Treatment of narcolepsy: A rare disease of unknown etiology

Background: Narcolepsy, also known as Gélineau syndrome, is a chronic and neurological disease that affects 0.05% of the European population, though that percentage could be higher due to the diagnostic difficulties. The main symptom is excessive daytime sleepiness, although it may be accompanied by cataplexy, sleep paralysis and hypnagogic hallucinations. Objective: Nowadays, there is no cure for narcolepsy and the treatment is symptomatic: psychostimulants for the sleepiness by means of amphetamines, methylphenidate or modafinil, and antidepressants and sodium oxybate for treating cataplexy. Method: This is a short review regarding pharmacotherapy for narcolepsy. Result: Hypocretins were discovered in 1998. They are neuropeptides whose deficit is responsible for this symptomatology, has opened up a new field of investigation. Conclusion: Agonists of hypocretins could be a promising therapy against this disease.

Clinical Characteristics of Intermittent Esotropia

Purpose: To evaluate clinical findings and surgical outcomes of intermittent esotropia.Methods: We retrospectively reviewed the medical records of 23 patients (aged 9-42 years) who presented with intermittent esotropia between January 2007 and December 2020. We analyzed the age at onset, angle of deviation, presence of symptomatic diplopia, fusional state, near stereoacuity, and surgical results.Results: The mean age at onset was 19.9 ± 8.0 years and mean duration of esodeviation was 23.4 ± 27.1 months. Mean follow-up time was 13.0 ± 15.6 months. All patients except three had symptomatic diplopia, and 78.3% showed intermittent diplopia. Mean angles of deviation were 21.6 ± 10.3 prism diopters (PD) at distance and 20.2 ± 10.4 PD at near. Twenty-one patients (91.3%) were myopia. No patients had amblyopia and one had dissociated vertical deviation. On Worth’s four-dot test, five patients (21.7%) showed diplopia and four showed suppression at both distance and near. The other patients showed fusion at near or distance. Eleven patients underwent surgical correction. At the final examination, all patients achieved successful motor alignment and fusion with resolution of diplopia. Only two patients (18.2%) achieved normal 60 arcsec stereopsis, and six attained subnormal stereopsis.Conclusions: The main symptom of intermittent esotropia was diplopia. Surgical treatment was effective in achieving good postoperative motor alignment and fusion. However, successful motor alignment did not guarantee recovery of fine stereopsis.

Violence as a main symptom of schizophrenia and expressed emotion in relatives of users from Instituto Jalisciense de Salud Mental

Introduction. Schizophrenia is a mental disorder that affects 21 million people worldwide, and it brings about environments with high Expressed Emotion (EE) in the families of these individuals. High EE is characterized by negative evaluations, criticism, and overinvolvement of family members towards the person with schizophrenia. Objective. Recognize the relationship between the cultural agreement about the symptoms of schizophrenia and EE. Method. The study had a mixed design, with a cognitive anthropology method. The sample had a probabilistic estimate based on Weller and Romney proposal, with a competence higher than 50%, a confidence level of 95%, and 5% of type I error. The 40 participants were selected with a simple randomized probability sampling, conformed by relatives of patients from the Instituto Jalisciense de Salud Mental (SALME). Results. The 45% of the sample showed a high EE according to the Questionnaire for Measuring the Level of Expressed Emotion (CEEE). A single valid cultural model with statistical significance was found, in which violence was identified as the main symptom of schizophrenia. The best-informed relatives showed a lower EE (Mann-Whitney U = 1,000, p #abr# .001). Discussion and conclusion. Schizophrenia disorder has been associated with stigmas that generate rejection and fear. A total of 40% of the world’s population believe people with schizophrenia are dangerous and violent. It must be considered opportune to reconsider the use of the term “schizophrenia”, which is etymologically imprecise and supports stigmas that have excluded and defamed people with schizophrenia for more than a century.

