Abnormal Lesions Research Articles

Ocular sarcoidosis: A clinicopathological study

Abstract Purpose: This study aims to deliver an in-depth analysis and detailed account of 15 patients diagnosed with ocular and periocular sarcoidosis, each case substantiated by biopsy and histopathological examination. Furthermore, our series emphasizes the critical role of computed tomography (CT) scans in assessing the lacrimal gland, particularly when clinical symptoms, paraclinical findings, and radiological evidence suggest the presence of sarcoidosis. Methodology: We conducted a retrospective analysis of biopsy-diagnosed sarcoidosis cases at the MUHC-McGill University Ocular Pathology and Translational Research Laboratory spanning from 1995 to 2023. Pathological descriptions were thoroughly assessed, and clinical information was obtained from medical records for each patient. Results: A total of 15 cases were analyzed, 8 females and 7 males, with ages ranging from 16 to 89. All biopsies revealed granulomatous inflammation characterized by discrete, noncaseating granulomas. The most common site for biopsy was the lacrimal gland, followed by conjunctiva. Patients who underwent lacrimal gland biopsy exhibited bilateral, symmetrical enlargement of the gland, as confirmed by a CT scan. Conclusion: Diagnosing sarcoidosis presents significant challenges. Conducting blind biopsies is inadvisable and should be avoided. Targeted biopsies of abnormal lesions in the conjunctiva and eyelid have been proven to be diagnostic. In cases of suspected sarcoidosis, a CT scan of the orbit serves as an invaluable tool for determining the optimal biopsy site, thereby enhancing diagnostic accuracy.

Clinical characteristics and MRI features of autoimmune glial fibrillary acidic protein astrocytopathy: a case series of 34 patients.

To analyze the clinical and imaging characteristics of autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). Forty-three patients diagnosed with GFAP-A between March 2017 and July 2023 were retrospectively recruited. The clinical characteristics and magnetic resonance imaging (MRI) features were collected. Twenty-one patients (61.8%) had a fever and 16 (47.1%) had a headache. Five patients (14.7%) had coexisting neural autoantibodies and one patient (2.9%) had a coexisting neoplasm. The most common presentation was meningoencephalomyelitis (13/34, 38.3%), followed by meningoencephalitis (12/34, 35.3%). The other clinical manifestations included blurred visions (5/34, 14.7%) and peripheral nervous system involvement (4/34, 11.8%). Twenty-six patients (76.5%) had elevated nucleated cell count, predominantly lymphocytes (15/15, 100%), and 27 (79.4%) had elevated protein levels of cerebrospinal fluid. One-half (50%) of the patients presented with hyponatremia. A majority of the patients (30/33, 90.9%) exhibited abnormal hyperintense lesions on T2WI, which were often located in juxtacortical white matter (18/33, 54.5%), followed by periventricular white matter (16/33, 48.5%), basal ganglia (15/ 33, 45.5%), brainstem (11/33, 33.3%), and thalamic lesions (9/33, 27.3%). Twenty-four patients (72.7%) had abnormal brain enhancement, with supratentorial leptomeningeal enhancement being the most frequent enhancement pattern (15/33, 45.5%), followed by linear perivascular radial enhancement (14/33, 42.4%). Nineteen patients (70.4%) had hyperintense intramedullary spinal cord lesions, with long segments (15/27, 55.6%) and transverse lesions (14/27, 51.9%) being the most frequent lesions. Most cases were sensitive to immunotherapy, such as glucocorticoids, intravenous immunoglobulin, and tacrolimus, with three patients (8.8%) experiencing relapses. Patients with brainstem lesions had higher onset modified Rankin scale scores and were more prone to intensive care unit admissions. Linear perivascular radial enhancement was positively associated with poor prognosis (p < 0.05). GFAP-A presented with meningoencephalomyelitis and meningoencephalitis. The brain lesions were often located in juxtacortical white matter, periventricular white matter, basal ganglia, brainstem, and thalamus. Long segments and transverse were the most frequent spine lesions. Leptomeningeal enhancement was the most frequent enhancement pattern, followed by linear perivascular radial enhancement, which may provide new insight into the differential diagnosis of GFAP-A.

