Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis.

We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.

Ultrasound-Guided Radiofrequency Ablation of Locally Recurrent Thyroid Carcinoma.

INTRODUCTION: We aimed to evaluate the effectiveness and safety of radiofrequency ablation (RFA) for non-surgical treatment of locally recurrent thyroid cancers, in both well-differentiated and medullary thyroid carcinomas (DTC and MTC) that are not amenable to traditional treatments. METHODS: We conducted a retrospective review of 48 patients with 103 recurrent tumors (81 DTC, 22 MTC) who underwent ultrasound-guided RFA. Patients were followed for 12-37 months to observe the outcomes and complications. RESULTS: 64 tumors (62.1%) completely disappeared at the last follow-up visit with 61 (59.2%) being resolved within 12 months. Technical success (volume reduction ratio (VRR) > 50%) was 96% (n = 99) in all tumors. The mean largest diameter of treated tumors decreased from 11.2 ± 5.3 to 2.4 ± 3.4 mm (p value < 0.001), and the mean volume decreased from 501.0 ± 807.0 to 41.6 ± 97.1 mm3 at the last follow-up (mean VRR = 91%). Our patients had a 77.1% recurrence-free survival rate (11 recurrences, 7 DTC, 4 MTC), with an overall mean recurrence-free survival time of 34.6 months (95% confidence interval, 30.0-39.1). We observed 3 cases with complications (voice changes in DTC patients) that completely resolved during follow-ups. CONCLUSION: RFA is a safe and effective alternative to repetitive surgeries in recurrent loco-regional DTCs as well as MTCs. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort/follow-up study.

A review of non-alcoholic fatty liver disease in non-obese and lean individuals.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of hepatic disorders. It represents a wide range of chronic liver diseases in patients with no history of significant alcohol consumption, starting with simple steatosis and progressing towards non-alcoholic steatohepatitis, cirrhosis, and ultimately hepatocellular carcinoma. NAFLD is usually associated with type 2 diabetes mellitus, dyslipidemia, metabolic syndrome, and obesity. This disease has mostly been studied in obese individuals; however, it has been widely reported and studied among the lean/non-obese population in recent years. The pathogenesis of NAFLD in non-obese patients is associated with various genetic predispositions, particularly a patatin-like phospholipase domain-containing protein 3 G allele polymorphism, which results in the accumulation of triglyceride in the liver and resistance to insulin. Additionally, dietary factors such as high fructose consumption seem to play a substantial role in the pathology of non-obese NAFLD. Although there is not enough evidence on the treatment of NAFLD in non-obese patients, the standard approach is to advise altering one's lifestyle in order to diminish visceral adiposity. Dietary modification, weight loss, and increased physical activity are highly recommended. We aimed to review and summarize the existing information on the prevalence, pathogenesis, genetic predispositions, diagnosis, and treatment of NAFLD in non-obese patients according to the latest literature.

Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature.

Pruritus is one of the most common complaints among patients referred to a dermatology clinic. "Chronic generalized pruritus" is described as the sensation of itching on the entire body surface, which lasts at least 6 or more weeks. This symptom can be a disabling phenomenon for patients and may sometimes interfere with daily activities such as sleep. If specific dermatological findings are observed, the physician easily comes to a diagnosis and treats the condition, whereas, when primary lesions are not detected, the diagnosis can become challenging, and some patients have to undergo extensive evaluations. The association between some systemic disorders and chronic generalized pruritus is widely known and confirmed. Many infections have been associated with pruritus, but few are considered to cause chronic generalized pruritus without any characteristic skin lesions. We aimed to gather all the available data on infectious causes of chronic generalized pruritus with no diagnostic cutaneous lesions to assist fellow physicians in the process of evaluation of these challenging cases.

Association between carotid intima-media thickness and ulcerative colitis: a systematic review and meta-analysis.

BACKGROUND: Early detection of atherosclerosis is an essential means of decreasing cardiovascular events and its associated mortality. Systemic inflammatory diseases such as ulcerative colitis (UC), are thought to be a contributing factor to atherosclerosis due to the rise of inflammatory cytokines. OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the association between atherosclerosis and UC. METHODS: This systematic review and meta-analysis was performed in February 2017 with no date restrictions. PubMed, Cochrane Library and Embase were searched to discover all available observational studies on atherosclerosis among UC patients. The STROBE criteria were used to assess the quality of the included articles. Heterogeneity was assessed by the I-square statistic and publication bias with funnel plot and Egger's regression test. Overall summary mean difference was calculated as study effect size using random effect model. Comprehensive Meta-Analysis Software version 2.2 was used to perform analyses. RESULTS: A total of 5 articles met our eligibility criteria. We included a sum of 206 UC patients and 229 non-UC individuals in our review with a mean difference of c-IMT ranged from 0.03±0.0 to 0.16±0.03 mm, and a pooled mean difference of 0.127 mm (95% CI 0.058-0.195: I2 =90.266%). Potential publication bias did not exist for the UC. CONCLUSION: Our findings showed significant differences in carotid intima-media thickness among UC and Non-UC groups, making c-IMT a viable choice as a predicting marker for atherosclerosis. Thus, we suggest that policy makers assess and consider its application in future protocols for the follow up and management of UC patients.