Cause Of Inflammation Research Articles

When and What to Test for Diarrhea: Focus on Stool Testing.

To review stool diagnostic tests in acute and chronic diarrhea. Narrative review of published literature. (A). In acute diarrhea, stool tests are indicated when there is strong pre-test probability of infectious etiology or C. difficile infection (CDI) suggested by >3 unformed bowel movements per 24h, symptoms lasting >7 days, and circumstances that are suggestive of infection. Several commercially available rapid tests for bacterial, viral or protozoal infections may be offered in addition to traditional methods (e.g. culture, microscopy), and provide a result within 6 hours. For CDI infection, a highly sensitive test such as glutamate dehydrogenase test is required; however, this does not distinguish infection from carrier state. That differentiation requires specialized nucleic acid amplification test (for toxin B) or enzyme immunoassays for toxin A or B, which are unfortunately not generally offered by microbiology labs. (B). Chronic diarrhea may result from inflammatory, fatty, osmotic or secretory causes; the commonest causes are IBS-D/functional diarrhea. Current recommendations in societal guidelines or clinical practice updates regarding stool tests in IBS-D/functional diarrhea in the absence of alarm symptoms include testing for giardia, calprotectin, fecal immunochemical test (FIT), and bile acid diarrhea (BAD). Comprehensive stool biochemical analyses (osmolality, pH, electrolytes) differentiate osmotic from secretory diarrhea and identify laxative abuse. Specific stool diagnostic tests for BAD and exocrine pancreatic insufficiency can lead to specific diagnosis and treatments. Surrogate markers associated with high fecal output and rapid transit in chronic diarrhea are stool form and colonic transit. Fecal testing is still very relevant in the practice of gastroenterology and deserves introduction of advanced microbiological and biochemical tests.

The diagnostic value of endomyocardial biopsy in the era of precision medicine: data from over 8,000 patients with comprehensive biopsy diagnostics

Abstract Background Endomyocardial biopsy (EMB) is an important diagnostic tool for evaluating various cardiac diseases such as myocarditis and storage disorders as well as for the monitoring heart transplant patients. Despite advances in non-invasive imaging techniques to characterize myocardial tissue, EMB remains the gold standard for definitive diagnosis and initiation of specific therapy. Here we report EMB laboratory results from over 8,000 patients and demonstrate the diagnostic utility of EMB. Methods and results We retrospectively reviewed EMB analyses performed at our institution. EMBs for monitoring graft rejection were not included in this study. Clinical data, suspected clinical diagnoses and EMB-based laboratory results were collected. Histopathological, immunohistochemical and molecular biology biopsy findings were recorded and reviewed for degree of concordance with clinical diagnosis. In total, EMBs from N=8,085 consecutive patients with unexplained heart failure were analyzed. The comprehensive EMB analysis revealed that N=616 (7.6%) patients had cardiac storage disease, most of whom had cardiac amyloidosis (N=606). N=357 (4.4%) patients were diagnosed with acute forms of myocarditis, including N=95 cases with active myocarditis, N=148 cases with giant cell myocarditis, N=95 cases with sarcoidosis and N=19 cases with eosinophilic myocarditis. A total of N=3,392 (42%) patients were found to have inflammatory heart disease such as inflammatory cardiomyopathy and borderline myocarditis, whereby a differentiation of the inflammatory infiltrates revealed considerable differences in the quality of inflammation. Viral genomes were found in the myocardium of N=6,072 (75%) patients, with treatment-relevant viral infections detected in N=2,015 (25%) cases. The remaining N=1,705 (21%) patients were diagnosed with other cardiomyopathies, including dilated cardiomyopathy (N=1,252), heart failure with preserved ejection fraction (N=325), hypertrophic cardiomyopathy (N=117) and arrhythmogenic right ventricular cardiomyopathy (N=11). Conclusions This retrospective study of over 8,000 patients with heart failure clearly shows that a definitive diagnosis is only possible with a comprehensive EMB diagnosis and leads to specific therapy in 79% of the cases. In the remaining 21% of patients, infectious and inflammatory causes could be excluded in order to initiate standard heart failure therapy. It is important to emphasize here that the quality of the inflammation and therapy-relevant viral infections cannot be detected with imaging techniques, which underlines the clinical-therapeutic importance of endomyocardial biopsy.

