Intravascular Large B-Cell Lymphoma (IVLBCL) Presenting with CNS Involvement in Patient with Chronic Lymphocytic Leukemia

Background: Intravascular lymphoma (IVL) is a rare, often fatal disease characterized by intraluminal proliferation of lymphoid cells within blood vessels. Intravascular Large B-Cell Lymphoma (IVLBCL) is frequently found in different organs, but the skin and central nervous system (CNS) are the most affected ones.Peer reviewe

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging : A Case Report

Publisher Copyright: © Am J Case Rep.Objective: Rare disease Background: Neurosyphilis is a central nervous system infection caused by Treponema pallidum, that can develop at any time after the initial infection. The clinical signs of neurosyphilis are very variable, as well as its radiological features, and it is a diagnostic challenge. Knowledge of clinical symptoms and correct laboratory diagnostics, combined with routine radiological examination and additional diagnostic tools, such as high-resolution, threedimensional FLAIR sequence, T2-weighted, and T1-weighted contrast-enhanced magnetic resonance imaging (MRI) are key to making an accurate diagnosis of neurosyphilis. Case Report: We present the clinical case of a patient who presented a 1-year history of vague clinical symptoms and was misdiagnosed with herpes simplex virus (HSV) encephalitis. Initial head MRI revealed extensive cerebral white matter lesions with cortical contrast enhancement, mainly of anterior and medial parts of the left temporal lobe, as typically seen in HSV encephalitis. Empirical therapy with acyclovir was started until a diagnosis of syphilis was confirmed with laboratory findings. Later, the therapy was changed to penicillin G. The patient’s condition improved after receiving targeted treatment. A control MRI scan was performed, and previously detected changes in the brain had decreased significantly. Conclusions: MRI is the imaging of choice to support the diagnosis of neurosyphilis. Our findings suggest that neuroimaging can play an important role in indicating suspicion of syphilitic encephalitis. Enhancement of the anterior and medial parts of the temporal lobe is an atypical imaging finding, and it can simulate an infection with HSV. Early treatment is critical to a positive outcome.publishersversionPeer reviewe

Burnout syndrome symptoms correlation with chronic pain

MedicīnaVeselības aprūpeMedicineHealth CareIzdegšanas sindroms tiek definēts kā darba vides hroniska stresa radīts fenomens un rada ietekmi ne vien uz cilvēka psihoemocionālo stāvokli, bet arī uz fizisko un sociālo labklājību. Pētījuma mērķis bija noskaidrot izdegšanas sindroma, hronisku sāpju un depresijas simptomu sastopamības biežumu un to atšķirības starp dzimumiem. Kā arī noskaidrot izdegšanas sindroma korelāciju ar hroniskām sāpēm un depresiju. Tika veikts prospektīvs pētījums, kurā izdegšanas sindroma noteikšanai tika izmantota Maslačas izdegšanas aptauja (Maslach Burnout Inventory - human services survey), hronisku sāpju novērtēšanai tika izmantota Īsā sāpju aptaujas anketa (Brief Pain Inventory) un depresijas izvērtēšanai tika izmantota Pacienta veselības aptauja – depresijas tests (PHQ-9). Dati tika ievākti un analizēti izmantojot MS Excel 2010 un IBM SPSS Statistics 22 programmas. Par statistiski nozīmīgu rezultātu tika uzskatīta p vērtība <0.05. Pētījumā iegūtie rezultāti liecina, ka izdegšanas sindroms pētāmajā grupā ir sastopams tikai sievietēm. Gandrīz puse no pētījuma dalībniekiem cieš no hroniskām sāpēm. Sievietes biežāk atzīmē sāpju neesamību, taču vīrieši biežāk tās novērtē kā vājas, abi dzimumi sāpju ietekmi uz ikdienas aktivitātēm nevērtē kā būtisku, tomēr statistiski nozīmīga dzimuma ietekme uz hronisku sāpju raksturojošajiem lielumiem netika pierādīta. Pastāv korelācija starp izdegšanas sindromu un hroniskām sāpēm. Lielākajai daļa pētījuma dalībnieku ir norādījumi par dažādas pakāpes depresijas esamību un pastāv korelācija starp izdegšanas sindromu un depresiju.Burnout syndrome is defined as an occupational phenomenon caused by chronic work stress and it has an impact not only on a person's psycho-emotional state, but also on physical and social well-being. The aim of this research is to find out the incidence of burnout syndrome, chronic pain and depressive symptoms and their differences between the sexes, as well to find out if there is a correlation between burnout syndrome and chronic pain, depression. A prospective study was conducted. To evaluate the incidence of burnout syndrome Maslach Burnout Inventory - human services survey was used. To evaluate the presence of chronic pain- Brief Pain Inventory was used, and to evaluate the presence of depression - Depression Test PHQ-9 was used. Data was obtained and analyzed with MS Excel 2010 and IBM SPSS Statistics 22 programms. Probability value <0.05 was considered to be statistically significant. The obtained results show that in the study group burnout syndrome is found only in women. Almost half of the study participants suffer from chronic pain. Women are more likely to report the absence of pain, but men are more likely to rate pain as mild. There is a correlation between burnout syndrome and chronic pain. Most study participants have signs of depression and there is a correlation between burnout and depression

Functional Disability and Brain MRI Volumetry Results among Multiple Sclerosis Patients during 5-Year Follow-Up

Background and Objectives: We aimed to determine the link between brain volumetry results and functional disability calculated using the Expanded Disability Status Scale (EDSS) among multiple sclerosis (MS) patients in relation to the provided treatment (disease-modifying therapies (DMTs)) during a 5-year follow-up period. Materials and Methods: A retrospective cohort study was performed enrolling 66 consecutive patients with a confirmed diagnosis of MS, predominantly females (62% (n = 41)). Relapsing–remitting (RR) MS was noted in 92% (n = 61) of patients, with the rest being patients with secondary progressive (SP) MS. The mean age was 43.3 years (SD 8.3 years). All patients were evaluated clinically using the EDSS and “FreeSurfer© 7.2.0” radiologically during a 5-year follow-up. Results: A significant increase in patient functional disability was noted, calculated using the EDSS during a 5-year follow-up. The baseline EDSS ranged between 1 and 6 with a median of 1.5 (IQR 1.5–2.0), and after 5 years, the EDSS was between 1 and 7, with a median EDSS of 3.0 (IQR 2.4–3.6). Compared with RRMS patients, SPMS patients demonstrated a significant increase in EDSS score during a 5-year period, with a median EDSS of 2.5 in RRMS patients (IQR 2.0–3.3) and 7.0 (IQR 5.0–7.0) among SPMS patients. Significantly lower brain volumetry results in different brain areas were found, including cortical, total grey and white matter, p p p > 0.05. The provided treatment (DMTs) did not demonstrate a significant impact on the brain MRI volumetry results during a 5-year follow-up, p > 0.05. Conclusions: Brain MRI volumetry seriously impacts the early detection of brain atrophic changes. In this study, significant relationship between brain magnetic resonance volumetry results and disability progression among MS patients with no important impact of the provided treatment was described. Brain MRI volumetry may aid in the identification of early disease progression among MS patients, as well as enrich the clinical evaluation of MS patients in clinical patient care