Vol. 7 No. 06 (2025)

This article presents an analysis of the clinical variability and diagnostic challenges associated with Epstein–Barr virus (EBV) infection in pediatric and adult populations. The study is based on an interdisciplinary approach, integrating data from virology, clinical immunology, and infectious disease pathology. The analysis focuses on age-specific clinical manifestations of EBV infection, differences in immunological markers and viral load, and the complexity of laboratory data interpretation in cases of chronic active EBV infection (CAEBV). Seropidemiological data from pediatric and adult cohorts are reviewed, including studies conducted in India, China, Japan, and Taiwan. Key clinical phenotypes are systematized across age groups, with detailed descriptions of typical manifestations of mononucleosis, latent and reactivated forms. Pathogenetic associations between EBV and autoimmune conditions (notably multiple sclerosis and inflammatory bowel disease) as well as lymphoproliferative disorders are explored. Particular attention is paid to diagnostic algorithms ranging from serological panels (VCA IgM/IgG, EBNA) to molecular and cytometric methods (PCR, EBER hybridization, T/NK-cell phenotyping). The analysis reveals a high level of diagnostic uncertainty, especially in atypical pediatric cases and chronic adult forms. Proposed approaches to diagnostic standardization take into account viral persistence, immune background, and geoepidemiological factors. The article includes three comparative tables illustrating age-related differences in clinical and laboratory features, symptom spectrum, and immunological markers of CAEBV. This work will be of value to clinicians, infectious disease specialists, immunologists, and researchers studying post-viral complications and systemic pathology associated with EBV persistence.

Background: Precocious puberty is the early onset of secondary sexual characteristics before age 8 in girls and 9 in boys. It is classified into central precocious puberty (CPP), which is GnRH-dependent, and peripheral precocious puberty (PPP), which is GnRH-independent. Hypothalamic hamartomas are a well-documented cause of CPP, while chronic rhinosinusitis has not been commonly associated with early puberty.

Case Presentation: We report a 6.5-year-old boy who presented with increased penile length, deepened voice, and axillary and pubic hair growth for six months. Additionally, he had a history of nasal obstruction, rhinorrhea, blurred vision, and mild headaches. Examination revealed signs of precocious puberty, including Tanner stage III pubic and axillary hair and an advanced bone age of 12 years. MRI revealed a hypothalamic hamartoma, while a CT scan showed chronic rhinosinusitis. Histopathology confirmed chronic inflammatory changes without fungal infection. The patient was initially considered for neurosurgical intervention, but after ENT evaluation, he was treated with intravenous antibiotics for chronic sinusitis. He showed clinical improvement, and surgery was no longer required.

Discussion: This case highlights a rare association between chronic rhinosinusitis and CPP. While hypothalamic hamartoma is a recognized cause of early puberty, chronic inflammation might contribute to HPG axis activation. Persistent sinonasal inflammation could induce systemic inflammatory responses affecting neuroendocrine regulation. This raises questions about the potential role of chronic infections in puberty onset.

Conclusion: Chronic rhinosinusitis may be an underrecognized factor influencing early puberty. Multidisciplinary evaluation, including endocrinology, neurosurgery, and ENT, is crucial in such cases to ensure accurate diagnosis and management. Further research is needed to explore the possible link between chronic inflammation and hypothalamic activation leading to precocious puberty.

Mammary Paget's disease (MPD), also known as Paget's disease of the breast, is an uncommon dermatological cancer of the nipple-areolar complex that can cause anything from redness and itching to more serious symptoms like breast lumps, destruction of the nipple-areolar complex, or nipple discharge. It is typically linked to either invasive ductal carcinoma or an underlying ductal carcinoma in situ. MPD can cause delayed diagnosis and improper therapy because it frequently presents as various benign and malignant dermatological disorders, such as eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas. Since only one-third of patients have a palpable lump when they first arrive, MPD should be suspected in patients who are older and have unilateral, persistent lesions. In order to distinguish MPD from other skin illnesses, our review paper highlights the major findings of clinical features and diagnostic workup. It also includes case studies of MPD mimicking other skin conditions. According to a study of the literature, research advises against using mammograms and ultrasounds alone to diagnose MPD, especially when there isn't a palpable lump. This demonstrates that the MRI is a better and more precise imaging method. However, because MRI results can occasionally be negative when there is a biopsy-proven MPD present, any suspicious lesion needs to be biopsied in order to undergo histological and immunohistochemical analysis. This highlights the need for clinicians to explore any suspicious lesion of the nipple or breast using the complete triple evaluation technique to exclude an underlying cancer. It is vital to establish therapeutic criteria to treat any nipple lesion to limit the risk of misdiagnosing any underlying cancer, which can be potentially lethal if left alone.

Growing pains are a prevalent condition in children, often leading to discomfort and anxiety for both patients and their families. These pains typically manifest as bilateral limb discomfort that occurs primarily in the evenings or at night, affecting approximately 10-20% of the pediatric population. Despite their benign nature, growing pains pose significant challenges in pediatric emergency care due to their episodic nature and lack of specific diagnostic markers.

