Accelerated Sedimentation Rate Research Articles

Clinical and morphological features of chlamydial pneumonia

This article defins chlamydial pneumonia, this disease, a subtype of atypical pneumonia, poses a significant health concern, particularly among pediatric populations. This retrospective study aims to investigate the clinical characteristics and treatment outcomes of chlamydial pneumonia in children aged 3 to 8 years. A total of 26 children with confirmed Chlamydia pneumoniae infection were examined, revealing notable respiratory and extrapulmonary manifestations. Clinical presentation varied, with symptoms ranging from rhinitis and tracheobronchitis to unproductive cough, fever, and chest pain. Bronchoobstructive syndrome was prevalent, accompanied by leukocytosis, eosinophilia, and accelerated erythrocyte sedimentation rate (ESR). Radiographic findings predominantly showed interstitial changes and increased vascular components. Macrolides emerged as the primary therapeutic agents, leading to clinical recovery within 10-14 days. These findings underscore the importance of early recognition and appropriate management of chlamydial pneumonia in pediatric patients.

Feline Calicivirosis in the catteries

Cat breeding has become very popular nowadays. The presence of these animals in catteries, especially in conditions of imperfect compliance with sanitary and hygienic requirements, often causes outbreaks of viral diseases, the causative agents of which are transmitted mainly by the aerogenic transmission mechanism. Calicivirosis is the most common kennel disease; it can occur as a mono-infection and can also be associated with other viral respiratory diseases. The study aimed to evaluate the epizootic features and clinical course of feline calicivirus in catteries. It was found that the disease's stationary focus was in the experimental cattery. Depending on the year's season, the morbidity increase begins in April, peaks (40 %) in July, and gradually decreases until September. The most vulnerable age group is kittens aged 2–6 months due to imperfect immune mechanisms at this age. The disease occurs mainly manifestly in this age group, with characteristic pronounced clinical signs. Sick cats have sub febrile or pyretic fever, lack of appetite, and salivation with viscous saliva. Ulcers develop on the mucous membranes of the oral cavity. Also, erosions and ulcers are noted in the nasal mirror and on the mucous membrane of the larynx. There was conjunctivitis with serous to catarrhal-purulent exudate. Laboratory tests revealed leukopenia, acceleration of erythrocyte sedimentation rate, left shift of the nucleus, lymphocytosis, and monocytosis, which indirectly determine the viral disease and stimulation of immune functions, and the development of a systemic inflammatory response. Biochemical tests revealed the development of intoxication syndrome, hepatitis liver failure, and renal failure. The data obtained prove the systemic nature of the impact of calicivirus infection, the development of complications in the form of a systemic inflammatory response, which affects various organs and systems, particularly the liver and excretory system. The development of multiorgan pathology in feline calicivirus infection requires an integrated approach to treatment, including pathogenetic and symptomatic measures in the treatment protocol.

Stabilization of Al2O3 dispersed slurry by controlling pH

This study delves into the critical role of pH in modulating the dispersion and stabilization characteristics of Al2O3 slurries, emphasizing the interaction between the dispersant and Polyvinyl Alcohol (PVA) binder in terms of the system's adsorption behaviors and stability parameters. Zeta-potential measurements elucidate the substantial impact of slurry pH on stability, correlating low zeta potential values with accelerated sedimentation rates. Thermogravimetric and Fourier-Transform Infrared Spectroscopy (FTIR) analyses are conducted to elucidate the co-adsorption dynamics of the dispersant and binder on the Al2O3 surface. Our findings highlight pronounced adsorption of the polymer below the isoelectric point (IEP) of slurry and demonstrate the preferential adsorption of the ionic dispersant over the binder, indicative of chemical bond formation with the former and hydrogen bonding with the latter. These results not only shed light on the interaction mechanisms between the particles and reagents in the system but also pave the way for optimizing slurry formulations for enhanced stability and performance in industrial applications.

