Search Results (1,812)

Background/Objectives: Burning Mouth Syndrome (BMS) is a common oral condition in older women and is characterized by a multifactorial etiology. To date, no standardized treatment strategy has been established. The aim of this study was to evaluate the effectiveness of topical application of capsaicin (0.025 mg/cm²) in the form of a mucoadhesive bilayer polymer reducing burning sensations in BMS. The study assessed levels of depression, sleep disturbances, and quality of life. Material and Methods: The proof-of-concept study included 29 patients with symptoms of BMS. The peripheral origin of BMS was confirmed by lingual nerve block. Pain intensity was assessed using the Numeric Rating Scale (NRS-11) and the Short-Form McGill Pain Questionnaire (SF-MPQ). Depression, sleep disturbances, and quality of life were evaluated using the Beck Depression Inventory (BDI), Athens Insomnia Scale (AIS), and WHO Quality of Life Questionnaire (WHOQoL). Results: A reduction in pain was observed in over 86% patients. Decrease in burning at treatment sites was recorded immediately after treatment and also at the 3-month follow-up. Gender, taste disturbances, depression, and age were found to have a significant effect on final NRS-11 scores. Conclusions: Significant reduction in pain intensity was achieved in nearly all treated patients, with adverse effects being rare. Full article

Background: We report an uncommon presentation of Lyme disease and highlight the importance of a detailed history in a patient with new-onset sixth nerve palsy. Methods: Case report and literature review. Results: A 46-year-old man receiving infliximab presented to the ophthalmology emergency department with horizontal binocular diplopia. History revealed a diffuse headache that had begun three weeks earlier. Ophthalmologic examination demonstrated a left sixth cranial nerve palsy. The workup showed positive Borrelia serum IgG, which was interpreted as a likely false-positive result given the limited specificity of serologic testing. At follow-up, the patient reported left-sided peripheral facial palsy, and worsening headache and diplopia. Further history revealed prior erythema migrans treated with doxycycline four months earlier. Considering these new findings, a lumbar puncture was performed and demonstrated intrathecal production of Borrelia antibodies. Neuroborreliosis, a neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi, was diagnosed. The patient was treated with oral doxycycline for 28 days with complete resolution of symptoms. Conclusions: Lyme disease may present with progressive neuro-ophthalmologic symptoms, underscoring the crucial role of ophthalmologists in its diagnosis. Moreover, immunosuppression may delay diagnosis and allow neurological progression, highlighting the need for careful history taking and close follow-up. Full article

Background: Cosmetic injection of botulinum neurotoxin type A (BoNT/A) into the submandibular glands is increasingly performed to enhance jawline contour. Although generally considered safe, unintended diffusion of the toxin can impair pharyngeal musculature and lead to dysphagia. Severe aspiration-prone dysphagia after esthetic submandibular gland injection has rarely been described. Case Presentation: A healthy 37-year-old woman developed acute oropharyngeal dysphagia the day after receiving cosmetic contouring injections with incobotulinumtoxinA (Xeomin^®), administered to both submandibular glands (20 units per gland, performed without ultrasound guidance). She presented to our rehabilitation medicine clinic 11 days later with severe difficulty swallowing solids and liquids. Her functional oral intake was severely restricted (Functional Oral Intake Scale [FOIS] score 3), and the Eating Assessment Tool-10 (EAT-10) score was 24. Videofluoroscopic swallowing study (VFSS) demonstrated markedly delayed pharyngeal swallow initiation, reduced palatal elevation, poor airway protection, consistent laryngeal penetration, and silent aspiration of thin liquids (Penetration–Aspiration Scale score 8). She underwent diet modification and structured dysphagia rehabilitation. At three months, repeat VFSS showed substantial improvement, with only occasional penetration of large-volume thin liquids, corresponding to FOIS 5 and EAT-10 score 8. By five months, VFSS confirmed complete resolution of penetration and aspiration with normalization of swallowing physiology, reflected by a FOIS score of 7 and EAT-10 score of 1. Conclusions: This case demonstrates that cosmetic incobotulinumtoxinA injection into the submandibular glands, particularly when performed without ultrasound guidance, can lead to significant oropharyngeal dysphagia. Clinicians performing esthetic lower-face procedures should be aware of this potential complication and ensure timely swallowing evaluation and rehabilitation when symptoms arise. Full article

