Abstract Introduction With its increasing prevalence, myasthenia gravis requires reliable prognostic tools. Neutrophil-lymphocte ratio (NLR) offers a simple inflammatory marker to aid early risk evaluation. This meta-analysis aimed to clarify the role of NLR in predicting MG outcomes to support earlier clinical risk stratification. Methods A comprehensive search of PubMed, ScienceDirect, Google Scholar, and Europe PMC were conducted from inception to November 2025. Studies were included if they compared NLR between MG patients and controls or evaluated its prognostic value, while nonclinical research, case reports, reviews, conference abstracts, and non-English papers were excluded. Secondary outcomes were other inflammatory measures, such as white blood cell counts, blood cell differentials, platelet–lymphocyte ratio (PLR), and lymphocyte–monocyte ratio (LMR). Methodological quality was assessed using the QUADAS-2 tool. Results Seven retrospective cohort studies including 1,526 participants were evaluated. Patients with MG had significantly increased white blood cell counts [WMD 1.00 (95% CI: 0.63–1.37; I² = 0%)], neutrophil counts [MD 0.75 (95% CI: 0.15–1.36; I² = 0%)], and NLR values [MD 0.52 (95% CI: 0.07–0.96; I² = 63%)]. No consistent differences were observed in lymphocyte or monocyte counts. Platelet levels were similar, though PLR was generally higher and LMR lower in MG patients. Diagnostic analysis demonstrated that NLR reliably predicted severe MG, with pooled sensitivity of 0.82, specificity of 0.71, and AUC of 0.85. Conclusions NLR is associated with disease severity in MG. NLR may serve as a simple, accessible, and cost-effective marker for disease activity.
Background: Electroencephalography (EEG) can characterize functional brain alterations in multiple sclerosis (MS), but many EEG features vary with age. We therefore examined resting-state EEG associations with MS using age-adjusted models while explicitly accounting for the severe age imbalance in the available dataset. Methods: Resting-state 128-channel EEG data from the BrainLat dataset were analyzed. Demographic files included 32 patients with MS and 32 healthy controls (HC); global-feature models included 29 patients with MS and 32 HC, and channel-level sample sizes varied by feature. Diagnosis and age were entered in linear models. Benjamini-Hochberg false discovery rate (FDR) correction was applied separately to five global spectral/aperiodic tests, 16 global microstate tests, and the 128 channel-wise tests within each feature. Within-MS continuous age regression and exploratory age-stratified ANOVA were evaluated with the same family definitions. Results: After correction, diagnosis coefficients were significant for global bandwidth (β = 1.928, q = 0.0287), global aperiodic offset (β = 1.816, q = 3.29 × 10⁻⁷), and offset at all 128 channels (β range = 1.52–2.41; q range = 3.56 × 10⁻⁸ to 7.43 × 10⁻⁵). Global central frequency, exponent, PSD, and all 16 microstate measures did not survive FDR correction. No within-MS continuous-age or age-stratified result survived FDR correction. Conclusions: Aperiodic offset showed the strongest diagnosis association under the specified age-adjusted model. However, the MS and HC age ranges did not overlap (21–55 vs 56–83 years), so the diagnosis coefficient depends on extrapolation and cannot establish an MS-specific effect. The findings are exploratory and require age-matched replication with detailed clinical, vigilance, site, sex, and MRI characterization.
