Accelerated Sedimentation Rate Research Articles

Detection and differential diagnosis of tuberculosis in patients of the pulmonary department with community-acquired pneumonia and chronic obstructive pulmonary disease

The purpose of the present work was to study the problem of tuberculosis detection in patients with chronic obstructive pulmonary disease (COPD) in the anamnesis and the role of Mantoux test and Diaskintest in diagnosing tuberculosis in patients hospitalized in the pulmonary department of the multidisciplinary emergency hospital. Materials. According to the results of analysis of 122 medical records of inpatient patients (form 003/u) hospitalized are divided into 2 groups: 1 st – patients admitted to hospital with the diagnosis of community-acquired pneumonia (CAP), 2 nd – patients with acute COPD, CAP at the follow-up of which was diagnosed in 73% of cases. Results. The age of patients with acute COPD was found to be 48.0 ± 1.9 and 69.9 ± 2.7 years respectively (z = –1.44; p = 0.149). Acute onset, duration and intensity of coughing, and pronounced shortness of breath were observed in patients with COPD in the clinical picture, but a CAP was detected in the follow-up survey. Coughing, fever, leukocytosis and accelerated sedimentation rate were more common symptoms in patients without COPD. Tuberculosis was detected in 10.7% of patients in the pulmonary department, while DNA of mycobacteria tuberculosis in the epithelial lining fluid was found in 30.8% of cases. Positive results of simultaneous immunodiagnostics (Mantoux test and Diaskin-test) were recorded in 76.9% of cases. Conclusion. Patients with COPD exacerbation, as well as patients with CAP, are a potential risk group for tuberculosis, need additional examination in the pulmonology department of the hospital according to the CAP standard to exclude or early diagnosis of pulmonary tuberculosis. If 2 diagnostic tests are used simultaneously (Mantoux test with 2 tuberculin units and Diaskintest), the accuracy and timeliness of tuberculosis diagnosis increases, including in case of exacerbation of COPD.

Long-term Outcome of Subacute Thyroiditis

Subacute thyroiditis (SAT) is a rare inflammatory disease that presents diagnostic challenges. The underlying pathophysiology and prediction of outcomes are elusive. We investigated the long-term follow-up of SAT for up to 30 years and determined predictors for later hypothyroidism. SAT outcome data from 127 patients (age: 47.6 ± 11.0 yrs. 24.7±4.8 kg/m²) were analyzed retrospectively. Patients with pre-existing and known causes of hypothyroidism unrelated to SAT were excluded. We also excluded patients without an accelerated erythrocyte sedimentation rate. SAT outcome parameters included anterior neck pain or tenderness of the thyroid, inflammation markers, hypoechoic areas in thyroid ultrasound, hyperthyroidism, fine-needle aspiration, and thyroid scan. Pre-treatment TSH-levels, gender, age, ultrasound findings, anti-thyroid antibodies and markers of inflammation were considered as possible predictors of SAT outcome. More than 26.8% of SAT patients developed permanent hypothyroidism within 3 years of treatment. The patient groups later developing hypothyroidism did not differ in age, BMI, pre-treatment TSH levels or initial dosage of prednisolone treatment. However, high cumulative doses of prednisolone were associated with a higher prevalence of hypothyroidism. Also, women were more likely to develop hypothyroidism (OR: 3.18 (95% CI: 1.14-8.65); p=0.0176). Our study suggests that one-quarter of patients with SAT develop hypothyroidism in the long-term. Hypothyroidism was predicted by high cumulative doses of prednisolone treatment and female gender. The reported lower prevalence of hypothyroidism in other countries may represent the faster establishment of diagnosis, different treatment protocols, or lower susceptibility to loss of thyroid function. Swift establishment of the diagnosis and rapid tapering of steroids may result in a higher proportion of patients with euthyroidism.

