THE EFFECT OF PRIMARY SJӦGREN’S SYNDROME ON THE SENSES OF SMELL, TASTE AND SEXUALITY IN FEMALE PATIENTS IN THE UK: IMPACT ON QUALITY OF LIFE

It is well established that mucosal dryness is the most common symptom in primary Sjögren’s Syndrome (pSS) patients, affecting the nasal, oral and genital mucosa. A systematic review was conducted and a study with the following aims was established: 1) To assess the functions of the smell, taste and sexuality in patients with pSS. 2) To determine whether the mucosal dryness has an impact on the functions of the smell, taste and sexuality in pSS patients. 3) To investigate the impact of the impairment of the functions of smell, taste and sexuality on the quality of life (QoL) and mental health well-being in women with pSS. Methodology: Sixty-five pSS patients and 62 sex-matched healthy volunteers were recruited for this study. The smell function was assessed by the University of Pennsylvania Smell Identification Test (UPSIT). The taste function was comprehensively evaluated by assessing the gustatory function using the Taste Strips Test (TST), and the neurosensory threshold by an electrogustometer (EGM). The sexual function was assessed by the Female Sexual Function Index (FSFI). The oral dryness was assessed by means of stimulated and unstimulated salivary flow rate (SFR), clinical assessment of oral dryness scale (CODS) and Xerostomia Inventory (XI). The World Health Organisation Quality of Life-BRÉF (WHOQoL- BRÉF) and Oral Health Impact Profile-14 (OHIP-14) were used for the general and oral health related QoL respectively. The Hospital Anxiety and Depression Scale (HADS) was used to assess the mental health status. Results: Data analysis showed that the smell dysfunction was twice as prevalent in the patients group (41.5%, n=27/65) compared with healthy volunteers (24.1%, n=15/62). This difference was even more pronounced when assessing the gustatory function impairment, which was six times more prevalent in pSS patients (54%, n=34/63) than in healthy participants (8.3%, n=5/60). The neurosensory threshold of taste was three times higher in the patients’ group (31.7%, n=20/64) compared with the healthy volunteers (9.8%, n=6/61), and was associated with gustatory deterioration in pSS group (β=-0.4, 95% CI=-0.2 – 0), indicating possible neurological impairment in this group. As expected, the salivary flow rate and the clinical oral dryness score were significantly lower in the patient group compared with healthy volunteers. No evidence was found to support that the oral dryness was associated with deterioration of smell, taste or sexual functions in pSS patients. The number of sexually active pSS patients (n=28) was half of that in the healthy volunteers group (n=42), and the FSFI showed that the sexual function was significantly impaired in pSS patients (p=<0.05). The self-administered questionnaires showed that the life quality was significantly compromised in patients, who were more anxious (58.5%, n=38/65) and four times more depressed (32.3%, n=21/65) compared with healthy volunteers (Anxiety=21%, n=13/61; depression=8.2%, n=5/61). However, neither smell nor taste dysfunction were contributory factors to the reduced QoL, but the sexual dysfunction was the main factor contributed to the compromised general QoL in pSS patients. Conclusion: The smell, taste and sexual impairment are manifestations seen in pSS, but only the sexual dysfunction appear to have a diminishing effect on the QoL and mental health well-being of patients. The taste deterioration in pSS does not seem to be associated with mucosal dryness but maybe precipitated by a Sjӧgren’s syndrome-associated neuropathy

Smell Dysfunction in Patients with Primary Sjögren’s Syndrome: Impact on Quality of Life

Objectives: Patients with primary Sjögren’s syndrome (pSS) often report smell and taste disturbances. However, the correlation between smell impairment and mucosal dryness is not well understood. The objectives of this study were to investigate the following: (1) the prevalence of smell hypofunction in patients with SS; (2) the impact of smell hypofunction on their quality of life (QoL); (3) whether the patients’ smell is correlated with xerostomia; and (4) whether the patients’ smell is affected by taste hypofunction, disease duration, age, smoking or self-reported neuropathy. Methodology: An ethically approved cross-sectional study was conducted on 65 female patients with SS and 62 sex-matched healthy controls. Their smell was assessed using the University of Pennsylvania Smell Identification Test. Their taste acuity was assessed using the Taste Strips Test. A visual analogue scale was used for the self-assessment of smell and taste functions. Xerostomia was assessed by the salivary flow rate, clinical oral dryness score and the Xerostomia Inventory. The patients’ QoL and mental health well-being were assessed using validated questionnaires. Results: In the SS group, the patients’ smell function was impaired in 27/65 patients compared with the controls (15/62, p < 0.05), and it did not correlate with the severity of xerostomia, taste acuity (r = 0.05, p = 0.6) or self-reported nasal dryness (r = −0.02, p = 0.7). In the patients’ group, smell hypofunction was not correlated with disease duration (β = 0.1, 95% CI = −0.07–0.1) or smoking (β = −0.02, 95% CI = −8–7). Age was not correlated with the smell function in the patients’ group (β = −0.1, p = 0.5) but was correlated significantly with smell in the healthy participants’ group (β = −0.3, p = 0.02). Neuropathy affected 81.2% of the patients’ group. Their QoL and mental health well-being were not affected by smell hypofunction. Conclusion: Smell hypofunction appears to be a clinical manifestation in patients with SS, but it does not seem to be associated with the severity of mucosal dryness or with taste disturbance