1775. Predictor Factors Of Severe Forms Of Rickettsial Infections

Abstract Background Rickettsial infections usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications might occur changing therfore the prognosis of the disease. We aimed to study the predictor factor of severe forms of rickettsial infections. Methods We conducted a retrospective study including all patients hospitalized in the infectious diseases department for rickettsiosis. The diagnosis was confirmed by serologies (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy. Severe forms included cases with acute respiratory distress syndrome, myocarditis, meningitis, meningoencephalitis, renal failure or septic shock. Results We encountered 472 cases among which 98 cases were severe (20.8%). Median age was 43[25-60] years among severe forms and 38[24-53] years among non-severe forms (p=0.132). Maculopapular skin rash (56.7% vs 88% ; p< 0.001), arthralgia (56.1% vs 77.3% ; p< 0.001) and eschar (16.3% vs 27% ; p=0.029) were significantly less frequent among severe forms. Meningeal syndrome (34.7% vs 8.3% ; p< 0.001), vomiting (56.1% vs 41.8% ; p=0.011) and cough (28.6% vs 13.9% ; p=0.001) were significantly more frequent among severe forms. Leukocytosis was significantly more frequent among severe forms (35.7% vs 20.6% ; p=0.002). The optimal cut-off value of white blood cell count for predicting severe forms was 7595/mm3, with a sensitivity of 61.9% and a specificity of 59.7%. The area under the curve was 0.622 and the 95% confidence interval ranged from 0.558 to 0.686. Elevated C-reactive protein levels (66.3% vs 65.5%; p=0.879) and accelerated erythrocyte sedimentation rate (36.7% vs 40.1%; p=0.543) were noted among severe and non-severe forms of rickettsiosis, with no significant difference. Conclusion The revealing symptoms of severe forms were characterized by the presence of vomiting, cough and meningeal syndrome, in the absence of the typical maculopapular skin rash and eschar. Leukocytosis was more frequent among severe forms of rickettsiosis. The diagnosis of severe forms should be kept in mind in order to promptly initiate the adequate treatment. Disclosures All Authors: No reported disclosures

Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Труднощі діагностики гістіоцитарного некротизуючого лімфаденіту

There is currently no consensus on the origin of histiocytic necrotising lymphadenitis (HNL), which is traditionally thought to be a self-limited, benign condition that usually resolves within 6 months. It is important to distinguish HNL as a clinical nosology because it can mimic other diseases such as lymphoma, infectious (mostly viral) and autoimmune diseases, including systemic lupus erythematosus. According to one study, HNL is misdiagnosed as lymphoma in 30% of cases. It has seen a similar clinical case in own practice. Purpose - to highlight the thoroughness of the diagnostic algorithm and differential diagnosis in case of suspected HNL. The article presents a clinical case of HNL in a 9-year-old child, which showed the complexity of clinical diagnosis. This observation combined the characteristic symptoms of the disease (fever, lymphadenopathy, hepatomegaly), haematological markers (leukemia, thrombocytopenia, anemia, accelerated erythrocyte sedimentation rate), as well as rare manifestations. There was a progressive development of edematous syndrome, which was manifested first by peripheral manifestations, and then bilateral pleurisy, ascites, soft tissue edema with the development of anasarca progressively increased. The difficulty in the diagnostic algorithm was that the first two histological examinations suggested the possibility of lymphoma in the child, and later immunohistochemical examination of the lymph node allowed to verify the clinical diagnosis. Obviously, a labour-intensive differential diagnosis in HNL requires the exclusion of the subject range of possible diseases of infectious or autoimmune origin. Conclusions. The diagnosis of HNL in the above observation was characterized by the complexity of the interpretation of clinical, morphological, histological studies, and only the result of immunohistochemical examination allowed to establish the diagnosis. In practice, the paediatrician should be properly aware of this pathology in order to refer the child to a paediatric hematologist in a timely manner. In the presence of a complex of clinical symptoms (prolonged fever, lymphadenopathy, rash, neurological symptoms), the possibility of a diagnosis of HNL should be considered. The study was performed in accordance with the Declaration of Helsinki. The informed consent of the child's parents was obtained for the study. The author declares no conflict of interest.

Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Case Report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Late Pleistocene to Holocene sedimentary history in the Pearl River Delta revealed by OSL and radiocarbon dating

A reliable chronology is essential to understand deltaic sedimentation processes in response to sea-level fluctuations and climatic changes. In the Pearl River Delta (PRD), high-resolution chronostratigraphy is still limited which hinders the detailed interpretation of sedimentary history. In this study, optically stimulated luminescence (OSL) dating and radiocarbon (14C) dating were applied to establish a chronological framework of core P5-4 (30 m depth) in the southern PRD. Fifteen OSL and four 14C samples produced ages ranging from c. 8 ka to 0.5 ka, and two older OSL samples produced minimum ages of 75 and 62 ka. 14C ages are generally older (up to c. 1 ka) than the corresponding OSL ages and the discrepancy increases with depth. The ages and sedimentary data of sixteen published cores have been compiled to correlate the regional stratigraphy and reconstruct the late Pleistocene to Holocene deltaic process. It is concluded that: (1) The bottom subaerially-exposed deposits of core P5-4 were dated to marine isotope stage (MIS) 5, which is consistent with similar OSL-based records in the PRD. The laterally correlation shows that a depositional hiatus during c. 70–8 ka prevailed in the PRD and may attribute to strong erosion due to weathering and fluvial scouring. (2) Due to the relatively high altitude of bedrock, the post-glacial marine deposition of the PRD started at c. 8 ka, postdating other megadeltas by at least 2–4 ka. During 8–0.5 ka, a three-stage sedimentary process that is common in the PRD occurred in P5-4, i.e., early-Holocene (8–6 ka) rapid accumulation rate (5.44 m/ka) associated with rapid sea level rise, followed by mid-Holocene (6–3 ka) decelerated sedimentation rate (1.17 m/ka) in response to reduced sediment supply and strong tidal forces and late-Holocene (3–0.5 ka) accelerated sedimentation rate (2.28 m/ka) due to enhanced human activity.

Generalized form of tularemia in pediatric surgeon practice: Difficulties of diagnosis and treatment

Tularemia in the practice of a pediatric surgeon is a rare disease, and abdominal and generalized forms of it are not detected without specific laboratory diagnostics. The long-term serious condition of patients, intoxication, abdominal pain with excluded acute surgical pathology in children force differential diagnosis with rare infectious diseases, including tularemia. In the Russian Federation, up to 30 children a year are diagnosed with tularemia, with the exception of outbreaks of the disease in some years. At the same time, the generalized form is detected in no more than 10% of patients. The authors presented a clinical case of a generalized form of tularemia in a 17-year-old patient. The disease started with abdominal pain, diarrhea and vomiting. At the beginning of the disease, a diagnostic error was made — suspicion of ovarian inversion and laparotomy according to Pfannenstiel. In the further development of the disease, pronounced ascites were detected with the production of up to 5 liters of effusion per day, damage to the kidneys, liver, heart, gastrointestinal tract. Laboratory data revealed leukocytosis up to 89×109, accelerated erythrocyte sedimentation rate, increased levels of creatinine, urea, transaminases, C-reactive protein, proteinuria persisted for a long time. Indirect hemagglutination reaction with tularemia diagnosticum made it possible to establish the diagnosis of tularemia, generalized form. During two weeks of the disease, an 8-fold increase in the titer of antibodies was noted. Syndrome therapy and specific antibacterial therapy made it possible to stop the infectious process and discharge the patient home on the 44th day of the illness with recovery.

Demographic and microbiological characteristics of tuberculous lymphadenitis and other extrapulmonary tuberculosis cases

Objective: Tuberculosis (TB) is a significant public health problem that remains important worldwide. This study aimed to examine the demographic characteristics and clinical features of patients with extrapulmonary tuberculosis (EPTB) and also identify the comorbidities of EPTB. Our secondary aim was to compare tuberculous lymphadenitis (TBL) with other forms of EPTB. Patients and Methods: This single-center, retrospective, observational study was conducted on patients diagnosed with EPTB in a training hospital in Turkey between January 1, 2011 and December 31, 2020. The demographic characteristics and clinical features of the patients were examined. TBL cases were compared with other forms of EPTB cases. Results: The most common clinical form was TBL. Fever, night sweats, and accelerated erythrocyte sedimentation rate were significantly more common in the other forms of the EPTB group compared to TBL. The rate of tuberculin skin test positivity was significantly higher in patients with TBL. The complication rate was 3%, and mortality rate was 4% among all patients. Conclusions: Extrapulmonary tuberculosis should be considered in the differential diagnosis by evaluating the medical history of patients who present with organ-specific symptoms, especially in TB endemic countries. The clinic may differ according to the organ involvement. TBL may be seen with milder symptoms compared to other clinical forms.

