Retrograde Cricopharyngeus Dysfunction, a New Motility Disorder: Single Center Case Series and Treatment Results.

Background/Aims: Retrograde cricopharyngeus dysfunction (R-CPD) is a new clinical entity characterized by inability to belch and associated symptoms of loud gurgling noises, chest and/or abdominal pressure, abdominal bloating, and excessive flatulence. R-CPD can be treated with botulinum toxin (BT) injection in the upper esophageal sphincter. We hereby report patient demographics, symptomatology, and treatment results of a series of consecutive patients who presented at our center. Methods: Data on 50 consecutive patients presenting with R-CPD were prospectively collected using a standardized questionnaire prior to, 1 month after treatment and at the end of follow-up. All patients were diagnosed using a set of clinical symptoms. Results: Fifty patients (26 females) were included, median age was 27.5 years (range, 17-65). Median body mass index was 22.7 kg/m2 (range, 16.6-37.5). Inability to belch was present in all patients, > 90% of patients experienced gurgling noises and abdominal/chest discomfort as result of their condition. One month after injection of BT, 40.8% of patients experienced complete relief of symptoms, 24.5% good symptom improvement, 24.5% some symptom improvement and 10.2% no improvement. At median follow-up of 29 months (range, 3-50) post-treatment, 51.3% (n = 20/39) of patients reported persistent complete relief of symptoms, 12.8% good improvement of symptoms (n = 5/39), in 15.4% some improvement (6/39) and 20.5% loss of or no response (n = 8/39). Only minor and transient side effects were reported. Conclusions: Our case series of 50 patients with R-CPD shows very good short-term and good long-term improvement of symptoms after injection of BT. These results are in line with previous studies.

Case report: renal recovery in Goodpasture's syndrome treated with rituximab.

Successful induction of remission in anti-glomerular basement membrane (anti-GBM) glomerulonephritis can be obtained by using rituximab as a first-line immunosuppressive agent. We report the case of a 20-year-old male patient with Goodpasture's (anti-GBM) syndrome, with poor prognostic factors at presentation including intra-alveolar hemorrhage and dialysis-dependent rapidly progressive glomerulonephritis. The diagnosis was confirmed on kidney biopsy and serology (anti-GBM antibody titer). Rituximab was used as the first-line immunosuppressive agent in combination with pulse corticosteroids and plasmapheresis, to avoid potential side effects of cyclophosphamide. Anti-GBM antibody titers became undetectable after initiating rituximab. No adverse events were reported, and the patient became dialysis-independent after 6 months. This case reports the successful remission of a patient with Goodpasture's syndrome after induction with rituximab.

Anterior Tibiotalar Fat Pad Involvement in Ankle Osteoarthritis: MRI Features in Patients 1 Year After a Lateral Ankle Sprain.

OBJECTIVE: To investigate the characteristics of the anterior tibiotalar fat pad (ATFP) in the ankle joint in a population of patients 1 year after an ankle sprain and its correlation with systemic factors and local articular pathology. DESIGN: The study is a secondary analysis of an observational case-control study. We included 206 patients who were followed 6-12 months after ankle sprain. T1 MRI scans were assessed for signal intensity and area of ATFP by mapping the fat pad using dedicated imaging software (Mimics 18.0). Quantitative values of intensity and area were generated. Linear regression analysis was used to examine the association between both local and systemic factors and the ATFP. Variables with a P value <0.2 were entered in 5 stepwise multivariate models: (1) age-sex-body mass index (BMI); (2) anamnesis; (3) physical examination; (4) radiographic findings; and (5) MRI findings. Predictors in these separate models were entered in the final model. RESULTS: The final multivariate model showed a significant positive association between age (P = 0.04; 95% confidence interval [CI] = 1.13 ± 1.06), BMI (P = 0.05; 95% CI = 3.61 ± 3.53), and sex (P < 0.01; 95% CI = -49.26 ± 30.04) with T1 intensity. The final model also showed a significant negative association between age (P < 0.01; 95% CI = -0.57 ± 0.34), diffuse cartilage loss in the lateral talus (P = 0.03; 95% CI = -0.71 ± 0.63), and Kellgren and Lawrence score in the tibiotalar joint (P < 0.01; 95%CI = -21.61 ± 7.24) and ATFP area. A positive association was found between BMI (P < 0.01; 95% CI = 2.25 ± 1.15) and ATFP area. CONCLUSION: This study demonstrates a correlation between ATFP and both systemic factors and local pathology in the ankle joint.

RSV induced rhabdomyolysis: a case report.

OBJECTIVE: Rhabdomyolysis induced by an RSV infection is a clinical entity. CASE PRESENTATION: A few years ago, one case of severe rhabdomyolysis associated with RSV was described. We present the case of an 18-year-old patient without relevant medical history with a nearly asymptomatic presentation of severe rhabdomyolysis induced by an RSV infection. He consulted the primary physician because of a cough with purulent sputa. A routine blood sample showed elevated creatine kinase levels and the patient was hospitalized. An extensive work-up could exclude other causes of rhabdomyolysis. Creatine kinase levels showed a spontaneous decrease. CONCLUSION: This case report highlights an important but very rare presentation of rhabdomyolysis associated with RSV in an adult patient. RSV should be considered as a possible etiological agent for rhabdomyolysis.

