Search Results (2,612)

Cervical dystonia (CD) is increasingly recognized as a disorder with a dynamic clinical course rather than a fixed phenomenological profile. This report describes the long-term observation of a man with isolated CD followed for nearly 12 years from symptom onset. The course was characterized by multiple pattern changes, including a clear shift from left- to right-sided torticollis in 2019, followed by alternating and mixed dystonic patterns. Three remission phases were documented during follow-up: two prolonged periods in 2017–2018 and 2020–2021, and a further phase from March to November 2022. Over time, treatment requirements decreased from higher initial doses (500–700 U abobotulinumtoxinA and up to 130 U onabotulinumtoxinA) to lower maintenance doses of 30–50 U incobotulinumtoxinA/onabotulinumtoxinA, with longer injection intervals and no obvious documented need for dose adjustment to maintain clinical responsiveness. This case highlights the coexistence of pattern changes and recurrent remissions within a single continuously followed patient over an unusually long period. Although a treatment-related mechanism remains speculative and alternative explanations cannot be excluded, the observation underscores the value of prolonged follow-up and individualized treatment strategies in CD. Full article

Colpodella spp. are phylogenetically related to apicomplexans such as Plasmodium spp., Babesia spp., and Cryptosporidium spp. Colpodella spp. are free-living protists that prey on bodonids, ciliates, and algae using myzocytosis. Colpodella spp. cause human and animal infections known as colpodellosis, with transmission via ticks across different geographic areas on different continents. Colpodella spp. DNA has been detected in ticks, the biting fly Stomoxys indicus and vertebrate samples using polymerase chain reaction (PCR). Ticks transmit zoonotic pathogens, and the identification of Colpodella spp. in animals poses a major public health risk due to human and animal encounters exposing humans to tick bites. However, it is unclear if ticks are confirmed vectors for Colpodella spp., since tick vector competence and capacity for Colpodella spp. transmission has not been experimentally demonstrated. Human cases of colpodellosis have involved three cases of blood infection, a fourth case of tickborne infection, and a fifth case of urinary tract infection. In this narrative review, the occurrence of Colpodella spp. in ticks that transmit zoonotic pathogens will be reviewed. Differences in the disease presentations and symptoms of colpodellosis in tickborne infections will be discussed. The pattern of Colpodella spp. coinfections with piroplasms and Cryptosporidium spp. will be evaluated. The pressing need for morphological identification of Colpodella spp. to assist proper characterization of the different species identified in arthropods and vertebrate hosts will be highlighted. Full article

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID-19 syndrome (LC) show substantial clinical overlap, but direct comparative microbiome studies remain limited. Methods: In this cross-sectional study, we compared the fecal gut microbiome of patients with ME/CFS, LC, and healthy controls (HC) within a unified analytical framework using 16S rRNA profiling, differential abundance testing, and multivariate modeling. We also examined associations between microbiome variation and questionnaire-derived symptom-domain scores. Results: Alpha-diversity did not differ significantly among groups, whereas beta-diversity analyses showed small but significant disease-associated community differences with broad overlap between cohorts. Differential abundance analysis identified stronger signals in disease-versus-control contrasts than in the direct ME/CFS vs. LC contrast. Both ME/CFS and LC shared enrichment of Sutterella and depletion of Terrisporobacter and Lachnospiraceae relative to HC. Predicted functional profiling showed shared disease-versus-control changes in pathways related to anaerobic acetate/H₂ carbon flow, inositol/polyol degradation, phosphonate/C1-related metabolism, and lysine-derived fermentation. Regression analyses showed the strongest microbiome associations with fatigue-related and physiosomatic domains, while affective, cognitive, and gastrointestinal outcomes showed weaker signals. Conclusions: Overall, these findings support the presence of overlapping but non-identical gut microbiome alterations in ME/CFS and LC. The results provide a basis for future longitudinal and multi-omics studies aimed at clarifying the stability, functional relevance, and clinical utility of these microbial patterns. Full article

