Frontiers in Medicine最新文献

Background: Tropical Candida spondylitis is an uncommon cause of lower back pain in patients, especially in non-tropical areas or in patients not at risk of immunocompromise.

Case presentation: A 65-year-old woman presented with a six-month history of poorly managed low back pain, now accompanied by numbness and pain in both lower extremities. Her medical history was significant for tertiary hypertension. Inflammatory markers were mildly elevated. MRI fluid sequences revealed lamellar enhancement of the L4-5 vertebral bodies, narrowing of the intervertebral space, peripheral soft tissue edema, and spinal canal compression. After 3 weeks of empirical anti-tuberculosis therapy, the patient's symptoms did not improve, prompting posterior lesion debridement and autologous iliac bone grafting with pedicle screw fixation. Postoperatively, disc tissue cultures and next-generation sequencing (NGS) identified Candida tropicalis. The patient was subsequently treated with a six-week course of voriconazole, resulting in symptomatic improvement, with no recurrence observed during follow-up.

Conclusion: The imaging and clinical presentation of Candida tropicalis spondylitis can closely mimic that of tuberculous spondylitis, particularly in patients without clear risk factors for immune compromise. This overlap in presentation often complicates the differential diagnosis, leading to potential delays in appropriate treatment.

Ascaris lumbricoides (AL), a prevalent nematode causing ascariasis, infects millions worldwide, with a higher risk in preschool and school-aged children. Though infections are usually mild, rare and life-threatening complications like gastrointestinal perforation exist. This article documents a case involving a 61-year-old deaf-mute man who presented with a month-long history of epigastric pain accompanied by nausea, anorexia, and constipation. The pain exacerbated, eventually extended to encompass the entire abdomen 4 h prior to being diagnosed with hollow viscus perforation. During the surgical procedure, three live ascarids were discovered within the abdominal cavity, and the jejunum was found to be filled with a large number of ascarids, accompanied by a perforation in the gastric antrum. Subsequently, the ascarids were extracted, and the perforated area was repaired. Postoperatively, the patient underwent anti-infection therapy, acid suppression, gastric mucosa protection, and nutritional support. On postoperative day (POD) 1, a single dose of 400 mg albendazole was administered. Fecal samples on POD 3, 5, and 6 tested positive for AL eggs. The patient recovered smoothly with no evidence of peptic ulcer disease on one-month follow-up endoscopy. Additionally, fecal tests conducted over three consecutive days did not detect any AL eggs. This case highlights the crucial importance of recognizing ascariasis-associated complications and underscores the paramount role of timely surgical intervention in such cases. Meanwhile, this article combines cases of gastrointestinal perforation caused by AL documented in the literature since 1903, elaborates on the epidemiological characteristics, pathogenesis, diagnosis, treatment, and prevention of ascariasis, and analyzes the reasons for the occurrence of such complications.

Aim: The study aimed to explore the coexisting patterns and assess the significance of serum hepatitis B virus (HBV) RNA and traditional virological biomarkers in patients with antiviral treatment-naïve chronic hepatitis B virus (HBV) infection.

Methods: Serum HBV RNA, HBV DNA, hepatitis B surface antigen (HBsAg), and hepatitis B envelope antigen (HBeAg) levels were measured and compared in patients with chronic hepatitis B virus infection. The HBV RNA levels were determined using a simultaneous amplification and testing assay.

Results: In the HBeAg-negative (HBeAg [-]) patients, the serum HBV RNA detectable (HBV RNA [+]) rate (33.33%, 14/42) was significantly lower than the serum HBV DNA detectable (HBV DNA [+]) rate (95.24%, 40/42; p < 0.001). However, there was no significant difference in the HBeAg-positive (HBeAg [+]) patients (p > 0.05). The HBV RNA (+) rate (33.33%, 14/42) was lower in the HBeAg-negative patients than in the HBeAg-positive patients (100%, 17/17, p < 0.001), while the HBV DNA (+) rate (95.24%, 40/42 vs. 94.12%, 16/17) showed no significant difference (p > 0.05). The HBV RNA (+) rates showed a significant difference (p < 0.001) among the different HBsAg levels (10.00, 65.00, 84.21%, p < 0.001), while the HBV DNA (+) rate showed no significant difference (p > 0.05). In all patients, serum HBV RNA correlated well with HBV DNA (r = 0.72, p < 0.001), HBeAg (r = 0.68, p < 0.001), and HBsAg (r = 0.66, p < 0.001). However, the correlations between HBV RNA and other biomarkers varied across the different HBsAg and HBeAg levels.