Introduction: Preclinical studies have demonstrated that dexmedetomidine (DEX), a sedative widely used in intensive care units (ICU), exerts neuroprotective effects. However, its potential protective role and underlying mechanisms in ischemic stroke patients with atrial fibrillation (IS-AF) remain unclear. The studyʼs objective was to assess the connection between the early administration of DEX and short-term mortality from all causes in patients with IS-AF. Methods: From the MIMIC-IV database, patients with IS-AF were identified, including those who were administered DEX and those who were not. The primary endpoint was 7-day all-cause mortality, and the secondary endpoint was 90-day all-cause mortality. Propensity score matching (PSM) was utilized to ensure baseline covariates were balanced. Cox proportional hazards models and Kaplan-Meier survival curves and were utilized to evaluate the association between DEX use and mortality, with subgroup analyses conducted to ensure the findingsʼ robustness. Results: In total, 1,355 patients with IS-AF participated, with 253 (18.7%) receiving DEX. After PSM, 208 pairs were matched. In the fully adjusted model, DEX administration was significantly associated with lower all-cause mortality compared with the control group at both 7 days (before PSM, HR = 0.36, 95% CI: 0.19–0.68, p = 0.002; after PSM, HR = 0.26, 95% CI: 0.12–0.54, p < 0.001) and 90 days (before PSM, HR = 0.84, 95% CI: 0.66–1.07, p = 0.162; after PSM, HR = 0.72, 95% CI: 0.53–0.97, p = 0.031). The subgroup analyses revealed that DEXʼs protective effect was stronger in patients aged 70 and above, females, those with hypertension, and those without heart failure or chronic kidney disease. Kaplan-Meier survival curves consistently illustrated that DEX users had greater survival probabilities both before and after matching. Conclusion: In patients with IS-AF, DEX administration is connected to decreased all-cause mortality mortality, underlining the possible importance of DEX in ICU settings.
Votive offerings (ex voto) are material objects deposited in sacred spaces as expressions of gratitude, petitions for divine assistance, or as part of consecration rituals. In Eastern Orthodox Christianity, particularly in Greece and the Balkan region, these offerings frequently take the form of tamata; these are small metal votive plaques depicting body parts or organs often rendered with a high degree of realism. Here we report previously unreported tama depicting a child/young adolescent with features suggestive of Parry-Romberg syndrome, also known as progressive hemifacial atrophy. The 18th-19th century collection of votive offerings from the Orthodox Monastery of Floreşti (Romania) was examined. Among the seven identified objects, one tama portrays a child/adolescent, approximately 10–15 years of age, in the shape of an angel, with evident pathological features. The artifact was carefully examined by a multidisciplinary team following the International Guidelines for Iconodiagnosis in order to establish a consensus diagnosis and to determine the level of iconodiagnostic evidence. The votive plaque displays right-sided hemifacial atrophy, ipsilateral enophthalmos, and atrophy of the right upper and lower limbs. A deliberate reduction in the size of the right wing compared to the contralateral side is also evident. Correlation of these morphological features with clinical data from the medical literature supports the iconodiagnostic hypothesis of Parry-Romberg syndrome with possible ipsilateral extension to both the upper and lower limbs (level II iconodiagnostic evidence). This tama may represent an early Orthodox votive depiction of Parry-Romberg syndrome. This finding highlights the value of votive collections as interdisciplinary sources for the historical documentation of rare diseases and for the application of iconodiagnosis within a religious context.
Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease requiring complex multidisciplinary care. As disability advances, patients’ and caregivers’ needs may diverge. Methods: The objectives of the study were to assess needs, priorities and satisfaction with care among people with ALS (pALS) and their caregivers; to examine the association between satisfaction and quality of life (QoL); to explore differences according to clinical characteristics; to understand the Italian ALS community's willingness to engage in research. In this cross-sectional multicenter study, 154 pALS and 211 caregivers were recruited (July 2021–November 2022). Structured interviews explored information received, care priorities, research expectations and satisfaction. Answers to the interview were compared between patients and caregivers and between different patients’ subgroups with the chi-square or Fisher’s exact test. The scores of QoL questionnaires were compared between satisfied and unsatisfied patients (ALSAQ-40) and caregivers (SF-36) with the Wilcoxon-Mann-Whitney test. Results: Patients prioritized finding a cure (95%) and overcoming disease-related limitations (72%) over safe and tolerable drugs (55%), similarly to caregivers. Research on psychological and emotional support was rated more important by caregivers (70%) than patients (49%). QoL was higher among satisfied patients, with better ALSAQ-40 scores in mobility, daily activities, communication and emotional domains. Caregivers needing urgent psychological support were fewer among the satisfied (35%) than the not satisfied (50%), and SF-36 mental health scores were also higher in satisfied caregivers. Conclusion: Incorporating both pALS and caregiver perspectives into clinical practice and research planning may enhance patient- and family-centered care, improve QoL, and better align healthcare research and resources with societal needs.
