Abnormal Radiological Findings Research Articles

Physicians’ irrational attitudes on the antibiotic prescribing for the treatment of COVID-19 in Turkey: A multicenter survey

BackgroundThe inappropriate and excessive use of antibiotics during the coronavirus pandemic has become an important issue.ObjectiveOur primary aim is to ascertain the attitudes of physicians toward the antibiotics prescribing for the treatment of COVID-19 in Turkey. Our secondary aim was to identify factors affecting to physicians’ decisions regarding antibiotic therapy for the treatment of COVID-19 and risk factors associated with antibiotic overprescribing.MethodsIt was a multicenter cross-sectional survey. Physicians from 63 different cities were invited to survey through social media (Facebook, Instagram, WhatsApp). Data were collected from respondents through an online questionnaires during November-December 2021.ResultsThe survey was completed by 571 participants from 63 cities. Pulmonologists comprised the majority (35.20%), followed by internal medical specialists (27.85%) and general practitioners (23.29%). The rates of participants who started empirical antibiotics in the outpatient, ward, and ICU (intensive care unit) were 70.2%, 85.5%, and 74.6%, respectively. When the practice of prescribing antibiotics by physicians for the treatment of COVID-19 in outpatients was compared according to the healthcare setting (primary, secondary, tertiary care hospitals) no significant difference was found. Sputum purulence (68.2%) was recognized as the most important factor for the decision of antibiotic therapy, followed by procalcitonin levels (64.9%) and abnormal radiological findings (50.3%). The most prescribed antibiotics were respiratory quinolones. (48%, 65.9%, 62.7% outpatient, ward, ICU respectively)ConclusionsIn this study, we found that physicians frequently had irrational attitudes toward antibiotic prescription to COVID-19 patients, including those with minor diseases. Our findings underline that the necessity of particular, workable interventions to guarantee the prudent use of antibiotics in COVID-19.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures. A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit. In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46-70 years) and the median Injury Severity Score was 17 (interquartile range, 13-22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems. Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

The Incidence of Abnormal Preoperative Testing Among Elective Surgery Patients in a Referral Hospital in Southern Saudi Arabia.

Background Preoperative investigations are important to assess the clinical condition of patients who undergo elective surgical procedures. However, there is still debate about the usefulness of performing preoperative investigations. We aimed to determine the prevalence of routine preoperative investigation abnormalities among elective general surgery patients. Methodology This retrospective hospital-record-based study was conducted at the King Abdullah Hospital in Bisha Province, southern Saudi Arabia. General and clinical data of 968 patients who underwent elective surgical interventions from February 2022 to January 2023 were retrieved and analyzed. Result A total of 968 patients (578 females and 390 males) aged between 14 and 80 years were included in the study. Four hundred and eleven (42.5%) patients were in the age groupof 40 years and above. The commonly detected comorbidities among the patients were diabetes (15%), hypertension (12%), respiratory diseases (7.5%), and cardiac diseases (2.5%). Abnormalities related to hemoglobin (31%), total leucocyte count (12.7%), and platelets (8.5%) were found in 968 patients. Around 15% of patients had increased creatinine levels. Hypokalemia was observed in 6.8% of patients. Increased liver enzymes were reported in limited proportions (10% to 14%) of patients. Slightly abnormal radiological findings were reported for chest X-ray (CXR) (2.8%), electrocardiogram (ECG) (2%), and Doppler echocardiography (Echo) (0.8%). A statistically significant association between the age of the patient and abnormal findings of ECG (p <.001), Echo (p = .001), and CXR (p <.001). Cardiac abnormalities were commonly associated with patients of ≥ 40 years. Abnormal cardiac findings (CXR, ECG, Echo) were significantly (p<.05) increased with the presence of diabetes, hypertension, and cardiovascular comorbidities. Conclusions Preoperative testing revealed limited proportions of abnormal findings among patients with elective surgical procedures. Routine ordering of many preoperative investigations without specifications may not predict postoperative complications of the patients. Therefore, undertaking preoperative testing should be guided by targeted history, physical examination, clinical risk factors, and type of surgical procedure intended to be performed.

