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IntroductionNeuropathic pain is common after spinal cord inflammation and trigeminal neuralgia may be expected with brainstem inflammation, particularly in multiple sclerosis. Interestingly we have observed ipsilateral facial pain following optic neuritis (ON) in several patients.AimTo describe 5 patients with ipsilateral facial pain following ONResultsFive patients (60% female) presented with ON which was bilateral in 1 case. MOG-IgG was positive in 3/5 cases and visual acuity at nadir was: 6/18, finger-counting, and hand movements in 3 patients. Four patients had IV methylprednisolone of which one also had plasma exchange. At 3 months, 2 showed no improvement, two moderate improvement, and one full recovery. Brainstem involvement was observed in 1 patient. All developed sharp ipsilateral V1 facial pain, 1 patient’s pain extended into V2. One patient fulfilled ICHD-3 criteria for short unilateral neuralgiform headaches with conjunctival tearing (SUNCT). Variable responses to greater occipital nerve blocks, Amitriptyline, and Lamotrigine were observed.ConclusionIpsilateral facial pain may complicate optic neuritis independent of brainstem involvement. We hypothesise a mechanism involving sensitisation of trigeminal afferents and the trigeminal autonomic reflex pathway. Increased recognition of this complication may help to identify an optimal treatment approach.

IntroductionNon-multiple sclerosis CNS inflammation encompasses conditions including neuromyelitis optica spectrum disorder (NMOSD), MOG-antibody associated disease (MOGAD), longitudinally extensive myelitis (LETM), and acute disseminated encephalomyelitis (ADEM). Disability rates may be high despite treatment. Compared to Rituximab, cyclophosphamide has a faster onset of action, lower cost and is accessible in most hospitals. Experience in non-MS CNS inflammation is limited.AimTo review refractory non-MS CNS inflammation cases referred to the national NMOSD service treated with cyclophosphamide.MethodsPatients with non-MS CNS inflammation refractory to standard relapse treatment administered cyclophosphamide were included from January 2018-2023. Clinical data including EDSS was collected.ResultsTen patients were identified (AQP4-IgG-NMOSD=2, seronegative NMOSD=2, MOGAD=2, LETM=3, and ADEM=1). Of 7 patients with transverse myelitis, 6 had LETM. Median treatment age was 50(18-76) years and 70% were female. Prior immunosuppressive treatments were given; IV methylprednisolone (IVMP)=1, PLEX=1, IVMP/PLEX=5, IVMP/IVIg=1, IVMP/IVIg/PLEX=2. Median pre- and 3-month EDSS was 8(6.5-9) and 6.5(6-8.5). Adverse events including mild infection were recorded in 6 patients but resolved with appropriate treatmentConclusionCyclophosphamide is an effective option for the treatment of refractory non-MS CNS inflam- mation. Adverse events were not uncommon but were effectively managed with no long-term sequelae. Ambulatory capacity was restored in most patients.

Futile recanalization remains a significant challenge for endovascular treatment (EVT) of acute ischemic stroke (AIS). The inflammatory response that occurs after cerebral infarct plays a central role in stroke pathobiology that can influence the outcome of a recanalization procedure. The aim of this study was to evaluate the relationship between the systemic inflammatory response index (SIRI) and futile recanalization in patients with AIS. We retrospectively identified consecutive patients with ischemic stroke due to proximal arterial occlusion in the anterior circulation, who were treated with EVT and achieved near-complete or complete recanalization. Absolute neutrophil count (ANC), absolute monocyte count (AMC), and absolute lymphocyte count (ALC) were collected from admission blood work to calculate SIRI as ANC × AMC/ALC. The study outcome was futile recanalization, defined as poor functional status [modified Rankin scale (mRS) score ≥ 3] at 3 months despite complete or near-complete recanalization. A total of 184 patients were included. Futile recanalization was observed in 110 (59.8%) patients. Older patients (odds ratio (OR) = 1.07, 95% confidence interval (CI): 1.04–1.10, p < 0.001), higher admission National Institutes of Health stroke scale score (OR = 1.10, 95% CI: 1.02–1.19, p = 0.013), and higher admission SIRI (OR = 1.08, 95% CI: 1.01–1.17, p = 0.028) increased the risk of the poor outcome at 3 months despite complete or near-complete recanalization.