Spinal Cord Infarction Following Transarterial Chemoembolization of Hepatocellular Carcinoma with Chest Wall Metastasis: A Case Report and Review of the Literature

Spinal cord infarction (SCI) is a rare but detrimental complication following transarterial chemoembolization (TACE). The case report presented a case of hepatocellular carcinoma (HCC) involving the lateral chest wall for which the patient underwent TACE, targeted at the right ninth intercostal artery. After the intervention, the patient fully developed complete spinal cord syndrome immediately after TACE. Magnetic resonance images of the spinal cord showed abnormal hyperintense lesions on T2-weighted images involving the anterior and central part of the 9th to 11th thoracic spinal cord, compatible with SCI. Although corticosteroids were not administered, the patient’s condition subsequently improved, being capable of walking with a gait aid. SCI after TACE is a possible disabling adverse event. To prevent this complication, the collateral vessels of the spinal arteries, such as the intercostal arteries, should be avoided. Furthermore, monitoring for the symptoms of SCI, especially in the first 24 hours after the intervention, should also be done in all TACE cases. Keywords: Spinal cord injury; Spinal cord infarction; Transarterial chemoembolization; Hepatocellular carcinoma; Case report

Comparison of the transarterial, transvenous, and superior ophthalmic vein approaches in the treatment of indirect carotid-cavernous fistulas.

Indirect carotid-cavernous fistulas (CCFs) are abnormal arteriovenous shunting lesions with a highly variable clinical presentation that depends on the drainage pattern. Based on venous drainage, treatment can be either transarterial (TA) or transvenous (TV). The aim of this study was to compare the outcomes of indirect CCF embolization via the TA, TV, and direct superior ophthalmic vein (SOV) approaches. The authors conducted a retrospective analysis of 74 patients admitted to their institution from 2010 to 2023 with the diagnosis of 77 indirect CCFs as confirmed on digital subtraction angiography. A total of 74 patients with 77 indirect CCFs were included in this study. Embolization was performed via the TA approach in 4 cases, the TV approach in 50 cases, and the SOV in 23 cases. At the end of the procedure, complete occlusion was achieved in 76 (98.7%) cases. The rate of complete occlusion at the end of the procedure and at last radiological follow-up was significantly higher in the SOV and TV cohorts than in the TA cohort. The rate of recurrence was highest in the TA cohort (25% for TA vs 5.3% for TV vs 0% for SOV, p = 0.68). The rate of immediate complete occlusion was higher in the TV and SOV cohorts than in the TA cohort while the rate of complete occlusion at final follow-up was highest in the SOV cohort. The SOV approach was significantly associated with higher rates of postoperative complications. Indirect CCFs require careful examination of the fistulous point and the venous drainage to provide the most effective patient-tailored approach.

Association of Human Leukocyte Antigens (HLA) with Keloids and Hypertrophic Scar in Thais

Background: Keloids and hypertrophic scars are abnormal fibro-proliferative lesions. Associations between genes, the human leukocyte antigen (HLA) system in particular, and keloids have been studied in various ethnic groups but not in Thais. Objective: To investigate the association of HLA alleles with keloids and hypertrophic scars in Thais. Materials and Methods: The present study employed a retrospective case-control design. Scar assessment was performed on 139 kidney donors who underwent nephrectomy at Ramathibodi Hospital between January 2008 and December 2015. The wound scars after nephrectomy were evaluated and graded by a plastic surgeon using the modified Vancouver Scar Scale. Kidney donors who were unable to communicate well or who had autoimmune diseases or complications from surgery were excluded from the study. The diagnosis of a keloid scar, hypertrophic scar, and flat scar was made by clinical criteria. The donors were categorized into groups with three scar types, flat as the control group, hypertrophic, and keloid. The associations between the frequencies of HLA antigen with hypertrophic scar and keloids were measured with an odds ratio using logistic regression analysis. Results: Of the 139 living kidney donors, 15 (10.8%) had keloids, 46 (33.1%) had hypertrophic scars, and 78 (56.1%) had flat scars. Sixty-one HLA-A, -B, -DRB1, and -DQB1 alleles were evaluated in the present study. Compared with controls, the allele frequency of HLA-DRB1*15 was significantly higher in the keloid group at 43.33% versus 24.36% (odds ratio 2.37, 95% confidence interval 1.06 to 5.33, p=0.036). No significant association between HLA alleles and hypertrophic scars was found. Conclusion: The present study demonstrated the positive association of HLA-DRB1*15 with keloids in Thai individuals. The HLA-DRB1*15 could be a susceptibility factor for the development of keloids. Keywords: Human leukocyte antigen; Keloids; Thais, HLA-DRB1; Positive association

Diagnostic Value of Ileal Lesions Found during Colonoscopy with Reference to Endoscopic Indications and Findings.