Infected epidermal cyst of the clitoris in an infant

Clitoral enlargement in the pediatric population is a rare condition, usually related to problems of sexual differentiation, but malignant and benign clitoral lesions have also been described. We report the case of a newborn infant, investigated at birth for an intersex disorder because of clitoromegaly. Hormonal screening was normal and ultrasound (US) did not show a pelvic or abdominal mass. Three weeks later, the lesion was larger, tense and erythematous. An abscess was suspected. A drainage was then performed, and the bacteriological culture revealed the presence of Staphylococci aurei. A magnetic resonance imaging (MRI) performed to exclude a tumor of the soft tissue was normal. A diagnosis of infected epidermal cyst was confirmed by the pathology. Two months later, the external genital aspect was normal and the child asymptomatic

Topological Flat Bands in Graphene Super-moir\'e Lattices

Moir\'e-pattern based potential engineering has become an important way to explore exotic physics in a variety of two-dimensional condensed matter systems. While these potentials have induced correlated phenomena in almost all commonly studied 2D materials, monolayer graphene has remained an exception. We demonstrate theoretically that a single layer of graphene, when placed between two bulk boron nitride crystal substrates with the appropriate twist angles can support a robust topological ultra-flat band emerging from the second hole band. This is one of the simplest platforms to design and exploit topological flat bands

Difficult management of an extremely rare case of giant pigmented epithelioid melanocytoma

Pigmented epithelioid melanocytoma (PEM), a heavily pigmented and highly uncommon melanocytic lesion, is extremely rare. It comes under several forms and names. We report the case of a three-year-old boy born with an isolated right lumbopelvic and femoral giant PEM. The boy was unable to walk due to the size and the shape of the lesion. He underwent two stages of intra lesional resections, one in Benin and the second in Switzerland. The first surgery was followed by hypothetic hypovolemic and anaphylactic shocks, and the second surgery by a continuous lymphatic leakage from the wounds for months. The strategic management approach, the surgery and follow-up of this case of giant PEM presented a real challenge. (C) 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND licens

Carrier transport theory for twisted bilayer graphene in the metallic regime

The mechanisms responsible for the strongly correlated insulating and superconducting phases in twisted bilayer graphene are still debated. The authors provide a theory for phonon-dominated transport that explains several experimental observations, and contrast it with the Planckian dissipation mechanism. Understanding the normal-metal state transport in twisted bilayer graphene near magic angle is of fundamental importance as it provides insights into the mechanisms responsible for the observed strongly correlated insulating and superconducting phases. Here we provide a rigorous theory for phonon-dominated transport in twisted bilayer graphene describing its unusual signatures in the resistivity (including the variation with electron density, temperature, and twist angle) showing good quantitative agreement with recent experiments. We contrast this with the alternative Planckian dissipation mechanism that we show is incompatible with available experimental data. An accurate treatment of the electron-phonon scattering requires us to go well beyond the usual treatment, including both intraband and interband processes, considering the finite-temperature dynamical screening of the electron-phonon matrix element, and going beyond the linear Dirac dispersion. In addition to explaining the observations in currently available experimental data, we make concrete predictions that can be tested in ongoing experiments

Extended magic phase in twisted graphene multilayers

Theoretical and experimental studies have verified the existence of ``magic angles'' in twisted bilayer graphene, where the twist between layers gives rise to flat bands and consequently highly correlated phases. Narrow bands can also exist in multilayers with alternating twist angles, and recent theoretical work suggests that they can also be found in trilayers with twist angles between neighboring layers in the same direction. We show here that flat bands exist in a variety of multilayers where the ratio between twist angles is close to coprime integers. We generalize previous analyses, and, using the chiral limit for interlayer coupling, give examples of many combinations of twist angles in stacks made up of three and four layers which lead to flat bands. The technique we use can be extended to systems with many layers. Our results suggest that flat bands can exist in graphene multilayers with angle disorder, that is, narrow samples of turbostatic graphite.Comment: Main text: 4 pages, 4 figures -- Supplementary Material: 15 pages, 13 figure

Healthcare-associated infections in a tunisian university hospital: From analysis to action

Introduction: our study was conducted, in university hospital center (UHC) Farhat Hached of Sousse (city in Tunisian center-east), within healthcare-associated infections (HAI) epidemiological surveillance (ES) program,  based, among others, on HAI regular prevalence surveys. Our objectives are to resituate HAI prevalence rate and to identify their risk factors (RF) in order to adjust, in our hospital, prevention programs.Methods: it is a transversal descriptive study, including all patients who had been hospitalized for at least 48 hours, measuring prevalence of HAI a “given day”, with only one passage by service. Risk factors were  determined using Epiinfo 6.0, by uni-varied analysis, then, logistic  regression stepwise descending for the variables whose pResults: the study focused on 312 patients. Infected patients prevalence was 12.5% and that of HAI was 14.5 %. Infections on peripheral venous catheter (PVC)  dominated (42.2%) among all HAI identified. HAI significant RF were neutropenia (p&lt;10-4) for intrinsic factors, and PVC for extrinsic factors (p=0,003). Conclusion: predominance of infections on PVC should be subject of specific prevention actions, including retro-information strategy, prospective ES, professional practices evaluation and finally training and increasing awareness of health personnel with hygiene measures. Finally,  development of a patient safety culture with personnel ensures best adherence to hygiene measures and HAI prevention