THE STRUCTURE AND CLINICAL MANIFESTATIONS OF JUVENILE IDIOPATHIC ARTHRITIS IN CHILDREN IN KRASNODAR

Aim. The research was conducted to study the structure (variants, sexual and age characteristics) and manifestations of articular syndrome in children with juvenile idiopathic arthritis in Krasnodar.Materials and methods. There was conducted a retrospective analysis of 89 case histories in patients aged 2-15 diagnosed with juvenile idiopathic arthritis for the first time.Results. As a result of the study, the following variants of juvenile idiopathic arthritis were diagnosed: oligoarticular – in 62 patients (69,6%), polyarticular – in 24 patients (27%) and systemic – in 3 children (3,4%). Group 1 consisted of 62 patients with oligoarticular variant, and group 2 consisted of 24 patients with polyarticular variant. In the sexual aspect, there were 1,5 times more girls than boys among all the studied children. There are also a higher number of the females within the groups. The average age of the onset of the disease in all patients with juvenile idiopathic arthritis was 8,9±0,4 years. In group 1, the average age was 9,6±0,5 years, in group 2 – 7,4±0,4 years. In children with oligoarticular variant of the disease, knee and ankle joints were more often involved in the process. In group 2, the pathological process involved both large joints and small joints of the hands and feet. Leukocytosis, accelerated erythrocyte sedimentation rate and positive results of immunological studies were more often detected among the children of the second group. On the radiographs, cartilage and bone changes were found in 9% of patients.Conclusion. Among the patients with juvenile rheumatoid arthritis, the residents of Krasnodar, the oligoarticular variant dominates (69,7%), the polyarticular RF-negative variant is in second place (25,8%), the systemic variant is in third place (3,4%), and the polyarticular RF-positive variant is in last place (1,1%). In the sexual aspect, there were 1,5 times more girls than boys among all the patients. The onset of the joint syndrome mainly occurs in early school and puberty age. The articular syndrome was manifested mainly by the arthritis of the knee, ankle joints, and the polyarticular variant was also manifested by the arthritis of the wrist joints and small joints of the hands and feet. Among the patients, the signs of humoral activity and immune inflammation were more characteristic of the polyarticular variant. At the onset of disease, the changes of cartilaginous and bony tissues of the joints were identified by the radiography only in 9% of cases.

Arterial hypertension in a patient with non‑ specific aortoarteritis (Takayasu disease) and AA-amyloidosis: a case report

Arterial hypertension (HTN) is the most common cardiovascular disorder around the world. High blood pressure is a manifestation of essential hypertension (EHTN) in the majority of cases. The exclusion of symptomatic HTN is crucial for correct diagnosis. We present a case of a very rare symptomatic HTN caused by nonspecific aortoarteritis (Takayasu disease). Morphological substrate of Takayasu disease is arteritis associated with the total wall damage of aortic brunches. The diagnosis is very difficult due to the chronic course, nonspecific signs and a variety of clinical masks. That often leads to late diagnosis and complications. Clinical features of Takayasu aortoarteritis include unilateral pulse weakening, blood pressure asymmetry on right and left arms, bruit on damaged artery, laboratory signs of inflammation: accelerated erythrocyte sedimentation rate (ESV), anemia, thrombocytosis, C‑reactive protein (CRP) elevation. Ultrasound vessel duplex scanning is important, but angiography of aorta and aortic branches are still the “gold standard”. We draw attention to clinical features, diagnostic methods and the course of the Takayasu disease in a young woman with high blood pressure.

High-resolution magnetostratigraphic study of the Paleogene-Neogene strata in the Northern Qaidam Basin: Implications for the growth of the Northeastern Tibetan Plateau