Preoperative Imaging in Cochlear Implants.

To determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) in cochlear implant candidates. Retrospective case review. Tertiary referral hospital. A total of 207 cochlear implanted patients with CT and/or MRI. N/A. Age versus abnormal radiologic findings, imaging abnormality versus postoperative outcomes, postoperative outcomes versus electrode design, Cambridge Cochlear Implant Protocol (CCIP) status for imaging abnormalities, sensitivity and specificity of CT and MRI for round-window/cochlear occlusion, and MRI for incomplete partitions. A total of 207 patients with CT, MRI, or both were reviewed retrospectively. Less than half (15.5%) of CT scans had findings that might affect surgical intervention compared with 5.9% of MRI. No significant difference was found between children and adults for relevant imaging abnormalities (grade 4 or higher) with either CT (p = 0.931) or MRI (p = 0.606). CCIP status correlated with cochlear abnormalities (p = 0.040); however, only 46.2% of radiographic abnormalities on CT would be identified by these criteria. For detecting cochlear occlusion requiring surgical intervention, the sensitivity and specificity for CT were 40% (4 of 10; 95% confidence interval [CI], 12.16-73.76) and 95.73% (95% CI, 91.40-98.27), respectively. For MRI, the sensitivity and specificity were 33.33% (1 of 3; 95% CI, 0.84-90.57) and 96.97% (63 of 65; 95% CI, 89.32-99.63), respectively. There was no difference for postoperative AzBio scores for higher-grade imaging abnormalities (p = 0.6012) or for electrode designs (p = 0.3699). Significant radiographic abnormalities were relatively uncommon in cochlear implant patients on either CT or MRI at our single-center institution. If present, abnormal imaging findings rarely translated to management changes. CCIP status does not reliably predict which patients are likely to have abnormalities. Both MRI and CT have low sensitivity for round-window or cochlear occlusion, but detection likely leads to changes in surgical management.

1345. Clinical Characteristics and Outcomes of Mild to Moderate COVID-19 Patients with Abnormal Chest Radiologic Findings Treated in the Hospitels in Thailand

Abstract Background Hospitels are the hotels converted into the healthcare facilities extension in areas with limited resources including hospital beds during the peak of COVID-19 pandemic in Thailand. This study aimed to determine the clinical features and outcomes of asymptomatic and mild to moderate COVID-19 patients who were treated in these facilities. Methods We conducted a retrospective study by reviewing the medical records of adult COVID-19 patients who were admitted to Siriraj Hospital’s affiliated hospitels in Bangkok between June and October 2021. Patients’ characteristics, vaccination status, treatment data, and clinical outcomes were collected. Results We compared baseline characteristics and clinical features of COVID-19 patients based on their initial chest x-ray (CXR) findings. Of 1,729 patients, 644 (37.2%) had an abnormal baseline CXR, and these patients were older (49.2 vs. 42.2 years, p &amp;lt; 0.001), had higher body weight (68.1 vs. 64.7 kg, p &amp;lt; 0.001) and BMI (26.3 vs. 24.9 kg/m², p &amp;lt; 0.001), and were more likely to have underlying diseases such as diabetes (p = 0.002), hypertension (p &amp;lt; 0.001), obesity (p &amp;lt; 0.001), chronic lung disease (p = 0.029), and autoimmune disease (p = 0.028). They were also more likely to have a risk of disease progression (p &amp;lt; 0.001) and were less likely to be fully vaccinated (p &amp;lt; 0.001). They were more likely to be referred back to the hospital (p &amp;lt; 0.001). We found no significant differences in sex or COVID-19 symptoms between the two groups, except cough and fatigue. The total cost of admission was significantly higher for referred patients than discharged patients (70,545 vs. 12,010 Thai baht, p &amp;lt; 0.001). Conclusion A significant proportion of COVID-19 patients with abnormal CXR findings who were admitted to the hospitels had underlying diseases and higher risk of disease progression. Additionally, they were more likely to be referred back to the hospital and had higher healthcare costs. Continued surveillance and monitoring of high-risk COVID-19 patients in hospitels to ensure efficient management and resource utilization were needed. Disclosures All Authors: No reported disclosures

