Hypophosphatemic Osteomalacia associated with Neurofibromatosis Type-1: A case report and literature review

Introduction: Skeleton abnormalities are not uncommon in neurofibromatosis type-1 (NF1), which usually manifest as congenital malformations, such as scoliosis and sphenoid wing dysplasia. However, very rare cases of NF1 have been associated with hypophosphatemic osteomalacia (HO), which is characterized with later onset in adulthood, severe hypophosphatemia and disorder of the mineralization of organic bone matrix. Patient concerns: Here we reported a rare case of a 29-year-old woman presented with weakness and pain in lower limbs for 18 months and aggravated for half a year. On physical examination, her lower limbs’ myodynamia reduced and tenderness in multiple bone areas was detected. Light brown patches and scattered nodules could be seen on her skin, and a soft subcutaneous mass was found in the low back. Laboratory evaluation showed hypophosphatemia. Bone ECT suggested multiple abnormal bone metabolism and MRI scan of lumbosacral spine revealed numerous fractures. Neuroimaging indicated the neurofibromas, and then the biopsy of the subcutaneous lump confirmed neurofibromatosis. Diagnosis: HO associated with NF1 was diagnosed, based on the presence of café-au-lait spots and the results of bone ECT scan and biopsy. Interventions: The patient was treated with oral calcitriol, calcium carbonate d3 and phosphorus, as well as intramuscular carbocalcitonin. Outcomes: During hospitalization, her serum phosphorus level increased and symptoms improved. Conclusion: The case reported here calls attention to that when NF1 patients manifested with weakness and neurology diseases have been excluded, HO should be taken into consideration.

Stabilizing Effect of Yawning on Nasal Cycle

The dominant passability of the left or right nostril in terms of nasal air resistance can be classified into 4 main modes. In the first mode, both nostrils are closed and have equal and low air passability. In the second mode, the passability of the right nostril is higher than the left. In the third mode, the passability of the left nostril is higher than the right. In the fourth mode, both nostrils are open and passability of nostrils is equal and high. The first and fourth modes are unstable (with duration- minutes). The second and third modes are stable (with duration-hours). Author presents a yawning as physiological reflex leading to transition from unstable to stable modes.

Marker structures in the liquor of patients with destructive processes in brain tissues

The paper presents the results of studies the solid phase structures of liquor 140 patients’ with various types of destructive brain diseases (74 - neurosyphilis, 26 - bacterial meningitis, 7 - aneurysms, 9 - malignant tumors, 24 - discogenic radiculitis). The transfer of liquor into the solid phase was carried out by the method of marginal dehydration of biological fluids. This method allows to visualize the structure of metabolites of the liquid phase of liquor. The results of the study showed presence in the patients’ liquor marker structures, which could be used to clarify the diagnosis.

Aging and Health: A New Relationship

Old age is not of itself a pure neurological ‘problem’, pathology or statement of need. ‘Older people’ or an ‘aging population’ are not a homogeneous group and categorisation as a distinct service user group is, arguably, contentious. Furthermore, since the advent of personalisation in the UK for, conceptualizing support by user groups is considered by many as obsolete. People do not receive health services by virtue of being ‘older’. Rather they are in need of a service - for example, because of ill health, physical impairment, mental health difficulties, addiction or offending. This article will enable us to consider the implications of the re-figuring of the relationship between the state, older people and health professions and social work. This constructs an ambiguous place for older people: they feature either as a resource - captured in the idea of the ‘active citizen’, as affluent consumers, volunteers or providers of childcare- or as a problem in the context of poverty, vulnerability and risk.

Subclinical atrial fibrillation and risk of stroke: An update

Stroke is one of the major causes of death and disability. Atrial fibrillation causes 15% of strokes, 60% is caused by cerebrovascular disease, whereas 25% of cases have no known cause. The technological advancement of cardiac implanted electronic devices has enabled the identification of subclinical atrial fibrillation (SCAF). The literature shows that SCAF is very frequent in the elderly population and that it represents a risk factors for the onset of stroke or systemic embolic disease, regardless of other cardiovascular risk factors. While for clinical atrial fibrillation (AF) the advantages of anticoagulant therapy based on the CHA2 DS2 -VASC score have been well established, much has been said about the usefulness of anticoagulant therapy in the case of SCAF. The role of AF and CHA2 DS2 -VASC score is much debated. A study has recently clearly shown how the SCAF burden together with CHA2 DS2 -VASC score play an important role in determining the risk of progression to persistent AF. Based on these data, the ongoing ARTESIA and AFNET-NOAH studies will provide us with data to evaluate the efficacy of anticoagulant therapy in SCAF.