Common Clinical Features Research Articles

Clinical Profile and Outcome of Children with Empyema Thoracis in Tertiary Hospital

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. It is a common condition in childhood having significant morbidity and mortality. The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. The present study analyses the epidemiological aspects of the disease, etiological agents, clinical features and associated lesions in diagnosis of empyema and the outcome of early Video-assisted thoracoscopic surgery (VATS) on morbidity of disease in children.
 Objectives: To study various demographic characteristic and to evaluate various management strategies and outcome in children with empyema thoracis.
 Methodology: This is a prospective hospital based observational study, conducted at Nobel Medical College Teaching Hospital Biratnagar, from December 2021 to November 2022. All children in the age group of 1month to 16 years diagnosed pyogenic empyema by lights criteria during the study are included in the study. Children below 1 month of age and pleural effusion not meeting the criteria for exudative pleural effusion by Light's criteria are excluded from the study.
 Results: Majority of the study population are in the age group of >5 years. Males are more common than females. Most common clinical feature was fever followed by cough, chest pain and shortness of breath. Culture is positive in 68% out of which 32% is staphylococcus aureus, 20% is mycobacterium tuberculosis ,16% is streptococcus pneumonia. Duration of illness is <1week in 48% of the children, 1-2weeks in 40% and >3weeks in 12% of the children. In 80% of the children there is unilateral involvement in the x- ray chest. In the children who are uncomplicated all of them had intercoastal chest tube drain (ICD) usage,76.4% had urokinase therapy and 5.8% had undergone thoracotomy and none of them had need for surgery. In the children with complication 87.5% had ICD usage and urokinase therapy,25% of them had undergone thoracotomy and 12.5% had need for surgery.
 Conclusion: Empyema thoracis is more commonly seen in the males of the group>5 years with duration of illness <1 week maned mostly by ICD usage, where there was mostly unilateral involvement in x ray chest.

Burden of human metapneumovirus infections among children with acute respiratory tract infections attending a Tertiary Care Hospital, Kathmandu

BackgroundAcute respiratory infections (ARIs) are one of the most common causes of mortality and morbidity worldwide. Every year millions of children suffer from viral respiratory tract infections (RTIs) ranging from mild to severe illnesses. Human Metapneumovirus (HMPV) is among the most frequent viruses responsible for RTIs. However, HMPV infections and their severity among children have not been explored yet in Nepal.PurposeTherefore, the study was focused on HMPV infections and other potential viral etiologies or co-infections using multiplex PCR among children attending Kanti Children’s Hospital and assessed the clinical characteristics of the infections as well as found the co-infections. A hospital-based cross-sectional study was designed and a convenience sampling method was used to enroll children of less than 15 years with flu-like symptoms from both outpatients and inpatients departments over three months of the study period.ResultsHMPV infection (13.3%) was the most predominant infection among the different viral infections in children with ARIs in Kanti Children’s Hospital. The HMPV was more prevalent in the age group less than three years (21.8%). Cough and fever were the most common clinical features present in all children infected with HMPV followed by rhinorrhea, sore throat, and wheezing. HMPV-positive children were diagnosed with pneumonia (42.9%), bronchiolitis (28.5%), upper respiratory tract infections (14.3%), and asthma (14.3%). The prevalence of HMPV was high in late winter (14.3%) followed by early spring (13.5%).ConclusionsThis study provides the baseline information on HMPV and associated co-infection with other respiratory viruses for the differential diagnosis based on molecular methods and also the comparison of clinical presentations among the different respiratory syndromes.

Abstract P2078: Vasohibin Inhibition Improves Myocardial Relaxation In A Rodent Model Of Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection (HFpEF) is a complex syndrome with few therapies available to patients. Diastolic dysfunction is a common clinical feature among HFpEF patients, and strategies to mitigate impaired relaxation may have a therapeutic benefit. Recognizing that increased stabilization of the microtubule network induced by detyrosination of α-tubulin contributes to increased cardiomyocyte stiffness ex vivo , we explored if inhibition of detyrosination with a small molecule vasohibin inhibitor (VASHi) could improve in vivo diastolic function in obese/hypertensive (ob) ZSF1 rats, compared to lean/hypertensive ZSF1 and non-hypertensive Wistar Kyoto (Wky) rats as controls. Animals received two intravenous injections of VASHi (6.6mg/kg) or vehicle (veh) at 30 weeks old, when ob have a HFpEF phenotype. Echocardiography and invasive hemodynamics were performed after the first and second injection, respectively. Compared to ob veh-treated animals, ob VASHi-treated animals had a significant improvement in invasively measured time constant of early LV relaxation, tau (veh: 14.73ms ± 0.73 vs. VASHi: 11.02ms ± 0.45; P < 0.05) and echo-derived deceleration time of early LV filling, indicative of improved early relaxation (Fig. A, B). VASHi improved early relaxation in cardiomyocytes isolated from non-failing (NF, N=3) and failing (HF, N=4) human hearts (Fig. C), providing the first evidence of small molecule VASHi improving human myocyte function. These studies indicate that excess detyrosination contributes to impaired early myocyte and myocardial relaxation in a clinically relevant HFpEF model and supports a potential therapeutic role for VASHi in HFpEF.