Background: Cholinesterase inhibitors (ChEIs) are commonly prescribed for the treatment of Alzheimer’s disease (AD) and achieve long-term benefits for cognition and survival in real-world settings. However, the discontinuation rate is high due to their side effects, with gastrointestinal (GI) symptoms hampering long-term prescriptions. The risk of side effects associated with rivastigmine was previously shown to be lower with transdermal delivery than with oral capsules; however, this has yet to be examined in detail for donepezil, the most widely used ChEI. The daily application of a donepezil transdermal patch was officially approved in Japan in 2023. The incidence of side effects was lower with the donepezil transdermal patch than with oral donepezil in healthy volunteers, but has not yet been assessed in clinical settings. Results: We herein report three AD patients in two different memory clinics who developed GI symptoms with oral ChEIs that were attenuated by switching to the donepezil transdermal patch. Conclusions: The donepezil transdermal patch may improve tolerability and adherence in patients who develop gastrointestinal adverse effects with oral donepezil. Full article

Oral lichen planus (OLP) is a chronic immune-mediated disorder affecting the mucous membranes of the oral cavity, characterized by inflammation caused by T-cell-mediated destruction of basal keratinocytes with the potential for malignant transformation. The exact etiology of the disease remains unclear, but as its symptoms may reduce patient quality of life, various treatment modalities have been proposed, generally based on managing symptoms and controlling disease progression. In this narrative review, we examine both conventional therapies (corticosteroids, immunosuppressants, retinoids) and emerging treatment options (photodynamic therapy, low-level laser therapy, and biologics) in terms of their efficacy and limitations. Although corticosteroid therapy remains a cornerstone of treatment, it is not effective in all cases, demonstrating the need to investigate alternative methods; hence, we also present possible future directions for OLP treatment in this study. Full article

Nickel allergy remains the most prevalent cause of allergic contact dermatitis worldwide, imposing a substantial socio-epidemiological and economic burden. Beyond its classical cutaneous presentation, systemic nickel allergy syndrome highlights the systemic dimension of Nickel hypersensitivity, wherein dietary nickel intake may provoke both gastrointestinal and cutaneous symptoms through mechanisms involving gut barrier impairment and mucosal immune priming. Recent evidence highlights the contribution of angiogenesis and lymph-angiogenesis to Nickel-induced allergic contact dermatitis, through crosstalk among keratinocytes, mast cells, endothelial cells, and pro-angiogenic mediators such as vascular endothelial growth factor. Against this background, we propose to revisit palmitoylethanolamide, an endogenous ALIAmide with well-documented anti-inflammatory, anti-angiogenic, and anti-allergic properties. Already studied in pain and inflammatory disorders and employed in veterinary dermatology, palmitoylethanolamide down-modulates mast cell degranulation, suppresses VEGF expression via PPAR-α/Akt/mTOR signaling, and enhances intestinal barrier integrity, acting as a promising “gatekeeper” molecule that reduces gut hyperpermeability characterizing systemic nickel allergy as well as other gut disorders with systemic consequences. This paper is presented as a viewpoint intended to highlight the untapped therapeutic potential of palmitoylethanolamide, suitable for both oral and topical administration, as a candidate to address the multifactorial pathophysiology of Nickel allergic contact dermatitis and systemic nickel allergy. Our purpose is not to provide definitive answers, but to stimulate scientific debate on its rational use within emerging gut–skin therapeutic strategies. We thus encourage future experimental and clinical studies to explore its potential integration within emerging gut–skin therapeutic paradigms. Full article

