Common Pathological Finding Research Articles

What Is the Prosthetic Survival After Resection and Intercalary Endoprosthetic Reconstruction for Diaphyseal Bone Metastases of the Humerus and Femur?

Large metastatic lesions of the diaphysis can cause considerable pain and result in difficult surgical challenges. Resection and cemented intercalary endoprosthetic reconstruction offer one solution to the problem, but it is an extensive operation that might not be tolerated well by a debilitated patient. The risk of aseptic loosening and revision after intercalary endoprosthetic replacement has varied in previous reports, which have not examined the risk of revision in the context of patient survival. (1) In a small case series from one institution, what is the survivorship of patients after cemented intercalary endoprosthetic replacement for diaphyseal metastasis, and what is the cumulative incidence of revision for any reason? (2) What are the complications associated with cemented intercalary reconstruction? (3) What is the functional outcome after the procedure as assessed by the MSTS93 score? We retrospectively studied 19 patients with diaphyseal long bone metastases who were treated with resection and cemented intercalary endoprosthetic reconstruction by five participating surgeons at one referral center from 2006 to 2017. There were 11 men and eight women with a median age of 59 years (range 46 to 80 years). The minimum follow-up required for this series was 12 months; however, patients who reached an endpoint (death, radiographic loosening, or implant revision) before that time were included. One of these 19 patients was lost to follow-up but was not known to have died. The median follow-up was 24 months (range 0 to 116 months). Eight of the 19 patients presented with pathologic fractures. Ten of 19 lesions involved the femur, and nine of 19 were in the humerus. The most common pathologic finding was renal cell carcinoma (in 10 of 19). Survival estimates of the patients were calculated using the Kaplan-Meier method. A competing risks estimator was used to evaluate implant survival, using death of the patient as the competing risk. We also estimated the cumulative incidence of aseptic loosening in a competing risk analysis. Radiographs were analyzed for radiolucency at the bone-cement-implant interfaces, fracture, integrity of the cement mantle, and component position stability. Complications were assessed using record review that was performed by an individual who was not involved in the initial care of the patients. Functional outcomes were assessed using the MSTS93 scoring system. Patient survivorship was 68% (95% CI 50% to 93%) at 1 year, 53% (95% CI 34% to 81%) at 2 years, and 14% (95% CI 4% to 49%) at 5 years; the median patient survival time after reconstruction was 25 months (range 0 to 116 months). In the competing risk analysis, using death as the competing risk, the cumulative incidence of implant revision was 11% (95% CI 2% to 29%) at 1 year and 16% (95% CI 4% to 36%) at 5 years after surgery; however, the cumulative incidence of aseptic loosening (with death as a competing risk) was 22% (95% CI 6% to 43%) at 1 year and 33% (95% CI 13% to 55%) at 5 years after surgery. Other complications included one patient who died postoperatively of cardiac arrest, one patient with delayed wound healing, two patients with bone recurrence, and one patient who experienced local soft tissue recurrence that was excised without implant revision. Total MSTS93 scores improved from a mean of 12.6 ± 8.1 (42% ± 27%) preoperatively to 21.5 ± 5.0 (72% ± 17%) at 3 months postoperatively (p < 0.001) and 21.6 ± 8.5 (72% ± 28%) at 2 years postoperatively (p = 0.98; 3 months versus 2 years). Resection of diaphyseal metastases with intercalary reconstruction can provide stability and short-term improvement in function for patients with advanced metastatic disease and extensive cortical destruction. Aseptic loosening is a concern, particularly in the humerus; however, the competing risk analysis suggests the procedure is adequate for most patients, because many in this series died of disease without undergoing revision. Level IV, therapeutic study .

Serum Cingulin levels are increased in children with autism spectrum disorder

Background Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders in which the underlying pathogenesis and etiologic factors are not fully understood. The blood brain barrier (BBB) ​​plays a critical role in central nervous system defense by limiting access to circulating solutes, macromolecules, and cells that can negatively affect neuronal activity. The loss of BBB integrity is likely to be seen as a common pathologic finding for many psychiatric disorders such as schizophrenia, ASD, and mood disorders. In this study, we aimed to investigate whether serum Cingulin levels are associated with ASD. Subjects and Methods A total of 40 treatment-naive children with ASD and 40 healthy controls were included in the present study. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version-DSM-5 (K-SADS-PL-DSM-5) has been used to screen healthy controls for psychiatric disorders by a psychiatrist after a physical examination by a paediatrician. The clinical severity of the ASD symptoms has been assessed by the Childhood Autism Rating Scale (CARS). Venous blood samples were collected and serum Cingulin levels were measured. Results When the ASD and control groups were compared, CARS and Cingulin values of the patient group were statistically higher than the healthy group. There is a statistically positive correlation between CARS and Cingulin values. Discussion To the best of our knowledge, this study is a first in the literature conducted about the serum Cingulin levels, which is a component of BBB, among patients with ASD. Our findings demonstrate that serum Cingulin levels are meaningfully higher in ASD group compared to the healthy control group. It has been also indicated that there has been a meaningful relationship between serum Cingulin levels and ASD symptom severity.