Adenomyosis is a benign gynecologic condition characterized by ectopic endometrial glands and stroma present within the myometrium. Background/Objectives: The gold standard in diagnosis is the histology of hysterectomy specimens. Due to the heterogeneity of this disease, there is a lack of valid classification. The most important symptoms are chronic pelvic pain and abnormal uterine bleeding, followed by infertility. Noninvasive diagnostic tools have been sought, with ultrasound being a valuable option. The objective of our study was to evaluate the correlation of transvaginal ultrasound, used in addition to three-dimensional ultrasonography and Doppler, with the histology of adenomyosis. Methods: An observational retrospective study was conducted between January 2015 and November 2018 on 160 women with adenomyosis managed by hysterectomy. All patients underwent transvaginal sonography combined with 3D and Doppler sonography. Results: Comparing the location of adenomyosis in the myometrium observed using ultrasound with histological findings, a statistically significant correlation was observed (p = 0.0001). Symptoms were associated with the location of the lesions, heavy period in internal adenomyosis (p ≤ 0.001), and infertility (p = 0.001), while pelvic pain was observed in external adenomyosis (p = 0.03). Deep endometriosis was associated with external adenomyosis (p = 0.001). An ill-defined junctional zone was observed via Doppler investigation in internal adenomyosis (p = 0.0001), also correlated with the symptoms. Histology confirmed all cases of adenomyosis, with statistically significant similarities regarding pattern, location, and depth (p < 0.001). Conclusions: The increasing use of 3D and Doppler evaluations enhances TVUS importance, and 3D TVUS offers high diagnostic capacity for adenomyosis, in accordance with histological findings. This procedure facilitates the adoption of therapeutic modalities other than surgery with uterus preservation. Full article

Background: Neuropathy and neuropathic pain (NP) are globally prevalent, remain difficult to manage, and are often exacerbated by underlying lifestyle factors. Alcohol use, particularly in the context of chronic consumption or dependence, is a recognized contributor to peripheral nerve damage, yet its association with neuropathy/NP has not been systematically evaluated. This systematic review synthesizes the current evidence on alcohol exposure, including quantity, frequency, and dependency, and its association with the incidence, prevalence, and severity of neuropathy/NP. Methods: This systematic review included observational studies assessing alcohol consumption patterns or dependence in relation to neuropathy/NP outcomes and was conducted in accordance with PRISMA guidelines. Exposure types were analyzed independently, and pooled odds ratios and relative risks were generated when sufficient data were available. The review was registered with PROSPERO number CRD42023484158. Results: Following de-duplication and exclusions, 76 studies were included, comprising cohort (n = 15), case–control (n = 12), and cross-sectional (n = 49) designs. While associations varied by study design and exposure category, alcohol dependence and consumption were more consistently linked with increased neuropathy incidence and severity, including electrophysiological evidence of compromised function. Notably, in studies examining alcohol cessation, abstinence was linked to clinical improvements in neuropathy/NP symptoms such as hypoesthesia and muscle weakness. While heterogeneity and risk of bias were present, largely due to the subjective classification of alcohol exposure and a lack of universally applied objective neuropathy measurement tools, multiple pooled estimates reached statistical significance. Conclusions: Evidence from observational studies supports an association between alcohol use, especially dependence, and the development and progression of neuropathy/NP, although causality remains unproven. Abstinence may offer therapeutic benefit, though further abstinence- and/or harm reduction-related interventional studies are required to clarify causality and guide low-cost, adjunctive strategies for alcohol-related neuropathy/NP. Full article

Background/Objectives: Interstitial lung disease (ILD) occurs commonly in systemic sclerosis (SSc) and is the leading cause of mortality. There are limited data on the accuracy of lung auscultation in identifying the presence of ILD in patients with SSc. Methods: We retrospectively identified patients with newly diagnosed SSc who had documented lung auscultation findings and chest high-resolution computed tomography (HRCT) available for review. Diagnoses were made by rheumatologists at Mayo Clinic, Rochester, Minnesota, USA over a 4-year period. Pulmonary function measurements included lung volumes, spirometry, and single-breath diffusing capacity. Results: Among 151 patients with SSc (median age, 62 years), 72.2% were female and 55.0% were never smokers. Limited cutaneous SSc was the most common phenotype (67.3%). Seventy (46.4%) patients were evaluated by pulmonologists. There was evidence of ILD by HRCT in 69 patients (45.7%); the most common pattern of ILD was fibrotic nonspecific interstitial pneumonia (59.2%). Respiratory symptoms were present in 46.4% of those with ILD compared to 15.9% among those without. The sensitivity and specificity for crackles heard by rheumatologists in detecting ILD were 50.7% and 97.6%, respectively; for pulmonologists, 71.4% and 85.7%, respectively. Presence of crackles was associated with high positive predictive values (94.6% for rheumatologists vs. 92.1% for pulmonologists, respectively); negative predictive values were moderate (70.2% vs. 56.3%, respectively). Crackles correlated with lower pulmonary function measures but did not differ across ILD patterns. Conclusions: Detection of crackles on lung auscultation appears to be a specific and moderately sensitive indicator of ILD (often asymptomatic) in patients with newly diagnosed SSc. The presence of crackles correlates with worse pulmonary function but may be absent in early ILD. Full article