Інформативність загальноприйнятих запальних маркерів крові у верифікації гострих інфекційно-запальних процесів нижніх дихальних шляхів у дітей

Verification of acute infectious inflammatory processes of the lower respiratory tract and indication for antibiotic therapy are often based on the evaluation of the activity of inflammatory blood markers, but the data on their informative value in the diagnosis of acute pneumonia and bronchitis in children are controversial and conflicting. Purpose - to study the diagnostic value of some inflammatory blood markers in the verification of uncomplicated community-acquired pneumonia and acute obstructive bronchitis with the purpose of management’s optimization of infectious inflammatory diseases of the lower respiratory tract in children. Materials and methods. At the pulmonological department of the Regional children’s clinical hospital in Chernivtsi city 75 children have been examined. In the I clinical group 51 patients with diagnosis of «community-acquired pneumonia» were enrolled, and the second (II) group consisted of 24 children with acute obstructive bronchitis. According to the main clinical characteristics, the comparison groups have been comparable. The results of the study have been analyzed by parametric («P», Student’s criterion) and non-parametric («Рφ», Fisher’s angular transform method) calculation methods, and methods of clinical epidemiology with an evaluation of the diagnostic value of the tests has been performed taking into account their sensitivity (Se) and specificity (Sp), as well as the odd ratio (OR) of the event, taking into account their 95% confidence intervals (95% CI). Results. The analysis of the obtained dada has showed that in the patients with community-acquired pneumonia such common inflammatory blood markers (leukocytosis, relative neutrophilosis, shift of leukocyte formula to the left, elevation of erythrocyte sedimentation rate (ESR) or high level of С-reactive protein - CRP) are characterized by low sensitivity (Se in range between 11% and 63%) indicating that they are inadvisable for use as the screening tests for the verification of pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity (in the range from 75% to 93%) in the verification of pneumonia only under their significant increase (total leukocyte count >15.0x10⁹, ESR >10 mm/h and СRP level in blood >6 mg/ml), indicating that they are relevant enough, but only for confirming inflammation of the lung parenchyma. It has been found that the normal level of leukocytes (<10.0x109) in the hemogram did not have sufficient diagnostic (the number of false-negative and false-positive results was 46% and 45%, respectively) or probable predictor role (OR=1.44; 95%CI: 0.54-3.81) in the diagnosis of acute obstructive bronchitis, and therefore could not influence the composition of etiotropic treatment, namely to cancellation of antibiotic therapy. However, the number of rod neutrophils ≤5% in the common blood count has been characterized by a small number (16%) of false-positive results, which allows the use of this marker as confirming the diagnosis of acute obstructive bronchitis, and as well, as indication for antibiotic therapy discontinuation, but not as a predictor (OR=2.21; 95% CI: 0.69-7.06) or screening index (Se=29%). Conclusions. Analysis of the data has showed that in children with community-acquired pneumonia such common indicators of inflammatory response (leukocytosis, relative neutrophilia, shift of leukocyte formula to the left, acceleration of ESR or high CRP level in the blood) are characterized by a large proportion of false-negative results, and thus indicates the inexpediency of their use as screening methods to verify pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity in the verification of pneumonia under their significant increase (number of blood leukocytes >15.0 x10⁹, ESR ≥10 mm/h and CRP level >6mg/ml), which indicates the possibility of their use to confirm inflammation of the lung parenchyma. Herewith the number of rod neutrophils in the hemogram ≤5% is characterized by a high specificity (Sp=84%), which allows to use this marker in confirming the diagnosis of acute obstructive bronchitis and, as well as, an indication for antibiotic therapy cancellation. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: community-acquired pneumoniae; obstructive bronchitis; children; markers of a blood inflammatory response; diagnostical value.