Recent research has shifted the understanding of growing pains from a simplistic view of mere skeletal growth to a multifactorial condition influenced by genetic predisposition, vitamin D deficiency, hypermobility syndrome, and psychosocial factors. This evolving perspective introduces new diagnostic uncertainties as healthcare providers must differentiate growing pains from serious underlying conditions, such as infections, malignancies, and autoimmune disorders.

Communication with parents plays a critical role, as they often seek immediate reassurance amid concerns about their child's health. The integration of mental health evaluations and tailored pain management strategies, including non-pharmacological approaches, is essential for effective treatment. Additionally, establishing structured follow-up care can aid in monitoring symptom progression and improving long-term outcomes.

In conclusion, addressing growing pains requires a holistic approach that encompasses both physical and psychological aspects of care. By enhancing the understanding of this condition and improving communication and management strategies, pediatric emergency care can better support children experiencing growing pains and their families

In this study, we investigated whether electrolysis is a more effective method of hair removal in clients with polycystic ovary syndrome (PCOS) than laser hair removal. A total of 203 women with PCOS who completed a full course of electrolysis between 2021 and 2025 were examined. The study focused on hormonal sensitive facial areas ( chin, cheeks, upper lip, sideburns), were traditional light-based treatments usually fail. We compared clinical outcomes, safety, cost, and client satisfaction. Electrolysis has repeatedly shown superior efficacy for permanent hair removal, particularly in hormonally sensitive facial areas for all skin types. Laser hair removal in clients with polycystic ovary syndrome was reported to cause paradoxical hair growth (paradoxical hypertrichosis). Although electrolysis required more treatment sessions, it ultimately offered a more reliable, cost-effective, and permanent solution. Based on our findings, we prioritize electrolysis over laser hair removal when planning the treatment of facial hirsutism associated with polycystic ovary syndrome.

Alzheimer's disease (AD) is the most common cause of dementia which results in progressive decline in memory, cognitive and functional abilities of patients. Pressure ulcers are a common complication in patients with AD in skilled nursing facilities (SNF) and contribute significantly to the mortality rate.^{1, 2} Pulsed short wave diathermy (PSWD) treatment has been shown to promote faster healing of pressure ulcers.¹² The purpose of this case report was to examine the effect of PSWD treatment on Stage III sacral pressure ulcer healing and its impact on sitting balance in an 80 year old female with advanced AD residing in an SNF.

Case Description

The patient was an 80-year-old female with stage 6 AD and a Stage III sacral pressure ulcer.

Intervention

The patient underwent 16, hour long physical therapy sessions over 4 weeks focused on localized PSWD treatment for wound healing alongside interventions to improve muscle strength, sitting balance, posture, and positioning.

Outcomes

Patient's sacral ulcer improved to Stage III healed, evidenced by 100% eschar and no slough tissue. Pain was effectively managed, with a final Pain Assessment in Advanced Dementia (PAINAD) score of 0. The patient's Braden Scale for Predicting Pressure Sore Risk (BRADEN) score improved to 18, indicating reduced risk for skin breakdown. The patient’s Function in Sitting Test (FIST) score improved to 46/56, indicating improved sitting balance.

Discussion

This case report demonstrates that PSWD facilitates faster wound healing and improved pain management in patients with AD. This case report encourages future research to validate the efficacy and safety of PSWD in similar patient populations.

Chronic headache disorders, particularly chronic migraine, present significant diagnostic and therapeutic challenges due to their complex neurobiological underpinnings. This study aims to elucidate the clinical, neurophysiological, and neuroimmunological characteristics of various chronic headache forms and to propose optimized treatment strategies based on individualized assessments. A cohort of patients with chronic migraine and other persistent headache syndromes underwent comprehensive evaluation, including EEG analysis, autonomic testing, and immunological profiling. Our findings reveal distinct neurophysiological markers, such as alterations in cortical excitability and autonomic imbalance, as well as specific immune patterns that correlate with headache severity and frequency. Moreover, personalized treatment protocols, integrating pharmacological, neuro-modulatory, and lifestyle interventions, demonstrated improved therapeutic outcomes compared to standard regimens. These results highlight the necessity of a multimodal diagnostic and therapeutic approach in managing chronic headaches effectively.

Ischemic stroke remains a leading cause of mortality and long-term disability globally, necessitating reliable prognostic markers for effective patient management and therapeutic stratification. This article explores the emerging role of the Neutrophil Percentage-to-Albumin Ratio (NPAR) as a novel and readily accessible prognostic indicator for mortality in patients suffering from ischemic stroke. Drawing upon current literature, we delve into the intricate pathophysiology of ischemic stroke, emphasizing the dual roles of inflammation (mediated by neutrophils) and protective mechanisms (attributed to albumin). The discussion highlights how an elevated NPAR reflects a heightened pro-inflammatory state and diminished antioxidant capacity, both detrimental in the acute phase of stroke. Evidence from various cardiovascular and critical illness contexts, alongside specific findings in ischemic stroke, supports NPAR's utility in predicting not only mortality but also stroke-associated infections and poor functional outcomes. This review synthesizes the current understanding of NPAR's predictive power, its underlying biological mechanisms, and discusses its potential clinical implications, while acknowledging the need for further large-scale prospective studies to validate its widespread application in clinical practice.