The diagnostic value of ileoscopy is not well established, and its routine practice is controversial. We aimed to investigate the diagnostic value of biopsy for macroscopically abnormal lesions in the terminal ileum and to identify the association between endoscopic indications and findings and the presence of significant disease. This retrospective study included 551 patients who underwent biopsy of abnormal lesions in the terminal ileum (TI) during colonoscopy between February 2000 and June 2019. Biopsy results were analyzed in relation to the endoscopic indications and gross findings. Significant disease was defined as a case in which a specific disease was suspected or confirmed by the biopsy results, requiring additional examination or treatment. Among the 551 biopsies from macroscopically abnormal lesions in the TI, 44 (8.0%) had significant diseases. The frequency of significant disease was high in patients with clinically suspected inflammatory bowel disease (IBD) (50.0%), anemia (31.6%), right lower quadrant (RLQ) pain (28.6%), and radiological abnormalities in the TI (27.5%). The frequency of Crohn's disease (CD) was high in patients with clinically suspected IBD. A concurrent abnormality in the ileocecal valve (ICV) (14.3%) and the presence of an ulcer (14.2%), mass, or polyp (25.4%) correlated with a high incidence of significant disease, particularly CD. In cases of suspected IBD, anemia, RLQ pain, and radiologic abnormalities in the TI, there is a high possibility of significant disease. Ulcers, masses, polyps, and concurrent abnormalities in the ICV were also associated with significant disease.

Optimized fuzzy K-nearest neighbor approach for accurate lung cancer prediction based on radial endobronchial ultrasonography

Radial endobronchial ultrasonography (R-EBUS) has been a surge in the development of new ultrasonography for the diagnosis of pulmonary diseases beyond the central airway. However, it faces challenges in accurately pinpointing the location of abnormal lesions. Therefore, this study proposes an improved machine learning model aimed at distinguishing between malignant lung disease (MLD) from benign lung disease (BLD) through R-EBUS features. An enhanced manta ray foraging optimization based on elite perturbation search and cyclic mutation strategy (ECMRFO) is introduced at first. Experimental validation on 29 test functions from CEC 2017 demonstrates that ECMRFO exhibits superior optimization capabilities and robustness compared to other competing algorithms. Subsequently, it was combined with fuzzy k-nearest neighbor for the classification prediction of BLD and MLD. Experimental results indicate that the proposed modal achieves a remarkable prediction accuracy of up to 99.38%. Additionally, parameters such as R-EBUS1 Circle-dense sign, R-EBUS2 Hemi-dense sign, R-EBUS5 Onionskin sign and CCT5 mediastinum lymph node are identified as having significant clinical diagnostic value.

FIRST REPORT OF RAPHIDASCARIS LOPHII INFECTION IN BLUEFIN SEAROBIN (CHELIDONICHTHYS SPINOSUS)

This study reports on diseased Chelidonichthys spinosus fish that were originally obtained from the Taiwan Strait for exhibition in an aquarium. These fish showed abnormal swimming behavior, eye damage and skin lesions. Gross examination and histopathology revealed that the C. spinosus was suffering from severe nematode infections in the pyloric caeca, liver and mesentery. Marine nematodes from internal organs were verified by partially sequencing the internal transcribed spacer (ITS) gene. Sequencing results revealed that the nematodes shared 99.75% sequence identity with Raphidascaris lophii (GenBank accession No. MW132926). Additionally, secondary Vibrio harveyi infections were also detected in some C. spinosus. This is the first report of R. lophii infection in C. spinosus.