ACUTE PANCREATITIS IN CHILDREN AND MULTISYSTEMIC INFLAMMATORY SYNDROME POST COVID INFECTION 19

During the SARSCoV2 pandemic children appear less likely to develop severe form Compared to adult subjects with higher contagiousness and mortality, especially in those at risk (age over 65 obesity cardiovascular disease diabetes). However a new multisystemic inflammatory syndrome associated with SARSCoV2 has been identified in the child associated with a cascade of inflammatory response responsible for clinical symptoms (prolonged high fever digestive disorders rash cheilite conjunctivit) and a highly disturbed inflammatory biological profile (high CRP accelerated sedimentation rate hyperferritinemia) mimicking an atypical post covid 19 Kawasaki syndrome in children as was recently published in the literature. Our case will illustrate an unusual presentation of post covid 19 multisystemic inflammatory Syndrome acute pancreatitis in a 9-year old with favorable clinical and biological development.

253. Clinical and Therapeutic Particularities of Brucellar Sacroiliitis

Abstract Background The misleading clinical presentation of brucellar sacroiliitis, which is usually confused with involvement of the lumbosacral hinge or the hip, is responsible for diagnostic and therapeutic delay. We aimed to study the epidemiological, clinical and therapeutic features of brucellar sacroiliitis. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for brucellar sacroiliitis between 1992 and 2020. The diagnosis of brucellosis was based on positive wright agglutination test and/or positive blood cultures. Results We included 12 patients, among whom 8 were males. The mean age was 35±13 years. Ten patients consumed unpasteurized milk and 9 had a close contact with animals. Three patients were previously treated for brucellosis and 4 patients had a family history of brucellosis. The revealing symptoms were sacroiliac joint pain (7 cases) and low back pain (5 cases), associated with fever and night sweats (9 cases). There were 8 cases localized on the left side of the joint. Spondylodiscitis was associated with sacroiliitis in 3 cases and genitourinary brucellosis in one case. An accelerated erythrocyte sedimentation rate and elevated C-reactive protein levels were noted in 7 cases, anemia in 7 cases and leukopenia in 4 cases. X-ray examination of sacroiliac joints revealed thickening of the sacroiliac joint (3 cases). Bone scintigraphy, which was performed in 8 cases, showed hyperfixation of the sacroiliac joint. Sacroiliac computed tomography and magnetic resonance imaging, performed in 6 cases and 4 cases, respectively, showed signs of sacroiliitis in all cases and soft tissue abscess in 2 cases. Blood cultures were positive to Brucella in 2 cases. All patients received doxycycline and rifampicin, associated with trimethoprim/sulfamethoxazole in 2 cases. The median duration of treatment was 4.5 months [3-9 months]. The disease evolution was favorable in 10 cases. Sequelae represented by sacroiliac joint pain was noted in 4 cases. There were 2 relapsing cases. Conclusion The diagnosis of brucellar sacroiliitis is based mainly on the imaging results and serological testing. Respecting preventive measures is a priority in order to eradicate brucellosis. Disclosures All Authors: No reported disclosures