The Cenozoic terrestrial, intermontane Qaidam Basin on the northeastern edge of the Tibetan Plateau contains >12km of sedimentary rocks that potentially document the accommodation of India-Asia convergence and the growth of the plateau. The chronology remains incomplete, hindering cross-basin correlation between lithostratigraphic units and their further interpretation. Here we present a high-resolution magnetostratigraphy spanning >5km of Paleogene-Neogene sequence at Dahonggou in the Northern Qaidam Basin. Based on correlation with the geomagnetic polarity time scale (GPTS), we have dated the section to being between ~52 and ~7Ma. The bottom conglomeratic unit, ranging from >52Ma to ~44Ma, was deposited in high-energy environments (e.g., alluvial fan or braided river), reflecting the earliest deformation and uplift of the basin-bounding Qilian Shan fold-thrust belt in response to India-Asia collision. In addition, we identified two major increases in sedimentation rate at 25–16Ma and after ~9.5Ma and three phases of lesser increases at 52–44Ma, 38–33Ma, and 14.6–12.0Ma. These increases in sedimentation rate are consistent with regional thermochronology and basin analysis studies, which revealed enhanced motion on basin-bounding thrust faults. We argue that these accelerated sedimentation rates indicate pulsed tectonism in the northeastern Tibetan Plateau. The pulse at 25–16Ma may further relate to phases of strong rainfall linked to an intense monsoon at that time.

СТАТЕВО-ВІКОВА ХАРАКТЕРИСТИКА ТА РЕЗУЛЬТАТИ КЛІНІЧНОГО ОБСТЕЖЕННЯ ХВОРИХ, ЩО ПЕРЕНЕСЛИ ТОНЗИЛЕКТОМІЮ

Мета: порівняти рівень захворюваності на хронічний тонзиліт серед чоловіків і жінок працездатного віку та встановити його найчастіші ознаки.Матеріали і методи. Проведено ретроспективний аналіз 272 карт стаціонарних хворих, які перебували на лікуванні у ЛОР-відділенні комунального закладу Тернопільської обласної ради «Тернопільська Університетська лікарня» за період з 2014 по 2016 роки з приводу декомпенсованого хронічного тонзиліту.Результати. Проведено порівняння частоти виникнення хронічного тонзиліту за статевою ознакою та встановлено віковий період найчастішого його розвитку. Проаналізовано частоту різних симптомів захворювання та результати лабораторних досліджень.Висновки. Найчастіше декомпенсований хронічний тонзиліт реєструється у віковому періоді від 18 до 44 років, причому у жінок у 1,43 разу частіше, ніж у чоловіків. Найхарактернішими симптомами є: щорічні повторні ангіни, біль у горлі з періодичним посиленням, першінням, напади кашлю, гіперемія і набряклість країв дужок мигдаликів, наявність у криптах рідкого, густого казеозного або у вигляді пробок гнійного вмісту. У загальному аналізі крові може відмічатися помірний лейкоцитоз із підвищеним вмістом паличкоядерних нейтрофілів і лімфоцитів та прискорення швидкості осідання еритроцитів. Досить часто реєструється знижений вміст еритроцитів.

Cutaneous basidiobolomycosis: Seven cases in southern Benin

Cutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis. A retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015. Seven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm3) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy. Cutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses. Cutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.

Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country.

The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16–89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.

Risk factors associated with local complications of erysipelas: a retrospective study of 152 cases.

Erysipelas is a common skin infection. Hemorrhagic, bullous, abcessing and necrotic lesions are the major local complications. However, their occurrence factors are not clearly known. The aim of this study is to identify the risk factors associated with the occurrence of local complications of Erysipelas. Medical records from all patients hospitalized with local complications of erysipelas admitted to the Military Hospital of Rabat between 2005 and 2015, were retrospectively studied. Using an univariate and multivariate statistical study, the main characteristics were compared with those from patients with erysipelas without local complications. In total, 152 patients were analysed, of whom 72 had local disease complications. Using univariate analysis, the factors significantly associated with disease complications were found to be: age ≤ 50 years, female gender, heart disease, smoking, taking antibiotics or non-steroid anti-inflammatory drug before hospitalization, and accelerated sedimentation rate. However, in multivariate analysis, taking antibiotics before hospitalization (OR 5.15, 95% CI 1.28 to 20.72, P = 0.01) and accelerated sedimentation rate (OR 5, 15, 95% CI 1.00 to 1.06, P = 0.001) were the only independent factors associated with complicated erysipelas. Our study showed that prior antibiotics taking and higher sedimentation rate are independent risk factors for local complications of erysipelas. Patients with these characteristics should be carefully evaluated and monitored.