The challenge of etiologic diagnosis of subacute and chronic meningitis: an analysis of 183 patients.

Subacute and chronic meningitis (SCM) presents significant diagnostic challenges, with numerous infectious and non-infectious inflammatory causes. This study examined patients aged 16 and older with SCM admitted to referral centers for neuroinfections and neuroinflammations in Mashhad, Iran, between March 2015 and October 2022. Among 183 episodes, tuberculous meningitis was the most common infectious cause (46.5%), followed by Brucella meningitis (24.6%). The cause of SCM was definitively proven in 40.4%, presumptive in 35.0%, and unknown in 24.6% of cases. In-hospital mortality was 14.4%, and 30.5% of survivors experienced unfavorable outcomes (Glasgow Outcome Scale 2-4). Patients with unknown causes had a significantly higher risk of death compared to those with presumptive or proven diagnoses (risk ratio 4.18). This study emphasizes the diagnostic difficulties of SCM, with one-quarter of cases remaining undiagnosed and over one-third having only a presumptive diagnosis. Improving diagnostic methods could potentially enhance prognosis and reduce mortality.

Effectiveness of surgical approach in the management of non-traumatic corneal perforations

ABSTRACT Clinical relevance Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters. Background The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations. Methods Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations. Results Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment. Conclusion There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice − especially in the lack of donor tissues − further interventions are necessary in most circumstances.

B-082 Clinical Investigation of Rods and Rings Pattern in Anti-Nuclear Antibody Test in Korean Patients

Abstract Background In the mid-2000s, a novel pattern in antinuclear antibody (ANA) testing was reported. Indirect immunofluorescence assays on HEp-2 cells, conducted with sera from patients with Hepatitis C virus (HCV) infection, revealed cytoplasmic structures in the form of rods and rings (RR). These structures typically displayed rod lengths of 3-10μm and ring diameters of 2-5μm. Inosine monophosphate dehydrogenase (IMPDH) was identified as the primary component of the RR structures. Research on the administration of interferon/ribavirin (IFN/RBV) showed that ribavirin, an IMPDH inhibitor, induced RR formation in over 95% of cells. Additionally, RR patterns were reported in patients receiving other IMPDH inhibitors such as mycophenolic acid and azathioprine. While cytidine triphosphate synthase 1 (CTPS1) was suggested to be associated with RR structures, there were no reported cases in patients. Interestingly, patients receiving methotrexate, which does not directly inhibit IMPDH but hinders GTP biosynthesis, also exhibited RR structures. To explore the clinical implications of specimens showing RR patterns, a study was conducted to investigate the actual clinical scenarios associated with these findings. Methods This is a retrospective study conducted at a single center, covering the period from January 2022 to December 2023, focusing on the results of ANA testing. The ANA tests were performed using HEp-2 cells (FLUORO HEPANA TEST, MBL, Nagoya, Japan) on slides manufactured with AP 16 IF Plus (das, Palombara Sabina, RM, Italy). ANA results were obtained through qualitative testing, ranging from 1+ to 4+, or quantitative testing based on dilutions ranging from 1:40 to 1:640, depending on clinical requirements. Results Out of the 7,648 ANA test results, the RR pattern was observed in 40 cases (0.5%). Among these, 2.5% had a history of HCV infection with IFN/RBV treatment, and an additional 2.5% had concurrent use of IMPDH inhibitors. There were no reported cases of medication history related to the synthetic pathway of nucleic acids, including CTPS1. Cases where RR patterns coexisted with autoimmune diseases accounted for 35%, infections for 25%, and other inflammatory conditions for 22.5%. RR patterns reported with an intensity of 3+ or at dilutions of 1:160 or higher constituted 27.5%. Among cases displaying strong fluorescence, 45% were associated with infections, 18% with autoimmune conditions, and another 18% with unexplained inflammatory causes. In the overall sample, elevated CRP or ESR was noted in 54.5% of cases with infections, autoimmune diseases, or other inflammatory conditions. Among samples with intense intensity, 55.5% showed elevated CRP or ESR when inflammatory conditions were present. Conclusions The majority of cases exhibiting the RR pattern showed no history of exposure to IMPDH inhibitors or drugs affecting the nucleic acid synthetic pathway. A high proportion of cases clinically diagnosed with inflammation showed a concurrent RR pattern, with only approximately half of them demonstrating elevated CRP or ESR levels. This study suggests the possibility of identifying inflammatory responses not captured by conventional acute inflammation markers through the RR pattern observed in ANA testing.