Development and verification of a nomogram for predicting short-term mortality in elderly ischemic stroke populations

Stroke is a major healthcare problem worldwide, particularly in the elderly population. Despite limited research on the development of prediction models for mortality in elderly individuals with ischemic stroke, our study aimed to address this knowledge gap. By leveraging data from the Medical Information Mart for Intensive Care IV database, we collected comprehensive raw data pertaining to elderly patients diagnosed with ischemic stroke. Through meticulous screening of clinical variables associated with 28-day mortality, we successfully established a robust nomogram. To assess the performance and clinical utility of our nomogram, various statistical analyses were conducted, including the concordance index, integrated discrimination improvement (IDI), net reclassification index (NRI), calibration curves and decision curve analysis (DCA). Our study comprised a total of 1259 individuals, who were further divided into training (n = 894) and validation (n = 365) cohorts. By identifying several common clinical features, we developed a nomogram that exhibited a concordance index of 0.809 in the training dataset. Notably, our findings demonstrated positive improvements in predictive performance through the IDI and NRI analyses in both cohorts. Furthermore, calibration curves indicated favorable agreement between the predicted and actual incidence of mortality (P > 0.05). DCA curves highlighted the substantial net clinical benefit of our nomogram compared to existing scoring systems used in routine clinical practice. In conclusion, our study successfully constructed and validated a prognostic nomogram, which enables accurate short-term mortality prediction in elderly individuals with ischemic stroke.

To study risk factors and biochemical profile of diabetic ketoacidosis patients with special emphasis on serum amylase

Background: Diabetes mellitus (DM) is a complex endocrinological disorder with altered metabolism of blood glucose. Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of DM that mainly occurs in type 1 diabetes patients, as well as in some patients with type 2 diabetes. The mortality rate associated with DKA depends on the experience of the treating hospital in dealing with this condition; thus, it is critical that patients detect DKA and get medical help as soon as possible. Aims and Objectives: To study risk factors for DKA, clinical and biochemical profile of DKA patients. Correlation between serum amylase level, serum bicarbonate level and mean duration of hospital stay. Materials and Methods: A cross-sectional analytical study was carried out on 100 DKA patients in the Department of Medicine, SGMH Rewa, Madhya Pradesh from January 2021 to June 2022. The data extracted included clinical presentation, precipitating factors, laboratory profile, complications, and hospitalization outcomes. Results: Of the 100 patients admitted for DKA; 70 had type 2 diabetes (70%) and 30 (30%) were type I diabetes. The average age at the time of presentation was 48.61±19.59 years. The commonest precipitating factor was infection (38%) followed by other factors (62%). The most common clinical features at the time of presentation were altered sensorium, fever, vomiting, polyuria, polydipsia, weakness, lethargy, myalgia, headache, anorexia, abdominal pain, and orthopnea. The values for RBS, HCO3, and pH were 525.0±62.4, 12.6±2.69, and 7.14±0.31, respectively. There was no significant difference in clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate was 3% and factors found to be significant predictors were comorbid condition, severity of mental status, severity of dehydration, RBS at the time of presentation, and severe acidosis. Conclusion: The most common precipitating factors are infection and omission of insulin or irregular treatment. The most common clinical features at the time of presentation are nausea, vomiting, abdominal pain, headache, and dehydration. There is no significant difference in the clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate in DKA is 3% and the most notable predictors of poor prognosis are; severity of altered sensorium, severity of comorbid condition, severe dehydration, severe acidosis, and identification and treatment of precipitating factors are more important. Patient education plays a crucial role in the prevention of DKA.

The Lung Microbiome in COPD and Lung Cancer: Exploring the Potential of Metal-Based Drugs.

