Methotrexate(MTX) is widely used in rheumatology practice for rheumatoid arthritis and many other conditions, including psoriatic arthritis, autoimmune connective tissue diseases, sarcoidosis, and vasculitis. The most common adverse effects of MTX include nausea, fatigue, dizziness, headache, stomatitis and abdominal pain. Serious adverse effects include hepatotoxicity, pulmonary toxicity, nephrotoxicity, myelosuppression and increased risk of lymphoproliferative disorders. In our review of the literature, case reports of sexual dysfunction have beeen reported during MTX therapy. We report here one case of sexual dysfunction during MTX therapy.
Parotid gland agenesis (PGA) is a rare congenital anomaly, often detected incidentally due to its typically asymptomatic nature. We report a 44-year-old woman referred for a neck CT scan because of dysphagia, which revealed complete absence of the left parotid gland, confirmed by ultrasound. The remaining salivary glands were normal. The patient had no facial asymmetry, syndromic features, recurrent infections, or xerostomia. Physical and oral examinations were unremarkable except for the absence of the left parotid papilla. Parotid agenesis may occur sporadically or in association with genetic syndromes. Asymptomatic unilateral agenesis generally requires no intervention, while symptomatic cases are managed with supportive oral care. Awareness of this rare anomaly is important to prevent misdiagnosis and unnecessary procedures, especially given the prevalence of parotid-origin salivary gland malignancies.
Purpose: This study compared empathy between first-year and fifth-year medical students and examined how self-compassion, burnout, and alexithymia relate to empathy in a Turkish medical school. Materials and Methods: In this cross-sectional study, 155 medical students (88 first-year, 67 fifth-year) completed the Jefferson Scale of Empathy (student version), the Maslach Burnout Inventory, the Self-Compassion Scale, and the Toronto Alexithymia Scale. Results: Fifth-year students scored higher on empathy than first-year students (99.1 +/- 12.8 vs. 90.8 +/- 12.7; r = 0.38). Burnout was higher in fifth-year students (45.4 +/- 7.3 vs. 40.4 +/- 8.9; d = 0.61) and alexithymia higher in first-year students (55.1 +/- 9.2 vs. 50.3 +/- 8.7; d = 0.54). Greater overidentification was associated with lower empathy (Spearman's rho = -0.22), an association confined to first-year students. In hierarchical regression, class year was the only individual predictor of empathy ((3 = 0.43) and explained about ten times more variance than all psychological variables combined. Sensitivity analyses confirmed this effect. Conclusion: In this sample, empathy was higher in students nearing graduation, contrary to the empathy erosion hypothesis. The cross-sectional design cannot separate cohort from training effects; longitudinal, multi-institutional studies are needed.
Purpose: This study aimed to evaluate the developmental pattern of mastoid pneumatization in the pediatric population and to investigate its relationship with the anatomical positioning of the mastoid segment of the facial canal. Materials and Methods: Computed tomography images of patients were retrospectively analyzed. Pneumatization degree was classified into four categories: The hypopneumatization, moderate, good, and hyperpneumatization. Measurements of the facial canal, including its distance to the external acoustic meatus, sigmoid sinus, posterior cranial fossa and mastoid surface, were obtained by two independent observers. Results: A total of 197 children (91 males,106 females; mean age 6.31 +/- 5.36 years) were included. Pneumatization degree differed significantly across age groups, with hypopneumatization most commonly observed in the infancy period and increasing progressively until the post-pubescent stage. Measurements of the facial canal varied significantly across pneumatization categories: The distance between the canal and the mastoid surface was greatest in the hyperpneumatized group (14.34 +/- 2.91 mm), whereas the canal sigmoid sinus distance was significantly larger (10.77 +/- 2.66 mm) in moderately pneumatized bones. Conclusion: Mastoid pneumatization demonstrates a clear age-dependent progression throughout childhood and adolescence, and the degree of pneumatization significantly influences the spatial relationships of the mastoid segment of the facial canal.
Purpose: The aim of this study is to evaluate the neurodevelopmental prognosis of fetuses with congenital heart defects by considering aortic flow and oxygen saturation in the ascending aorta, and to investigate them in terms of cortical developmental delay. Materials and Methods: In this retrospective study, neurosonographic and hemodynamic parameters were measured in fetuses diagnosed with congenital heart defects. These measurements were compared with those of gestational-age-matched low-risk controls in the second and third trimesters. Standard fetal biometry, transcerebellar diameter, Sylvian fissure area, and related ratios were evaluated. Results: The study included 53 fetuses with congenital heart defects and 72 controls in the second trimester, and 72 fetuses with congenital heart defects and 58 controls in the third trimester. In the second trimester, the Sylvian fissure area was lower in the CHD group (50.98 +/- 21.02 mm2 vs 58.37 +/- 16.41 mm2), while the HC/SYL ratio was higher in the CHD group in both the second trimester (4.53 +/- 1.69 vs 3.44 +/- 0.74) and the third trimester (2.71 +/- 1.31 vs 2.09 +/- 0.49). Neurodevelopmental parameters showed that the Sylvian fissure area was smaller in the second-trimester congenital heart defects group compared with controls. Consequently, the aortic valve diameter/Sylvian fissure area and head circumference/Sylvian fissure area ratios were higher in the congenital heart defects group. In the third trimester, patients with normal aortic flow and two functional ventricles had higher aortic valve diameter/Sylvian fissure area ratios than other patient groups. Conclusion: Detecting early-onset cortical developmental delay in patients with left cardiac dysfunction using proportional data is crucial for a holistic approach to evaluation. Incorporating head circumference/Sylvian fissure area and aortic valve diameter/Sylvian fissure area ratios into routine prenatal follow-up measurements may help identify fetuses at potential risk for adverse postnatal neurodevelopmental outcomes.
