Explore the vast range of titles available.

Serum HBsAg levels have been quantified extensively in recent years with simple completely automated assays in the various phases of the natural course of chronic HBV infection, have been compared with cccDNA in the liver, with various markers of HBV replication and have been correlated with several viral, host and environmental variables. Low HBsAg levels in inactive carriers predict a spontaneous HbsAg loss. Quantification of HBsAg in serum at baseline and its decline under interferon-alfa based regimens, both in HBeAg-positive and HBeAg-negative CHB, provides important information on the prediction of sustained post-treatment outcomes and on subsequent HBsAg clearance. The value of HBsAg quantification in the monitoring of long term nucleos(t)ide analogue treatment of CHB and in the prediction of sustained response remains unclear. In this review, the most recent data regarding the overall clinical utility of HBsAg measurement in HBeAg-positive and -negative CHB and in their treatment, is critically presented.

Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.

Psychological treatments for young people with sub-threshold or full-syndrome borderline personality disorder (BPD) are found to be effective. However, little is known about the age at which adolescents benefit from early intervention. This study investigated whether age affects the effectiveness of early intervention for BPD. = 626 participants ( age = 15 years, 82.7% female) were consecutively recruited from a specialized outpatient service for early intervention in BPD in adolescents aged 12- to 17-years old. DSM-IV BPD criteria were assessed at baseline, one-year ( = 339) and two-year ( = 279) follow-up. Older adolescents presented with more BPD criteria (χ = 58.23, < 0.001) and showed a steeper decline of BPD criteria over the 2-year follow-up period compared with younger adolescents (χ = 13.53, = 0.001). In an attempt to disentangle effects of early intervention from the natural course of BPD, a parametrized regression model was used. An exponential decrease ( = 0.10, < 0.001) in BPD criteria was found when starting therapy over the 2-year follow-up. This deviation from the natural course was impacted by age at therapy commencement ( = 0.06, < 0.001), although significant across all ages: older adolescents showed a clear decrease in BPD criteria, and young adolescents a smaller decrease. Early intervention appears effective across adolescence, but manifests differently: preventing the normative increase of BPD pathology expected in younger adolescents, and significantly decreasing BPD pathology in older adolescents. The question as to whether developmentally adapted therapeutic interventions could lead to an even increased benefit for younger adolescents, should be explored in future studies.

Epidemiological data offer conflicting views of the natural course of binge-eating disorder (BED), with large retrospective studies suggesting a protracted course and small prospective studies suggesting a briefer duration. We thus examined changes in BED diagnostic status in a prospective, community-based study that was larger and more representative with respect to sex, age of onset, and body mass index (BMI) than prior multi-year prospective studies. Probands and relatives with current DSM-IV BED ( = 156) from a family study of BED ('baseline') were selected for follow-up at 2.5 and 5 years. Probands were required to have BMI > 25 (women) or >27 (men). Diagnostic interviews and questionnaires were administered at all timepoints. Of participants with follow-up data ( = 137), 78.1% were female, and 11.7% and 88.3% reported identifying as Black and White, respectively. At baseline, their mean age was 47.2 years, and mean BMI was 36.1. At 2.5 (and 5) years, 61.3% (45.7%), 23.4% (32.6%), and 15.3% (21.7%) of assessed participants exhibited full, sub-threshold, and no BED, respectively. No participants displayed anorexia or bulimia nervosa at follow-up timepoints. Median time to remission (i.e. no BED) exceeded 60 months, and median time to relapse (i.e. sub-threshold or full BED) after remission was 30 months. Two classes of machine learning methods did not consistently outperform random guessing at predicting time to remission from baseline demographic and clinical variables. Among community-based adults with higher BMI, BED improves with time, but full remission often takes many years, and relapse is common.