Chronic obstructive pulmonary disease (COPD) and lung cancer 17 are two of the most prevalent and debilitating respiratory diseases worldwide, both associated with high morbidity and mortality rates. As major global health concerns, they impose a substantial burden on patients, healthcare systems, and society at large. Despite their distinct aetiologies, lung cancer and COPD share common risk factors, clinical features, and pathological pathways, which have spurred increasing research interest in their co-occurrence. One area of particular interest is the role of the lung microbiome in the development and progression of these diseases, including the transition from COPD to lung cancer. Exploring novel therapeutic strategies, such as metal-based drugs, offers a potential avenue for targeting the microbiome in these diseases to improve patient outcomes. This review aims to provide an overview of the current understanding of the lung microbiome, with a particular emphasis on COPD and lung cancer, and to discuss the potential of metal-based drugs as a therapeutic strategy for these conditions, specifically concerning targeting the microbiome.

Common clinical laboratory features among women with polycystic ovary syndrome and metabolic syndrome.

Women with polycystic ovary syndrome (PCOS) have a high prevalence of metabolic syndrome (MS), with rates up to 33%. This is associated with long-term consequences such as cardiovascular diseases, type 2 diabetes mellitus (T2DM), cancer, sleep apnea, and psychological issues. The prevalence of MS worldwide is often associated with obesity and T2DM, yet regional variations are reported. In this study, 122 women consulting general practice and family medicine physicians were evaluated, revealing a BMI exceeding 30 kg/m2. Among MS criteria, the most common diagnoses were T2DM in 29 patients, insulin resistance (IR) in 36, arterial hypertension (AH) in 51, reduced HDL levels in 53, and elevated triglycerides in 39. Further analysis revealed 16 unique combinations of MS components in these patients, with 75% of PCOS cases exhibiting three MS components and 25% having four. Additionally, research indicated that most women with PCOS face persistent, treatment-resistant obesity, with a notably higher BMI (ρ=0.87; r=0.76). These findings highlight the multifactorial nature of PCOS and MS etiology.

The Multifaceted Syndromic Primary Immunodeficiencies in Children.

Disorders of immunity are poorly recognised in some rare multisystem genetic conditions. We aim to describe syndromic features and immunological defects in children with syndromic primary immunodeficiencies (sPIDs). This is a retrospective descriptive study of children aged 0-18 years with sPIDs under the care of the paediatric immunology service at the Bristol Royal Hospital for Children, United Kingdom, from January 2006 to September 2021. sPIDs were identified in 36 patients. Genetic diagnoses which are not commonly associated with PIDs and not included in the International Union of Immunological Societies classification were present in 7/36 (19%): Trisomy 22, Arboleda-Tham syndrome, 2p16.3 deletion syndrome, supernumerary ring chromosome 20 syndrome, Myhre syndrome, Noonan syndrome, and trichothiodystrophy/Cockayne syndrome complex. Recurrent and/or severe infections were the most common clinical features (n = 33, 92%). Approximately half had combined immunodeficiency or antibody deficiency. The most common extra-immunological manifestations include dysmorphism (72%), disorders of nervous (78%), musculoskeletal (69%), haematology/lymphatic (58%), and gastrointestinal, hepatic/pancreatic (58%) systems. Patients with sPIDs often have multiorgan involvement and some are non-immunologically mediated. There should be a low threshold to clinically assess and investigate for disorders of immunity in any patients with syndromic features especially when they present with recurrent/severe/opportunistic infections, features of immune dysregulation, autoinflammation or lymphoproliferation.

Demography and Clinical Characteristic COVID-19 with Diabetes Mellitus at the Universitas Sumatera Utara Hospital

Background: COVID-19 is a disease caused by a virus called SARS-CoV-2. COVID-19 can infect almost all age groups, however, the elderly and those with co-morbidities such as diabetes mellitus can get worse complications from COVID-19. The study aims to find out the demographics and clinical characteristics of COVID-19 patients with diabetes mellitus treated at the Universitas Sumatera Utara Hospital. Method. This research is a descriptive study using retrospective data. The data used is secondary data taken from medical records. The number of samples that met the inclusion criteria was 37 people. Results. The majority of patients were dominated by the age group of 46-65 years (56.8%) and males (54.1%). The predominating clinical characteristics of COVID-19 with diabetes mellitus are cough (70.3%), shortness of breath (59.5%), and fever 51.4%. There was an increase in the laboratory results of COVID-19 patients with diabetes mellitus on blood sugar levels at admission, HbA1c, urea, creatinine, SGOT, SGPT, and d-dimer levels. The most treatment results were recovered by as many as 24 people (64.9%). Conclusion. The majority of patients are in the age group of 46-65 years and are male. The most common clinical characteristic is cough and there is an increase in laboratory results in patients

Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis.

Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed.

Evaluation of the clinical, biochemical, and genetic presentation of neonatal and adult-onset 5,10-methylene tetrahydrofolate reductase (MTHFR) deficiency in patients from Pakistan.

To study the biochemical, clinical and molecular characteristics of 5,10- methylenetetrahydrofolate reductase (MTHFR) deficiency in Pakistani patients from a single center. Medical charts, urine organic acid chromatograms, plasma methionine and Hcys levels, and molecular testing results of MTHFR gene of patients presenting at the Biochemical Genetics Clinic, AKUH from 2016 to 2022 were reviewed. Neonatal MTHFR deficiency was found in five patients. The median (IQR) age of symptom onset and diagnosis were 18 (8.5-22) and 26 (16.5-31) days. The median lag between symptom onset and diagnosis was 8 (4.5-12.5) days. The median age of treatment initiation and duration of treatment were 26 (16.5-49) and 32 (25.5-54) days. The most common clinical features were lethargy, poor feeding, and seizures. The MTHFR gene sequencing revealed homozygous variants p.K510K, p.R567*, and p.R157W. Renal insufficiency manifesting as elevated serum creatinine and responding to betaine therapy was noted in one patient. This has not been previously reported in neonatal MTHFR deficiency and may reflect engagement of alternate pathways of remethylation. Adult onset MTHFR deficiency was found in six patients, with a heterogeneous neurological presentation. The median lag between symptoms onset and diagnosis was 7 (3-11) years. MTHFR gene sequencing revealed homozygous variant p.A195V in five patients from one family and p.G261V in the other. Two of the five reported variants are novel that include p.R157W and p.G261V. Eleven patients of this rare disorder from a single center indicate the need for clinical awareness and appropriate biochemical evaluation to ensure optimal outcomes.

Predictive value of preoperative inflammatory indexes for postoperative early recurrence of hepatitis B-related hepatocellular carcinoma.

To investigate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune inflammation index (SII) for early recurrence after liver resection in patients with hepatitis B-related hepatocellular carcinoma. A retrospective study was conducted on 162 patients who underwent hepatitis B-related hepatocellular carcinoma (HCC) resection between January 2013 and April 2016. The Youden index was utilized to calculate the optimal cut-off value. The Pearson Chi-square test was applied to analyze the relationship between inflammatory indexes and common clinical and pathological features. The Kaplan-Meier method and Log-Rank test were implemented to compare the recurrence-free survival rate within 2 years of the population. The Cox regression analysis was used to identify the risk factors for early postoperative recurrence. The best cut-off values of SIRI, PLR, NLR and SII were 0.785, 86.421, 2.231 and 353.64, respectively. Tumor diameter, degree of tumor differentiation, vascular invasion, SIRI>0.785, PLR>86.421, NLR>2.231 and SII>353.64 were risk factors for early recurrence. Combining the above seven risk factors to construct a joint index, the AUC of the joint prediction model was 0.804. The areas under the ROC curves of SIRI, PLR, NLR, and SII were 0.659, 0.725, 0.680, and 0.723, respectively. There was no significant difference in the predictive ability between the single inflammatory index models, but the predictive performance of the joint prediction model was significantly higher than that of the single inflammatory index models. The patients with lower SIRI, PLR, NLR, SII and joint index value had longer recurrence-free survival within 2 years. The joint index CIP, constructed by combining preoperative SIRI, PLR, NLP and SII with pathological features, can better predict the early recurrence of HBV-related HCC patients after surgery, which is beneficial in identifying high-risk patients and assisting clinicians to make better clinical choices.

Predictive Factors of Mortality in Patients with Severe COVID-19 Treated in the Intensive Care Unit: A Single-Center Study in Vietnam.