PANDEMIC INFLUENZA A (H1N1) PDM 09 IN THE SEASON 2015/2016: ANALYSIS OF FATAL OUTCOMES IN CHILDREN

The analysis of the characteristics of the current influenza A(H1N1) pdm 09 at 624 children in the 2015/2016 season. For severe illness (5%) characterized by short incubation period, lack of initial period, acute or acute onset with rapid development of multiorgan failure, prolonged febrile body temperature (up to 5—6 days or more) in the absence of complications, a prolonged severe intoxication (4—5 days or more), a significant frequency of diarrhea syndrome (10,2%), hemorrhagic syndrome (5.3%), exacerbation of comorbidity (20%), combined with other viral infections — herpes, rotavirus, enterovirus and others (33%). In the clinical analysis of blood — leukopenia (33.9%), leukocytosis (14.5%) with neutrophilic shift (11.3%), neutrophilia (51.6%), monocytosis (45.2%), lymphocytosis (9.7%), thrombocytopenia, anemia, accelerated erythrocyte sedimentation rate moderately; in the biochemical analysis of blood, hypernatremia, increase in the concentration of lactate, hyperfermentemia (ALT, AST, ALP, LDH, CPK), hypoproteinemia, dysproteinemia, increased CRP, increased creatinine and urea, increase of procalcitonin (PCT). In the structure of complications of pneumonia was 6%, stenosing laryngotracheitis — 9.8%, obstructive bronchitis — 14.5%. Two unvaccinated against influenza in infants who become ill during the epidemic period for influenza and SARS from homes with a typical clinical picture, died from severe (toxic) form of pandemic influenza. Pandemic influenza occurred at the background of severe immunosuppression (atrophy of the thymus, depletion of follicles of peripheral organs of immunogenesis — spleen, lymph nodes, tonsils). The main cause of death was the development of multiple organ failure with rapid progressive lesion of the vital organs.

Holocene hydrological events and human induced environmental changes reflected in a southeastern Mediterranean fluvial archive

The chronostratigraphy of an eastern Mediterranean Holocene fluvial sequence reflects global trends (climate and sea-level), local modulations (hydrological regime and storm surges) and anthropogenic impact. Two continuous cores retrieved from the Tanninim Stream estuary, on the Carmel coast of Israel, are dated by optically stimulated luminescence (OSL) to span the Holocene. The sedimentology and faunal assemblages are analyzed for reconstructing environmental conditions. Despite time gaps recognized in the fluvial successions, three main depositional periods provide distinctive archives capturing natural and anthropogenic centennial to millennial changes. Alternations between enhanced and reduced fluvial activity associated with humid and dry climate conditions, characterized the early to mid-Holocene fluvial record between about 7.8 and 5.7ka, and may match eastern Mediterranean climate records. The first humid phase, from 8 to 6ka, features organic-rich fine sediments and proliferating brackish ostracods, foraminifera and molluscs. The appearance of this biofacies indicates the initiation of seepage from the Yarkon-Tanninim aquifer through the brackish oligohaline Enot Timsah springs. The advancing coastline, due to sea-level rise starting about 5.8ka, resulted in an increasing supply of quartz sands and marine-transported foraminifera. Relatively fast accumulation of organic-rich fine-grained sediments with enhanced preservation of brackish fauna during the late Holocene is probably associated with maintenance of the Tanninim dams during the early Arab period (7th–8th centuries CE).The last century has been characterized by accelerated sedimentation rates that may be associated with reduced vegetation cover due to modern human activity, and by deposition by a high-energy surge event.This study demonstrates that the lower part of a semi-arid southeastern Mediterranean estuary responds to periods of climatic and sea-level change on a regional scale, and to human impact and abrupt past hydrological events on a local scale.