Conclusion: The coexisting patterns of serum HBV RNA and HBV DNA varied with the levels of HBeAg and HBsAg in the patients with treatment-naïve chronic HBV infection. This further suggests that serum HBV RNA should be included in the key index panel to accurately evaluate the natural history of HBV infection and the effects of antiviral treatment.

Congenital thrombotic thrombocytopenic purpura (cTTP) is a thrombotic microangiopathy (TMA) characterized by severe hereditary ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motifs 13) deficiency caused by ADAMTS13 mutations. This rare autosomal recessive genetic disorder is often misdiagnosed as immune thrombocytopenia (ITP) or hemolytic uremic syndrome (HUS). Here, we report a 21-year-old male cTTP patient with a compound heterozygous ADAMTS13 mutation. The patient was admitted for acute thrombocytopenia, with a 5-year history of chronic thrombocytopenia and 1 month of renal dysfunction. Initially diagnosed with ITP, he was treated with immunosuppressive therapy, including glucocorticoids and intravenous immunoglobulin, which provided temporary relief but failed to prevent recurrent thrombocytopenia. Ultimately, cTTP was confirmed by the low ADAMTS13 0% activity and two heterozygous variants (c.1335del and c.1045C > T) in the ADAMTS13 gene, and the patient received prophylactic fresh-frozen plasma (FFP) infusions every 2-3 weeks regularly. Interestingly, the patient also exhibited elevated sC5b-9 levels during the acute phase, necessitating differentiation from HUS. This report highlights a cTTP caused by a compound heterozygous ADAMTS13 mutation, although its pathogenesis requires further investigation. Given the atypical clinical manifestations of cTTP, it is necessary to conduct ADAMTS13 activity and even genetic testing in patients with recurrent thrombocytopenia and end-organ damage.

Background: Psittacosis, also known as parrot fever, is an uncommon infectious disease caused by Chlamydophila psittaci (C. psittaci). While C. psittaci infections are usually not life-threatening, the pathogenesis and associated complications are not yet fully understood.

Case description: A 54-year-old male was hospitalized due to a cough, accompanied by expectoration and dyspnea. After admission, the patient's breathing rapidly deteriorated, and despite the use of a ventilator, it was challenging to maintain respiratory function. While initiating extracorporeal membrane oxygenation (ECMO) and empirical anti-infection treatments, the alveolar lavage fluid was collected and examined by metagenomics next generation sequencing (mNGS). The mNGS result indicated C. psittaci. Subsequently, the anti-infection regimen was immediately adjusted. The respiratory function improved on the 13th day after admission, and ECMO was withdrawn. However, the patient developed abdominal distension and intestinal edema. After intravenous infusion therapy, intestinal ischemia and necrosis occurred and surgical resection was performed. The patient's condition improved after the operation and he was transferred to a local hospital for rehabilitation.

Conclusion: This case report demonstrates the development of intestinal ischemic necrosis following severe C. psittaci pneumonia. This unique association has not been reported previously and highlights the importance of potential gastrointestinal complications in severe C. psittaci pneumonia, which are often underestimated. Timely diagnoses and treatments of such infections and complications are necessary to achieve favorable clinical outcomes.

Lumbar disc herniation (LDH) affects millions globally, with annual healthcare costs exceeding $100 billion in the United States alone, driving increasing interest in minimally invasive radiological interventions as treatment alternatives. This narrative review examines developments in collagenase chemonucleolysis for LDH, integrating a literature analysis with clinical experience. Key advancements include the transition from single-agent to combination therapies, exploration of diverse injection routes, and the progression from C-arm fluoroscopy to multi-slice CT guidance. The synergistic use of collagenase, oxygen-ozone, and anti-inflammatory analgesics has enhanced efficacy. Safety measures such as aspiration tests, contrast agent tests, and lidocaine tests implemented to mitigate procedural risks. However, challenges persist, including non-standardized dosages and potential complications arising from intradiscal injections. Future research should focus on establishing accreditation systems, refining patient selection criteria, optimizing drug dosages, and exploring advanced image-guided technologies. While chemonucleolysis offers advantages such as minimal invasiveness and cost-effectiveness, its complexity necessitates a multidisciplinary approach. Key findings demonstrate that combination therapy achieves superior outcomes compared to monotherapy, with long-term efficacy rates reaching 90% and 6-month success rates of 95%. Additionally, CT guidance has significantly improved procedural precision and safety compared to traditional fluoroscopy. This review provides insights for clinicians and researchers, highlighting the potential of chemonucleolysis in LDH management to ensure its safe and effective integration into mainstream treatment protocols.