Clinical Outcomes of Human Rhinovirus Infections in Pediatric Hemopoietic Stem Cell Transplant Patients

Abstract Background Respiratory viral infections (RVIs) are common among pediatric transplant patients, with Human rhinovirus (HRV) being most frequently. In pediatric patients undergoing hematopoietic cell transplant (HCT), HRV infection prior to, or early post-transplant has been associated with progression to lower respiratory tract infection (LRTI) and adverse outcomes. The primary objective is to describe the clinical presentation and outcomes of HRV infections in patients undergoing HCT at St. Jude Children’s Research Hospital. Methods This is a single-center retrospective cohort study. HCT recipients who had a respiratory sample positive for HRV (HRV positive) or negative for any respiratory virus (virus negative) between October 1, 2014, and December 31, 2017, were included. Testing was performed using BioFire® Respiratory Panel. Primary outcomes were progression to LRTI, ICU admission, all-cause mortality rate, and respiratory event-related mortality rate. Results A total of 227 patients (166 allogeneic and 61 autologous transplants) were included in the analysis. Of these, 108 (47.5%) were HRV positive and 119 (52.4%) were virus negative. Of the HRV patients, 63.6% were diagnosed pretransplant. All samples were nasopharyngeal, except for 1 tracheal aspirate. There were no significant differences in sex, race, type of transplant, underlying malignancy, and conditioning regimen between patients with and without HRV infection. However, patients who had HRV were significantly younger compared with virus negative (Table 1). Cough and rhinorrhea were more frequently observed in patients with HRV (53.7% vs 19.8%, and 60.2% vs 22.8%, respectively). Almost 1 in 4 patients with HRV had LRTI. No significant association was found between the severity of respiratory disease and the type of conditioning regimen, type of transplant, or absolute lymphocyte count (ALC) within a week of infection. HRV positive patients were more likely to be tested due to symptoms, have URTI, and present with co-infections compared to the virus negative group. There were no differences in the proportion of abnormal radiological findings, and no differences in outcomes between groups (Table 1). Clearance of HRV infection was confirmed with a negative PCR in 45 patients. Of these, 60% remained positive by week 4. Conclusion HRV infection is frequently detected in symptomatic patients undergoing transplant. Despite presenting respiratory symptoms more frequently, there was not a significant association with progression to LRTI, need for intensive care unit, mechanical ventilation or mortality.

The Clinical Characteristics and Outcomes of Infantile Seizures in the First Year of Life: A Single-Center Study

BackgroundEpilepsy has a high incidence among infants during their first year of life, yet the prognosis can vary significantly. Although considerable research has been conducted on infantile spasms, studies examining infantile-onset epilepsy, excluding infantile spasms, remain limited, particularly concerning the factors influencing outcomes. Therefore, our study aims to elucidate seizure control, developmental outcomes, and prognostic factors in infants with epilepsy during their first year of life, within a single-center study in Malaysia. MethodsWe retrieved data from patients who experienced seizures before age 12 months and were followed for over two years, using electronic patient records at Hospital Raja Perempuan Zainab II in Kelantan, a state in Malaysia's east coast. We retrospectively reviewed these records and assessed clinical outcomes based on the last follow-up. ResultsOf 75 patients, 61 (81.3%) achieved good seizure control or remission. At the last follow-up, 24 (32%) exhibited developmental delay, whereas 19 (25.3%) displayed abnormal neuroimaging. Patients with abnormal background electroencephalographic (EEG) activity, as well as abnormal radiological findings, were more likely to experience poor seizure control and unfavorable developmental outcomes (P < 0.05). ConclusionsOur study underscores that most infants with epilepsy can achieve seizure remission. However, poor seizure control and developmental delay are associated with abnormal EEG background and characteristics, as well as neuroimaging abnormalities. The management of infantile-onset epilepsies may necessitate substantial resources and precise interventions to enhance overall outcomes.