473 - Inflammatory breast cancer: the case of a swollen arm mimicking deep vein thrombosis as the cause of inflammation

473 - Inflammatory breast cancer: the case of a swollen arm mimicking deep vein thrombosis as the cause of inflammation

Patients and clinicians have different priorities when discussing pain in the IBD clinic.

Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain. In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups. Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain). The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.

Study the Effect of IL-1beta on Thyroid Hormones Levels in Women with Hypo- and Hyperthyroidism in the City of Ramadi

Thyroiditis is a medical condition of particular concern due to its diverse causes, including autoimmune factors, drug-induced inflammatory causes or fibrotic process, the most common of which is thyroiditis and includes hypothyroidism and hyperthyroidism. The study aimed to measure interleukin 1 beta (IL-1β) and compare it with the studied groups and the hormones TSH, T3, T4 and their relationship with IL-1β. The study included investigating the relationship between IL-1β and thyroid patients in females aged between (18-60) in the city of Ramadi as well as knowing the relationship between thyroid hormones (TSH, T4, T3) and IL-1β. 45 samples were collected from Ramadi Teaching Hospital. The current study showed that there was a significant increase in the level of IL-1β compared to the control group in hypothyroid patients at a significant level (P≤0.05), which was (2.3497ng/dl). There were no significant differences in the level of IL-1β in patients with hyperthyroidism at a significant level (P≤0.05), which was (ng/dl 2.0690) compared to the control group. The study showed that there is an inverse relationship between TSH and IL-1β (0.858) and a positive relationship between T4 and IL-1β (0.809) .We conclude from the study that interleukin 1 beta (IL-1β) has an effect on the thyroid gland, especially hypothyroidism, as it showed a highly significant increase in IL-1β in patients with hypothyroidism and no significant differences in IL-1β, as IL-1β affects thyroid hormones

Inflammatory setting, therapeutic strategies targeting some pro-inflammatory cytokines and pathways in mitigating ischemia/reperfusion-induced hepatic injury: a comprehensive review.

Ischemia/reperfusion injury (IRI) is a key determining agent in the pathophysiology of clinical organ dysfunction. It is characterized by an aseptic local inflammatory reaction due to a decrease in blood supply, hence deprivation of dependent oxygen and nutrients. In instances of liver transplantation, this injury may have irreversible implications, resulting in eventual organ rejection. The deterioration associated with IRI is affected by the hepatic health status and various factors such as alterations in metabolism, oxidative stress, and pro-inflammatory cytokines. The primary cause of inflammation is the initial immune response of pro-inflammatory cytokines, while Kupffer cells (KFCs) and neutrophil-produced chemokines also play a significant role. Upon reperfusion, the activation of inflammatory responses can elicit further cellular damage and organ dysfunction. This review discusses the interplay between chemokines, pro-inflammatory cytokines, and other inflammatory mediators that contribute to the damage to hepatocytes and liver failure in rats following IR. Furthermore, it delves into the impact of anti-inflammatory therapies in safeguarding against liver failure and hepatocellular damage in rats following IR. This review investigates the correlation between cytokine factors and liver dysfunction via examining databases, such as PubMed, Google Scholar, Science Direct, Egyptian Knowledge Bank (EKB), and Research Gate.

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy.

Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in bacterial infections: contributions to diagnostic strategies in a tertiary care hospital in Tunisia.