Background: The interplay between neuronutrition, physical activity, and mental health for enhancing brain resilience to stress and overall human health is widely recognized. The use of brain mapping via quantitative-EEG (qEEG) comparative analysis enables researchers to identify deviations or abnormalities and track the changes in neurological patterns when a targeted drug or specific nutrition is administered over time. High-functioning mild-to-borderline intellectual disorders (MBID) and autism spectrum disorder (ASD) constitute leading global public health challenges due to their high prevalence, chronicity, and profound cognitive and functional impact. Objective: The objectives of the present study were twofold: first, to characterize an extremely vulnerable group of children with functioning autism symptoms, disclosing their overall pattern of cognitive abilities and areas of difficulty, and second, to investigate the relevance of the effects of a mushroom (Hericium erinaceus) biomass dietary supplement on improvement on neurocognitive behavior. Methods: This study used qEEG to compare raw data with a normative database to track the changes in neurological brain patterns in 147 children with high-functioning autistic attributes when mushroom H. erinaceus biomass supplement was consumed over 6 and 12 months. Conclusions: H. erinaceus biomass in children with pervasive developmental disorders significantly improved the maturation of the CNS after 6 to 12 months of oral use, decreased the dominant slow-wave activity, and converted slow-wave activity to optimal beta1 frequency. Therefore, despite the lack of randomization, blinding, and risk of bias, due to a limited number of observations, it may be concluded that the H. erinaceus biomass may generate a complex effect on the deficits of the autism spectrum when applied to high-functioning MBID children, representing a safe and effective adjunctive strategy for supporting neurodevelopment in children. Full article

Aim of the study: Anxiety about dental treatment is one of the main barriers to accessing dental services and, at the same time, a well-known problem for dentists. The main objective of this observational pilot study was to assess the prevalence and determinants of dental anxiety and severe forms compatible with dental phobia among adult dental patients and to explore their association with psychological distress, as well as patients’ preferences for methods to reduce pain and anxiety during dental treatment. Materials and Methods: We carried out a pilot observational study using two well-established questionnaires, namely the BSI-18 (Brief Symptom Inventory-18), which assesses the psychological distress of patients visiting the dentist, and the DAS (Dental Anxiety Scale), which evaluates dental anxiety toward dental treatment. The questionnaires were administered in independent dental practices in Timisoara, and the study was conducted between August 2024 and January 2025 on a sample of 231 persons. Results: The results of our study revealed a clear link between sources of oral health information, the high prevalence of anxiety as a personality trait, anxiety towards the dentist, and referral to dental services. Conclusions: The intensity of dental anxiety is higher before the therapeutic manoeuvre. It has been found, however, that people who are more educated experience lower levels of anxiety in specific situations. Full article

Background: Occlusal dysesthesia (OD), also known as phantom bite syndrome, is characterized by the subjective sensation of an uncomfortable or “wrong” bite despite the absence of objective occlusal pathology. This scoping review aimed to synthesize the current evidence on the epidemiology, etiology, clinical presentation, diagnosis, and management of OD. Methods: The PubMed, Google Scholar, Scopus, Web of Science, ScienceDirect, and Cochrane Library databases were systematically searched using the terms “phantom bite,” “occlusal dysesthesia,” “occlusal hyperawareness,” “occlusal hypervigilance,” “uncomfortable occlusion,” and “oral cenestopathy.” Studies were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (2020), and evidence quality was assessed using the Oxford Center for Evidence-Based Medicine levels of evidence. Results: A total of 20 studies were included. OD predominantly affected middle-aged women, with symptom durations often exceeding several years, and was believed to be caused by disorderly central sensory processing or maladaptive signal processing rather than by a primary occlusal abnormality, with high rates of psychiatric comorbidities reported. Current evidence supports conservative multidisciplinary management, including patient education, cognitive behavioral therapy, and supportive pharmacotherapy, and irreversible dental interventions are contraindicated. Conclusions: OD is a complex biopsychosocial condition requiring multidisciplinary care. The current low-quality evidence is primarily obtained from case reports and case series. Therefore, high-quality controlled trials are urgently required to establish evidence-based diagnostic criteria and treatment protocols. Full article