The mean relative signal intensity ratio (SIR) difference in patients undergoing dynamic contrast enhanced magnetic resonance imaging (DCE MRI) for diagnosis of pituitary microadenoma.

Objective: To determine the mean relative signal intensity ratio (SIR) difference in patients undergoing dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) for the diagnosis of pituitary microadenoma. Study Design: Descriptive, Cross-sectional study. Setting: Radiology Department, Allied Hospital I, Faisalabad. Period: 5th April 2021 to 4th October 2022. Material &amp; Methods: A total of 65 individuals undergoing magnetic resonance imaging with dynamic contrast enhancement of pituitary gland of any gender aged between 20 and 60 years were encompassed. Patients taking any medication (antipsychotics, anti-depressants, opiates or antiemetics), hepatic or renal failure, uncontrolled DM and hypothyroidism were excluded. Senior radiologist interpreted the DCE MR images. Pituitary microadenoma was assessed according to operational definition. For all patients, a region of interest (ROI) was defined on the area displaying varying enhancement, specifically identified as zone A. Amongst the entire patient population, a second ROI was made in the pituitary gland's normal-appearing tissue identified as zone B. Signal intensity time curves were created for all patients using both SIR T and SIR P, and the disparity between SIR T and SIR P was calculated. Relative SIR difference was calculated. Results: In my study, mean relative signal intensity ratio (SIR) difference in patients undergoing the utilization of DCE MRI for detecting pituitary microadenomas was 0.212 ± 0.181. The relative SIR difference on DCE MRI in patients with pituitary microadenoma was 0.35 ± 0.12 and in patients without pituitary microadenoma it was 0.03 ± 0.01. Conclusion: This study concluded that estimation of pre contrast T1 signal intensity ratio of a potentially abnormal lesion in dynamic contrast-enhanced MRI can enhance the accuracy of the diagnosis for locating microadenoma.

Reduction of overfitting on the highly imbalanced ISIC-2019 skin dataset using deep learning frameworks.

With the rapid growth of Deep Neural Networks (DNN) and Computer-Aided Diagnosis (CAD), more significant works have been analysed for cancer related diseases. Skin cancer is the most hazardous type of cancer that cannot be diagnosed in the early stages. The diagnosis of skin cancer is becoming a challenge to dermatologists as an abnormal lesion looks like an ordinary nevus at the initial stages. Therefore, early identification of lesions (origin of skin cancer) is essential and helpful for treating skin cancer patients effectively. The enormous development of automated skin cancer diagnosis systems significantly supports dermatologists. This paper performs a classification of skin cancer by utilising various deep-learning frameworks after resolving the class Imbalance problem in the ISIC-2019 dataset. A fine-tuned ResNet-50 model is used to evaluate the performance of original data, augmented data, and after by adding the focal loss. Focal loss is the best technique to solve overfitting problems by assigning weights to hard misclassified images. Finally, augmented data with focal loss is given a good classification performance with 98.85% accuracy, 95.52% precision, and 95.93% recall. Matthews Correlation coefficient (MCC) is the best metric to evaluate the quality of multi-class images. It has given outstanding performance by using augmented data and focal loss.

Description of Thorax X-ray and Brixia Score in Pregnancy with COVID-19 Infection