Clinical and Laboratory Features of Infectious Mononucleosis in Children Depending on the Etiology of the Disease

Study of clinical and laboratory features of infectious mononucleosis (IM) in children depending on the etiological variant of the disease. The study involved 94 children aged 4 months to 15 years old with a diagnosis of «infectious mononucleosis». The study analyzed the etiologic structure of IM, clinical and laboratory features of its individual etiological variants. The findings showed that the most common cause of myocardial infarction in children under the age of 15 years is HHV-6, which is more common as monoinfection (51.06% of the total number of patients with IM), at least — in association with EBV and CMV. IM mixed etiology recorded in 29.79% of cases. The acute phase of infectious mononucleosis, regardless of the etiology of the disease is accompanied by a moderate leukocytosis, accelerated erythrocyte sedimentation rate, an increase in alkaline phosphatase activity. The level of IL-4 in the blood varies depending on the etiology of the disease and is the highest at the infarction caused by EBV. Severity of the clinical picture varies depending on the etiology of the disease. The most pronounced intoxication, lymphoproliferative and hepatolienalis syndromes were identified in children with IM-EBV, IM-HHV-6 and IM mixed etiology (version «EBV + HHV-6»). Determination of etiologic variant of IM is relevant for the diagnosis of disease, prediction of its course and possible complications.

Dispersion of atmospheric fine particulate matters in simulated lung fluid and their effects on model cell membranes

Atmospheric fine particulate matter (PM2.5) was collected to investigate its dispersion in simulated lung fluid (SLF) and its interaction with model cell membranes. Organic acids, NH4+, SO42− and NO3− were detected in PM2.5 soluble fraction, and heavy metals were detected from the total mass. The insoluble fraction contained kaolinite, CaCO3, aliphatic carbons, aromatic rings, carboxyl and hydroxyl groups reflected by the infrared spectra. Proteins dispersed PM2.5 in SLF, resulted in smaller hydrodynamic diameter (dH) and slower sedimentation rate. Conversely, phospholipids increased dH value and accelerated sedimentation rate. Giant unilamellar vesicles (GUVs) and supported lipid bilayers (SLBs) were used as model cell membranes. PM2.5 adhered on and disrupted the membrane containing positively-charged lipids but not the membrane containing neutrally- and negatively-charged lipids, which was monitored by microscopy and a quartz crystal microbalance with dissipation (QCM-D). The cationic sites on membrane were necessary for PM2.5 adhesion, but membrane should be disrupted by the combined action of electrostatic forces and hydrogen bonds between PM2.5 oxygen containing groups and the lipid phosphate groups. Our results specified the roles of proteins and phospholipids in PM2.5 dispersion and transport, highly suggested that the health hazard of PM2.5 was related to the biomolecules in the lung fluid and the particle surface groups.

Pleurésie infectieuse révélatrice d’un myélome multiple chez un jeune de 28 ans

Multiple myeloma is a malignant proliferation of plasma cells, mainly affecting the bone marrow. It rarely occurs in young patients. The medical observation study reveals multiple myeloma discovered through a purulent pleurisy in a 28-year-old subject. This patient was admitted to the pneumology service of the Mohamed V military hospital in Rabat for a fever and dyspnea evolving into a context of poor general condition. Clinical examination found a right pleural fluid effusion syndrome. The pleural puncture reveals a germ-free exudative purulent fluid without plasma cells. The myeloma diagnosis was suspected due to the combination of an aplastic normochromic normocytic anemia at 4.5g/dL of hemoglobin, an accelerated erythrocyte sedimentation rate, hypercalcemia, renal failure and osteolytic lesions located mainly in the skull and pelvis area, oriented by electrophoresis and serum protein immunosubstraction revealing a narrow peak in monoclonal beta-2 globulin at 70.56g/L with a lambda monoclonal gammopathy with immunoglobulin G, and confirmed by the myelogram showing a 74% rate of bone marrow plasma cells. The occurrence of myeloma at a young age is rare and the purulent pleurisy without plasma cells is a rare form of presentation and represents a poor prognosis.