Associations of inflammatory polyarthritis with clinical and radiological findings of temporomandibular disorders

Objective To evaluate the association of different forms of inflammatory polyarthritis with clinical signs of temporomandibular disorders (TMD) and radiological findings in temporomandibular joint (TMJ), based on a nationwide health survey in Finland. The aim was also to assess the presence of clinical and radiological TMD findings in subjects with increased risk for developing rheumatoid arthritis (RA). Material and methods A nationally representative sample included 6331 Finnish adults who participated in the Health 2000 Survey (BRIF8901). Subjects were examined for signs of TMD, findings in panoramic radiograph of TMJ, musculoskeletal health and serology (rheumatoid factor, RF, and anti-cyclic citrullinated peptide, aCCP). Results Sixty-four percent of seronegative RA and 60% of seropositive RA subjects had at least one sign of TMD. While adjusting for confounding factors (gender, age, dentures and smoking history), RA was significantly associated with crepitation and abnormal radiological findings in TMJ. Seronegative RA was also associated with restricted mouth opening. Systemic autoimmunity associated with RA (“at risk of RA”) was not associated with clinical or radiological TMD findings. Conclusions Clinical and radiological findings of TMD are more prevalent among subjects with inflammatory polyarthritis than among the population in general in the Finnish adult population.

Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability.

In primary healthcare settings, chronic low back pain (cLBP) is a widespread health issue with a great global impact. A cross-sectional analytical study was performed on 918 adults attending primary healthcare settings in Makkah, Saudi Arabia, to estimate the cLBP prevalence, its effect on health-related quality of life (QOL), and predictors of subsequent disability. The visual analog scale of pain(VAS), World Health Organization Quality of Life Scale (WHO-QOL), and Oswestry low back pain disability index (ODI) were used to assess back pain severity, impact on QOL, and physical disability, respectively. The prevalence of cLBP among adults attending primary care settings in Makkah City was 25.9%, and 88.6% of them had a limited range of motion of the spine. About 58.1% had abnormal radiological findings detected by MRI. Based on the VAS scale, most patients (83.8%) had mild pain. The median (IQR) QOL score was 70 (60-80). Minimal and moderate disability scores were prevalent among 16.2% and 65.7% of patients, respectively. Disability scores were independently predicted by a lower QOL score (beta = -0.39, 95%CI = -0.49 to -0.29, p < 0.001) and higher VAS scores (beta = 0.47, 95%CI = 0.38-0.56, p < 0.001). Furthermore, disability was independently associated with having post-void residual volume (PVRV) (beta = 5.84, 95%CI = 1.97-9.72, p = 0.004) and abnormal X-ray findings (beta = 7.10, 95%CI = 1.77-12.4, p = 0.010). cLBP is common among adults attending primary care settings in Makkah City; it is associated with moderate disability and lower health-related QOL.