Effects of manganese toxicity on the growth of soybean (Glycine max L.) at the seedling stage

Effects of manganese (Mn) toxicity stress on the growth of soybean, the number of Mn spots on leaves and the absorption of iron and magnesium were studied by nutrient solution hydroponics. The results showed that the presence of Mn spots on leaves was the main symptom of Mn toxicity in soybean. When the concentration of exogenous Mn was 25 μmol/l, the leaf generated obvious Mn oxidation spots; when the concentration of exogenous Mn exceeded 50 μmol/l, the growth of soybean was inhibited, and the number of Mn spots increased significantly. With the increase in exogenous Mn concentration, the Mn concentration in the roots, young leaves and old leaves of soybean increased significantly. When the concentration of exogenous Mn reached 200 μmol/l, the number of Mn spots on primary leaves, old leaves and young leaves increased significantly. Although the iron concentration in the roots remained the same, the iron content in the old and young leaves decreased significantly. On the other hand, although Mn toxicity significantly reduced the concentration of magnesium in soybean roots, it increased the concentration of magnesium in old and young leaves. Bangladesh J. Bot. 50(3): 803-811, 2021 (September) Special

Different clinical symptom patterns in patients with reflux micro-micro-aspiration

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.

Analysis of 9 Cases of Takotsubo Syndrome and an Analysis of the Clinical Characteristics of Takotsubo Syndrome From a Chinese Population

Objective: To summarize the clinical features, hematology and imaging features of Takotsubo syndrome.Methods: The hospitalization data of Takotsubo syndrome patients in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2020 were collected, and their clinical characteristics were summarized. Patient outcomes were clarified through follow-up visits, and relevant objective indicators were statistically analyzed before and after admission. The characteristics of TTS incidence in Chinese population were summarized by searching three (Wanfang, CNKI, China's VIP database) major databases in China (PRISMA).Results: A total of 9 patients were enrolled, including 6 females (66.7%). The mean age of onset was 46.4 years old, the median time from onset to treatment was 1 day. The main symptom of 8 cases (88.9%) was chest pain, 1 case had a main symptom of syncope, and 7 cases (77.8%) had mood fluctuations or mental stimulation as the main symptom of the disease. Paired T-tests were conducted on routine blood, biochemical, coagulation, myocardial markers, inflammatory indicators and objective indicators of ECG before and after admission. The study found that the counts of white blood cells and neutrophils were statistically significant (P < 0.05). Prolongation of the QT interval was observed in all 9 patients. After a mean follow-up of 24 ± 28 months, no adverse cardiovascular events or recurrence occurred.Conclusion: Takotsubo syndrome is a group of clinical syndromes with emotional or somatic stimulation and chest pain as the main symptoms, partly accompanied by an increase in white blood cells, neutrophilic granulocyte count, creatine kinase, and troponin and is characterized by a prolonged QT interval and no obvious coronary stenosis. The prognosis is generally good, with few serious complications.

Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report -

Background: In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.Case: We report a case of a 23-year-old man with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved.Conclusions: Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.

Painful nail: What’s is your diagnosis

A glomus tumor is a rare benign neoplasia; which involves a thermoregulatory microvascular system, the glomus body. It is often found in the subungual tissue. Eccrine angiomatous Hamartoma (EAH) is a rare proliferation of vascular and eccrine structures. We present an original case by its location, clinical examination (pain is the main symptom with onycholysis) and its misleading appearance on MRI. The treatment consists of surgical excision of the tumor with good evolution. We will insist on the histological exam of the piece, which is the key to the diagnosis.

641 CLINICAL SYMPTOM PATTERNS IN PATIENTS WITH REFLUX ASPIRATION

Multiple papers have discussed pulmonary manifestation of gastro-oesophageal reflux disease (GORD), however little primary reported data exists on presenting symptoms of patients in whom reflux aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux aspiration. Methods Data was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright. Results Inclusion criteria were met by 243 patients (33% males; mean age 59). Most common symptoms amongst patients with aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Clusters analysis demonstrated two main symptom clusters one suggestive of proximal large volume reflux symptoms (regurgitation, heartburn) and the other with IBS type symptoms (bloat, dysphagia, constipation). Conclusion Combination of typical symptoms of GORD and a respiratory or upper aero-digestive complaint should prompt consideration of reflux aspiration. Cluster analysis of symptoms in this group supports previously postulated hypothesis of reflux aspiration pathogenesis by either large volume proximal reflux or by ineffective oesophageal motility.