Hipertiroidismo como manifestación de la enfermedad trofoblástica gestacional: a propósito de un caso

Gestational trophoblastic disease (GTD) is a group of tumours caused by the hyperproliferation of trophoblast cells and is noted for its overproduction of hCG. Among its manifestations, there may be hyperthyroidism, due to the stimulating activity of hCG on TSH receptors. In most cases it is only a biochemical hyperthyroidism, with its presentation as symptomatic hyperthyroidism being much less frequent. We report the case of a patient with GTD, who at diagnosis presented with symptomatic hyperthyroidism. Treatment included surgical evacuation of the hydatidiform mole, as well as a beta-blocker and antithyroid drug treatment to relieve the symptoms.     

Single nucleotide polymorphisms in immune system genes and their association with clinical symptoms persistence in dengue-infected persons

This study was undertaken to determine the prevalence of dengue clinical symptom persistence during 60 days of disease follow up, in patients of Espírito Santo state (ES)-Brazil and to evaluate the relation of single nucleotide polymorphisms (SNPs) in FcγRIIa, CD209, VDR, TNF-α, IL-4, IL-6 and IFN-γ genes with symptom persistence. During 2012–2013, 96 blood samples from individuals diagnosed with symptomatic dengue were collected. Clinical symptom persistence in 60 days of follow-up was assessed by a clinical and epidemiological questionnaire filled in 4 interviews. SNP genotyping was performed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). In two months of monitoring the dengue infection, we observed that symptoms persisted in 38.5% (37/96) of dengue patients at the end of the first month (D30) and in 11.5% (11/96) of dengue patients at the end of the second month (D60). Our results show an association between FcγRIIa, TNF-α and IL-6 gene SNPs and symptom persistence and an association trend with CD209, IL-4 and IFN-γ gene SNPs. Our findings may increase the knowledge on the pathophysiological mechanisms of persistent symptoms of infection with the dengue virus (DENV) and thus help the clinical management of patients.     

Clinical and radiological characteristics of spinal epidural lipomatosis: A retrospective review of 90 consecutive patients

BackgroundThe epidemiology and clinical characteristics of spinal epidural lipomatosis (SEL) have been well-reported in the literature. However, few studies investigated the concomitant spinal pathologies that were present in patients with SEL. Therefore, we aimed to summarize the clinical and radiological characteristics of patients with SEL diagnosed on spinal imaging.MethodsPatients who were diagnosed with SEL on magnetic resonance imaging from January 2018 to October 2020 at our institution were included in the study. Clinical data was collected using a standardized data collection form. SEL was graded using a modified version of the Borré grading system. Factors associated with moderate or severe SEL were determined using multiple logistic regression.ResultsA total of 90 patients were included in the analysis. The mean (±SD) age was 59.3 (±17.1) years, and 62 patients (68.9%) were male. 61 patients (67.8%) had moderate or severe SEL. Most patients were overweight or obese (57 patients, 63.3%). The most common presenting symptoms was back pain (57 patients, 63.3%). SEL was diagnosed incidentally in 42 patients (46.7%). The lumbar spine was the most common site of SEL (35 patients, 38.9%). The most common concomitant spinal pathologies were disc bulge (83 patients, 92.2%) and flavum hypertrophy (60 patients, 66.7%). Moderate or severe SEL was associated with WHO Obesity Class, back pain or radicular leg pain at first presentation, and SEL that was worst at the lumbar or lumbosacral spinal level.ConclusionsModerate or severe SEL were independently associated with WHO Obesity Class, back pain, radicular leg pain, and SEL that was worst at the lumbar or lumbosacral spinal level. Future studies should prospectively evaluate whether weight loss therapy is warranted in patients with SEL.     

焦虑症状的临床诊断和治疗

焦虑症状是焦虑的情绪体验,植物神经功能失调及运动性不安,是常见的临床症状。本文引述近几年诊疗研究成果,结合临床实践,进行系统的总结,以探讨焦虑症状,为系统诊断及其治疗方法。     

The experience of providing support about menopausal symptoms to women with breast cancer

PurposeThe purpose of this study was to describe the experiences and expectations of both women with breast cancer and the health professionals who care for them, in relation to the management of menopausal symptoms.MethodA qualitative, exploratory study using a combination of focus groups and in depth individual interviews was carried out to collect data from women with breast cancer (14) and Health Professionals (15).Key resultsA number of categories arose including breast cancer experience, menopausal symptoms, seeking support, taking control; with a number of contributory factors.ConclusionThe findings illustrated the complexity of supporting women experiencing menopausal symptoms following their breast cancer diagnosis. They also captured the difficulty women have in isolating these symptoms from their experiences of breast cancer and associated management from diagnosis and beyond. The results indicate that health professionals are working and reacting to individual requests for support in isolation of the team. There is a need to assess and manage women both individually and within a multidisciplinary context. This would allow complex issues that span across the pre, peri, or post-menopausal stages, to be identified and resolved effectively.     

Pain severity reduces life quality in chronic pancreatitis: Implications for design of future outcome trials

Background/objectivesChronic pancreatitis (CP) is a disabling disease characterised by abdominal pain, and various pancreatic and extra-pancreatic complications. We investigated the interactions between pain characteristics (i.e. pain severity and its pattern in time), complications, and quality of life (QOL) in patients with CP.MethodsThis was a cross-sectional study of 106 patients with CP conducted at two North European tertiary medical centres. Detailed information on clinical patient characteristics was obtained from interviews and through review of the individual patient records. Pain severity scores and pain pattern time profiles were extracted from the modified brief pain inventory short form and correlated to QOL as assessed by the EORTC QLQ-C30 questionnaire. Interactions with exocrine and endocrine pancreatic insufficiency, as well as pancreatic and extra-pancreatic complications were analysed using regression models.ResultsPain was the most prominent symptom in our cohort and its severity was significantly correlated with EORTC global health status (r = −0.46; P < 0.001) and most functional and symptom subscales. In contrast the patterns of pain in time were not associated with any of the life quality subscales. When controlling for interactions from exocrine and endocrine pancreatic insufficiency no effect modifications were evident (P = 0.72 and P = 0.85 respectively), while the presence of pancreatic and extra-pancreatic complications was associated with an almost 15% decrease in life quality (P = 0.004).ConclusionsPain severity and disease related complications significantly reduce life quality in patients with CP. This information is important in order to design more accurate and clinical meaningful endpoints in future outcome trials.