3. Pain originating from the lumbar facet joints.

Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

Major determinant factors of pediatric COVID-19 severity; a single center study

BackgroundAccording to several recently published studies, pediatric Corona virus infection is mostly mild. However, a severe COVID-19 illness could occur in children, resulting in grave outcomes. Unfortunately, the data regarding the major determinants of disease progression in the pediatric population is still limited. Here, we aimed to identify the most significant risk factors associated with severe COVID-19 infection in children to predict the patients at elevated risk for serious illness.ResultsThis single-center, retrospective study enrolled eighty hospitalized children and adolescents under the age of 18 years with coronavirus type 2 infections, who were divided according to the level of clinical severity into severe and non-severe groups. Epidemiological data, clinical features, radiological findings, laboratory test results, and disease outcomes of the studied patients were collected and analyzed to demonstrate their relation to disease severity. Patients with severe illness tend to have more respiratory symptoms (97.8% vs. 79.4%, p = 0.007), cardiac affection (23 (50.0%) vs. 5 (14.7%), p = 0.001, and neurological involvement (13 (28.1%) vs. 1 (2.9%), p = 0.003). Furthermore, abnormal radiological findings and higher radiological scores were significantly more common among patients with severe disease compared to non-severe cases (p = 0.037, 0.013). In multivariable analysis, clinical scoring, abnormal coagulation function, and ICU admission were the most significant parameters for forecasting severe illness.ConclusionsWe identified the most remarkable parameters involved in the progression of severe disease in Egyptian children with COVID-19 infection, which may be implemented in anticipation of susceptible children for earlier prompt management and a better prognosis.

Radiological Imaging Results in HIV-Infected Patients in Mogadishu-Somalia: A Four-Year Retrospective Review

Somalia, which is one of the countries that has been trying to integrate with the rest of the world in terms of many socio-economic parameters, including the field of health in recent years, still faces some important health problems. One of these problems is the difficulties encountered in the early diagnosis and treatment of patients with human immunodeficiency virus (HIV) infection, primarily due to social discrimination and limited treatment access. In this study, it was aimed to examine the findings detected in the radiological imaging examinations requested during the first examination in patients who were diagnosed with HIV for the first time by detecting HIV seropositivity in tests performed for different clinical reasons, and to determine the pathologies caused by advanced disease in patients who did not receive treatment. The study includes 235 patients who were diagnosed for the first time out of 269 patients with HIV confirmed by two different serological diagnostic tests during a previous comprehensive seroepidemiological study, and 14 patients with a suspicious test result for HIV infection but the presence of infection cannot be definitively proven in the absence of molecular diagnostic methods. In retrospective examinations, it was determined that 117 (49.8%) and 13 (92.9%) patients in both groups had radiological imaging (magnetic resonance imaging-MRI, computed tomography-CT, ultrasonography, and chest X-ray), respectively. While 16 of 117 HIV-infected patients had non-specific radiological findings and 53 had normal radiological findings, at least one radiological imaging of 48 patients revealed abnormal radiological imaging findings that may be associated with HIV infection. In these 48 patients, pneumonia findings in thorax CT and chest X-ray examinations, and encephalitis-related findings in patients with central nervous system involvement were the most common anomalies. In addition of these, other abnormal radiological findings included mass lesions compatible with neoplasia, lesions compatible with metastasis, lymphadenopathies, hepatosplenomegaly, and lesions indicating spleen involvement. The presence of similar findings (lesions compatible with pneumonia, encephalitis, and neoplasia) in 9 of 13 patients whose HIV infection could not be confirmed indicates that radiological tests can make significant contributions to clinical evaluations in the management of patients with suspicious laboratory results. The data we present from a region where significant obstacles are encountered in the diagnosis and follow-up of HIV infections due to the fear of discrimination (stigma) of the patients and the lack of molecular tests draw attention to the fact that many patients have advanced lesions when they are diagnosed, and this situation will have negative effects in the patient management and treatment process.

Survival Analysis and Risk Factors of Pulpectomy among Children with Severe Early Childhood Caries Treated under General Anesthesia: A Retrospective Study.