Tilapia lake virus (TiLV) causes severe anaemia and systemic disease in tilapia.

Tilapia lake virus disease (TiLVD) is an emerging disease in tilapia that is associated with mass mortality affecting global tilapia aquaculture. In this study, red hybrid tilapias (Oreochromis spp.) were experimentally infected by intracoelomic injection with Tilapia lake virus (TiLV) to gain a better understanding of the clinicopathological changes during infection. Pale bodies and gill were observed in infected fish after 7 days of post-challenge (dpc) associated with severe anaemia. Further haematological analysis in TiLV-infected fish revealed decreased levels of haemoglobin and haematocrit at 3 dpc. Common pathological findings included pale and friable liver, pale intestine with catarrhal content, and dark and shrunken spleen in TiLV-infected fish at 7 dpc and 14 dpc. Histologically, reduced numbers of red blood cells and accumulation of melano-macrophage centre in the spleen were found in infected fish at 3 dpc, and severe lesions were more commonly observed at 7 and 14 dpc. Lymphocyte infiltration, syncytial cell formation and multifocal necrotic hepatitis were the prominent pathological findings in the liver of infected fish. The severity of pathological changes was associated with TiLV-infection with higher viral loads and with the expression pattern of pro-inflammatory cytokines and antiviral genes, including interferon regulatory factor 1 (irf1), interleukin (il-8), radical s-adenosyl methionine domain containing 2 (rsad2) and mx. Our study provides a comprehensive analysis of the haematological profile and pathological changes in tilapia during TiLV infection. Overall, lesions present in various organs, together with alteration of host immune response in TiLV-infected fish, indicate the systemic infection of this virus. The knowledge gained from this study improves our understanding of how TiLV causes pathological and haematological changes in tilapia.

β-1,3-glucan improved the health and immunity of juvenile African catfish (Clarias gariepinus) and neutralized the histological changes caused by lead and fipronil pollutants

BackgroundWater pollutants cause adverse effects in aquatic ecosystems. The immunomodulatory and mitigating effects of dietary 1,3-glucan on fipronil and lead-induced intoxication in African catfish (Clarias gariepinus) were investigated. Two hundred forty catfish were randomly divided into four equal groups: those in the first group were fed basic diet and served as controls; those in the second group were supplemented with β-1,3-glucan (0.1%); those in the third group were exposed to combination of lead nitrate at 0.041 mg/L (1/10 96 h LC50) and fipronil at 2.8 mg/l (1/10 96 h LC50); and those in the fourth group were exposed to combination of fipronil, lead, and β-1,3-glucan. The health status, haematological, immunological, and histological changes were all evaluated.ResultSwelling on the dorsolateral side, spinal column deviation, sluggish movement, skin bleaching, excessive mucus secretion, significant variations in blood indices-related measures, and a 45% death rate were observed in the third group. There was a significant reduction in interleukin-1 (IL-1) and interleukin-6 (IL-6) and immunoglobulin M (IgM) concentrations, as well as decrease in their corresponding gene expression, indicating that fipronil and lead had immunosuppressive activity. Severe catarrhal enteritis and mucinous degeneration of the lining epithelium, and notable depletion of white pulp, congested red pulp and hemosiderosis were common pathological findings in the spleen. β-1,3-glucan alone or in combination with fipronil and lead provoked physical activity, blood indices, with elevations in IL-1β, IL-2, IL-6, and IgM concentrations, as well as up-regulation in their genes’ expression in splenic tissues, when compared to the third group. The spleen and intestine had normal histological architecture with 5% mortalities. There were no fish deaths in the β-1,3-glucan-alone or control groups.ConclusionThe use of β-1,3-glucan (0.1%) as dietary supplement could be implemented to protect against the toxic effects of fipronil and lead toxicity by improving the health and immunological parameters of intoxicated catfish.

Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis

BackgroundUndifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to determine the precise histopathological diagnosis. In this study, we aimed to evaluate the efficacy of synovial biopsy for establishing a definite diagnosis in patients with undifferentiated chronic knee monoarthritis.MethodsThe present retrospective case series was conducted in 2005 in the rheumatology research center of Shariati hospital and the 501 hospital in Tehran, Iran. The study included the synovial biopsy of patients with chronic knee monoarthritis who did not have a definite diagnosis after all the diagnostic steps before the synovial biopsy. Pathology slides of the patients’ synovial biopsy were reevaluated with a senior expert pathologist.ResultsEighty patients with a mean age of 37.6 ± 17.32 years (range: 6–68) were included, of whom 50% were female. The gap time between the onset of knee monoarthritis and the decision-making for synovial biopsy was 14.34 ± 19.61 months. Histopathologic evaluations revealed non-specific synovitis in 65% of the patients and a definite diagnosis in 35%. The most common definite diagnosis was rheumatoid arthritis (9%), followed by septic arthritis (5%). The most common pathologic findings were endothelial proliferation (89%) and synovial proliferation (88%), and the most common infiltrating cell was lymphocyte (54%). Patients with non-specific synovitis were more likely to have neovascularization, cellular infiltration (p-value < 0.001), synovial proliferation, endothelial proliferation (p-value = 0.001), pannus formation (p-value = 0.009), and fibrosis (p-value = 0.022) compared to the patients with a definite pathologic diagnosis. However, age, gender, and the gap time between disease symptoms to synovial biopsy were not significantly different between the different groups of diagnosis (p-value > 0.05).ConclusionNon-specific synovitis remains the most common histopathologic finding, highlighting the importance of physician expert opinion for most of the patients with undifferentiated chronic knee monoarthritis. Studies with larger samples and immunohistochemistry analyses are needed to clarify this uncategorized entity further.

Longitudinal Assessment of Plasma Syndecan-1 Predicts 60-Day Mortality in Patients with COVID-19.

Endotheliopathy is a common pathologic finding in patients with acute and long COVID-19. It may be associated with disease severity and predispose patients to long-term complications. Plasma levels of a proteoglycan, syndecan-1, are found to be significantly elevated in patients with COVID-19, but its roles in assessing disease severity and predicting long-term outcome are not fully understood. A total of 124 consecutive hospitalized patients with SARS-CoV-2 infection were prospectively enrolled and blood samples were collected on admission (T1), 3-4 days following treatment (T2), and 1-2 days prior to discharge or death (T3). Plasma levels of syndecan-1 were determined using an immunosorbent assay; various statistical analyses were performed to determine the association between plasma syndecan-1 levels and disease severity or the 60-day mortality rate. Compared with those in the healthy controls, plasma levels of syndecan-1 in patients with critical COVID-19 were significantly higher (p &lt; 0.0001). However, there was no statistically significant difference among patients with different disease severity (p &gt; 0.05), resulting from large individual variability. Longitudinal analysis demonstrated that while the levels fluctuated during hospitalization in all patients, plasma syndecan-1 levels were persistently elevated from baseline in critical COVID-19 patients. Cox proportional hazard regression analyses revealed that elevated plasma levels of syndecan-1 (&gt;260 ng/mL at T1, &gt;1018 ng/mL at T2, and &gt;461 ng/mL at T3) were significantly associated with the 60-day mortality rate. Endotheliopathy, marked by glycocalyx degradation and elevated plasma syndecan-1, occurs in nearly all hospitalized patients with SARS-CoV-2 infection; elevated plasma syndecan-1 is associated with increased mortality in COVID-19 patients.

Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors

Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). Data from 2577 LLDs who underwent living donor hepatectomy (n=2511) or aborted living donor hepatectomy (n=66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n=446; 17.9%), adenomyomatosis (n=9), and papillary hyperplasia (n=6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n=207; 0.4%), cholelithiasis (n=53), cholesterol polyp (n=31), and noncholesterol polyp (n=19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P=.001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P=.015). The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.