BACKGROUND: Based on data until December 31, 2020, confirmed cases of coronavirus disease 2019 (COVID-19) have been reached nearly 750,000 cases, COVID-19 can infect pregnant women because a reduction in the immune receptor and increase in another pro-inflammatory factor. Complications include fetal distress, premature rupture of membranes, fetal death, chorioamnionitis, preeclampsia, sepsis, renal failure, and disseminated intravascular coagulation. A serial chest X-ray is used as a basis for assessing COVID-19 progression. An experimental study in Italy proposed a scoring system known as the Brixia score divides the chest X-ray image posteroanterior or anteroposterior into 3 zones, namely, the upper, middle, and lower zones labeled as A to F, then assess the abnormalities that exist in each area with a score of 0–3, a score of ranges from 0 to 18. This score can be used to assess the severity of symptoms suffered by confirmed patients and determine the patient’s prognosis. AIM: This study aims to determine the characteristics of the chest X-ray and Brixia score in pregnancy with COVID-19 infection. METHODS: This descriptive research aims to describe the characteristics of the chest X-ray and the Brixia score in pregnancy with COVID-19 infection in pregnancy at the Department/KSM Obstetrics and Gynecology FK Udayana/Sanglah Hospital, Denpasar. This research carried out from April 2020 to March 2021. The sample of this study was all pregnant women with confirmed COVID-19 at Sanglah Hospital Denpasar during the period April 2020–March 2021. Data collected are all pregnant women who are confirmed to have COVID-19 and met the inclusion and exclusion criteria of the study. Data recorded and data tabulation is carried out according to characteristics that have been determined, then data processing is carried out descriptive. RESULTS: In pregnant patients with confirmed COVID-19 in the period from April 2020 to March 2021, there were 95 people. The highest proportion of mothers pregnant with COVID-19 infection performs antenatal care checks at midwives and Obstetric Gynecologist (47.4%) with age 20–35 years (86.3%), primipara (41.1%), age term pregnancy (74.7%), and using the abdominal method for delivery (87.4%). X-ray results that it was found that from 95 pregnant women, there were 56 pregnant women with thorax abnormal and 39 with normal conditions. The highest proportion of the X-ray results was obtained pregnant with COVID-19 infection with abnormal thorax consolidation lesions found (94.6%) and the distribution of the lesions on the right lung side (39.3%). Based on the cross-tabulated analysis, it can be seen that the consolidation lesion is found in all Brixia scores with the highest proportion in the 0–5 category, which is 80.3%. Results chest X-ray of pregnant women with COVID-19 infection with Brixia score 0–5 had the same values including pleural effusion lesions 1.8%, pulmonary edema 1.8%, and fibrotic by 1.8%. CONCLUSION: Following conclusions can be drawn: Overview of the characteristics of pregnant women with the most COVID-19 infections is at the age of 20–35 years with a primiparous pregnancy. Gestational age term gave birth by the abdominal method; abnormal chest X-ray images are more often found in patients with COVID-19 in pregnancy with consolidated lesions as well as diffuse distribution mostly on the right side of the lung; Brixia score in pregnancy with COVID-19 infection with proportion the highest is in parameter 0–5 as much as 85.7%.

Effects of added 25(OH)D3 with varying standardized total tract digestible phosphorus concentrations on nursery pig performance, bone characteristics, and serum vitamin D status.

A total of 360 pigs (DNA 600 × 241; initially 5.8kg) were used in a 45-d growth study to evaluate the effects of adding 25(OH)D3 with 3 levels of standardized total tract digestible (STTD) P on nursery pig growth performance, bone and urine characteristics, and serum vitamin D. Pigs were weaned at 19 d of age and randomly allotted to 1 of 6 dietary treatments with 5 pigs per pen and 12 replications per treatment. Dietary treatments were arranged in a 2 × 3 factorial with main effects of 25(OH)D3 (0 or 50 µg/kg equivalent to 2,000 IU/kg of vitamin D3; Hy-D, dsm-firmenich, Plainsboro, NJ) and STTD P (70%, 100%, or 130% of the NRC [NRC 2012. Nutrient requirements of swine. 11th rev. ed. Natl. Acad. Press, Washington, DC) requirement estimate on a dietary percentage basis]. All diets contained 1,653 IU/kg of vitamin D3. On day 45, 1 pig per pen was euthanized to collect the right fibula, metacarpal, and 2nd and 10th ribs. Overall, increasing STTD P increased (quadratic, P ≤ 0.003) ADG, ADFI, and G:F with minimal improvement above 100% of the NRC STTD P requirement estimate. Added 25(OH)D3 had no effect on growth performance. Increasing STTD P decreased urinary Ca concentration (linear, P < 0.001) and increased urinary P concentration (quadratic, P < 0.001). When pigs were fed added 25(OH)D3, serum 25(OH)D3 increased (quadratic, P = 0.005) as STTD P increased but no differences were observed when 25(OH)D3 was not added and STTD P increased (25(OH)D3 × STTD P interaction, P = 0.032). When pigs were fed 25(OH)D3, serum 1,25(OH)2D3 increased (quadratic, P < 0.001) as STTD P decreased but the increase was not significant when no 25(OH)D3 was fed (STTD P × 25(OH)D3 interaction, P = 0.002). Bone ash percentage and weight increased (quadratic, P ≤ 0.065) in all bones as STTD P increased. Added 25(OH)D3 had no effect on bone density or bone ash weight; however, the reduction in bone ash percentage observed with reducing STTD P level tended to be less when 25(OH)D3 was provided (linear interaction, P = 0.098). Increasing STTD P decreased the likelihood of abnormal histologic bone lesions in the 10th rib. In summary, added 25(OH)D3 had limited effect on growth performance; however, an increase in serum concentrations of 25(OH)D3 and 24,25(OH)2D3 was observed. The addition of 25(OH)D3 to P-deficient diets increased percentage bone ash. Increasing STTD P to 100% of NRC [NRC 2012. Nutrient requirements of swine. 11th rev. ed. Natl. Acad. Press, Washington, DC] requirement estimate increased growth and 130% of NRC maximized bone ash.