The fourth outbreak of COVID-19 with the delta variant in Vietnam was very fierce due to the limited availability of vaccines and the lack of healthcare resources. During that period, the high mortality of patients with severe and critical COVID-19 caused many concerns for the health system, especially the intensive care units. This study aimed to analyze the predictive factors of death and survival in patients with severe and critical COVID-19. We conducted a cross-sectional and descriptive study on 151 patients with severe and critical COVID-19 hospitalized in the Intensive Care Unit of Binh Duong General Hospital. Common clinical symptoms of severe and critical COVID-19 included shortness of breath (97.4%), fatigue (89.4%), cough (76.8%), chest pain (47.7%), loss of smell (48.3%), loss of taste (39.1%), and headache (21.2%). The abnormal biochemical features were leukopenia (2.1%), anemia, thrombocytopenia (18%), hypoxia with low PaO2 (34.6%), hypocapnia with reduced PaCO2 (29.6%), and blood acidosis (18.4%). Common complications during hospitalization were septic shock (15.2%), cardiogenic shock (5.3%), and embolism (2.6%). The predictive factors of death were being female, age > 65years, cardiovascular comorbidity, thrombocytopenia (< 137.109/l), and hypoxia at inclusion or after the first week or blood acidosis (pH < 7.28). The use of a high dose of corticosteroids reduced the mortality during the first 3weeks of hospitalization but significantly increased risk of death after 3 and 4weeks. Common clinical symptoms, laboratory features, and death-related complications of critical and severe COVID-19 patients were found in Vietnamese patients during the fourth wave of the COVID-19 pandemic. The results of this study provide new insight into the predictive factors of mortality for patients with severe and critical COVID-19.

Advances in attractive therapeutic approach for macrophage activation syndrome in COVID-19.

Nowadays, people have relaxed their vigilance against COVID-19 due to its declining infection numbers and attenuated virulence. However, COVID-19 still needs to be concern due to its emerging variants, the relaxation of restrictions as well as breakthrough infections. During the period of the COVID-19 infection, the imbalanced and hyper-responsive immune system plays a critical role in its pathogenesis. Macrophage Activation Syndrome (MAS) is a fatal complication of immune system disease, which is caused by the excessive activation and proliferation of macrophages and cytotoxic T cells (CTL). COVID-19-related hyperinflammation shares common clinical features with the above MAS symptoms, such as hypercytokinemia, hyperferritinemia, and coagulopathy. In MAS, immune exhaustion or defective anti-viral responses leads to the inadequate cytolytic capacity of CTL which contributes to prolonged interaction between CTL, APCs and macrophages. It is possible that the same process also occurred in COVID-19 patients, and further led to a cytokine storm confined to the lungs. It is associated with the poor prognosis of severe patients such as multiple organ failure and even death. The main difference of cytokine storm is that in COVID-19 pneumonia is mainly the specific damage of the lung, while in MAS is easy to develop into a systemic. The attractive therapeutic approach to prevent MAS in COVID-19 mainly includes antiviral, antibiotics, convalescent plasma (CP) therapy and hemadsorption, extensive immunosuppressive agents, and cytokine-targeted therapies. Here, we discuss the role of the therapeutic approaches mentioned above in the two diseases. And we found that the treatment effect of the same therapeutic approach is different.

Upsurge in hospitalization of pediatric patients with severe acute respiratory infections in Kolkata and surrounding districts caused by recombinant human respiratory adenovirus type B 7/3.

Globally, different genotypes of human adenoviruses are associated with outbreaks of acute respiratory infection (ARI) though such evidence is lacking from India. In the present study, we report a sudden increase in the positivity of respiratory adenovirus among hospitalized children with ARI from Kolkata and the surrounding districts of West Bengal, India, from December 2022 to date. A sharp rise in the positivity rate of respiratory adenovirus was found which ranged from 22.1% in early December 2022 to 52.6% in mid-March 2023. The overall positivity was 40.4% during the period and children in the 2 to <5 years (51.0%) age group were mostly affected. Single infection with adenovirus was found in 72.4% of cases while co-infection with rhinovirus was the maximum (9.4%). Around 97.5% of positive cases required hospitalization. Cough, breathlessness, and wheeze were the most common clinical features among positive patients. Phylogenetic analysis of the hexon and fiber gene of all the sequenced strains revealed HAdV-B 7/3 recombination with more than 99% homology within themselves. This report of a respiratory adenovirus outbreak in West Bengal, India causing severe illness in the pediatric population underscores the need for regular monitoring of the circulating strains.