This study aims to retrospectively evaluate the survival rate of pulpectomy performed under dental general anesthesia (DGA) through long-term follow-up and to explore the risk factors associated with treatment failure. The medical records of the children who were diagnosed with S-ECC and received pulpectomy treatment under general anesthesia (GA) from 1 August 2014 to 1 December 2019, in the Stomatological Hospital of Xi'an Jiaotong University, were collected. Two dentistry postgraduates extracted the necessary information and filled in a predesigned excel form. Survival analysis was performed using the Kaplan-Meier method. The shared frailty model was used to explore possible factors affecting the success rate of pulpectomy in primary teeth. A total of 381 children (mean age 3.49 ± 0.90) with S-ECC and 1220 teeth were included in the study, including 590 primary anterior teeth and 630 primary molars. The overall 35-month survival rate was 38.5%, which was 52.9% for anterior teeth and 31.1% for molars. The overall median survival time was 31 months, in which anterior teeth were 35 months and molars were 26 months. The older the children were, the greater the risk of treatment failure (HR 1.56, 95% CI 1.09, 2.24). The risk of pulpectomy failure of primary molars was 1.9 times that of primary anterior teeth (95% CI 1.36, 2.65) and the teeth with abnormal radiological findings before treatment was 1.41 times higher than that of teeth without imaging abnormalities (95% CI 1.74, 3.36). The survival rate of primary tooth pulpectomy is acceptable but decreased gradually with time. The failure rate of pulpectomy in primary molars is higher than that of primary anterior teeth. When the primary caries has extended to the pulp and resulted in a nonvital lesion, pulpectomy could be an option for maximum retention of the primary tooth.

The predictive association between radiological findings and lung cancer development in patients exposed to sulfur mustard gas: 4 decades follow up of 719 victims

BackgroundRespiratory diseases are the leading cause of morbidity and mortality in the survivors exposed to Sulfur Mustard (SM). The late abnormalities can be present as chronic bronchitis, tracheobronchial stenosis, asthma, bronchiectasis, airway narrowing, lung fibrosis, and lung cancers. This study aims to investigate the association between radiological findings and lung cancer development in patients exposed to sulfur mustard gas.MethodsWe entered 719 victims exposed to SM during the Iran–Iraq war into our follow-up study in a consensus manner. They were periodically followed with Chest HRCT scans from 2001 to an interval of 2014–2019. The mean year interval between exposure and the last follow-up was 38 years. For confirming the lung cancer in those with evidence of malignancy in their imaging, fine needle aspiration/biopsy and/or surgical intervention were done.ResultsAmong 719 patients, 57% were free from any pathologic findings in their HRCT scan. Among the subjects who had the abnormal radiologic findings, Air Trapping (AT), Lung Fibrosis (LF), Bronchiectasis (B), and the evidence of lung cancer were found in 265 (36.9%), 207 (28.8%), 151 (21.0%), and 42 (5.8%), respectively. Adenocarcinoma (38.1%) was the most common type of cancer. The right lung was involved more than the left one regarding LF, B, and cancer (p value < 0.05). Considering the laterality, a significant correlation was found between the side of LF and B and the tumor side. Furthermore, it was shown that the lung lobes with LF were statistically correlated to tumor-involved lobes. The relative risk of AT and B existence for tumor development was 11.73 [4.87–28.26] and 10.14 [5.12–20.090], respectively. The most predictive finding was LF which caused the risk of developing tumor 17.75 [7.35–42.86] times higher in the patient with this pathology. By each increment of the number of LF and B, the risk of developing tumors increased by 51% and 76%, respectively.ConclusionIn survivors exposed to Sulfur Mustard, those with bronchiectasis and lung fibrosis have a significantly higher risk of developing lung cancers, so a close follow-up of these victims is recommended.Trial registration This study was confirmed by the institutional review board and ethics committee at Shiraz University of Medical Sciences (SUMS) with the ethical code IR.SUMS.MED.REC.1399.637.

Detailed prenatal and postnatal MRI findings and clinical analysis of RAF1 in Noonan syndrome

Noonan syndrome is a genetically heterogeneous developmental disorder, which usually includes findings such as short stature, facial dysmorphia, cardiac abnormalities and a varying degree of intellectual disability. We present a unique case of a rare variant of Noonan syndrome in a very preterm female infant born at 28 + 4 gestational weeks, with abnormal radiological findings visible at fetal magnetic resonance imaging (MRI) and evolution of the brain lesions during infancy.

