one year while on immunosuppressive therapy with infliximab and then filgotinib. Previous ultrasound examinations of the kidney highlighted only simple cysts in the contralateral kidney in previous years. The neoplasm was promptly examined using contrast-enhanced ultrasound, confirming the diagnosis of a Bosniak IV cyst, which was corroborated by a subsequent computed tomography study. Conclusions: The patient underwent a nephrectomy and is currently scheduled for therapy with vedolizumab. Given the increasing use of biologics and small molecules in UC management, periodic ultrasound screening may be a valuable tool for the long-term monitoring of these patients. Full article

Biochemical markers can be used in addition to neuroimaging techniques to evaluate the extent of ischemic brain injuries and to enable earlier diagnosis and faster intervention following the ischemic event. Among the potential biomarkers of ischemic brain injuries during surgery, neuron-specific enolase (NSE) and S100B are the most frequently studied and were shown to be the most promising. The aim of this review was to summarize the role of NSE and S100B as biomarkers of ischemic brain injuries that occur during selected surgical procedures, predominantly carotid endarterectomy (CEA). Some other invasive interventions that cause ischemic brain injuries, like extracorporeal membrane oxygenation, were also included. We can conclude that these biomarkers can be useful for the evaluation of ischemic brain injuries that occur during various surgical procedures. They can help to determine the most optimal conditions for performing the surgery and therefore improve the procedures to consequently minimize brain damage caused during surgery. Because of a significant delay between sample collection and obtaining the results, they are not suitable for real-time assessment of brain injuries. Some improvement can be expected with the future development of laboratory methods. The association of the changes in NSE and S100B levels during surgery with potential consequences of ischemic brain injury have been described in numerous studies. However, even in a very homogenous group of surgical procedures like CEA, these findings cannot be summarized into a common final conclusion; therefore, the prognostic value of the two markers is not clearly supported at the present time. Full article

Background/Objectives: The coronavirus disease (COVID-19) pandemic was associated with an intense impact on health worldwide. Among the sequelae, it became necessary to clarify respiratory impairment related to lung function and aerobic capacity, as well as the treatment of curative and preventive measures of pulmonary involvement. In this context, this study aimed to compare vital signs, the sensation of dyspnea (Borg scale), lung function, and exercise tolerance before and after the use of non-invasive mechanical ventilation (NIV) in adults of both sexes after acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: A cross-sectional analytical clinical study was performed with the inclusion of individuals who had been diagnosed with COVID-19 at least three months before data collection. Individuals were evaluated for vital signs (heart rate and peripheral oxygen saturation), Borg scale, spirometry, and submaximal exercise protocol of two minutes of the step test before and after receiving NIV in ventilation mode by continuous positive airway pressure of 6 cm H₂O for 30 min. Results: A total of 50 participants were enrolled and grouped as a mild (N = 25) or severe (N = 25) clinical phenotype during SARS-CoV-2 infection according to the criteria of the World Health Organization. In our data, the forced vital capacity (p < 0.001), the ratio between the forced expiratory volume in the first one second to the forced vital capacity and the forced vital capacity (p = 0.020), and the two-minute submaximal step exercise protocol (number of steps—p = 0.001) showed a statistical improvement in the severe clinical phenotype group after NIV. In addition, forced expiratory volume in the first one second to the forced vital capacity (p = 0.032) and the two-minute submaximal step exercise protocol (number of steps—p < 0.001) showed a statistical improvement in the mild clinical phenotype group after NIV. No changes were described for vital signs and the Borg scale. Conclusions: This study allowed us to identify that NIV is a tool that promotes better exercise capacity by increasing the number of steps achieved in both clinical phenotype groups and improving lung function observed in the spirometry markers. Full article