Aseptic meningitis after SARS-CoV-2 Pfizer/BioNTech vaccination.

OBJECTIVE: Aseptic meningitis is a rare, but possible severe side effect after SARS-CoV-2 Pfizer/BioNTech vaccination. CASE PRESENTATION: Recently, a first case of aseptic meningitis after the first shot of mRNA-BNT162b2 SARS-CoV-2 (Pfizer/BioNTech) vaccine was reported. We present the first case of a 34-year-old woman without relevant medical history developing aseptic meningitis after her 2nd Pfizer/BioNTech vaccination. She was admitted with severe headache and fever for 5 days prior to her presentation at the emergency department. An extensive work-up of the clinical problem could narrow the differential diagnosis. Symptoms resolved after methylprednisolone therapy. CONCLUSION: This case highlights a rare but important side effect after vaccination that primary physicians and neurologists should be aware of in order to identify and efficiently manage these patients.

Heart failure related to adult congenital heart disease: prevalence, outcome and risk factors.

AIMS: Information on the prevalence, outcome and factors associated with heart failure in patients with adult congenital heart disease (CHD) (ACHD-HF) is lacking. We aimed at assessing the prevalence and outcome of ACHD-HF, the variables associated with ACHD-HF, and the differences between major anatomical/pathophysiological ACHD subgroups. METHODS AND RESULTS: We included 3905 patients (age 35.4 ± 13.2 years) under active follow-up in our institution (last visit >2010). Outcome of ACHD-HF cases was compared with sex- and age-matched cases. Univariable and multivariable binary logistic regression with ACHD-HF diagnosis as a dependent variable was performed. Overall prevalence of ACHD-HF was 6.4% (mean age 49.5 ± 16.7 years), but was higher in patients with cyanotic CHD (41%), Fontan circulation (30%), and a systemic right ventricle (25%). All-cause mortality was higher in ACHD-HF cases when compared with controls (mortality rate ratio 4.67 (2.36-9.27); P = 0.0001). In multivariable logistic regression analysis, age at latest follow-up [per 10 years; odds ratio (OR) 1.52; 95% confidence interval (CI) 1.31-1.77], infective endocarditis (OR 4.11; 95%CI 1.80-9.38), history of atrial arrhythmia (OR 3.52; 95%CI 2.17-5.74), pacemaker implantation (OR 2.66; 95% CI 1.50-4.72), end-organ dysfunction (OR 2.41; 95% CI 1.03-5.63), New York Heart Association class (OR 9.28; 95% CI 6.04-14.25), heart rate (per 10 bpm; OR 1.27; 95% CI 1.08-1.50), ventricular dysfunction (OR 3.62; 95% CI 2.54-5.17), and pulmonary hypertension severity (OR 1.66; 95% CI 1.21-2.30) were independently related to the presence of ACHD-HF. Some variables (age, atrial arrhythmia, pacemaker, New York Heart Association, and ventricular dysfunction) were related to ACHD-HF in all anatomical/physiological subgroups, whereas others were not. CONCLUSIONS: ACHD-HF is prevalent especially in complex CHD and is associated with poor prognosis. Our data provide insight in the factors related to ACHD-HF including differences between specific anatomical and physiological subgroups.

Experiences of women receiving mhealth-supported antenatal care in the village from community health workers in rural Burkina Faso, Africa.

OBJECTIVE: This qualitative study explored the experiences of women receiving mhealth-supported antenatal care in a village, from community health workers (CHWs) in rural Burkina Faso, Africa. INTERVENTION: CHWs entered patient clinical data manually in their smartphone during their home visits. All wireless transferred data was monitored by the midwives in the community clinic for arising medical complications. METHODS: Semi-structured interviews were conducted with 19 pregnant women, who were housewives, married and their age ranged from 18 to 39 years. None had completed their formal education. Depending on the weeks of gestation during their first antenatal care visit, length of enrollment in the project varied between three and eight months. Transcripts were content-analyzed. RESULTS: Despite the fact that mhealth was a novel service for all participants, they expressed appreciation for these interventions, which they found beneficial on three levels: 1) it allowed for early detection of pregnancy-related complications, 2) it was perceived as promoting collaboration between CHWs and midwives, and 3) it was a source of reassurance during a time when they are concerned about their health. Although not unanimous, certain participants said their husbands were more interested in their antenatal care as a result of these services. CONCLUSION: Findings suggested that mhealth-supported visits of the CHWs have the potential to increase mothers' knowledge about their pregnancy and, as such, motivate them to attend more ANC visits. In response to this increased patient engagement, midwives approached women differently, which led to the mothers' perception of improvement in the patient-provider relationship. Results also indicated that mhealth may increase spousal involvement, as services are offered at home, which is an environment where spouses feel more comfortable.