Estudio de la nutrición en niños pobres de Lima

Se ha realizado el estudio de la nutrición en 102 niños escolares de la clase pobre de Lima, de edades comprendidas entre los 6 a 14 años, con los siguientes resultados: Desde el punto de vista clínico se ha constatado en un buen porcentaje carencia de vitaminas del complejo B, estados anémicos en menor grado y otros signos que atestiguan estados de hiponutrición, debidos a una deficiente alimentación, de acuerdo a la encuesta practicada. Casi en el 50% se ha constatado disminución de la talla y peso comparado con sujetos normales de la misma edad. El estudio bioquímico de la sangre reveló una disminución de las proteínas totales y sus fracciones en la casi totalidad de los casos; en el 67% las cifras de hemoglobina estuvieron por debajo de la normal. Hay un marcado porcentaje de niños con velocidad de sedimentación acelerada, sin relación con procesos pulmonares activos. Se ha observado una hipoascorbinemia acentuada en la casi totalidad, de acuerdo al pobrísimo aporte de vitamina C de sus alimentos. Las determinaciones de fósforo inorgánico y fosfatasas alcalinas en el suero se presentan en otro trabajo por el Dr. A. Guzmán Barrón. En resumen, consideramos, de acuerdo a los datos anteriores, que existe en los niños de la clase pobre de Lima signos, especialmente bioquímicos de estados de hiponutrición, debidos a pobre alimentación, en parte corregibles con una adecuada orientación educativa.

Infective endocarditis - maybe yes, maybe no: Case report

Infective endocarditis (IE) is a rare disease which manifests in different ways. We are presenting a female patient who was suspected of IE based on the presence of fever, accelerated erythrocyte sedimentation rate, increased levels of C-reactive protein and echocardiographic findings of filamentous structures on the aortic valve which were assumed to be vegetation. Because of the well-known fact that in the pre-antibiotic era IE was almost always a fatal disease, empirical antibiotic therapy was conducted despite the absence of clear criteria for IE and it resulted in a satisfactory outcome. The course of the disease and the persistence of echocardiographic findings with a completely competent aortic valve, suggested us to consider the diagnosis of Lambl's excrescences. There was no indication for surgical treatment in our patient; so that in the absence of pathological confirmation our diagnostic dilemma was left unresolved. In patients with typical clinical features of IE and filamentous structures on the cardiac valves that are completely competent, Lambl's excrescences should be kept in mind as a possible differential diagnosis.

914 Clinical Features of Mycoplasmal Pneumonia at Early Age Children

Background and AimsIn recent years the problem of mycoplasmal pneumonia, especially in early age children attracted the attention of pediatricians around the world. Purpose - to study the peculiarities of...

Particularities of 2009 influenza A (H1N1) Infection in outpatients

Summary. Emergence of a new influenza virus А / H1N1 / CA / 2009 (IA2009) in October–December, 2009, in Russia required to investigate clinical features of the infection and effectiveness of treatment in ambulatory practice. Information from outpatient medical cards of 44 patients seeking for medical aid because of acute respiratory viral infection (ARVI) during pandemic 2009 was analyzed. All patients were examined for the presence of influenza А / H1N1 / CA / 2009 virus RNA, seasonal influenza virus RNA and influenza B virus RNA in nasopharyngeal swabs using polymerase chain reaction (PCR). According to the PCR results, patients were identified as having influenza А / H1N1 (n = 21) or other ARVI (n = 23). Signs and symptoms, complete blood count test, urine test, and chest X-ray were analyzed. Retrospective analysis found that 76.2 % of influenza А / H1N1 patients had acute respiratory diseases during previous 12 months and 19.0 % of them were healthcare workers. Leading symptoms and signs in patients with influenza А / H1N1 were cough, headache, weakness, myalgia, fever, obstruction of upper and lower airways. Mild course of disease was observed only in 23.8 % of the cases with recovery during 10 days. Complications were found in 28.6 % of the patients, 14.3 % of them were hospitalized. The most frequent changes in complete blood count tests were accelerated erythrocyte sedimentation rate, neutropenia / leucopenia, lymphocytosis, monocytosis, anisocytosis, thrombocyte aggregation. In 31.3 % cases, changes in white cell count remained after clinical recovery and resolving all respiratory symptoms. Administration of antiviral antibiotic Ingavirin in patients with influenza А / H1N1 started in the first 2 days of the disease was more effective compared with immunomodulating drug Arbidol.