Background Studies in MS and NMOSD have shown that relapses can frequently occur in the same location as the first attack. Factors associated with this outcome in MOGAD are unclear. Objective The objective of this study was to investigate the likelihood of a relapse occurring at the same site in MOGAD. Methods This was a UK national cohort study. MOGAD patients with a minimum of one relapse and one year of follow‐up were included. To identify factors associated with relapse location, logistic regression was performed. Results An increased risk of a relapse in the same location was observed when the first attack was optic neuritis—for the second attack (OR 12.9, 95% CI 3.31–50.55, p = .001) and all subsequent attacks (OR 5.39 95% CI 1.61–18.03, p = .006). Conversely, a reduced risk of relapse in the same location was associated with transverse myelitis—for the second attack (OR 0.25, 95% CI 0.07–0.82, p = .022) and all subsequent attacks (OR 0.25 95% CI 0.06–0.96, p = .045). Conclusion In relapsing MOGAD, patients with optic neuritis are at high risk of a new attack in the same location, while those with transverse myelitis are at low risk. Retrospective cohort from the United Kingdom regarding MOGAD relapsing patients to investigate the new attack pattern. Sixty‐three patients were included and patients with optic neuritis as a first clinical manifestation have a high risk of a new attack in the same location. Conversely, patients with transverse myelitis are less likely to have a relapse in the same topography.

Crohn’s disease (CD) of the pouch and chronic pouchitis represent the most common long-term complications of total proctocolectomy and ileal pouch anal anastomosis (IPAA) for refractory ulcerative colitis (UC). These conditions are treated with multiple agents, including antibiotics, immunomodulators, and biologics. Among the latter, ustekinumab is approved for both CD and UC. We performed a systematic review to evaluate the efficacy of this anti-IL12/23 in CD of the pouch and chronic refractory pouchitis. Pubmed, Embase, Ovid, and the Cochrane Controlled Trials Register were searched to identify studies published until August 2020 investigating the use of ustekinumab for these conditions. Eighty-six eligible patients with IPAA—51 with CD of the pouch, 35 with chronic pouchitis—were identified from 2 retrospective studies and 5 case reports. Reported clinical response to ustekinumab was 63 and 85% in chronic pouchitis and CD of the pouch after 4–12 and 4–16 weeks, respectively. Clinical remission was reported in 10% of patients with chronic pouchitis and 27% of patients with CD of the pouch after 8–52 and 4–52 weeks of treatment, respectively. Endoscopic response was reported in 60% and 67% of patients with chronic pouchitis and CD of the pouch after 24–32 and 8–24 weeks of treatment respectively. Small sample sizes and large heterogeneity of therapy protocols/outcome definitions were significant studies limitations. In conclusion, there is a limited and inconclusive body of evidence suggesting that ustekinumab may be a therapeutic option for patients with chronic pouchitis and CD of the pouch refractory to other therapies.

The relationship between body height and the risk of non‒communicable diseases such as cardiovascular disease and cancer has been the subject of much debate in the epidemiological literature. Concerns have recently arisen over spurious associations due to confounding factors like birth cohort, especially in the context of epidemiological transition. The population of Sardinia represents an interesting case study, as the average physical stature of inhabitants was the lowest recorded in Europe until a few decades ago. In this population we tested whether height is an independent risk factor for cardiovascular disease and cancer. We analysed the stature of 10,427 patients undergoing endoscopy for any reason, for whom a detailed clinical history of cardiovascular disease and/or malignancies had been documented. Poisson regression modelling was used to test the association between stature and disease risk. When patients were subdivided according to sex and height tertiles, the risk of cardiovascular disease proved significantly greater for subjects in the lowest tertile irrespective of sex (men: 1.87; 95%CI 1.41‒2.47; women: 1.23; 95%CI 0.92‒1.66) and smaller for those in the highest tertile (men: 0.51; 95%CI 0.35‒0.75; women: 0.41; 95%CI 0.27‒0.61). However, after adjusting the risk for birth cohort and established risk factors, it mostly resulted in non-significant values, although the overall trend persisted. Similar results were obtained for all-cancer risk (relative risk for men and women in the lowest tertile: 1.44; 95%CI 1.09-1.90 and 1.17; 95%CI 0.93-1.48, in the highest tertile: 0.51; 95%CI 0.36-0.72 and 0.62; 95%CI 0.47-0.81, respectively) as well as for some of the most common types of cancer. We concluded that the risk of developing cardiovascular disease and malignancies does not vary significantly with stature in the Sardinian population, after adjusting for birth cohort and more obvious risk factors.

