Superior vena cava (SVC) syndrome develops because of intravascular thrombosis or extrinsic compression of the SVC. Current literature shows that 90%- 97% of SVC syndrome cases are due to malignant mediastinal disease, and a small proportion of the cases develop because of benign conditions. The classic symptoms include dyspnea, cough, headache, facial and arm swelling. We present a rare case of SVC syndrome caused by retrosternal goiter in a 77-year-old woman. After confirming the diagnosis, total thyroidectomy was performed, resulting in complete remission of compressive symptoms. Multidisciplinary management is necessary to avoid complications in the treatment of high-risk patients with SVC syndrome.
Sphingolipids are a complex group of lipids that are becoming increasingly important in many aspects of disease and cell physiology. They are composed of a long-chain sphingoid base backbone, a long-chain fatty acid linked by an amide bond, and one or more polar head groups the structures of which are characterized by different sphingolipid subtypes such as ceramide, sphingomyelin, and glycosphingolipids. The metabolism of these lipids plays an integral role in scaling body functions. They take involvement in the membrane domains and signaling, inflammation, cell proliferation, death, migration, and central nervous system development. Due to their discovery as potent messenger and signaling molecules, sphingolipids have lately attracted interest and are now thought to be potential therapeutic targets for a number of diseases. Here, we provide a thorough overview of sphingolipid metabolism and numerous biological functions inside the cell. Additionally, we draw attention to the sphingolipid involvement in a number of diseases, such as cancer, cystic fibrosis, and inflammatory disease, Alzheimer’s disease, Parkinson’s disease, and diseases related to lysosomal storage.
The sequence of deterioration in different cognitive domains, depending on the severity of Alzheimer's disease (AD), is still largely unknown. The aim of this study was to use the Mini-Mental State Examination (MMSE) scale to divide subjects into six groups of disease severity and compare the deterioration in cognitive domains (orientation in time and place, working memory, concentration, recall, language, and visuospatial orientation) between the groups. A total of 624 par-ticipants with a median age of 76 years (interquartile range (IQR) 70-80 years) were included in the study. A significant difference in age was observed between participants with severe cognitive impairment compared to other participants. No difference in sex structure was observed between the groups. The highest fluctuation, even in persons without cognitive impairment, was observed in the recall and concentration domains, followed by visuospatial orientation. The first deteriorated domains with progression of the disease were concentration and visuospatial orientation. Deterioration then continued in orientation in time and place, language, and working memory. The results can be used to predict the development of the disease, as well as for the adequate planning and testing of therapeutic approaches for AD.
Intravenous sedation for endoscopic retrograde cholangiopancreatography (ERCP) in patients aged 65 years or older is associated with respiratory instability. During ERCP, oxygen therapy is commonly delivered using a conventional nasal cannula (CNC) or a high flow nasal cannula (HFNC). Respiratory instability may require minor airway interventions (MAI), including chin lift, secretion suctioning, the insertion of an oropharyngeal airway, or escalation from CNC to HFNC. This randomized controlled trial aimed to compare the incidence of MAI in patients receiving HFNC versus CNC during ERCP. In this single center, prospective, randomized, controlled trial, 115 patients aged 65 years or older undergoing ERCP under intravenous sedation were randomized to HFNC (n = 58) or CNC (n = 57). The primary outcome was the incidence of MAI in each group. MAI occurred in 30 patients (26.1%) overall and significantly less frequently in the HFNC group (7 of 58, 12.1%) than in the CNC group (23 of 57, 40.4%) (P < 0.001; relative risk (RR) 0.30, 95% confidence interval (CI) 0.14-0.64). Chin lift was the most frequent MAI. No associations between MAI and age, sex, or the American Society of Anesthesiologists (ASA) physical status were observed. HFNC significantly reduces the incidence of MAI compared with conventional nasal cannula oxygen therapy.
This study aimed to evaluate the impact of low-level laser therapy (LLLT) and topical vitamin B12 treatment on patients with burning mouth syndrome (BMS). A total of 123 patients were enrolled and assigned randomly into three groups: LLLT, B12, or no-treatment. Patients completed the EuroQol Five-Dimension Health-Related Quality-of-Life (EQ-5D-5L HRQoL) questionnaire and a visual analog scale (VAS) both before and after treatment. The data were analyzed using R 4.4.2 statistical software to compare pre- and post-treatment differences. Significant differences in the post-treatment period were observed between the three groups for pain/discomfort, anxiety/depression, and VAS scores. Both the B12 and LLLT groups had significantly higher post-treatment scores compared to those in the no-treatment group. Although the differences between the B12 and LLLT groups were not statistically significant, the LLLT group had consistently higher scores. Significant improvements were observed in the LLLT group (P < 0.001). Similarly, pain/discomfort (P < 0.001) and anxiety/depression (P < 0.001) improved significantly after treatment (P < 0.05) in the B12 group. LLLT and topical vitamin B12 therapy both improved the overall systemic health status of patients with BMS, with LLLT being more effective than topical vitamin B12 treatment.