Background: Frailty, a geriatric syndrome associated with adverse outcomes, lacks a universal definition. No consensus exists on the most effective frailty scale for predicting mortality.

Methods: This prospective observational study followed community-dwelling volunteers for 6 years. Frailty was measured with the Frailty Index (FI) and the Frailty Phenotype (FP). Concordance was assessed using Cohen's Kappa coefficients. Age-and sex-adjusted Cox regression analyses were conducted to evaluate the association with mortality.

Results: Out of 1,114 participants (median age 72 years, IQR 69-77), 186 were classified as frail by the FI, 13 by the FP and 48 by both definitions. The concordance between the two measures was fair (κ = 0.26). Thirty-nine individuals died during the follow-up period. The FI showed a stronger association with mortality (HR 75.29, 95% CI 8.12-697.68, p < 0.001) compared to the FP (HR 3.3, 95% CI 1.45-7.51, p = 0.004). Individuals classified as frail by both definitions had the highest mortality risk and the highest FI scores (median 0.36).

Conclusion: Definitions of frailty identify different individuals as frail. The FI was more closely related to mortality than the FP. Individuals classified as frail according to both definitions displayed the highest complexity (corresponding also ho higher FI scores) and the greatest mortality. The FI demonstrated a more accurate ability to predict mortality due to its comprehensive nature.

[This corrects the article DOI: 10.3389/fmed.2024.1490314.].

Background: To explore the application value of multi-disciplinary collaborative diagnosis (MDT) and treatment combined with the case-based learning (CBL) teaching method based on real clinical cases in gynecological malignant tumor practice teaching.

Methods: A total of 120 clinical students who were interning in the Department of Gynecology in our hospital from January 2022 to June 2023 were selected and divided into a research group (n = 60) and a control group (n = 60) according to the random number table method. The research group adopted a MDT combined with the CBL teaching model, while the control group followed a traditional teaching model. After the two-month internship, the teaching faculty completed a self-evaluation form, and the students jointly evaluated the teaching effect through an exit assessment, which included basic theory, clinical skills, and case assessment. Additionally, a questionnaire survey was conducted to evaluate the student's recognition of the teaching model and collect their opinions and suggestions.

Results: The research group showed significantly higher scores in basic theoretical knowledge, clinical skills, and case analysis assessments compared to the control group (p < 0.05). The questionnaire survey results indicated that the research group outperformed the control group in knowledge acquisition, learning initiative, learning interest, clinical analysis ability, clinical diagnosis, treatment thinking, teamwork ability, literature retrieval, and reading ability, and clinical language expression ability (p < 0.05). Students' feedback suggested increasing doctor-patient communication time and improving the doctor-patient communication skills.

Conclusion: MDT combined with the CBL teaching model based on real clinical cases can effectively foster autonomous learning, enhance the application of basic theoretical knowledge, and improves the quality of clinical teaching in gynecology. This method is worthy of promotion in clinical teaching.

Introduction: The minority of the chronic hepatitis B (CHB) patients received polyethylene glycol interferon (PEG-IFN) combined with nucleotide analogs (NAs) can obtain hepatitis B surface antigen (HBsAg) clearance.

Methods: In order to find out the advantaged population, we retrospectively collected 122 CHB patients treated with NAs alone or NAs plus PEG-IFN for 48 weeks, who were admitted to Sun Yat-sen Memorial Hospital from 2019 to 2024.

Results: We found HBsAg clearance rate in NAs plus PEG-IFN group was 40.98%, which was significantly higher than that in the NAs group. Thus, NAs plus PEG-IFN therapy served as a relatively ideal regimen and the patients received combined treatment were then incorporated for further analysis for searching efficacy predictors. Through using univariate and multivariate analysis, we confirmed the predictive value of HBsAg, alanine aminotransferase (ALT) at week 24, and ALT change values from baseline to week 24. The area under the receiver operating characteristic (ROC) curve of each indicators ranged from 0.663 to 0.982.

Discussion: In conclusion, our study verified the clinical value of NAs plus PEG-IFN for treating CHB patients. Moreover, for the first time, we found ALT change values from baseline to week 24 (dALT2) could act as a novel independent clinical efficacy predictors in the forementioned population.