Primary Sjögren syndrome-related peripheral neuropathy: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. METHODS: A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. RESULTS: The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. CONCLUSIONS: PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.

Rare Causes of Cerebral Venus Sinus Thrombosis: A Systematic Review.

Background: Cerebral venous sinus thrombosis (CVST) is a rare manifestation of thrombosis commonly caused by thrombophilia, hormonal-related factors, non-cerebral malignancy, and hematologic diseases. The aim of this review was to identify and summarize rare CVST cases. Methods: A literature search of the Medline database was performed in November 2022. CVST cases of a common cause were excluded. Demographic and clinical data were extracted. Eligible cases were categorized into inflammatory, primary CNS tumors, post-operative/traumatic, and idiopathic groups to allow statistical group comparisons. Results: 76 cases were analyzed. Idiopathic CVST was most frequently reported followed by inflammatory, post-traumatic/operative and primary CNS tumor causes. The intracranial hemorrhage rate was 23.7% and it was found to increase in the inflammatory group (45.8%). Anticoagulation was used in the majority of cases and it was significantly related to better outcomes. A low rate of anticoagulation use (43.8%) was found among CVST cases in the post-operative/traumatic group. The overall mortality rate was 9.8%. 82.4% of patients showed significant early improvement. Conclusions: Most rare CVST cases were either of idiopathic or inflammatory origin. Interestingly, hemorrhage occurred often he idiopathic CVST cases. A low rate of anticoagulation use in neurosurgical CVST cases after trauma or head surgery was observed.

Primary Sjögren's syndrome (pSS)-related cerebellar ataxia: a systematic review and meta-analysis.

BACKGROUND: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder characterized by lymphocytic infiltrates of the exocrine glands, particularly the salivary and lacrimal glands, resulting in oral and ocular dryness. pSS has been linked to various neurological manifestations, including cerebellar dysfunction. We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related cerebellar ataxia. METHODS: A systematic literature search in the PubMed database was performed and 19 papers were eligible to be included in this paper. RESULTS: The pooled prevalence of cerebellar ataxia in pSS is estimated to be 1.5% (95% CI 0.3-6.8%). pSS patients with cerebellar involvement have a female-to-male ratio of 6:1. Although most of the patients are adults in their fifth decade of life when diagnosed, cases of children with pSS and cerebellar involvement have been reported. Typical cerebellar ataxia related to pSS manifests with vermian dysfunction, namely gait ataxia and/or cerebellar speech. Cerebellar ataxia due to pSS may also mimic degenerative cerebellar ataxia, especially when the onset is progressive. CONCLUSIONS: The diagnostic approach to a patient with cerebellar ataxia of unknown etiology should include evaluation for an underlying pSS. A thorough history and clinical examination, antibody testing, brain MRI imaging and/or MRS of the cerebellum will assist in establishing the diagnosis. Setting up a joint neuro-rheumatology clinic can be valuable given that rheumatic and neurological diseases share comorbidities.

Adjuvant physical exercise for the management of painful polyneuropathy.

INTRODUCTION: Physical exercise appeared to be effective, when implemented as an adjuvant to the pharmacotherapy option, in a variety of painful conditions. Peripheral neuropathic pain (PNP) is very prevalent and affects up to two-thirds of individuals with polyneuropathy (PN), regardless of etiology. The aim of this systematic review was to evaluate the currently available studies that assess adjuvant physical exercise for the management of PNP. METHODS: A systematic literature search was conducted in the PubMed international database. For the systematic search, three medical subject headings (MeSH) were used. Term A was 'physical exercise' OR 'exercise' OR 'activity' OR 'workout' OR 'training'; term B was 'pain' OR 'painful'; term C was 'neuropathy' OR 'polyneuropathy.' Additionally, three filters were used: human subjects, English language, and full text. The reference lists of eligible papers and relevant reviews were also meticulously searched in order to include further relevant studies. Six papers eligible to be included were identified. RESULTS: Physical exercise in various forms can be of benefit in the management of PNP when used as an adjuvant to the standard care. Overall, using the American Society of Interventional Pain Physicians (ASIPP) criteria, the current best available evidence exists for both aerobic and muscle strengthening exercise programs (level II evidence). The intensity of the exercise seems to play a significant role, with higher intensity interval training programs being more promising, though this remains to be confirmed in future studies. CONCLUSIONS: Physical exercise is a promising non-pharmacological intervention for the management of PNP. Future RCTs should be conducted to make a face-to-face comparison of the available exercise treatments with the aim to design specific exercise programs for patients with PNP.

Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students' Burnout and Mental Health.

OBJECTIVES: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. BACKGROUND: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. METHODS: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory-Student Survey (MBI-SS). RESULTS: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). CONCLUSIONS: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

Burnout among medical students in Cyprus: A cross-sectional study.

OBJECTIVES: The primary aim was to estimate the burnout prevalence among all medical students at the Medical School of the University of Cyprus. Secondary aims were to ascertain the predictors of burnout and its relationship with lifestyle habits, sleep quality and mental health. BACKGROUND: Burnout in the healthcare sector has drawn significant scientific attention over the last few years. Recent research underscored the large burden of profession-related burnout among medical students. MATERIALS AND METHODS: An anonymous questionnaire was administered to all 189 eligible candidates. This included demographic and lifestyle characteristics. Sleep quality was assessed via the Pittsburg Sleep Quality Index, mental health was assessed via the mental health (MH) domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory-Student Survey (MBI-SS). RESULTS: Overall response rate was 96.3%. The burnout prevalence was 18.1%. There was a significant linear effect of between the year of studies and the burnout frequency [F(1) = 5.09, p = 0.024], implying that with increasing academic year there were more students with burnout, especially after the 4th year of education which signifies the beginning of clinical education. Students with burnout were more likely to have poor sleep quality (90.9% vs. 60.8%, odds ratio 4.33, p = 0.023) and worse mental health (MH score 40.2 ± 17.7 vs 62.9 ± 20.3, p<0.001). Alcohol consumers had more symptoms of cynicism and less feelings of efficacy than non-alcohol consumers. Moreover, less feelings of efficacy were significantly associated with more alcohol consumption among alcohol consumers. CONCLUSIONS: Burnout is prevalent in medical students and increases significantly during the clinical years. Students with burnout have worse sleep and mental health and might use alcohol as a coping mechanism. Implementing prevention strategies of burnout may be beneficial.