Background: Ischemic heart disease is a major global health problem with significant morbidity and mortality. Several cardiometabolic variables play a key role in the incidence of adverse cardiovascular outcomes. Objectives: The aim of the present study was to apply a machine learning approach to investigate factors that can predict acute coronary syndrome in patients with a previous episode. Methods: We recruited 652 patients, admitted to the hospital for acute coronary syndrome, eligible if undergoing immediate coronary revascularization procedures for ST-segment-elevation myocardial infarction or coronary revascularization procedures within 24 h. Results: Baseline pulse wave velocity appears to be the most predictive variable overall, followed by the occurrence of left ventricular hypertrophy and left ventricular end-diastolic diameters. We found that the potential of machine learning to predict life-threatening events is significant. Conclusions: Machine learning algorithms can be used to create models to identify patients at risk for acute myocardial infarction. However, great care must be taken with data quality and ethical use of these algorithms. Full article

Introduction: About one in four people show an immunological reaction to an infection with Mycobacterium tuberculosis, which can remain latent or lead to active forms of the disease. Psoriasis is a chronic, immune-mediated skin disease that can be associated with numerous comorbidities. Biologic therapies have revolutionized psoriasis treatment but carry the risk of reactivating latent tuberculosis infection. However, the link between tuberculosis as a triggering factor for the onset of psoriasis remains unknown. Clinical Case: We present the case of a patient initially diagnosed with secondary pulmonary tuberculosis, who, two months after the diagnosis, showed a remarkable clinical evolution by developing lesions consistent with vulgar psoriasis, necessitating a multidisciplinary treatment approach. Discussions: This unique case highlights the shared immune mechanism of these diseases, particularly involving TNF-α, IL-17, and CD4+ T cells. Conclusions: The coexistence of these conditions raises critical questions about the interplay between infectious and autoimmune diseases and the impact of genetic susceptibility. Full article

Background: Streptococcal toxic shock syndrome (STSS) is a serious and potentially fatal complication of invasive Streptococcus pyogenes (Group A Streptococcus, GAS) infection, often stemming from severe soft tissue infections. While uncommon, tonsillitis can also lead to STSS, with lethality rates reported as high as 70%. Methods: We present three cases of patients diagnosed with tonsillitis who developed STSS. Point-of-care testing for GAS antigens was utilized to facilitate rapid diagnosis. Results: In all three cases, the characteristic clinical presentations, including scarlatiniform rash, strawberry tongue, and signs of shock with multi-organ dysfunction, were observed. Microbiological evidence confirmed ongoing GAS infections, and point-of-care testing for GAS antigens assisted in the diagnosis of tonsillitis in conjunction with STSS, enabling timely treatment interventions. Conclusions: Rapid diagnosis is crucial for the optimal management of STSS. The point-of-care testing for GAS may be useful for diagnosing STSS associated with tonsillitis. Full article

Background: To examine the changes in perceived tinnitus sound qualities following internet-based cognitive behavioral therapy (ICBT) for tinnitus. Method: This study was embedded within several clinical trials evaluating the efficacy of ICBT and used a quasi-experimental design (N = 152). Participants completed a series of online questionnaires, including measures of tinnitus sound qualities (Tinnitus Qualities and Impact Questionnaire; TQIQ), tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). Data were analyzed using a range of parametric and non-parametric statistics, and Cohen’s d effect sizes were reported. Results: There were no significant differences between the intervention and control groups in sociodemographic and clinical variables at baseline except for anxiety and depression symptoms, which were higher in the intervention group. A statistically significant reduction in tinnitus severity, anxiety, depression, and insomnia was noted post-intervention, with small-to-moderate effect sizes. Statistically significant improvements were also noted for the TQIQ (overall and all subscales) following ICBT compared to the no-intervention group (p ≤ 0.028), all with small-to-large effect sizes, except for the loud sounds subscale and for participants with a TQIQ < 38 at baseline, or “mild” perceived qualities of tinnitus (p ≥ 0.136). A significantly greater proportion of participants in the intervention group had minimum clinically important differences (38%) on the TQIQ compared to the no-intervention group (9%). Conclusions: ICBT can lead to changes in the perceived qualities of tinnitus sound in addition to reducing tinnitus severity and other aspects, such as anxiety, depression, and insomnia. While these findings are preliminary, they highlight that tinnitus distress and perception may be related. However, the study has several limitations including a lack of audiological variables and objective measures. For this reason, the study results must be viewed with caution and must be treated as preliminary. Full article