Sleep in chronic fatigue syndrome
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
Chronic fatigue syndrome (CFS) is a chronic, complex, systemic disease that often can profoundly affect the lives of patients. Sleep disturbances are frequently reported in CFS, and these complaints have been shown to persist throughout the course of the illness. Patients with CFS describe sleep to be a vital process for health and well-being, which has a direct bearing on the course and progression of their illness. Considered together, the theoretical model of the role of sleep in CFS may explain the process by which fatigue develops, is maintained and continues via a cycle of irregular sleeping patterns, biological dysregulation, and cognitive and behavioral responses. Self-report techniques have been employed to determine the perceptual role of sleep in CFS and include the use of sleep diaries and sleep questionnaires, such as the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale.
Coma and reduced level of consciousness
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
Coma and reduced level of consciousness may result either from global cerebral dysfunction or from pathology affecting the reticular activating system located in the brainstem. Global cerebral dysfunction may be caused by systemic disease or by specific central nervous system disorders. Damage to the reticular activating system may result from pathology directly affecting the brainstem, or from indirect compression of this area due to raised intracranial pressure. In clinical practice, the causes of coma and reduced conscious level are most conveniently classified into systemic and central nervous system categories. Local central nervous system pathology may be further classified into infectious, inflammatory, vascular, neoplastic and miscellaneous categories. Confusion in the elderly may be precipitated by almost any acute illness. Conditions that commonly present with acute confusion in the elderly include urinary retention, constipation and myocardial infarction. Glasgow Coma Scale score, this is a standardised method of measuring a patient's level of consciousness.
Hair and Nails
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Hair, derived from the epidermis, develops around the third to fourth months of fetal life. At birth, the number of hair follicles on the scalp and on other parts of the body stabilises and no more follicles are developed. The hairs are typically broken at various lengths. Vellus hair is fine, soft and non-pigmented, and covers most of the body before puberty. Terminal hair, in contrast, is coarse, curly and pigmented. Pubertal androgens promote the conversion from vellus to terminal hair. Hair growth in excess of what is expected for age, sex and ethnicity is termed hirsutism or hypertrichosis. The nails become thickened and dystrophic. Abnormal nails may occur as a result of generalised skin disease, skin disease confined to the nails, systemic disease, fungal or bacterial infection or tumour. In paediatrics, nail clubbing is the most important of all nail abnormalities.
The eye in systemic disease
Published in South African Family Practice, 2014
The eye is a unique organ which is often involved in systemic disease. Patients with systemic disease may first present with eye pathology, and patients with known systemic illnesses may need to have their eyes specifically checked for ocular complications. It is thus useful for the physician to be familiar with the ocular manifestations of common systemic diseases at primary care level. Diseases like diabetes, herpes zoster ophthalmicus and thyroid ophthalmopathy often involve the eyes, and if the eye signs are not identified early, the visual consequences can be devastating. Diabetic retinopathy is an important cause of blindness in this country. These, as well as common ocular manifestations of human immunodeficiency virus/acquired immune deficiency syndrome, syphilis, some dermatological conditions and the ocular side-effects of certain drugs, are discussed in this article. It is important for the primary care physician to be familiar with the spectrum of ocular involvement in systemic diseases since appropriate intervention and referral can be sight saving for the patient.
Clinical presentation, treatment, and outcomes of patients with central nervous system involvement in extranodal natural killer/T-cell lymphoma
Published in Leukemia & Lymphoma, 2019
Kathryn S Nevel, Elena Pentsova, Mariza Daras
Extranodal natural killer (NK)/T-cell lymphoma (ENKTCL) is a rare type of Non-Hodgkin’s lymphoma which rarely metastasizes to the central nervous system (CNS). Ten of 60 patients (16.7%) with ENKTCL followed at Memorial Sloan Kettering Cancer Center (MSKCC) were diagnosed with CNS involvement between 1995 and 2016. Eight patients had systemic disease at the time of CNS diagnosis; one patient never developed systemic disease and another was in remission at the time of CNS relapse. Median overall survival was 3.8 months; at time of this report 9 patients have died and one who underwent autologous stem cell transplant (ASCT) is alive 27 months after CNS diagnosis. Five patients achieved a complete response in the CNS; one is still alive, one died of systemic disease, and three died of infection. CNS ENKTCL portends a grim prognosis, with no standard treatment. Prospective study on ASCT and immunotherapy in CNS ENKTCL is warranted.
Isolated and Transient Nuclear Midbrain Blepharoptosis in a Young and Healthy Adult
Published in Neuro-Ophthalmology, 2020
Bulent Yazici, Gamze Ucan Gunduz, Nukhet Yargic
A 32-year-old otherwise healthy man presented with acute-onset bilateral blepharoptosis of 6 days’ duration. On examination, he had severe ptosis bilaterally and mildly restricted abduction in the left eye. Brain magnetic resonance imaging showed a 10-mm-diameter lesion in the dorsal midbrain. The ptosis resolved spontaneously within two weeks. Systemic investigation did not uncover any aetiological factor. During 70 months’ follow-up, neither any systemic disease nor ptosis relapse developed. Isolated nuclear midbrain ptosis has been previously reported in a few patients and these had neoplastic or inflammatory causes. In this patient, spontaneous resolution of the nuclear ptosis within weeks suggested that the underlying cause might be isolated ischaemic damage to the central caudal nucleus.
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