加速型高血圧を主症状とし,著明な腎内多発動脈瘤を示した結節性多発動脈炎(PN)の1例

A twenty-one-year-old male was admitted to our hospital because of hypertension and proteinuria. He had felt general fatigue and low grade fever for one month. Blood pressure was 180/120 mmHg on admission. Laboratory findings showed 3+ proteinuria and 1+ occult blood in urinalysis; an accelerated erythrocyte sedimentation rate (ESR) of 39 mm/hr; elevation of LDH to 755 IU/l. Antinuclear antibody was positive with a titer of 1: 160, with a speckled pattern. Plasma renin activity and serum aldosterone were markedly elevated to 25.8 ng/ml/hr and 585.3 pg/ml, respectively. Renal function had declined mildly; endogenous creatinine clearance was 60 ml/min. Renal arteriogram demonstrated multiple intrarenal aneurysms in the bilateral kidneys. Aneurysms, 5-8 mm in diameter were located in the arteries from the interlobar to interlobular region. He was diagnosed as having polyarteritis nodosa (PN) and was then treated with 20 mg/day of prednisolone and monthly pulse therapy of cyclophosphamide. After steroid, cyclophosphamide and anti-hypertensive therapy, he became well and had normal blood pressure. The patient was considered a rare case of PN with multiple intrarenal aneurysms and accelerated hypertension. We discuss aneurysms in PN and accelerated or malignant hypertension documented in the literature.

Spectrum of disease in patients with positive antineutrophil cytoplasmic antibodies in general hospitals

Objective To investigate clinical significance of positive antineutrophil cytoplasmic antibodies (ANCA) in diagnosis for vasculitis or other diseases. Methods From January 2005 to December 2008, 104 patients with positive ANCA detected by enzyme-linked immunosorbent assay (ELISA) in People's Hospital of Peking University were randomly selected and their clinical features and diagnoses were analyzed retrospectively. Results Among 104 ANCA-positive patients, 22 were diagnosed as vasculitis and 13 as ANCA-associated vasculitis, and 82 (78. 8% )were diagnosed as non-vasculitis including 40 of connective diseases such as systematic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and 42 of non-connective diseases with the most common of ulcerative colitis. According to the results of ANCA tests by ELISA, ANCA-positive patients could be divided into those with proteinase 3 (PR3)-positive and myeloperoxideaso (MPO)-positive. More organs were involved in MPO-positive patients (n =48 ) than that in PR3-positive ones ( n = 49), and more frequent involvement of the kidneys and less frequent involvement of the gastrointestinal tract in MPO-positive than those in PR3-positive ones (P < 0. 01 ). As compared to those with non-vasculitis, more organs (2. 28 organs vs. 3.55 organs in average) were involved in patients with vasculitis (P <0. 01 ) and more frequent involvement of the upper or lower respiratory tracts and the kidneys in vasculitis patients ( P <0. 01 or <0. 05, respectively). Elevated leukocyte count and accelerated erythrocyte sedimentation rate (ESR) were also more common in vasculitis patients than those in non-vasculitis ones (P <0. 01 and P <0. 05, respectively). Positive ANCA combined with number of organs involved, clinical manifestations and other laboratory findings, its positive predictive value (PPV) in diagnosis for vasculitis can be improved. Conclusions Spectrum of disease in patients with positive ANCA was varied. Diagnostic value of positive ANCA in diagnosis for vasculitis can be improved if combined with comprehensive analysis of their clinical features and laboratory examinations. Key words: Antibodies; antineutrophil cytoplasmic; Vasculitis; Diagnosis