Bacterial infections continue to pose a global health challenge, driven by antibiotic resistance and septicemia. This study aimed to assess the diagnostic utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in bacterial infections versus non-infectious causes of inflammation. A prospective study included 164 adult patients who were divided into two groups: a group of patients with confirmed bacterial infections and a second group of patients with other diagnoses (inflammatory pathologies, neoplasms, venous thromboembolic diseases, etc.). NLR and PLR values were compared between the bacterial infection group and the non-infectious causes group and the diagnostic performances of NLR and PLR for detecting bacterial infections were evaluated in comparison with other infection markers. NLR and PLR were significantly higher in bacterial infections (p < 10 ^-6), and NLR was correlated positively with inflammation markers. NLR and PLR demonstrated significant potential in diagnosing bacterial infections, with an AUC of 0.72 and 0.60, respectively, using the following cutoff values: 4.3 for NLR and 183 for PLR. These findings underscore the importance of NLR and PLR as adjunctive tools for bacterial infection diagnosis.

NLRP3 inflammasomes as a target for hesperidin and diosmin flavonoids in varicose vein disease and its complications

Varicose vein disease of the lower extremities is an inflammatory disorder with abnormal structure and functional activity of the venous valves, venous walls and cells, as well as with abnormal activity of the infiltrating leukocytes. The abnormally changed varicose vein are characterized by increased venous pressure, blood accumulation and congestion, ischemia, and metabolic and energy turnover derangement, which result in clinical manifestations of complications, such as pain, edema and formation of trophic ulcers. For many years, flavonoids have been used to treat varicose veins. The most effective flavonoids used in varicose vein disease and its complications, are hesperidin and diosmin, as well as their combinations. The review sets forth the state-of-the-art knowledge on the universal inflammatory processes playing a leading role in the pathophysiology of many cardiovascular disorders, including venous ones. In the recent years, it has been found that one of the main causes of inflammation is the formation of intracellular protein complexes (inflammasomes), which both produce a set of proinflammatory cytokines and are responsible for their excretion from the cells. In addition, inflammasomes control the development of regulated necrosis (pyroptosis) that takes part in the process of ulceration. The inflammasome activity can be modified by various mechanisms, of which the gene independent synthesis of the inflammasomal proteins has been recognized as the leading one. It has been shown that flavonoids inhibit the activation of a key factor NF-kappa B and suppress the synthesis of proteins, including NOD-like receptor protein 3 (NLRP3) inflammasome components, decrease the expression of NLRP3 receptor, protein ASC and caspase 1, as well as diminish interleukin 1 beta, interleukin 6 and tumor necrosis factor-alpha expression. Thus, this is the explanation of positive effects observed with the use of hesperidin, diosmin and their combination in clinical practice.

Burden of osteoarthritis in Indonesia: A Global Burden of Disease (GBD) study 2019.

Osteoarthritis (OA) is a complex and common condition, especially affecting the knees due to their weight-bearing role. Traditionally seen as a degenerative disease, OA is now understood to have both mechanical and inflammatory causes. Despite its increasing prevalence, there is limited data on OA in Indonesia, resulting in low awareness among clinicians and the public. The aim of this study was to describe the OA burden in Indonesia, focusing on its prevalence, incidence, and years lived with disability (YLD) from 1990 to 2019, using data from the Global Burden of Disease (GBD) study 2019. A descriptive cross-sectional study was conducted to examine the prevalence, incidence, and YLD of OA in Indonesia from the GBD study 2019. OA prevalence and YLD were compared to other countries according to similar social demographics and geographical proximity. OA YLD was also compared to the top causes of death and disability YLD in Indonesia. The study found that OA cases in Indonesia more than doubled from 1990 to 2019, with increases of 153.12% in males and 143.36% in females. Similar trends were observed for knee OA. The age-standardized prevalence rate in Indonesia increased by 11.03% in males and 8.42% in females, and these were higher compared to China, India, Singapore, and the global average. Younger people had a higher OA prevalence rate growth than older groups. The incidence rate for OA also rose significantly, with males seeing a 10.89% increase to 290 per 100,000 people and females with an 8.57% increase to 384 per 100,000 people. Despite lower overall burden rates compared to some countries, Indonesia experienced significant growth in YLD due to OA (12.16% in males and 9.65% in females) since 1990. Although OA was less burdensome than stroke, diabetes, low back pain, and chronic obstructive pulmonary disease (COPD), its YLD growth rate was higher. In conclusion, OA prevalence and incidence in Indonesia significantly increased from 1990 to 2019, with a notable rise among younger populations. OA had a higher YLD growth compared to several other major diseases in Indonesia, highlighting the need for early detection and preventive measures, particularly for the younger population.

