BackgroundWe aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM).MethodsThis case–control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders.ResultsFifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%).ConclusionSD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM.

The publications regarding the continuing of pandemic coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing. Increased age, hypertension, cardiovascular diseases, lung diseases, and diabetes mellitus seem to be the main risk factors for mortality in COVID-19 [1]. However, the possible association between obstructive sleep apnea syndrome (OSAS), repetitive airway collapse with apnea/hypopnea and hypoxia during sleep, and COVID-19 has not been reported yet.Angiotensin converting enzyme 2 (ACE2) is the entry receptor of SARS-CoV-2 [2]. Of note, the increased expression of ACE and dysregulation of renin angiotensin system in untreated OSAS patients due to chronic intermittent hypoxia has been shown [3]. Furthermore, cardiovascular complications or comorbidities such as hypertension, heart failure, coronary artery disease, cerebrovascular diseases, diabetes mellitus, and obesity-those are also risk factors for mortality in COVID-19-are commonly seen in OSAS patients [1,4]. Fibrotic changes can also be seen after and fibrosis was peviously shown to be a risk factor for OSAS.To the best of our knowledge, this is one of the first reports highlighting the possible association between OSAS and COVID-19. Herewith, presenting this clinical perspective is two-fold. First, OSAS may be a risk factor for mortality or deteriorate the clinical scenario in COVID-19. Therefore, keeping in mind the modulating effects of sleep on the immune system, proper treatment of OSAS patients may be protective/beneficial in COVID-19. Second, patients who suffered from COVID-19, particularly severe cases, may be under risk for OSAS due to pulmonary fibrosis. Clinicians should be cautious against the OSAS presence during the later periods in relevant patients.

BackgroundA number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function.MethodsThe present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points) and MMSE (cutoff: ≤24 points) scores were compared between these two groups.ResultsThe nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively) as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year.ConclusionIn the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

Reflex epilepsies can be provoked by various types of external stimuli, but triggered by smell is rare in the literature. In this case report, we present a patient whose reflex epilepsy is triggered by smell. Physical examination findings and electrophysiologic studies of the patient are discussed.

Alice in Wonderland syndrome (AIWS), named for Lewis Carroll's titular character, is a disorder characterized by transient episodes of visual hallucinations and perceptual distortions, during which objects or body parts are perceived as altered in various ways (metamorphopsia), including enlargement (macropsia) or reduction (micropsia) in the perceived size of a form. Migraine aura is a transient neurological symptom that most commonly involves the visual fields and occurs before the headache phase. Aura symptoms include the perception of flashing lights that begin in the center of vision and expand in jagged patterns out into the periphery. Symptoms may be somatosensory, such as numbness and tingling in the lips or fingers. They may also involve a profound alteration of the perception of space and time (the "Alice in Wonderland" syndrome). In this article, we present a child had Alice in Wonderland syndrome as aura of migraine.

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