Incidental Findings in Prostate above the Age of 50 Years in Autopsy of 100 Cases

Background: Autopsy study is used to disclose many hidden prostatic pathologies and their incidence. Thecurrent study aims to evaluate the histopathological pattern of prostatic lesions such as nodular hyperplasia ofthe prostate, precancerous lesions, and latent cancer in autopsy series of males over the age of 50 and to correlatethem with age.Methods: The present study was a prospective autopsy study carried out in the pathology department, afteren bloc harvestation of prostate gland from autopsies of men aged more than 50 years by the forensic team ofGovernment Medical College Patiala.Results: Age ranges from 51-90 years and the mean age was 58.57 ± 8.11years. The weight of the prostate glandranged from 18 to 42 grams with mean weight 27.01 ± 3.34g. Benign prostatic hyperplasia was the commonpathological finding (79%), 38 cases of chronic non-specific prostatitis, 3 cases with acute prostatitis and 4 caseswere associated with prostatic intraepithelial neoplasia. Prostatic adenocarcinoma was detected in 9 cases.Conclusions: The present study shows that normal prostate gains weight with advancing age. The majority ofcases are in the 6th decade, benign prostatic hyperplasia is the most common lesion encountered

The Multifaceted Clinical Characteristics of Congenital Cytomegalovirus Infection: From Pregnancy to Long-Term Outcomes.

The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6-40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.

The EMory BrEast imaging Dataset (EMBED): A Racially Diverse, Granular Dataset of 3.4 Million Screening and Diagnostic Mammographic Images.

Supplemental material is available for this article. Keywords: Mammography, Breast, Machine Learning © RSNA, 2023.

High-Resolution Finger MRI: What Should You Look for in Trauma of the Fingers?

The fingers are among the most commonly injured structures in traumatic injuries resulting from sports and work. Finger injuries encompass a broad spectrum of injuries to bone and soft tissues, including tendons, ligaments, and cartilage. The high resolution of 3T MRI with dedicated surface coils allows for optimal assessment of the intricate soft tissue structures of the fingers. There have been several reports on detailed MRI features of the basic anatomy and common pathological findings of the finger and hand. Understanding the normal anatomy and familiarization with common traumatic lesions of the ligaments, tendons, and pulleys of the fingers on high-resolution MRI will allow radiologists to perform accurate preoperative evaluations of traumatic hand lesions. The purpose of this study is to review the normal hand anatomy and common traumatic lesions of the finger on high-resolution MRI and correlate them with surgical findings.

Comparison of transnasal esophagoscopy and sedated esophagogastroduodenoscopy in the assessment of laryngopharyngeal reflux.

Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs. 48%) and gaping cardia (69% vs. 24%), followed by peptic esophagitis (41% vs. 24%). The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease.

The spectrum and changes of biopsy-proven kidney diseases in Chinese children.

The study aimed to investigate the spectrum of biopsy-proven kidney disease in Chinese children. Records of children 0-17years old who underwent native kidney biopsy from June 1st, 2013 to December 31st, 2018 in the national inpatients' database of China were analyzed. Biopsy-proven kidney diseases of different sex, age groups, and diagnosis, and the changing patterns of kidney disease compared with the previous study were analyzed. A total of 21,311 patients from 232 hospitals with a median age of 11.34years were included. Immunoglobulin A vasculitis with nephritis (IgAVN) was the most common pathological finding [29.17%, 95% confidence interval (confidence interval, CI) = 28.56-29.78], followed by IgA nephropathy (IgAN) (22.70%, 95% CI = 22.14-23.27). IgAN was the most common finding in patients with hematuria (60.75%, 95% CI = 58.83-62.65], proteinuria (33.43%, 95% CI = 30.54-36.42), and hematuria plus proteinuria (62.77%, 95% CI = 56.19-69.02). Minimal change disease was the most common finding (40.69%, 95% CI = 39.41-41.98) in nephrotic syndrome. The proportion of IgAVN in patients with biopsy-proven glomerular disease increased year by year during 2013-2018 (p for trend < 0.001) and washigher than that of2004-2014 [29.41% (95% CI = 29.10-29.72) in 2013-2018 vs. 13.35% (95% CI = 12.97-13.73) 2004-2014, p < 0.001]. The proportion of hepatitis B virus associated nephritis during 2013-2018 was lower than that of 2004-2014 [0.44% (95% CI = 0.36-0.54) in 2013-2018 vs. 0.87% (95% CI = 0.67-1.10) in 2004-2014, p < 0.001]. IgAVN and IgAN were the most common types of pathological findings in children who underwent kidney biopsies from 2013 to 2018. The pathological spectrum of kidney biopsy changed over time.

