Adult-Onset Still's Disease-A Complex Disease, a Challenging Treatment

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder with an unknown cause characterized by high-spiking fever, lymphadenopathy, hepatosplenomegaly, hyperferritinemia, and leukocytosis. The clinical course can be divided into three significant patterns, each with a different prognosis: Self-limited or monophasic, intermittent or polycyclic systemic, and chronic articular. Two criteria sets have been validated. The Yamaguchi criteria are the most generally used, although the Fautrel criteria offer the benefit of adding ferritin and glycosylated ferritin values. AOSD's pathogenesis is not yet completely understood. Chemokines and pro-inflammatory cytokines, including interferon (IFN)-γ, tumor necrosis factor α (TNFα), interleukin (IL)-1, IL-6, IL-8, and IL-18, play a crucial role in the progression of illness, resulting in the development of innovative targeted therapeutics. There are no treatment guidelines for AOSD due to its rarity, absence of controlled research, and lack of a standard definition for remission and therapy objectives. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are used in AOSD treatment. Biological therapy, including IL-1, IL-6, IL-18, and IL-17 inhibitors, as well as TNFα or Janus-kinases (JAKs) inhibitors, is administered to patients who do not react to CS and csDMARDs or achieve an inadequate response.

The Involvement of Smooth Muscle, Striated Muscle, and the Myocardium in Scleroderma: A Review

Systemic sclerosis (SSc) is a complex autoimmune disease characterized by heterogeneous changes involving numerous organs and systems. The currently available data indicate that muscle injury (both smooth and striated muscles) is widespread and leads to significant morbidity, either directly or indirectly. From the consequences of smooth muscle involvement in the tunica media of blood vessels or at the level of the digestive tract, to skeletal myopathy (which may be interpreted strictly in the context of SSc, or as an overlap with idiopathic inflammatory myopathies), muscular injury in scleroderma translates to a number of notable clinical manifestations. Heart involvement in SSc is heterogenous depending on the definition used in the various studies. The majority of SSc patients experience a silent form of cardiac disease. The present review summarizes certain important features of myocardial, as well as smooth and skeletal muscle involvement in SSc. Further research is needed to fully describe and understand the pathogenic pathways and the implications of muscle involvement in scleroderma.

Oral-Facial Manifestations Caused by the Use of Psychotropic Medication in Psychiatric Patients

The development of psychotropic chemotherapy with widespread use in the psychiatric clinic for its anxiolytic, hypnotic, antidepressant, psychostimulant or psycho-destructive sedative effects has given rise to a new pathology secondary to increased abuse and accessibility. Their neurotropism is generally exerted on the central nervous system at the level of the complex meso-diencephalo-striate structures, influencing the elementary psychic functions, but also the activity of the whole organism through the neuro-humoral system. The clinical investigation of the patient must be interdisciplinary in nature, as human beings are characterized by a bio-psycho-social unit, in which the various biological and psychological components, influenced to a greater or lesser extent by the social environment, are involved in a special way, which gives an original personality to everyone. There are five fundamental axes, which are usually evaluated: thinking, memory, attention, emotion and behavior. A disorder in any of these axes, intense enough to interrupt the normal activity in more than one operating field over a sufficiently long period of time, is diagnosable as a mental disorder. There is an indication borrowed from internal medicine regarding the acute character (weeks), subacute character (months) and chronic character (years), which is attached to the diagnosis. A small part of the entire psychiatric population suffers from severe conditions, which involve intermittent episodes of severe disinhibition, aggressive behavior and self- or hetero-directed violence. In most cases, we talk about conditions such as depression or anxiety disorders (panic disorder, phobias, obsessive-compulsive disorder), which do not make him a social predator, although they cause enormous suffering to the individual. This study includes 67 patients with mental illness. While conducting the study, we took into account that the first contact with the patient is essential for the results of the anamnesis, oral examination, risk assessment and provisional treatment plan. In the 67 cases there were performed mycological analyses. It is necessary that dentists have certain knowledge of psychology and psychopathology, in order to understand the mechanism of psychopathological reactions and avoid them.

Restoring the salivary cortisol awakening response through nasal continuous positive airway pressure therapy in obstructive sleep apnea

Partial and largely conflicting data are currently available on the interplay between obstructive sleep apnea (OSA) and hypothalamus-pituitary-adrenal axis (HPA) activity in adult obese men. This study was performed to evaluate the daily trajectories of salivary cortisol, specifically with respect to the salivary cortisol awakening response (CAR), a common method used to assess HPA axis activity. The main findings of this study were that adult male obese subjects who were newly diagnosed with severe OSA showed the following: (1) a flattening of the CAR; (2) levels of cortisol at awakening that were lower than those of the controls; and (3) maintenance of the physiological circadian activity of the HPA axis, with the highest hormone concentrations produced in the morning and the lowest in the evening. This study was also designed to investigate the effects of 3 and 6 mos of treatment with continuous airways positive pressure (CPAP). CPAP use resulted in a significant recovery of the sleep patterns disrupted by OSA; moreover, mild neuropsychological signs of depression and anxiety in severe OSA patients were concomitantly progressively improved by CPAP treatment. Furthermore, this study reports that 3 and 6 mos of CPAP therapy restored the presence of CAR and was able to significantly reduce the difference in the morning cortisol levels between the OSA and control groups. In conclusion, we report here that compared with obese nonapneic matched controls, OSA patients present a dysregulation of HPA axis activity, as shown by the flattening of the diurnal pattern of cortisol production in response to repeated challenge due to hypoxia and sleep fragmentation. This dysregulation was especially detectable in the first hour after awakening and restored after 3 and 6 mos of treatment with CPAP.