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To meet the diagnostic criteria for pEDS, a person must meet: Major criterion 1 AND two other major criteria AND one minor criterion OR Major criterion 2 AND two other major criteria AND one minor criterion Major Criteria Severe and intractable periodontitis of early onset (childhood or adolescence) Lack of attached gingiva Pretibial plaques Family history of a first-degree relative who meets the clinical diagnostic criteria for pEDS Minor Criteria Easy bruising Joint hypermobility, mostly distal joints Skin hyperextensibility and fragility, abnormal scarring (wide or atrophic) Increased rate of infections Hernias Marfanoid facial features Acrogeria Prominent vasculature Spondylodysplastic EDS (spEDS) If a person meets the diagnostic criteria for spEDS, genetic testing should be done to confirm the diagnosis

Recent findings indicate that excessive ROS production in HT leads to structural changes in thyroglobulin and thyroid peroxidase, increasing their immunogenicity (Batg et al

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3.5 Clostridium in primary Sjgrens syndrome The primary Sjgrens syndrome (pSS) is a type of AD characterized by inflammation and destruction of exocrine glands, primarily manifesting as xerophthalmia and xerostomia (201)