Background/Objectives: Loneliness is a critical public health concern associated with adverse mental and physical health outcomes in later life. However, few large-scale studies have examined loneliness in relation to depression, aspiration risk, frailty, and social participation among Japanese older adults. This study examined associations between loneliness and psychosocial and health-related factors among older adults. Methods: This cross-sectional study involved a secondary analysis of data obtained from online surveys conducted in 2018 and 2021 among 1000 community-dwelling Japanese adults (≥65 years). Loneliness was assessed using the UCLA Loneliness Scale Version 3 and dichotomized at the median to define a high-loneliness group. Depressive symptoms, aspiration risk, frailty, conversation frequency, and volunteering participation were assessed using validated scales. Multivariable logistic regression was used to identify factors associated with loneliness and interaction terms were examined to assess effect modification. Results: High loneliness was observed in 52.2% of participants. Greater loneliness was significantly associated with depressive symptoms (GDS ≥ 5; OR = 4.69, 95% CI: 2.84–7.76), higher dysphagia risk (DRACE score; OR = 1.08, 95% CI: 1.00–1.16), and lower daily conversation frequency (OR = 0.76, 95% CI: 0.67–0.86); however, volunteering (OR = 0.475, 95% CI: 0.23–0.87) was a protective factor. Conclusions: Loneliness among Japanese older adults is closely linked to depressive symptoms and aspiration risk, while frequent conversations and volunteer participation appear to be protective. Community-based interventions promoting social engagement and oral health may mitigate loneliness and its health consequences and improve quality of life for older adults. Given the cross-sectional design, the observed associations should not be interpreted as causal. Full article

Down Syndrome Regression Disorder (DSRD) is a rare but severe neuropsychiatric condition characterized by abrupt loss of speech, autonomy, and cognitive abilities in individuals with Down syndrome, often associated with immune dysregulation and gut–brain axis dysfunction. We report the case of an 11-year-old girl with Down syndrome who developed developmental regression at age five, in temporal proximity to a family transition (the birth of a younger sibling), with loss of continence, language, and comprehension, alongside persistent behavioral agitation and gastrointestinal symptoms. Laboratory assessment revealed Giardia duodenalis infection, elevated fecal calprotectin and secretory IgA, and microbial imbalance with overgrowth of Streptococcus anginosus and S. sobrinus. The patient received a single oral dose of tinidazole (2 g), daily folinic acid (1 mg/kg), and a 90-day course of transcranial and abdominal photobiomodulation (PBM) (1064 nm, 10 min per site). Post-treatment, stool analysis showed normalized inflammation markers and restoration of beneficial bacterial genera (Bacteroides, Bifidobacterium, Lactobacillus) with absence of Enterococcus growth. Behaviorally, she exhibited marked recovery: CARS-2-QPC decreased from 106 to 91, ABC from 63 to 31, and ATEC from 62 to 57, alongside regained continence, speech, and fine-motor coordination. These outcomes suggest that abdominal and transcranial PBM, by modulating mitochondrial metabolism, mucosal immunity, and microbiota composition, may facilitate systemic and neurobehavioral recovery in DSRD. This translational case supports further investigation of PBM as a non-invasive, multimodal therapy for neuroimmune regression in genetic and developmental disorders including validation through future randomized controlled clinical trials. Full article

Exposure to plant protection products (pesticides) is common among agricultural workers and may represent an underrecognized cause of mucocutaneous disease. We conducted a descriptive cross-sectional survey in agricultural communities in southern Thailand (August–November 2025) to estimate the prevalence, clinical characteristics, and dermatology-specific quality-of-life impact of pesticide-attributed symptoms. Agricultural workers with pesticide use or exposure within the preceding 12 months were recruited via convenience sampling; participants provided consent and completed standardized interviewer-administered questionnaires assessing demographics, pesticide exposure history and application practices, personal protective equipment (PPE) use, self-reported cutaneous and mucosal symptoms (ocular and oral/nasal), and the Dermatology Life Quality Index (DLQI). Of the 354 eligible individuals, 228 participated in the study, and 226 were included in the analyses. The median age was 54 years (interquartile range [IQR], 15), and 82.7% were male. Overall, 14.6% reported pesticide-attributed cutaneous symptoms, 5.3% reported ocular mucosal symptoms, and 0.4% reported oral/nasal mucosal symptoms. Cutaneous manifestations were predominantly symptoms occurring after exposure, with pruritic, erythematous eruptions affecting the arms and hands that typically resolved within 1–7 days after cessation of exposure. Among symptomatic participants, the median DLQI was 0.5 (IQR 3.0); however, DLQI scores were significantly higher among participants who reported pesticide-attributed cutaneous symptoms (p < 0.001) and ocular symptoms (p < 0.001). These findings suggest that pesticide-associated mucocutaneous effects are generally mild yet clinically meaningful, underscoring the need to strengthen PPE training, risk communication, and occupational health surveillance in agricultural settings. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article