872 The Role of Clinical Core Biopsy in Palpable Breast Lumps with Normal Imaging: 10 Year Experience of a Tertiary Symptomatic Breast Service

Abstract Aim Patients presenting with a palpable breast lump with normal imaging presents an investigative challenge. While the reported sensitivity of US and mammogram is high, radiologically occult cancers do occur. Traditionally these patients have undergone clinical core biopsy. The aim of our study was to examine the use of clinical core biopsy in our department over a 10-year period and assess its efficacy in diagnosing radiographically occult malignancies. Method We performed a retrospective review of a prospectively maintained database of all clinical core biopsies performed from 2010–2019 in a symptomatic tertiary breast cancer unit. Patients who underwent fine needle aspiration or skin punch biopsy without breast clinical core biopsy were excluded. A number of patients underwent clinical core biopsy despite abnormal radiological findings for clinical reasons, these patients were excluded from the final analysis. Clinical examination findings, radiological findings and ultimate pathological findings were reviewed. Results 370 clinical core breast biopsies were performed over the study period. 11 patients were excluded as they underwent clinical biopsies despite abnormal imaging. Of the remaining 359 biopsies, 349 (97.21%) were benign and 9 (2.51%) required further investigation. Of these patients, 6 underwent excisional biopsy with one patient being diagnosed with DCIS. The remaining excisional biopsies were benign. 1 patient (0.29%) with normal imaging was diagnosed with a malignancy on clinical core biopsy. Conclusions The management of patients with palpable breast lumps despite normal imaging is challenging. Clinical core biopsy, in the context of normal imaging, has a low rate of detection of malignancy.

Primary Pancreatic Lymphoma Evaluated by Fine-Needle Aspiration.

Primary pancreatic lymphoma (PPL) is rare, mimicking pancreatic ductal adenocarcinoma (PDAC) clinically and radiologically. The aim of this study is to evaluate the clinical, radiologic, and pathological characteristics of PPL diagnosed by fine-needle aspiration (FNA) in our institution. Patient clinical, radiologic, and pathological information was collected from the electronic health record system. In total, 11 of 4,353 pancreatic FNAs met the criteria. The most common clinical symptom was jaundice, followed by abdominal pain, weight loss, and diarrhea. Abnormal laboratory findings included elevated alkaline phosphatase, total bilirubin, lactate dehydrogenase, and cancer antigen 19-9. Abnormal radiologic findings included pancreatic mass, biliary dilatation, vessel encasement, and common bile duct encasement and thickening. Five patients underwent more than 1 tissue sampling procedure before the final diagnosis of lymphoma. Final pathologic diagnosis included 7 large B-cell lymphomas and 4 follicular lymphomas. Flow cytometric analysis was performed on 9 specimens, and all demonstrated an aberrant monoclonal B-cell population. PPL mimics PDAC clinically and radiologically and could be a challenge for pathologic diagnosis if lymphoma is not included in the differential diagnosis during immediate evaluation. If lymphoma is suspected during immediate evaluation, PPL could be reliably diagnosed by FNA with the aid of ancillary studies.

Post-COVID‑19 complications in hospitalized and nonhospitalized patients: the Silesian database of COVID‑19 complications (SILCOV‑19).

Due to the extent of the pandemic, high prevalence and severity of complications in the early post‑recovery period are expected. This study aimed to compare the scope of early post-COVID‑19 complications in patients who had the disease and were or were not hospitalized. This was a prospective, observational, registry‑based cohort study conducted at a tertiary cardiovascular hospital in Silesia, Poland. Interdisciplinary diagnostics, including cardiovascular, pneumatological, respiratory, neurological, and psychiatric tests, was performed during the study visit. All patients completed the study. Two‑hundred unselected, adult, white men and women with the symptoms of acute COVID‑19 were included, of which 86 patients had the disease but did not require hospitalization. The median (interquartile range) time from symptom onset to the study visit was 107 (87-117) and 105 (79-127) days in nonhospitalized and hospitalized patients, respectively. Lung lesions on high‑resolution computed tomography were found in 10 (8.8%) and 33 (39.3%) of nonhospitalized and hospitalized patients, respectively (P <0.01); no lesions were visualized on chest X‑ray images. Elevated platelet distribution width was found in more than 70% of the patients in both groups. More than half of the patients had insomnia, regardless of the hospitalization status. The abnormal platelet parameters, functional and radiological findings in the lungs, and insomnia were the most frequent short‑term COVID‑19 complications in hospitalized and nonhospitalized patients. Considering the number of patients who have had COVID‑19 worldwide, a high burden of the post-COVID‑19 complications might be expected.