240. Epidural Involvement Complicating Pyogenic Spondylodiscitis

BackgroundPyogenic spondylodiscitis is an infection of the intervertebral disc(s) and/or adjacent vertebrae. It might be associated with epidural involvement. We aimed to study clinical, laboratory and evolutionary features of epidural involvement complicating pyogenic spondylodiscitis.MethodsWe conducted a retrospective study including patients hospitalized for spondylodiscitis with epidural involvement in the infectious diseases department between 2007 and 2019.ResultsWe included 22 patients among whom 16 were males (72.7%). The mean age was 64±11 years. Eleven patients had diabetes mellitus (50%). The onset of the disease was acute in 18 cases (81.8%) and sub-acute in 4 cases (18.2%). The median delay to diagnosis was 4 [2-13] weeks. The revealing symptoms were back pain (95.5%), fever (68.2%) and asthenia (54.5%). Motor deficit was noted in 9 cases (40.9%), sensory deficit in 4 cases (18.2%) and sphincter dysfunction in one case (4.5%). Physical examination revealed spinal tenderness (77.3%), paravertebral tenderness (22.7%) and spinal stiffness (18.2%). Blood cultures were positive in 13 cases (59.1%) represented by Staphylococcus aureus (31.8%). Elevated C-reactive protein levels (81.8%) and accelerated erythrocyte sedimentation rate (63.6%) were noted. Imaging features showed vertebral body osteolysis (81.8%), inflammation of adjacent soft tissue (81.8%), spinal cord compression (40.9%) and psoas abscess (13.6%). Along with medical treatment, immobilisation (72.7%), abscess drainage (13.6%) and surgery (9.1%) were indicated. The disease evolution was favourable in 20 cases (90.9%). Two patients were dead (9.1%). Sequelae were noted in 9 cases (40.9%) represented by back pain (31.8%) and spinal deformity (9.1%).ConclusionSpondylodiscitis complicated with epidural involvement might lead to complications and sequelae if not promptly diagnosed and treated. Disclosures All Authors: No reported disclosures

Dermatomyositis following COVID-19 infection

IntroductionViruses have been shown to reveal autoimmune diseases like type1 diabetes and systemic connectivities like dermatomyositis (DM). Coronavirus disease 2019 (COVID-19) is best known for its respiratory symptoms but multiple systems could be affected in acute or post COVID-19 infection period. Clinical dermatomyositis following COVID-19 infection was exceptionally reported.ObservationWe report a case of a 61-year- woman with no medical history observed in March 2021 with bilateral edema. Doppler ultrasound demonstrated a superficial venous thrombosis of saphenous veins. The patient had a suspicious epidemiological history, and her chest CT scans showed lung damage similar to that caused by COVID-19. PCR test for Coronavirus confirmed the infection. She was treated by curative anticoagulation, steroids and oxygen therapy. Two months after her leaving, she was presented in internal medicine's department with pulmonary embolism despite good anti coagulation. Her PCR test for Coronavirus was negative. At her admission, she was complained of asthenia weight loss and pain in scapular and pelvic muscles. Physical examination revealed erythematous patches with edema in periorbital areas. Chest auscultation found bilateral basal lung crepitation. Bilateral proximal muscle weakness in upper and lower extremities was objectified. Oral examination found ulcerations in the lower gingiva. We found signs of arthritis in wrists and proximal interphalangeal joints. Biological tests showed anemia (hemoglobin =8.6 g/dl), accelerated erythrocyte sedimentation rate (65 mm H1) ; high C-reactive protein(119 mg/l)d biological myolysis and cytolydid (Creatinin kinase = 1052 U/l, LDH = 478 AST/ALT 238 U/l/119 U/l). Infectious investigations including HCV, HBV and HIV serology were negative. Thyroid function test was in normal range. Neoplastic research was negative. Immunologic analysis revealed positive antinuclear antibodies (ANA) with anti JO1 antibodies. Anti cardiolipin antibodies and kit-myositis were negatives. Electromyographic findings revealed inflammatory myositis. The patient was treated by high doses of steroids then progressively decreased. Good progress was noticed.ConclusionDermatomyositis is an inflammatory myopathy relatively rare. An elevation of its incidence was noticed during the pandemic period coinciding of corona virus [1]. Viral infections could induce autoimmunity and may be the eliciting event in the pathogenesis of myositis [2]. In our case, dermatomyositis is hypothetically linked to viral trigger on the background of genetic predisposition. The spectrum of complications following COVID-19 is broad but incidence is too rare including Idiopathic thrombocytopenic purpura, Guillain-Barré syndrome and autoimmune haemolytic anaemia recorded in 1, 5 and 7 patients respectively, 4–13 days following onset of COVID-19 symptoms. We assume that true dermatomyositis, triggered by COVID-19 may occur and the immunopathogenicity is via type 1 IFN pathway. Tanboon et al. commented that 58-year-old COVID-19 patient reported to have myositis may actually have dermatomyositis.

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study.