Abstract Mo126: A sex-specific CD4 + T cell response limits Coxsackievirus B pathogenesis in mice.

Coxsackievirus B3 (CVB3) is an enteric virus that is a primary cause of inflammation of the heart muscle, known as viral myocarditis. Viral myocarditis is a significant cause of heart failure, and nearly 40,000 cases are reported each year. Unfortunately, approximately 5% of CVB3 infections are fatal. Unfortunately, no vaccines or drugs are available for this virus. Interestingly, there is a sex bias in viral myocarditis where men are more susceptible than women. Unfortunately, the underlying basis for the sex bias in infection is incompletely understood. We recently determined that T cells play an essential role in CVB3 clearance using a novel oral inoculation mouse model. Here, we show a sex difference in the CD4 + T cell response to CVB3 that is important in limiting viral pathogenesis. We found that CVB3 induced CD4 + cell expansion in female mice but not in male mice. CVB3 infection also led to the expansion of CD62L lo CD4 + T cells in the mesenteric lymph node and spleen of female but not male mice as early as five days post-inoculation, indicative of activation. Using a recombinant CVB3 virus expressing a model CD4 + T cell epitope, we found that the expansion of CD4 + T cells in females is viral-specific and not due to bystander activation. Finally, the depletion of CD4 + T cells before infection led to enhanced mortality, indicating that CD4 + T cells protect against CVB3 in female mice. We are also currently investigating the impact of CD4 + T cell subtypes, and the role of intestinal T cells play in limiting intestinal CVB3 replication and dissemination. These data demonstrate that CVB3 induces a CD4 + T cell response in female mice and highlight the importance of sex-specific immune responses to viral pathogens.

Inflammatory causes of stroke-Diagnostics and treatment

Inflammatory causes of stroke are frequent and often pose diagnostic and therapeutic challenges due to the scarcity of randomized trials and the absence of clear guideline recommendations for many scenarios. Following the publication of the recommendations of the European Stroke Organization on primary angiitis of the central nervous system (PACNS) last year, the German Neurological Society (DGN) has issued very clear guidelines this year on the diagnostics and treatment of PACNS and updated the recommendations for systemic vasculitides; however, stroke often occurs not only as aresult of primary vascular inflammation but also as acomplication of another organ infection. Approximately 5% of all patients with sepsis, ca. 20% of patients with bacterial meningitis and up to 40% of patients with bacterial endocarditis suffer from astroke as acomplication. This article summarizes the key characteristics of these inflammatory causes of stroke and particularly focuses on the current recommendations for diagnostic and therapeutic management.

A series of atypical cases of exudative retinal detachment with diagnostic dilemma presenting to a rural eye care center in South India

Abstract Introduction: Retinal detachment results due to the accumulation of fluid in the subretinal space. Retinal detachment can be rhegmatogenous, exudative, or tractional detachment. Exudative detachment occurs due to various choroidal or retinal pathologies. We report a case series of exudative retinal detachment (ERD) with atypical presentation, who were diagnosed and treated in our retina clinic. The aim of our study was to stress on the timely etiological diagnosis in patients who present with ERD in achieving a good visual recovery. We also would like to emphasize thorough systemic evaluation in the management of such cases. Materials and Methods: In this case series, patients who presented to our institution with ERD underwent a comprehensive ocular and systemic evaluation in order to determine the underlying etiology. Results: Our study showed that inflammatory causes, whether infectious or noninfectious uveitic conditions and certain systemic conditions unrelated to uveitis can also cause ERD. Conclusion: A thorough examination of both ocular and systemic condition is crucial for identifying the cause of ERD, ultimately aiding in the preservation of vision. In addition, timely recognition and management of any underlying systemic conditions by the appropriate specialist can significantly decrease the morbidity and mortality in these patients. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024 Part I.

Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.

Australasian recurrent pregnancy loss clinical management guideline 2024, part II.

Part II of the Australasian guideline for the investigation and management of recurrent pregnancy loss (RPL) provides evidence-based guidance on the management of RPL provided. The implications of inherited and acquired thrombophilia with respect to RPL and suggestions for clinical management are provided. Autoimmune factors, including human leukocyte antigen, cytokines, antinuclear antibodies and coeliac antibodies, and guidance for management are discussed. Infective, inflammatory and endometrial causes of RPL are discussed in detail. Environmental and lifestyle factors, male factor and unexplained causes are outlined. Levels of evidence and grades of consensus are provided for all evidence-based statements.

Цитологические исследования при диагностике увеита. Клинический пример

Purpose. To demonstrate on a clinical example the use of laboratory cytological methods for the differential diagnosis of masquerade syndrome and uveitis. Methods. A clinical example of а 77-year-old patient is presented. She was diagnosed with uveitis and received courses of anti-inflammatory therapy for 6 years without positive dynamics. Further, an assumption was made about the tumor cause of inflammation (primary bilateral intraocular lymphoma), a diagnostic vitrectomy with vitreous sampling for cytological examination was performed. Cytological examination confirmed the diagnosis of lymphoma. Results A patient with uveitis was suspected to have masquerade syndrome. A cytological examination of the vitreous body was performed; as a result, the diagnosis of intraocular lymphoma was unequivocally confirmed. The patient’s examination plan and further treatment were radically revised. Key words: intraocular lymphoma; uveitis; cytological examination.

Combined Cesarean Section and Splenectomy in a Patient with Massive Splenomegaly

Background To date, there is limited knowledge of patients with idiopathic splenomegaly in pregnancy, and the literature lacks cases of a combined cesarean section with splenectomy. The documented cases of splenomegaly in pregnancy often have infectious etiology such as that of malarial infection or an autoimmune component such as idiopathic thrombocytopenic purpura. This condition is life-threatening and complicates medical management, but its rarity has led to a paucity of management guidelines for patients with idiopathic splenomegaly in pregnancy. Objective The aim of this case is to provide novel insight into the management and outcomes of patients with idiopathic massive splenomegaly in pregnancy. Study Design This study is a case report with a review of the current literature on the reported cases of splenomegaly in pregnancy, splenectomy in pregnancy, and cesarean section with splenectomy. This case describes a history of pancytopenia and massive splenomegaly in a pregnant patient who underwent extensive workup with no clear etiology. This case additionally describes the course of care for this patient, including a combined cesarean section with splenectomy. We searched PubMed for all English language articles from 2000 to 2023, with search terms including “splenomegaly in pregnancy,” “splenectomy in pregnancy,” and “cesarean section and splenectomy.” Results In this patient’s case, despite an exhaustive infectious disease workup and evaluation for hematologic, inflammatory, and neoplastic causes, no clear etiology was identified. Delivery was deemed necessary at 34 weeks and 2 days gestation due to the patient’s severe, persistent pain, her worsening pancytopenia, and the risk of spontaneous splenic rupture during labor and delivery; our multidisciplinary team concluded that it was safer for both mother and baby to proceed with cesarean delivery and splenectomy in the early pre-term period. This patient’s pancytopenia improved within hours of spleen removal and has remained stable to date in outpatient follow-up. Baby Boy completed a NICU course of 22 days after requiring surfactant and respiratory support due to prematurity as well as monitoring due to maternal splenomegaly and thrombocytopenia. Conclusion This case offers valuable insights into managing patients with idiopathic splenomegaly during pregnancy and underscores the need for further investigation. Establishing clear delivery indications for these patients remains crucial, and prospective studies should evaluate the long-term impacts on both mother and child following combined splenectomy and cesarean delivery in the context of pancytopenia.