Background: Workplace victimization is a form of repeated and systematic psychological violence that can severely affect both mental and physical health. From a psychological perspective, it impacts mood states, defense mechanisms, and personality functioning. Methods: This cross-sectional study investigated the psychological and behavioural correlates of workplace victimization in a sample of 33 workers from various professional sectors, using a multidimensional assessment including standardized measures of personality traits, mood states, and defense mechanisms. Results: The MMPI-2 profile revealed elevated scores in Hypochondriasis (Hs: 72.00), Depression (D: 70.21), Hysteria (Hy: 67.61), and Paranoia (Pa: 68.76), indicating somatic symptoms, depressive features, and suspiciousness. The POMS showed increased Tension–Anxiety (T: 65.06), Depression–Dejection (D: 68.21), Anger–Hostility (A: 68.15), and Fatigue–Inertia (F: 65.24), alongside reduced Vigor–Activity (V: 43.18). The DMI analysis highlighted a high Reversal score (REV: 65.91), suggesting a predominant use of defense mechanisms such as altruism and idealization to cope with distress. Conclusions: In this selected sample of adults referred for psychological evaluation for suspected or documented workplace victimization, participants showed a clinically relevant psychological burden, including depressive symptoms, somatic concerns, Anger–Hostility, fatigue, reduced vigor, and specific defensive patterns. Given the cross-sectional design, small sample size, and absence of a control group, these findings should be interpreted as preliminary and cannot establish causality or the specificity of this profile to workplace victimization. Full article

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. Methods: A retrospective descriptive study was conducted of pediatric patients aged 1–14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023–October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes. Results: The mean patient age was 4.6 years, with most (57.5%) aged 1–5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1–5-year age group, whereas obesity predominated in the 6–10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health. Conclusions: Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions. Full article

Background: The COVID-19 pandemic has generated widespread concerns regarding its long-term effects on children’s mental health. While numerous studies documented increased psychological distress among children during the pandemic, less is known about how children’s emotional and behavioral functioning have evolved in the post-pandemic period. Objective: This study examines patterns of children’s mental health using survey data collected in 2023 and 2025. Guided by the dual-factor model of mental health, the analysis considers both psychological difficulties and positive social functioning in order to provide a multidimensional understanding of children’s well-being. Method: Data were collected using the Strengths and Difficulties Questionnaire (SDQ-25), a widely used behavioral screening instrument assessing emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. These domains were analyzed across two time points to explore patterns of change in internalizing difficulties, externalizing difficulties, and social strengths among school-age children in the post-pandemic context (N = 1262 students in 2023 and N = 575 students in 2025). Results: The findings suggest that children’s mental health after the pandemic reflects both persistent vulnerability and adaptive capacity. Emotional symptoms and behavioral challenges remain present among a proportion of children, indicating that the psychological effects of pandemic-related disruptions may extend beyond the immediate crisis period. At the same time, many children demonstrate relatively stable levels of prosocial behavior, highlighting the continued importance of positive social functioning as a protective factor for psychological adjustment. Contributions: These results underscore the importance of adopting a comprehensive perspective on children’s mental health that recognizes both difficulties and strengths. The study highlights the role of schools and families in supporting children’s post-pandemic recovery through early mental health screening, social–emotional learning initiatives, and programs that promote empathy and peer support. Such approaches may contribute to strengthening children’s resilience and long-term well-being in the aftermath of large-scale social disruptions. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition with psychosocial impact. Dietary carbohydrates, particularly added sugars, refined starches, and high-glycemic index/load (GI/GL) patterns, have been proposed as modifiable exposures that may relate to attention and behavioral regulation. This systematic review synthesized evidence linking carbohydrate quantity and quality to ADHD-related outcomes. Methods: Following PRISMA 2020, PubMed, Scopus, and Web of Science were searched for English-language studies published from January 2015 to December 2025. Eligible studies included observational and interventional designs in children, adolescents, or adults with a clinical ADHD diagnosis or validated symptom assessment. Risk of bias was assessed using NOS/NOS-adapted criteria, RoB 2, and ROBINS-I. Findings were synthesized narratively by exposure domain. Results: Of 1174 records identified, 48 studies were included: 38 observational and 10 interventional. Sugar-related exposures showed the most consistent pattern: 15 of 16 studies examining added sugars, sugar-sweetened beverages, sweets, candy, or sweet dietary patterns reported positive associations with ADHD diagnosis, symptom severity, hyperactivity, or less favorable ADHD-related outcomes. Findings for total carbohydrate intake were inconsistent. GI/GL-specific evidence was limited but generally adverse in direction. Among intervention studies, symptom improvement after modification was reported in 6 of 10 studies, whereas 4 studies showed mixed, preliminary, non-significant, or non-superior findings. Most observational studies showed moderate to high risk of bias, while interventional studies showed variable risk across domains. Conclusions: Poorer carbohydrate quality may be associated with greater ADHD-related symptom burden, whereas total carbohydrate intake showed inconsistent associations. Certainty remains limited by heterogeneity, residual confounding, risk of bias, and limited carbohydrate-specific intervention evidence. Full article

Background/Objectives: The COVID-19 pandemic has raised concerns about maternal mental health, particularly among women infected during pregnancy. This study aimed to examine longitudinal changes in depressive and anxiety symptoms and subjective distress among pregnant women in Slovakia with confirmed SARS-CoV-2 infection and to explore the role of obstetric complications and vaccination status in these trajectories. Methods: In this retrospective longitudinal study, women with SARS-CoV-2 infection during pregnancy were assessed at three time points: during infection, six weeks postpartum, and one year postpartum (11 March 2020–5 May 2023). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS; cut-off ≥ 11), anxiety symptoms were measured using the EPDS-3A subscale (cut-off ≥ 5), and subjective distress was measured using visual analogue scales (VAS). A repeated-measures ANCOVA design was used to evaluate within-subject changes over time while adjusting for vaccination status and pregnancy complications. Results: Of 1184 contacted women, 170 provided complete data. The proportion of women exceeding the EPDS cut-off decreased from 27.6% during infection to 17.6% at six weeks postpartum and 4.7% at one year postpartum. Anxiety symptoms showed a similar pattern, declining from 27.6% during infection to 20.6% at six weeks postpartum and 7.6% at one year postpartum. Repeated-measures analyses confirmed significant time effects across psychological outcomes, with symptom levels decreasing over the postpartum year. Post-infection obstetric complications were associated with higher subjective distress at selected time points. Conclusions: Psychological symptoms were highest during the acute infection period and declined significantly over time. These findings support the importance of timely mental health screening during pregnancy affected by COVID-19, while suggesting that, in many women, psychological distress may decrease across the postpartum year. Full article

Background/Objectives: Sleep disturbances are highly prevalent in young individuals with eating disorders (EDs) and are associated with increased psychopathology and poorer clinical outcomes. However, sleep alterations in ED populations are heterogeneous and may reflect distinct underlying clinical profiles. The study aimed to identify sleep quality profiles and examine their clinical correlates in youth with EDs. Methods: A total of 288 youth outpatients with EDs completed the Pittsburgh Sleep Quality Index (PSQI), along with measures of eating and general psychopathology. Latent Profile Analysis (LPA) was conducted using PSQI scores to identify distinct sleep profiles. Multinomial logistic regression models were performed to assess clinical variables of profile membership. Results: A four-profile solution was identified: (1) less impaired sleepers, (2) medication-using sleepers, (3) global poor sleepers, and (4) sleep-initiation-difficulty sleepers. Profiles differed significantly in ED severity, affective symptoms, emotion regulation difficulties, and sleep-related eating behaviors. Profiles characterized by greater sleep impairment exhibited higher levels of binge eating, night eating, and psychological distress. Multinomial logistic regression analyses indicated that night eating was the largest contributor to latent profile membership across all comparisons, significantly increasing the likelihood of belonging to more impaired sleep profiles. Conclusions: Sleep in individuals with EDs is characterized by distinct and clinically meaningful profiles rather than a uniform pattern of impairment. These findings support the clinical utility of person-centered approaches to better characterize sleep disturbances in ED populations. Full article