Objectives: The study aimed to explore the clinical predictors of pharmaco-resistance in patients with post-stroke epilepsy (PSE). Methods: Patients with epilepsy secondary to cerebral infarct or spontaneous intracerebral hemorrhage were included. The study outcome was the occurrence of pharmaco-resistance defined as the failure of adequate trials of two tolerated and appropriately chosen and used antiseizure medication schedules, whether as monotherapies or in combination, to achieve sustained seizure freedom. Results: One-hundred and fifty-nine patients with PSE and a median follow-up of 5 (3–9) years were included. The mean age of the patients at stroke onset was 56.7 (14.9) years, and 104 (65.4%) were males. In the study cohort, 29 participants were pharmaco-resistant. Age at stroke onset [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.93–0.99; p = 0.044], history of intracerebral hemorrhage (OR 2.95, 95% CI 1.06–8.24; p = 0.039), severe stroke (OR 5.43, 95% CI 1.82–16.16; p = 0.002), status epilepticus as initial presentation of PSE (OR 7.90, 1.66–37.55; p = 0.009), and focal to bilateral tonic-clonic seizures (OR 3.19, 95% CI 1.16–8.79; p = 0.025) were independent predictors of treatment refractoriness. Conclusions: Pharmaco-resistance developed in approximately 20% of patients with PSE and was associated with younger age at stroke onset, stroke type and severity, status epilepticus occurrence, and seizure types.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper airway dimensions. Objective: this systematic review evaluates the effectiveness of functional appliances in improving upper airway structures in children with OSAS. Materials and Methods: the study was conducted according to PRISMA guidelines, analyzing studies published between 2004 and 2024 on PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases. Inclusion criteria focused on growing patients (≤14 years) with OSAS and Class II skeletal malocclusions treated with FAs. Results: Of 1298 articles screened, four studies met the inclusion criteria. All studies reported a significant increase in upper airway dimensions of approximately 21% after treatment with FAs. Specifically, the cephalometric and tomographic evaluations revealed a clear enlargement of the superior posterior airway space of about 0.5 mm and a consequent improvement of the respiratory function. Discrepancies arose regarding changes in soft palate length and hyoid bone position, perhaps due to the measurement methods’ variation. Conclusions: Functional appliances appear effective in improving upper airway dimensions and alleviating OSAS symptoms in children. However, the limited number of studies, small sample sizes, and short follow-up periods emphasize the need for further research to confirm long-term efficacy and standardize evaluation protocols.

Alterations of intestinal microflora are involved in the pathogenesis and natural history of inflammatory bowel diseases (IBDs). Manipulation of human gut microbiota with probiotics may be a therapeutic option. In this retrospective cohort study, the benefits of probiotic use in reducing adverse events were analyzed. Data from clinical charts of IBD patients followed up for at least 36 months were retrieved. The occurrence of adverse events including the need for systemic steroids, hospitalization, and surgery related to IBD was analyzed according to age, gender, body mass index, treatments, IBD phenotype, disease duration, and probiotic use. The amount of probiotic use was calculated as the ratio of time under probiotic treatment to the disease duration starting from the date of the first probiotic administration and expressed as a percentage. Patients were stratified according to the percentage of probiotic use as ≤ 24%, 25–74%, and ≥ 75%, and the number of adverse events per patient-years was calculated. Results were adjusted for Crohn’s disease (CD) and ulcerative colitis (UC) by multivariate analysis including study variables. Data from 200 patients (78 CD, 122 UC; 117 females; mean age 40.6 ± 15.3 years; mean disease duration 12.1 ± 8.7 years) were available. CD patients taking probiotics for 25–74% of the disease duration experienced a 64% reduction in total adverse events. The need for systemic steroids, hospitalization, and surgery dropped to zero events per person-year in UC patients and decreased by 93% ( p  < 0.001) in CD patients taking probiotics for ≥ 75% of the disease duration. Our findings suggest that the use of probiotics may be an additional therapeutic tool in patients with IBD.

Subjects with glucose-6-phosphate dehydrogenase (G6PD) deficiency may be more susceptible to infections due to impaired leukocyte bactericidal activity. The disorder is common in the Mediterranean area. The aim of this study was to investigate whether G6PD deficiency may be a risk factor for acquiring H. pylori infection. We performed a retrospective study. Data from clinical records of 6565 patients (2278 men and 4287 women, median age 51, range 7‒94) who underwent upper endoscopy between 2002 and 2014 were collected. H. pylori status, assessed by histology plus rapid urease test or 13C-urea breath test, and G6PD status were also reported. A multiple logistic regression model was used to investigate the association between G6PD deficiency and H. pylori infection. Enzyme deficiency was detected in 12% (789/6565) of the entire cohort, and more specifically in 8.3% of men and in 14.0% of women. Overall, the proportion of patients positive for H. pylori was 50.6% and 51.5% among G6PD deficient and non-deficient patients (χ² = 0.271; p = 0.315). Moreover, among G6PD-deficient and normal patients the frequency of previous H. pylori infection was similar. After adjustment for age and gender the risk for acquiring H. pylori infection was similar in G6PD-deficient and normal patients. Only age was a strong statistically significant risk predictor. These results demonstrate for the first time that G6PD deficiency does not enhance patients' susceptibility to acquire H. pylori infection in Sardinia.