Differentiated vulvar intraepithelial neoplasia (dVIN) is the precursor of human papillomavirus (HPV)-independent vulvar squamous cell carcinoma (VSCC). Given the rare incidence of dVIN, limited information on the exact cancer risk is available. We systematically reviewed the primary and recurrent VSCC risk in patients with dVIN, as well as the time to cancer development. A systematic search was performed up to July 2021 according to the PRISMA guidelines. Five reviewers independently screened articles on title, abstract and full text, followed by critical appraisal of selected articles using the Quality in Prognostic Studies (QUIPS) tool. Of the 455 screened articles, 7 were included for analysis. The absolute risk for primary VSCC in dVIN varied between 33 and 86%, with a median time to progression to VSCC of 9–23 months. The risk of developing recurrent VSCC in dVIN associated VSCC was 32–94%, with a median time to recurrence of 13–32 months. In conclusion, patients with dVIN have a high risk of developing primary and recurrent VSCC with a short time to cancer progression. Increased awareness, timely recognition, aggressive treatment and close follow-up of HPV-independent vulvar conditions including dVIN is therefore strongly recommended.

The necessity of bilateral bypass in adult moyamoya disease (MMD) remains unclear despite its recommendation for pediatric and hemorrhagic cases. We aimed to investigate the natural course of hemodynamically stable unoperated hemispheres after bypass surgery for symptomatic and hemodynamically unstable hemispheres in adult patients with ischemic MMD. Among 288 patients, the mean age at the first operation of the unstable hemispheres was 40.8 ± 12.2 years. The mean follow-up period was 62.9 ± 46.5 months. 45 patients (15.6%) experienced stroke events in the unoperated hemisphere, consisting of hemorrhagic stroke in 8 (2.8%) and ischemic stroke in 37 (12.8%), including progressive transient ischemic attack in 25 (8.7%) and infarction in 12 (4.2%). Among them, 39 patients (13.5%) underwent bypass surgery. The annual risk of total stroke is 3.0%/patient-year, with 2.5% for ischemic stroke and 0.5% for hemorrhagic stroke. The 5- and 10-year cumulative risks of ischemic stroke were 13.4% and 18.3%, respectively, and those of hemorrhagic stroke were each 3.2%. The natural course of hemodynamically stable hemispheres contralateral to the operated ones appeared fairly good. Additional bypass surgery on the unoperated hemispheres should be considered for symptomatic and hemodynamically unstable hemispheres in adult patients with ischemic MMD during the follow-up.

Background We explored the changes in metabolic dysfunction-associated steatotic liver disease (MASLD) severity over time by analyzing data from the placebo arms of randomized controlled trials (RCTs), focusing on the presence of diabetes. Methods RCTs on MASLD that included a placebo arm were identified using a systematic search of the literature. Primary outcomes were changes in hepatic steatosis and fibrosis. Results The meta-analysis included 8 RCTs involving 386 patients without diabetes and 24 RCTs involving 637 patients with diabetes. The pooled estimate of mean change in steatosis grade was − 0.1 in patients without diabetes, and − 0.37 in patients with diabetes ( P  = 0.066). The mean change in fibrosis stage was 0.05 in patients without diabetes, and − 0.03 in patients with diabetes ( P  = 0.359). The mean change in nonalcoholic fatty liver disease activity score was − 0.55 in patients without diabetes, and − 1.50 in patients with diabetes ( P  = 0.100). The mean change in ALT and AST were significantly larger in patients without diabetes compared to those with diabetes ( P  < 0.05). Conclusion Placebo treatment had a greater effect in improving liver steatosis in patients with diabetes compared to those without. These findings highlight the importance of tailored treatment strategies in MASLD, particularly considering diabetes status.