Re-emergence of canine influenza in the United States of America; a call for One Health approach; a letter to the editor

Re-emergence of canine influenza in the United States of America; a call for One Health approach; a letter to the editor

Comparing Clinical Examination and Radiological Evaluation in the Preoperative Diagnosis and Location of Symptomatic Interdigital (Morton's) Neuroma

This study investigates whether clinical examination is as sensitive as ultrasound and magnetic resonance imaging (MRI) in the diagnosis and localization of symptomatic interdigital neuroma. A retrospective cohort study was conducted at two tertiary centers on all consecutive patients who underwent excision by a single foot and ankle specialist surgeon for a presumed interdigital neuroma between January 2008 and December 2020. Investigators collected pre-operative clinical findings, radiological investigations and post-operative outcomes. Sensitivity and positive predictive value were calculated and Z-score for two populations proportions was performed. 114 consecutive patients were operated on for 131 suspected interdigital neuroma. Thirteen patients were excluded due to lack of adequate clinical documentation. Of the remaining 101 patients with 118 suspected interdigital neuroma, 115 were confirmed histologically (97.5%). The sensitivity of clinical assessment to accurately diagnose and place an interdigital neuroma in the correct space was calculated as 96.5%. The most common pre-operative clinical feature was pain (99.2%). The calculated sensitivity for ultrasound to accurately diagnose an interdigital neuroma was 83.6%, and to correctly locate neuroma was 79.5% respectively, which were both statistically different compared to clinical assessment (P-value: <0.001 and P-value: <0.001). The calculated sensitivity for MRI to accurately diagnose an interdigital neuroma was 93.6%, which was statistically different to clinical assessment (P-value: 0.005). Pre-operative clinical assessment has the highest sensitivity to accurately diagnose interdigital neuroma when compared to MRI and ultrasound. Pre-operative clinical assessment has higher sensitivity to accurately locate interdigital neuroma when compared to ultrasound.

Huntington disease exacerbates action impulses.

Impulsivity is a common clinical feature of Huntington disease (HD), but the underlying cognitive dynamics of impulse control in this population have not been well-studied. To investigate the temporal dynamics of action impulse control in HD patients using an inhibitory action control task. Sixteen motor manifest HD patients and seventeen age-matched healthy controls (HC) completed the action control task. We applied the activation-suppression theoretical model and distributional analytic techniques to differentiate the strength of fast impulses from their top-down suppression. Overall, HD patients produced slower and less accurate reactions than HCs. HD patients also exhibited an exacerbated interference effect, as evidenced by a greater slowing of RT on non-corresponding compared to corresponding trials. HD patients made more fast, impulsive errors than HC, evidenced by significantly lower accuracy on their fastest reaction time trials. The slope reduction of interference effects as reactions slowed was similar between HD and controls, indicating preserved impulse suppression. Our results indicate that patients with HD show a greater susceptibility to act rapidly on incorrect motor impulses but preserved proficiency of top-down suppression. Further research is needed to determine how these findings relate to clinical behavioral symptoms.

INCIPIENT ORAL SQUAMOUS CELL CARCINOMA MIMICKING TRAUMATIC ULCER

Squamous cell carcinoma (SCC) is the main histological type of oral cancer and is usually diagnosed at a late stage. The most common clinical feature is an infiltrating and chronic ulcer with hardened edges. However, it can present other manifestations, mimicking different conditions. Case report: Two Caucasians patients, smokers, 53 and 59 years old, were referred, complaining of tongue sores. Upon clinical examination, superficial ulcers were observed on the posterior lateral border of the tongue. The main diagnostic hypothesis was traumatic ulcers. However, as no improvement was observed after polishing of the cusps (case 1) and extraction (case 2), incisional biopsies were performed and revealed squamous cell carcinoma. Partial glossectomy, neck dissection, and radiotherapy were performed. The two cases exemplify the importance of a correct diagnosis, especially for oral lesions that mimic non-neoplastic processes. Squamous cell carcinoma (SCC) is the main histological type of oral cancer and is usually diagnosed at a late stage. The most common clinical feature is an infiltrating and chronic ulcer with hardened edges. However, it can present other manifestations, mimicking different conditions. Case report: Two Caucasians patients, smokers, 53 and 59 years old, were referred, complaining of tongue sores. Upon clinical examination, superficial ulcers were observed on the posterior lateral border of the tongue. The main diagnostic hypothesis was traumatic ulcers. However, as no improvement was observed after polishing of the cusps (case 1) and extraction (case 2), incisional biopsies were performed and revealed squamous cell carcinoma. Partial glossectomy, neck dissection, and radiotherapy were performed. The two cases exemplify the importance of a correct diagnosis, especially for oral lesions that mimic non-neoplastic processes.

Clinical epidemiology of COVID-19 among hospitalized children in rural western Kenya.

The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection.