Search Results (103)

Objective: To assess the long-term effects of Dienogest on clinical complaints and nodule sizes in women affected by recto-sigmoid deep endometriosis (DE). Methods: This was a single-center longitudinal prospective observational study comprising a consecutive series of women affected by recto-sigmoid DE, who underwent medical treatment with Dienogest (2 mg daily continuous). All women underwent clinical visits and transvaginal sonography (TVS) with bowel preparation prior to starting therapy and at 3–6-month intervals for at least 12 months. Clinical complaints such as dysmenorrhea, dyspareunia and dyschezia were assessed using a visual analog scale (VAS). The DE recto-sigmoid lesion was measured in the three orthogonal planes. The lesion’s volume was estimated using the prolate ellipsoid formula. The maximum diameter and lesion volume were used for analysis. Patients’ complaints and lesion sizes before starting the treatment and at final follow-up were compared. Results: From January 2017 to July 2020, 125 patients were consecutively recruited (mean age: 37 years, ranging from 20 to 50 years). The median follow-up period was 47.8 months (range: 12–74 months). We did not observe a significant correlation between the severity of the symptoms and the lesion size prior to starting therapy. Clinical complaints improved significantly during treatment (88% of women were symptomatic at initial visit, versus 53% at final follow-up, p < 0.001). The median lesion volume significantly decreased (median initial volume vs. final volume: 1.1 mL vs. 0.9 mL, p = 0.017). However, the median maximum lesion diameter did not change significantly (26.0 mm vs. 25.0 mm, p = 0.779). Conclusions: Long-term Dienogest therapy significantly relieves clinical symptoms related to recto-sigmoid DE. This is accompanied by a significant reduction in the lesion volume but not the maximum lesion diameter. Full article

In an air-conditioned multinational graduate students’ office in Japan during the winter season, we examined indoor environmental conditions, occupants’ perceptions, and their acceptance levels over five consecutive days. Indoor air quality (IAQ) acceptance peaked on the third day, coinciding with the most favourable thermal sensation vote, which was “neutral” at a geometric mean indoor temperature of 25.1 °C. Aural comfort received the lowest acceptance due to ongoing construction work, but did not significantly impact overall IEQ acceptance, thus suggesting that unacceptable aspects of indoor environmental quality (IEQ) can be offset by acceptable aspects. IAQ and thermal comfort compensated for its effects, offering insights into occupants’ environmental tolerance. IAQ sensation votes and visual comfort votes exhibit a strong relationship with overall comfort, as indicated by their respective R² values. However, variations in overall comfort are primarily explained by IAQ, which has the highest R² value of 0.50, suggesting that IAQ accounts for 50% of the changes in overall occupant comfort. Non-Japanese participants had lower IEQ acceptance and a significantly higher number of complaints than Japanese participants more so in visual comfort where acceptable luminance levels were higher in Japan than other participants’ countries of origin. Thermal comfort was mutually highly accepted by both groups. Nose and eye irritation were significantly experienced by the international participants due to low RH levels but experiencing loss of concentration and lethargy was comparable in both groups (p > 0.05, t-test). We recommend global coherence in indoor environmental quality standards as is the case with drinking water standards for public health protection and seamless transitions in new indoor environments. Full article

Background and Clinical Significance: Choroidal nevi are common benign growths originating from pigment cells in the fundus of the eye. They are typically up to 5 mm in diameter, asymptomatic, and incidentally discovered during routine ophthalmological examinations. Case Presentation: We present the case of a 48-year-old woman with presbyopic complaints and an incidental finding of a large, pigmented, slightly raised tumor in the fundus of the left eye. Examinations revealed normal visual acuity in both eyes and normal intraocular pressure. Ophthalmoscopy of the left eye identified a large, pigmented lesion measuring 11.55 mm in diameter, with drusen-like deposits along the superior nasal vascular arch. Fluorescein angiography showed atrophic changes in the retinal pigment epithelium without evidence of a pathological vascular network. Ultrasound revealed dimensions of 10.21 mm at the base and 0.57 mm prominence, with no changes observed during a one-year follow-up. Optical coherence tomography (OCT) did not detect any subretinal fluid. The right eye appeared normal. Based on these findings, a giant choroidal nevus in the left eye was suspected, and the clinical approach involved monitoring at 3- to 6-month intervals. Discussion: This case highlights the diagnostic challenges associated with a large, pigmented fundus lesion in a relatively young patient. Giant choroidal nevi, defined as lesions larger than 10 mm at the base, may clinically mimic malignant melanoma. However, features such as drusen and atrophic changes in the retinal pigment epithelium suggest a chronic process. Differentiating between giant choroidal nevi and malignant melanoma is essential due to differing therapeutic approaches. Since some choroidal nevi can undergo malignant transformation, close monitoring for signs of malignancy is crucial. Conclusions: The size of pigmented nevi is a significant risk factor for malignant transformation, underscoring the importance of long-term follow-up for affected patients. Full article

Chronic fungal sinusitis (FS) can cause bone erosion and extend to the sellar region, often misdiagnosed as pituitary tumors or malignancies. We report a 56-year-old immunocompetent female with sphenoid FS presenting as a giant sellar mass compressing the optic chiasm, with normal pituitary function. The surgery successfully resolved her symptoms, and a histological examination confirmed the presence of a fungal hyphal mass. We conducted a literature review of 52 publications on FS cases with bone erosion and inflammatory extension to the sellar region, which included analyses of 67 patients (35 females, mean age 49.6 years, half immunocompetent). The most common symptom was headache (73.1%), followed by visual complaints (71.7%), visual deterioration (40.3%), ophthalmoplegia (38.8%), and visual field defects (13.4%). Symptom duration averaged 4.5 months in 65.7% of cases. Aspergillus was the most frequent (71.6%). Hormonal abnormalities included hypopituitarism (25.4%) and hyperprolactinemia (13.4%). Surgery was performed in 92.5% of patients. Common diagnoses included pituitary abscess (41.8%), fungal granuloma (16.4%), aspergillosis (16.4%) and allergic FS (14.9%). Antifungal therapy was administered in 53.7% of cases. Cure was achieved in 67.2%, while the mortality rate was 10.4%. Early recognition of fungal involvement, supported by a multidisciplinary approach, is essential for the accurate diagnosis and effective treatment. This highlights the need for vigilance to improve the outcomes in similar cases. Full article

Autoantibodies have been implicated in the pathogenesis of autoimmune diseases, including autoimmune retinopathies. Our study aimed to identify retinal autoantigens recognized by serum autoantibodies (AAbs) in patients with visual disturbance. We evaluated 2453 serum samples for anti-retinal AAbs from patients with or without cancer and complaints of visual loss. Anti-TULP1 AAbs were more prevalent in the subset of women with breast cancer and vision loss. Epitope mapping was determined by ELISA using peptides covering the conservative carboxy terminal of TULP1, revealing major lineal epitopes within the sequences 334–341 and 480–488. We found no significant difference in the main epitope recognition between sera from patients with or without breast cancer. Although we show a correlation of anti-TULP1 AAbs with breast cancer, we found no TULP1 protein expression in breast cells, making this association unclear. In the retina, anti-TULP1 AAbs can disrupt the transport of proteins to outer segments and be involved in the degeneration of photoreceptors in a similar fashion to the degeneration induced by TULP1 gene mutation. Nevertheless, the strong association of detectable anti-TULP1 AAbs in breast cancer patients with vision problems indicates its potential as a biomarker for cancer-associated autoimmune retinopathy. Full article

Background and Clinical Significance: Intracranial dermoid cysts (IDCs) are rare benign congenital intracranial lesions. In the case of IDC rupture, these lesions may manifest clinically. Cysts may be visualized on non-enhanced computed tomography (NECT) and magnetic resonance imaging (MRI), facilitating discussions between clinicians and radiologists to determine cyst content and potential dissemination in cases of rupture. This case report describes an IDC rupture presenting as fat-containing lesions in the subarachnoid space and ventricular system, resembling a subarachnoid hemorrhage on MRI. Case Presentation: A thirty-two-year-old Caucasian male patient was admitted to the hospital due to recurrent headaches and visual impairment that began at the age of thirty-one. MRI revealed a lesion radiologically consistent with a ruptured dermoid or epidermoid cyst in the anterior fossa with a mass effect on the optic nerve intracranial segments, the chiasma opticum, and proximal optic tracts. The patient underwent a successful neurosurgical resection of the lesion, and histopathological analysis confirmed the diagnosis of a dermoid cyst. The postoperative period was uneventful. MRI follow-up revealed residual tissue of the IDC without any volume increase. Multiple punctate fat-containing lesions were noted, similar to previous MRIs. The patient reported no complaints at discharge. Follow-up MRI imaging demonstrated no recurrence or progression of the dermoid cyst at 4 months, 1 year, and 2 years. Conclusions: IDC rupture is a rare event that may present clinically and appear as a blooming artifact on MRI, mimicking subarachnoid hemorrhage. Fat-containing lesions in the subarachnoid space and ventricular system can demonstrate findings indicative of an IDC rupture. MRI diffusion-weighted imaging (DWI) and decreased apparent diffusion coefficient (ADC) values may mimic an epidermoid cyst, a phenomenon rarely described in the literature, further complicating the diagnostic process. Full article

Background/Objectives: Aging is associated with a progressive decline in biological function due to a complex interplay of physical, psychological, and social factors. This randomized controlled trial aimed to evaluate the effects of a functional health education program on functional capacity in older adults. Methods: Twenty participants (mean age: 80.70 ± 5.992 years) were randomized to either an experimental group that received a 12-week exercise program or a control group. The exercise program included aerobic, flexibility, strength, and cognitive components. Outcomes were assessed using the Timed Up and Go (TUG) test, Falls Efficacy Scale (FES), and Visual Analog Scale (VAS) for pain. Results: In the population studied, 80% of the older adults indicated some type of back pain. The experimental group results showed a significant reduction in back pain (p = 0.032) and risk of falling (p = 0.013). Additionally, the experimental group demonstrated significant improvements in functional capacity (p = 0.016) and cognitive capacity (p = 0.023). Conclusions: This study demonstrated that a specific activity significantly improved participants’ perceived risk of falls, functionality, cognitive function, and reduced back pain complaints in the experimental group. Full article

Lexical retrieval difficulty is a common daily complaint among older adults. Recent evidence suggests that older adults name motor-related nouns (e.g., knife) more accurately than non-motor nouns (e.g., steak). However, it remains unclear whether this motor-relatedness effect can reduce older adults’ object naming latency (a potentially more sensitive measure of word retrieval than accuracy) and how it may be modulated by individual differences (e.g., age and global cognition). Therefore, we recruited a large number of older adults to complete a Chinese version of the Montreal Cognitive Assessment (MoCA) and a timed picture-naming task, and we explored the two remaining issues with data from 76 community-dwelling older adults (65–81 years old), excluding participants with possible AD. Linear mixed-effects analysis revealed a main effect of motor-relatedness on naming latency in older adults and a significant interaction with the MoCA score after controlling for a number of stimulus-related factors (i.e., age of acquisition, familiarity, name agreement, and visual complexity) and participant-related factors (i.e., gender and education) as covariates, but age showed neither a main effect nor a significant interaction with motor-relatedness. Further simple slope analysis showed that older adults were faster at naming objects with high motor-relatedness and that older adults with low MoCA scores benefited more from the motor-relatedness effect. These findings suggest that motor-relatedness may compensate for the normal course of cognitive ageing in older adults. Implications for the motor-relatedness effect were discussed. Full article

Complaint processing is of great importance for companies because it allows them to understand customer satisfaction levels, which is crucial for business success. It allows them to show the real perceptions of users and thus visualize the problems, which are regularly processed from oral or written natural language, derived from the provision of a service. In addition, the treatment of complaints is relevant because according to the laws of each country, companies have the obligation to respond to these complaints in a specified time. The specialized literature mentions that enterprises lost USD 75 billion due to poor customer service, highlighting that companies need to know and understand customer perceptions, especially emotions, and product reviews to gain insight and learn about customer feedback because of the importance of the voice of the customer for an organization. In general, it is evident that there is a need for research related to computational language processing to handle user requests. The authors show great interest in computational techniques for the processing of this information in natural language and how this could contribute to the improvement of processes within the productive sector. This work searches in indexed journals for information related to computational methods for processing relevant data from user complaints. It is proposed to apply a systematic literature review (SLR) method combining literature review guides by Kitchenham and the PRISMA statement. The systematic process allows the extraction of consistent information, and after applying it, 27 articles were obtained from which the analysis was conducted. The results show various proposals using linguistic, statistical, machine learning, and hybrid methods. We find that most authors combine Natural Language Processing (NLP) and Machine Learning (ML) to create hybrid methods. The methods extract relevant information from complaints of the customers in natural language in various domains, such as government, medical, banks, e-commerce, public services, agriculture, customer service, environmental, and tourism, among others. This work contributes as support for the creation of new systems that can give companies a significant competitive advantage due to their ability to reduce the response time of the complaints as established by law. Full article

Background: Cycling involves specific body positions that, when maintained for prolonged periods, may affect spinal curvature and increase the risk of pain-related issues. This study aimed to evaluate sagittal spinal curvatures, the prevalence of pain in spinal segments, and their interrelation among amateur road cyclists. Methoods: The research included 30 male participants aged 18–48 years. Pain severity was assessed using the Visual Analog Scale (VAS) and Laitinen scale, while spinal curvature was evaluated with an electronic inclinometer. Results: Results showed no statistically significant differences in spinal curvature angles between cyclists with and without pain complaints (p = 0.056). However, tendencies were noted, such as higher mean VAS scores for lower back pain (4.90) compared to neck pain (3.38), and variations in parameters like Beta, LL, and KGP. Conclusions: While the findings did not confirm clear distinctions, they suggest trends indicating potential links between spinal curvatures and pain occurrence. These results underscore the importance of further studies involving larger cohorts to verify these observations and explore the biomechanical adaptations associated with amateur cycling. Insights from such research could inform strategies for preventing and managing spinal pain among cyclists. Full article

Background: Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline. Objectives: To evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function, activity levels, and quality of life in older adults at risk of cognitive decline. Adherence and usability were also evaluated. Methods: We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score ≥ 2). Participants received a six-month intervention (app-based cognitive training, personalized nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was a change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains: attention, processing speed, memory, and executive function). Secondary outcomes were activity levels (Frenchay Activities Index, FAI), and quality of life (EQ-5D). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed-effects models. Results: 96% of participants in the intervention and 89% in the control group completed the study. At six months, the intervention group showed a significant NTB composite score improvement (mean change: 0.086 (95% CI 0.020 to 0.15)), with a between-group difference of 0.17 (95% CI 0.071 to 0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in the processing speed domain at nine months. The control group’s FAI scores declined at six months (mean change: −1.04 (95% CI −1.83 to −0.26)), while the intervention group’s scores remained stable. The intervention group’s EQ-5D visual analogue scale (VAS) scores improved at both six and nine months, with between-group differences of 4.06 (95% CI 0.23 to 7.90) at six months and 5.12 (95% CI 0.81 to 9.43) at nine months. Adherence was high, while average usability scores were obtained. Conclusions: The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality of life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts. Full article

Uncorrected refractive error and unsatisfactory performance on several clinical accommodation and binocular vision tests are more common in children who struggle with reading. The aim of the current study is to explore the prevalence of accommodative and binocular dysfunctions in children with and without reading difficulties. Reading performance was assessed with the Acadience Reading (formerly DIBELS Next) test adjusted and validated for the Latvian language. Children with (N = 39) and without (N = 43) reading difficulties underwent thorough assessment of their subjective refraction, as well as binocular and accommodation functions. The results demonstrate no difference in the prevalence of complaints between children with and without reading difficulties (26% and 23%, respectively). However, children with reading difficulties more frequently present with significant uncorrected refractive errors and/or accommodative and binocular dysfunctions than children without reading difficulties (69% and 47%, respectively). According to the findings, even in cases where a child does not exhibit any ocular or visual complaints, a comprehensive visual function evaluation should be required for any child who struggles with reading. Full article