Chronic chikungunya disease (CCD) affects approximately 30–50% of infected individuals and is associated with persistent inflammatory arthritis, chronic pain, and long-term functional disability. We conducted a prospective observational cohort study including 584 patients with laboratory-confirmed chikungunya infection, evaluated between 3 and 12 months after acute infection, to better understand the natural history, risk factors, clinical presentation, and treatment patterns of CCD. Here, we present a cross-sectional analysis derived from this cohort. Older age, female sex, and higher body mass index were identified as major risk factors for CCD. Four distinct clinical phenotypes were identified: Axial (12.2%), defined by inflammatory axial pain regardless of peripheral manifestations; Oligoarthritis (18.1%), defined by fewer than four swollen joints; Polyarthritis (10.6%), defined by four or more swollen joints; and Pain without Swelling (70.4%), characterized by myalgia and/or arthralgia in the absence of objective inflammatory findings on physical examination. The axial phenotype could overlap with peripheral phenotypes, whereas oligoarthritis, polyarthritis, and pain without swelling were mutually exclusive categories. These phenotypes differed substantially in symptom burden and clinical impact. Patients with the Pain without Swelling phenotype had longer symptom duration, whereas Axial and Polyarthritis phenotypes were associated with greater functional impairment and higher disease burden. These findings reinforce the clinical heterogeneity of CCD and support the potential value of phenotype-based approaches for clinical management and future therapeutic research. Full article

Background: Body perception disturbances (BPDs) are highly prevalent in chronic limb pain, manifesting as hostile feelings towards the limb, reduced sensory–motor function, and altered limb ownership. Various questionnaires and tests assess BPD, but their interrelation and associations with limb disability remain underexplored. This study aimed to evaluate BPD assessments, examine whether they capture overlapping or distinct aspects of BPD, and determine their associations with upper- and lower-limb disability. Methods: This observational cross-sectional study included 92 participants with chronic limb pain. Participants completed BPD questionnaires (Bath-BPD, Neurobehavioral) and tests (Laterality Recognition, Fingers/Toe Perception, Human Figure Drawing), along with clinical pain measures and the symptom severity index. Dependent outcomes were upper- and lower-limb disability. Results: Cluster analysis grouped all measures into ‘High’ and ‘Low’ BPD severity clusters, with overall cluster quality rated as fair (silhouette = 0.40). The Neurobehavioral questionnaire emerged as the primary contributor to the cluster structure (silhouette = 1). The ‘High’ BPD cluster showed significantly greater symptom severity (t(63) = −4.13, p < 0.001). Pain severity, Bath-BPD questionnaire, and symptom severity were significantly associated with upper-limb disability (p < 0.001), whereas pain intensity alone accounted for 24% of lower-limb disability variance. Conclusions: Despite the diversity of BPD assessments, the clustering pattern suggests a partial convergence between measures, though a weak cohesiveness of BPD tests indicates that they capture partially distinct aspects of body perception. BPD questionnaires were associated with upper-limb disability, whereas lower-limb disability was associated with pain intensity. These findings emphasize the importance of assessing BPDs in musculoskeletal care and suggest their potential role as indicators of symptom severity. Full article

Background/Objectives: Diving exposure can cause auditory injury involving both the middle and inner ear structures. Inner ear barotrauma (IEB) and inner ear decompression sickness (IEDCS) are the major inner ear disorders and frequently present with auditory and vestibular symptoms. This study examined how diving characteristics relate to patterns of auditory trauma. Methods: A retrospective chart review of 30 patients, with 36 affected ears, was performed. Diving depth, clinical manifestations, and treatment responses were analyzed to identify factors influencing related prognosis. Results: Diving depth was an important factor associated with symptom severity and the type of injury. Dives deeper than 30 m of seawater were linked to a higher incidence of sudden sensorineural hearing loss and vertigo. In contrast, transient symptoms with minimal objective abnormalities were typically observed in shallow dives. Patients with concomitant decompression sickness (DCS) showed poorer auditory and vestibular recovery following hyperbaric oxygen therapy, while those without DCS showed better hearing improvement. Vertigo was observed in 80% of IEB cases and 66.7% of IEDCS cases. Hearing recovery appeared to be more frequently observed in cases presenting with middle ear symptoms, suggesting a relatively favorable prognosis for IEB compared with IEDCS. Conclusions: The findings suggest potential associations between diving depth and DCS, and its involvement may play a role in the severity and prognosis of diving-related inner ear injury. IEB appeared to be associated with more favorable auditory outcomes compared with IEDCS; however, this observation should be interpreted with caution due to potential diagnostic uncertainty. Given the descriptive nature of the study, further studies with larger cohorts are needed to refine prognostic indicators and optimize management strategies. Full article