Background: Growing evidence indicates that oral microbiome dysbiosis contributes to systemic inflammation, immune activation, and neural dysfunction. These processes may influence the onset and progression of major neuropsychiatric and neurodegenerative disorders. This review integrates clinical, epidemiological, and mechanistic findings linking periodontal pathogens and oral microbial imbalance to Alzheimer’s disease (AD), Parkinson’s disease (PD), depression, and anxiety. Methods: A narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar to identify recent studies examining alterations in the oral microbiota, microbial translocation, systemic inflammatory responses, blood–brain barrier disruption, cytokine signaling, and neural pathways implicated in brain disorders. Results: Evidence from human and experimental models demonstrates that oral pathogens, particularly Porphyromonas gingivalis, Fusobacterium nucleatum, and Treponema denticola, can disseminate systemically, alter immune tone, and affect neural tissues. Their virulence factors promote microglial activation, cytokine release (IL-1β, IL-6, TNF-α), amyloid-β aggregation, and α-synuclein misfolding. Epidemiological studies show associations between oral dysbiosis and cognitive impairment, motor symptoms in PD, and alterations in mood-related taxa linked to stress hormone profiles. Immunometabolic pathways, HPA-axis activation, and the oral–gut–brain axis further integrate these findings into a shared neuroinflammatory framework. Conclusions: Oral dysbiosis emerges as a modifiable contributor to neuroinflammation and brain health. Periodontal therapy, probiotics, prebiotics, synbiotics, and targeted inhibitors of bacterial virulence factors represent promising strategies to reduce systemic and neural inflammation. Longitudinal human studies and standardized microbiome methodologies are still needed to clarify causality and evaluate whether restoring oral microbial balance can modify the course of neuropsychiatric and neurodegenerative disorders. Full article

Background: Chagas disease, caused by Trypanosoma cruzi, remains endemic throughout Latin America but is increasingly reported in urban areas due to migration and vector adaptation. The cardiac form is the most severe manifestation, associated with arrhythmia, mural thrombus formation, and a high risk of cardioembolic events. Stroke secondary to Chagas cardiomyopathy is uncommon and poses diagnostic and therapeutic challenges. Case Presentation: A 58-year-old woman with serologic evidence of T. cruzi infection presented with sudden-onset dyspnea, oppressive chest pain, and left-sided weakness. Neurological examination revealed left brachiocrural hemiparesis and mild dysarthria (NIHSS = 9). Non-contrast cranial CT showed an acute infarct in the right middle cerebral artery territory (ASPECTS = 7). Electrocardiography demonstrated typical atrial flutter with variable conduction, and transthoracic echocardiography revealed a markedly dilated left atrium containing a mural thrombus and a left ventricular ejection fraction of 45%. Intravenous thrombolysis with alteplase (0.9 mg/kg) was administered within 4.5 h of symptom onset. Pharmacologic rhythm control was achieved using intravenous and oral amiodarone, followed by oral anticoagulation with warfarin (target INR 2.0–3.0) after excluding hemorrhagic transformation. The patient showed rapid neurological improvement (NIHSS reduction from 9 to 2) and was discharged on day 10 with minimal residual deficit (mRS = 1), sinus rhythm, and stable hemodynamics. Conclusions: This case highlights the rare coexistence of Chagas cardiomyopathy, atrial flutter, and cardioembolic stroke due to left atrial thrombus. Early recognition, adherence to evidence-based guidelines, and multidisciplinary management were key to achieving a favorable outcome. Timely diagnosis and intervention remain crucial to preventing severe complications in patients with Chagas disease. Full article