Introduction: Invasive aspergillosis (IA) is an opportunistic fungal infection that typically occurs in the immunocompromised host and is associated with severe morbidity and mortality. Myocardial abscess formation is seldomly described. Detailed Case Description: We present a case of IA with purulent myocarditis. The patient was on long-term high-dose corticosteroid and mycophenolate mofetil therapy for severe lupus nephritis. After multiple visits to his general practitioner and nephrologist for general malaise, he was admitted to our hospital with visual complaints. Within several days, he developed atrial fibrillation, respiratory insufficiency, and, finally, a decreased level of consciousness. After admission to the intensive care unit, the broncho alveolar lavage (BAL) fluid galactomannan (GM) index was normal, but the serum GM index was severely elevated. Despite initiation of antifungal therapy, the patient passed away shortly thereafter. Autopsy revealed massive intracranial hemorrhage and disseminated IA affecting the lungs, brain, and myocardium, with macroscopic myocardial abscess formation. Discussion: This classic case of diagnostic uncertainty illustrates how invasive fungal infections can progress to disseminated disease while showing nonspecific symptoms only. It emphasizes the importance of vigilance for opportunistic fungal infections in a growing category of immunocompromised patients. Conclusion: Clinicians should have a low threshold of suspicion for fungal infections in patients on combination immunosuppressive medication, such as high-dose corticosteroid therapy in combination with T-cell inhibitors like MMF. Full article

Background: Ectopic organ-associated conditions belong to the larger panel of developmental ailments, and among this challenging medical and surgical chapter, ectopic endocrine glands-related picture is mostly focused on the presence of the ectopic parathyroid and thyroid. Ectopic thyroid tissue within mediastinum (ETTM) stands for a less common ETT site; while, globally, less than 1% of the mediastinum masses are ETTM. Objective: We aim to introduce a rare case of ETTM in a senior lady to whom one-time synchronous thyroidectomy with ETT removal was successfully performed via a minimally invasive modern procedure upon cervicotomy and intra-operatory use of the Cooper thymectomy retractor. Results: The panel of pros and cons with respect to providing endocrine thoracic surgery for ETTM resection in a 73-year-old subject is discussed amid a PubMed search of original English-language original reports from January 2000 until 15 August 2024 in order to identify similar distinct cases (individuals of 70 years or older who underwent surgery for ETTM). Conclusions: 1. We propose the term “three-leaf-clover thyroid” to capture the imaging essence of having an enlargement of both (eutopic) thyroid lobes and ETTM. 2. The modern surgical approach under these circumstances provided a rapid patient recovery with a low rate of complications and a minimum hospital stay. Hence, the procedure may be expanded to older patients after a careful consideration of their co-morbidities and of the need to releasing connected complaints (e.g., a 7-month history of intermittent dyspneea was found in this case with post-operatory remission). 3. The management remains a matter of individualised decision, and age may not be a limiting factor. 4. At the present time, this case adds to the very limited number of similar published cases in the mentioned age group that we could identify (seven patients, aged between 72 and 84; male-to-female ratio of 5 to 2; the rate of malignant ETTM was 3/7); of these cases, not all were reported to have a trans-cervical approach, and none reported the use of the Cooper thymectomy retractor to help the overall surgical procedure. This innovative surgical procedure offers the advantage of avoiding a sternotomy incision which has clear functional and aesthetic implications, while the video-assisted approach allows optimal visualization of the mediastinal anatomy and safe vascular sealing under visual control, without the risk of a major hemorrhage. Full article

Background: Limited information is available on factors that affect the burden tinnitus. The aim of this study is to investigate the association between tinnitus burden and demographic, patient-specific and tinnitus characteristics. Secondly, it was examined which variables could predict a change in tinnitus burden after 12 months. Method: In a prospective Dutch cohort of 383 tinnitus patients seeking medical help, tinnitus complaints, demographics, tinnitus characteristics, psychological wellbeing and quality of life were assessed using an online self-report survey at three timepoints (start, 6 months, 12 months). The main outcome variables for tinnitus burden are the Tinnitus Questionnaire (TQ) and Visual Analog Scale (VAS) for tinnitus burden and loudness. Results: Several variables (time, sex, education level, life events, anxiety and depression, sleep issues, tinnitus loudness, hearing impairment and treatment) were significantly associated with tinnitus burden. Additionally, tinnitus burden after 12 months was associated with anxiety, following treatment, sleep issues, negative life events and hearing impairment (increase) and anxiety, total of life events and environmental quality of life (decrease) predicted the tinnitus burden after 12 months. Conclusions: Several factors, such as education level, life events, psychological factors and sleep quality, are related to tinnitus burden and can predict tinnitus burden over time. Full article