Background: Cervical spine lesions are a common manifestation of rheumatoid arthritis (RA). The purpose of this study was to conduct a retrospective analysis of radiological lesions in cervical spine in patients with RA and to correlate findings with clinical and laboratory parameters. Methods: Overall, 240 consecutive patients with RA were referred for imaging by clinicians based on symptoms suggesting cervical spine involvement and/or long disease duration. In each patient, lateral radiographs and MRI of the cervical spine were performed. The imaging data were correlated with clinical records and laboratory data. Results: The cervical spine was affected in 179 patients (75%). The most common lesions were anterior atlanto-axial subluxation (AAS; 58%), subaxial subluxation (58%), and demineralization (48%). Cervical spine involvement was linked to longer disease duration (p = 0.007), the presence of rheumatoid factor (RF; p = 0.010), elevated C-reactive protein (CRP) levels (p = 0.016), and accelerated erythrocyte sedimentation rate (ESR; p = 0.025). Longer disease duration was associated with anterior AAS (p = 0.005), subaxial subluxation (p = 0.005), and basilar settling (p = 0.003). Conclusions: As many as 75% of RA patients develop lesions that can be observed on radiographs and through MRI. The most frequent radiological findings include anterior AAS and subaxial subluxation. Long disease duration, RF seropositivity, and elevated inflammatory markers were risk factors for cervical spine involvement.

Climate and land-use as the main drivers of recent environmental change in a mid-altitude mountain lake, Romanian Carpathians.

Recent decades have been marked by unprecendented environmental changes which threaten the integrity of freshwater systems and their ecological value. Although most of these changes can be attributed to human activities, disentagling natural and anthropogenic drivers remains a challenge. In this study, surface sediments from Lake Ighiel, a mid-altitude site in the Carpathian Mts (Romania) were investigated following high-resolution sedimentological, geochemical, environmental magnetic and diatom analyses supported by historical cartographic and documentary evidence. Our results suggest that between 1920 and 1960 the study area experienced no significant anthropogenic impact. An excellent correspondence is observed between lake proxy responses (e.g., growth of submerged macrophytes, high detrital input, shifts in diatom assemblages) and parameters tracking natural hydroclimate variability (e.g., temperature, NAO). This highlights a dominant natural hydroclimatic control on the lacustrine system. From 1960 however, the depositional regime shifted markedly from laminated to homogenous clays; since then geochemical and magnetic data document a trend of significant (and on-going) subsurface erosion across the catchment. This is paralleled by a shift in lake ecosystem conditions denoting a strong response to an intensified anthropogenic impact, mainly through forestry. An increase in detrital input and marked changes in the diatom community are observed over the last three decades, alongside accelerated sedimentation rates following enhanced grazing and deforestation in the catchment. Recent shifts in diatom assemblages may also reflect forcing from atmospheric nitrogen (N) deposition, a key recent drive of diatom community turnover in mountain lakes. In general, enhanced human pressure alongside intermittent hydroclimate forcing drastically altered the landscape around Lake Ighiel and thus, the sedimentation regime and the ecosystem’s health. However, paleoenvironmental signals tracking natural hydroclimate variability are also clearly discernible in the proxy data. Our work illustrates the complex link between the drivers of catchment-scale impacts on one hand, and lake proxy responses on the other, highlighting the importance of an integrated historical and palaeolimnological approach to better assess lake system changes.

Some Indicators of Blood of Rats Poisoned with Pesticide Karate

An artificially reconstructed karate pesticide leads to cytopsy of blood corpuscles and a shift of the Leiko formula to the right. In this case, the erythrocyte indices, the color index of erythrocytes and the average hemoglobin content, as well as the erythrocyte sedimentation rate, significantly increase. A decrease in the number of corpuscles with increased erythrocyte indices (CP and DES), accompanied by granulocytopenia, agranulocyte and accelerated erythrocyte sedimentation rate are additional evidence of B12-deficiency and folate-deficiency anemia. The research of the parameters of peripheral blood poisoned with karate of rats at introduction of its per os RAF is shown that all studied indicators of approximately identical size with indicators of blood of intact rats.