[LANGUAGE=”English”]Background and Design: The onset chronology of disease symptoms in patients with hidradenitis suppurativa (HS) and their gender differences have not yet been fully elucidated. We aimed to define the onset chronology of the disease symptoms and the socio-demographic and clinical characteristics.Materials and Methods: This single-center case series study included 100 consecutive patients. The disease symptoms for each patient were recorded in the time order of manifestations.Results: HS was more common in males (72%); 70% of the patients were overweight or obese. Smoking and alcohol consumption was significantly higher in males. The axilla was the most common onset area, followed by the inguinal and gluteal regions. The incidence of disease onset in the axilla in male and disease onset in the gluteus in female patients was significantly higher. Also, involvement of the pubis, perianal region, neck, back, and behind the ear was more common in males. The disease followed a more severe course in patients with the involvement of axilla, perianal, and inframammary areas (p<0.05).Conclusion: Besides being the most commonly involved site, axilla was the most common disease onset area in both genders; however, the incidence of disease onset in the gluteus is higher in females and the axilla in males. The male dominance observed in our cohort followed previous results reported from Türkiye, although differing from other countries. This suggests each society’s unique genetic and environmental characteristics may influence the course and evolution of the disease.[LANGUAGE=”Turkish”]Amaç: Hidradenitis supurativa (HS) hastalarında hastalık semptomlarının başlangıç kronolojisi ve cinsiyet farklılıkları henüz tam olarak aydınlatılamamıştır. Hastalık belirtilerinin başlangıç kronolojisi ve hastalarımızın sosyo-demografik ve klinik özelliklerini tanımlamayı amaçladık.Gereç ve Yöntem: Bu tek merkezli olgu serisi çalışmasına ardışık 100 hasta dahil edildi. Her hasta için hastalık semptomları klinik ortaya çıkışlarının zaman sırasına göre ve diğer özellikler retrospektif olarak elde edildi.Bulgular: Çalışmamızda HS erkeklerde daha yaygın (%72) izlenirken; hastaların %70’i aşırı kilolu veya obezdi. Sigara ve alkol tüketimi erkeklerde anlamlı olarak daha yüksekti. Koltuk altı en yaygın başlangıç bölgesiydi, bunu inguinal ve gluteal bölgeler takip etti. Erkeklerde aksillada hastalık başlangıcı ve kadın hastalarda gluteusta hastalık başlangıç insidansı anlamlı olarak daha yüksekti. Ayrıca pubis, perianal bölge, boyun, sırt ve kulak arkası tutulumları erkeklerde daha sıktı. Ayrıca koltuk altı, perianal ve meme altı tutulumu olan hastalarda hastalığın daha şiddetli seyrettiği izlendi (p<0,05).Sonuç: En sık tutulan bölge olmasının yanı sıra aksilla her iki cinsiyette de en sık hastalık başlangıç bölgesiydi ve kadınlarda gluteusta, erkeklerde aksillada hastalık başlama insidansı daha yüksekti. Çalışmamızda gözlemlenen erkek egemenliği, diğer ülkelerden farklı olmakla birlikte, Türkiye’den bildirilen önceki sonuçlarla tutarlıydı. Bu, her toplumun benzersiz genetik ve çevresel özelliklerinin hastalığın seyrini ve evrimini etkileyebileceğini düşündürmektedir.

Idiopathic cervical dystonia (ICD) is by far the largest subgroup of dystonia. Still, its natural course is largely unknown. We studied the natural course of 100 ICD patients from our botulinum toxin clinics (age at ICD onset 45.8 ± 13.5 years, female/male ratio 2.0) over a period of 17.5 ± 11.5 years with follow-ups during botulinum toxin therapy and with semi-structured interviews. Two courses of ICD could be distinguished by symptom development of more or less than 6 months. ICD-type 2 was less frequent (19% vs 81%, p  < 0.001), had a more rapid onset (8.7 ± 8.0 weeks vs 3.8 ± 3.5 years), a higher remission rate (92% vs 5%, p  < 0.001) and a higher prevalence of excessive psychological stress preceding ICD (63% vs 1%, p  < 0.001). In both ICD-types, the plateau phase was non-progressive. Significant differences in patient age at ICD onset, latency and extent of remission, female/male ratio and prevalence of family history of dystonia could not be detected. ICD is a non-progressive disorder. ICD-type 1 represents the standard course. ICD-type 2 features rapid onset, preceding excessive psychological stress and a high remission rate. These findings will improve prognosis, treatment strategies and understanding of underlying disease mechanisms. They contradict the widespread fear of patients of a constant and continued decline of their condition. Excessive psychological stress may be an epigenetic factor triggering the manifestation of genetically predetermined dystonia.