Reconnoitering correlation between human papillomavirus infection-induced vaginal microecological abnormality and squamous intraepithelial lesion (SIL) progression

ObjectiveThis study aims to investigate the relationship between abnormal vaginal microecology and human papillomavirus (HPV) infection, as well as the squamous intraepithelial lesions (SIL) progression.MethodsA total of 383 patients diagnosed with HPV infection in our hospital between March 2017 and February 2022 were selected as the experimental group. In addition, several volunteers (n = 898) who underwent physical examination during the same period were randomly selected as the control group. Subsequently, we conducted several investigations, such as HPV detection and gene typing, examined vaginal microecological imbalances, and performed cytological examinations to analyze the correlation between microecological changes, different types of HPV infection, and SIL progression.ResultsHPV detection primarily included single and high-risk types of HPV infections. Moreover, significant disparities in the vaginal microecological environment between patients with persistent HPV infection and the control group, as well as patients with low-grade and high-grade SIL (LSIL and HSIL), were observed. The regression analysis revealed a correlation between LSIL and microflora density, diversity, bacteriological vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonas vaginalis (TV), sialidase, as well as Lactobacillus. In addition, we identified an association between HSIL and pH, flora density, diversity, BV, VVC, candida vaginitis (CV), leukocyte esterase, catalase, and Lactobacillus levels.ConclusionThese findings revealed a significant association between abnormal vaginal microecology and both HPV infection and the SIL progression.

The First Record of an Aggressive Form of Ocular Tumour Enhanced by Marek's Disease Virus Infection in Layer Flock in Al-Najaf, Iraq.

Marek's disease (MD) is a highly infectious poultry illness with a tendency to form tumours in peripheral nerves and internal organs of affected birds. Tumours accompany MD, mostly caused by oncogenic Gallid alpha herpesvirus 2 (MD Herpes virus serotype I). Studies on avian tumours associated with MD infection are limited in Iraq. In the presented study, the positive samples of ocular tumour were 168 out of 282 MD positive samples, which accomplished in farm suffered from an unexpectedly high mortality rate. We investigated a rapidly developed tumour mass that was observed in an MD-vaccinated layer flock that showed obvious clinical signs of MD, accompanied by forming a small lump in one eye at age 21 weeks, which developed to a big lump at week 28 of age, leading to death. The diagnosis MD infection was confirmed by a Polymerase Chain Reaction (PCR) amplification of a specific region of the target gene meq of the causative agent, followed by Sanger sequencing and BLASTn search of the sequence against the NCBI nucleic acid database, resulted in Gallid alpha herpes virus 2 strain, and according to the phylogenetic analysis, the sequence from this study was uniquely clustered in its own branch in the tree. Histopathological examination of the ocular tumour core revealed aggregation of neoplastic cells and haemorrhage that replaced the normal eye tissue, as well as early tumour formation in internal organs such as the lung and liver. In addition, abnormal lesions are susceptible to tumours in the gizzard and spleen. To our knowledge, this is the first record of an aggressive MD virus infection-mediated ocular tumour in a layer flock in Al-Najaf province, Iraq.