Alcohol consumption epidemic and its complications during the COVID-19 pandemic in Khuzestan Province, Iran; 2020.

After unprecedented demand for ethanol in the pandemic, profiteers used methanol for making illegal alcoholic drink. Final judgements passed by criminal divisions of common courts of law in cases where death or grievous bodily harm was caused by injuries to the facial and cerebral parts of the skull resulting solely from punches to the facial area of the skull. Assessment of individual cases within each group to determine similarities and differences. Comparative analysis of both groups. This cross-sectional descriptive-analytical study investigated the effects of methanol poisoning on 400 patients who referred to hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences from March 20 to September 20, 2020. Ninety-eight-point five percent of patients had consumed alcohol for social reasons and only 0.3% had used it as a measure to avoid COVID-19. Eighty-seven percent of the patients used homemade alcohol bought from peddlers. The most common clinical symptom was gastrointestinal disorders (64.8%) and the most common complications were vision problems (12.3%). Ten-point-six percent (42 patients) of the patients died. The most important factors affecting mortality risk were dyspnea, neuropathic problems, abnormal radiological findings, dialysis, abnormal blood pressure, vision problems and dizziness. Informing the public about the risks of using homemade alcoholic beverages is essential if the associated disability and mortality has to be avoided.

Clinical and Epidemiological Correlates of Low IFN-Gamma Responses in Mitogen Tube of QuantiFERON Assay in Tuberculosis Infection Screening During the COVID-19 Pandemic: A Population-Based Marker of COVID-19 Mortality?

BackgroundThe clinical and epidemiological implications of abnormal immune responses in COVID-19 for latent tuberculosis infection (LTBI) screening are unclear. MethodsWe reviewed QuantiFERON TB Gold Plus (QFT-Plus) results (36,709 patients) from July 2016 until October 2021 in Asturias (Spain). We also studied a cohort of ninety hospitalized patients with suspected/confirmed COVID-19 pneumonia and a group of elderly hospitalized patients with COVID-19 who underwent serial QFT-Plus and immune profiling testing. ResultsThe indeterminate QFT-Plus results rate went from 1.4% (July 2016 to November 2019) to 4.2% during the COVID-19 pandemic. The evolution of the number of cases with low/very low interferon-gamma (IFN-gamma) response in the mitogen tube paralleled the disease activity and number of deaths during the pandemic waves in our region (from March 2020 to October 2021). The percentages of positive QFT-plus patients did not significantly change before and during the pandemic (13.9% vs. 12.2%). Forty-nine patients from the suspected/confirmed COVID-19 pneumonia cohort (54.4%) had low/very low IFN-gamma response to mitogen, 22 of them (24.4%) had severe and critical pneumonia. None received immunosuppressants prior to testing. Abnormal radiological findings (P=0.01) but not COVID-19 severity was associated with low mitogen response. Immune profiling showed a reduction of CD8+T cells and a direct correlation between the number of EMRA CD8+T-cells and IFN-gamma response to mitogen (P=0.03). ConclusionLow IFN-gamma responses in mitogen tube of QFT-Plus often occur in COVID-19 pneumonia, which is associated with a low number of an effector CD8+T-cell subset and does not seem to affect LTBI screening; however, this abnormality seems to parallel the dynamics of COVID-19 at the population level and its mortality.