Acute cardiovascular manifestations with multisystem inflammatory syndrome in children due to COVID-19 infection: A single-center prospective observational study

Abstract Background: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the COVID-19 pandemic. A majority of children have significantly raised levels of NT pro-BNP, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. Cardiac involvement may include rhythm disturbance, depressed myocardial function, valvar regurgitation, and/or coronary artery inflammation. This hospital-based prospective study was aimed to evaluate cardiovascular manifestations in cases of multisystem inflammatory syndrome in children (MIS-C). Subjects and Methods: The current study was a prospective observational study that included 100 children admitted to the pediatric intensive care unit after getting the requisite clearance from the institutional ethics committee; informed written consent of parents was taken before the start of the study. Results: The mean age of the study participants was 8.9 ± 3.9 years with 62% male children. Ninety-four percentage had MIS-C with KD phenotype while only 6% of kids developed shock. Abnormal electrocardiography (ECG) was found in 41%, pericardial effusion in 16%, left ventricular dysfunction (LVD) in 42%, and coronary lesions found in 30% of patients. Abnormal NT-proBNP (&gt;125 pg/ml) was noted in 90% of children. Abnormal cTnT was seen in 89%, and 91% of children had abnormal BNP. The present study found a mortality of 6%. Conclusions: MIS-C with KD phenotype is the most common presentation with raised cardiac injury markers. Abnormal ECG LVD and coronary lesions are transient common cardiac abnormalities which get resolved within 3 months of treatment.

Idebenone-Loaded Nanocomposite Microspheres for Nasal Administration-A Perspective in the Treatment of Alzheimer's Disease.

Alzheimer's disease results in neurodegeneration and is characterized by an accumulation of abnormal neuritic lesions and intracellular aggregates of hyperphosphorylated Tau proteins in the cerebrum. That leads to progressive decline in memory, thinking, and learning skills. Oxidative stress has been shown to play a significant role in the pathogenesis of Alzheimer's disease. Antioxidants are identified as part of therapeutic strategy to prevent or reduce the disease. Idebenone is a synthetic analogue of coenzyme Q10 with potent antioxidant properties, originally developed for the treatment of Alzheimer's disease and other cognitive disorders. After oral administration idebenone undergoes excessive first-pass metabolism and has a very low bioavailability of only about 1%. The use of an alternative route of administration such as the nasal and its incorporation into a novel carrier (nanocomposite microspheres) will eliminate the problems associated with reduced absorption, stability, and rapid biotransformation and will increase the opportunity for idebenone to realize its therapeutic potential in Alzheimer's disease. Idebenone-loaded nanocomposite microspheres were obtained by spray drying. The structures were characterized using laser diffraction, scanning electron microscopy, high-performance liquid chromatography, Fourier-transform infrared spectroscopy, and differential scanning calorimetry. The ability of nanocomposite microspheres to bind human serum albumin was investigated by fluorescence spectroscopy. The mucoadhesive properties of the carrier were also determined. Bioadhesive nanocomposite microparticles with spherical shape, smooth surface, size of 7.37 ± 2.4 μm, and with high production yield, good drug entrapment efficiency, and loading values were obtained. Infrared spectra demonstrated no chemical interactions between idebenone and structure-forming polymers. The ability of particles to bind to human serum albumin depends on their drug loading. Nanocomposite microspheres were developed as the novel delivery system of idebenone for target nose-to-brain delivery. The obtained carrier may increase the therapeutic potential of idebenone by providing higher concentrations in brain tissue and reducing systemic exposure and side effects.

Gastro-BaseNet: A Specialized Pre-Trained Model for Enhanced Gastroscopic Data Classification and Diagnosis of Gastric Cancer and Ulcer.

Most of the development of gastric disease prediction models has utilized pre-trained models from natural data, such as ImageNet, which lack knowledge of medical domains. This study proposes Gastro-BaseNet, a classification model trained using gastroscopic image data for abnormal gastric lesions. To prove performance, we compared transfer-learning based on two pre-trained models (Gastro-BaseNet and ImageNet) and two training methods (freeze and fine-tune modes). The effectiveness was verified in terms of classification at the image-level and patient-level, as well as the localization performance of lesions. The development of Gastro-BaseNet had demonstrated superior transfer learning performance compared to random weight settings in ImageNet. When developing a model for predicting the diagnosis of gastric cancer and gastric ulcers, the transfer-learned model based on Gastro-BaseNet outperformed that based on ImageNet. Furthermore, the model's performance was highest when fine-tuning the entire layer in the fine-tune mode. Additionally, the trained model was based on Gastro-BaseNet, which showed higher localization performance, which confirmed its accurate detection and classification of lesions in specific locations. This study represents a notable advancement in the development of image analysis models within the medical field, resulting in improved diagnostic predictive accuracy and aiding in making more informed clinical decisions in gastrointestinal endoscopy.

Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.

The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.

The use of BPaL containing regimen in the MDR/PreXDR TB treatments in Thailand

The primary objective of this study was to evaluate the real-world effectiveness, side effects and challenges associated with the implementing of the groundbreaking BPaL-containing regimen in Thailand. Another aim was to investigate the characteristics and severity of the disease, the presence of abnormal extensive lesions in chest X-Rays and the influence of cavitation on sputum conversion. Material and method: The case series study included patients at TB clinic of Central chest institute of Thailand between August 2021-April 2023. All 28 Patients fullfilled the diagnostic criterial for MDR-TB by molecular tests and/or sputum culture. Sputum molecular test, utilizing GeneXpert MRB/XDR or Genotype MTBDRsl assay, was conducted. The 8 Pre-XDR patients who exhibited quinolone resistance and the 2 MDR-TB patients who encountered side effected from quinolone drugs were treated with BPaL regimen, while the remainder received BPaLM regimens. Results: Among the 28 patients, 23 (82.1 %) successfully completed the treatment with favorable outcomes. However, one patient from the BpaL regimen died due to severe destroy lung lesion, and four patients from the BpalM regimen discontinued treatment. The investigation into the correlation between extension lesion, cavitation lesions, and culture conversion unveiled that the group with extension lesions and cavitation ≥4 cm had a diminished probability of achieving sputum culture conversion within 8 weeks in comparison to the group without attributes. The associated risk ratio was 0.56 (95 % CI, 0.14–2.27), p = 0.14. Although the study report minimal side effects, 6 patients (22.2 %) experienced peripheral neuropathy and a notable adverse reaction identified was optic neuritis, affecting 2 cases (7.1 %). Summary: The administration of the BPaL-containing regimen resulted in rapid sputum conversion within 8 weeks and had minimal side effects.

Tau Protein in the Retina

AbstractBackgroundCurrently there is no definite cure for Alzheimer’s therefore early detection is critical. Undetected Alzheimer’s Disease (AD) can lead to severe accidents, neglecting to take essential medications, injury to oneself or others, and/or financial problems. Currently, biomarkers are the most promising way to detect Alzheimer’s early on. Biomarkers such as beta‐amyloid and tau levels taken through invasive mehods or brain scans that involve radiation are among them.As the retina is an extension of the brain and the brain structure, it is possible to detect misfolded proteins via retinal examination non‐invasively. The aim of this study was to discover the binding property of curcumin to both Tau and AB in the retina as a potential biomarker for AD.MethodIn this study, 20 patients were invited with mild AD who had undergone retinal examination within the past 2 years. All the patients had retinal imaging with curcumin which revealed misfolded proteins during the examination and then they were advised to take daily curcumin. The mean age of the patients was 71, and the patients were instructed to take Curcumin Meriva in 500 mg supplements once daily after their prior examinations. All patients had tests repeated with FAF and Heidelberg Spectralis OCT device. The regions with abnormal lesions on FAF were detected and the layer of the defect was scanned by OCT plus compared with the previous imaging of the patients. The images were examined in a masked fashion by 2 specialists.ResultThe images disclosed hyperfluorescent lesions on FAF and OCT revealed accumulations in the inner layers of the retina. Some accumulations had dot shapes and others had fibril‐tangle shapes. Some lesions were present in prior exams, but they were more pronounced and shinier after curcumin use. Their size and shape were in concordance with misfolded proteins in the brain (Figure).ConclusionRetinal examination with curcumin revealed AB plaques in the retina in prior studies. Our study is the first that may demonstrate an easy way to detect the culprit plaque Tau inside the retina of live patients.