Histopathology pattern and survival analysis of patients with kidney biopsy in the top end of Northern Australia from 2007 to 2020

AimRoyal Darwin Hospital (RDH) is the main tertiary hospital that has performed more than 600 biopsies since its establishment. Although Indigenous people in Australia’s Northern Territory (NT) has the highest rate of renal replacement therapy, the histopathology pattern of their renal diseases is still under discussed. We aimed to analyse the histopathology pattern of patients undergoing renal biopsy in RDH from June 2007 to June 2020. Secondary aims include clinical indication and survival analysis of patients with kidney biopsies.MethodsWe conducted a retrospective cohort study on all native kidney biopsy reports from patients over the age of 16, from June 2007 to June 2020. Descriptive statistics was used to summarise age, sex, indigeneity, histopathological pattern, and mortality. Categorical values were expressed as absolute frequencies and percentages. Survival analysis was performed using multivariate analyses and Cox proportional hazard regression model.ResultsThere were 364 native renal biopsies included in the analysis. Sub-nephrotic proteinuria was the most common clinical indication for kidney biopsy (n = 160,47.8%). Diabetes nephropathy (DN) was the most common pathological finding (n = 71,12.8%). Indigenous population who had dialysis performs poorly compared to their non-indigenous counterpart (HR 2.37,95% CI 1.53–3.67,p < 0.001).ConclusionDiabetic nephropathy is the most common native kidney biopsy in the NT with higher mortality among indigenous patients. This study supports the previous findings of indigenous female excess, younger age of kidney disease requiring kidney biopsy, and excess of diabetic nephropathy in the top-end of the NT. It can be speculated that some diabetic patients had atypical features prompting a biopsy.

Elevated Plasma Levels of Von Willebrand Factor and Syndecan-1 Predict 60-Day Mortality in Patients with Severe and Critical COVID-19

Introduction: Endotheliopathy is common pathologic findings in acute and long COVID-19, which is associated with the disease severity and predisposes to long-term complications. Previous studies have demonstrated that plasma levels of von Willebrand factor (VWF) and proteoglycan syndecan-1 are significantly elevated in patients with severe COVID-19. However, the role of these endothelial biomarkers for predicting a long-term outcome is still lacking. Patients and Methods:151 consecutive hospitalized patients between January and March 2022 at the University of Kansas Hospital with a confirmed SARS-CoV-2 infection by polymerase chain reaction were prospectively enrolled for the study. Whole blood anticoagulated with EDTA or sodium citrate was collected at least 3 times on admission (T1), 4-5 days following treatment (T2), and a few days prior to discharge or death (T3). Plasma levels of VWF antigen, ADAMTS13 antigen/activity, and syndecan-1 were determined using immunoassays or a functional assay. Kaplan-Meier survival analysis was performed to determine the predictive value of each biomarker for 60-day mortality. Results. Of 151 patients with a positive PCR test for SARS-CoV2, 124 patients were studied and analyzed. These patients were categorized into an asymptomatic control, a moderate, a severe, and a critical group according to an updated World Health Organization (WHO) guidance. The admission plasma levels (median, IQR) of VWF in patients of critical (334%,164.7-526.2%) (p=0.0049) and severe (255%, 143.1-410.9%) (p=0.0088) groups were significantly higher than in those of moderate (153%, 186.3-240.1%) (Fig. 1A). Interestingly, no statistically significant difference in the admission plasma levels of ADAMTS13 antigen among all groups (p>0.05) (Fig. 1B) despite a significantly lower plasma ADAMTS13 activity (median, IQR) in patients with severe (39.8%, 30.0-49.3%) (p=0.0067) and critical (38.6%, 26.9-51.5%) (p=0.047) COVID-19 than in those with a asymptomatic disease (49.2%, 37.5-103.4%) (Fig. 1C). Furthermore, plasma levels of syndecan-1 on admission were not different among all groups (p>0.05) (Fig. 1D). Longitudinal analysis demonstrated that plasma levels of VWF antigen and syndecan-1 were persistently elevated from baseline in patients who died but not in those who survived (Fig. 2A-D). Kaplan-Meier survival analysis revealed that an elevated level of plasma VWF (> 320%) on T2 (p<0.0001) (Fig. 2E) or an elevated level of plasma syndecan-1 on admission (T1) (> 260 ng/mL) (p=0.0002) (Fig. 2F), but not 4-5 days following therapy (T2) or before being discharged home or death (T3) predicted the 60-day mortality rate. Conclusions: Our results demonstrate significantly elevated plasma VWF antigen and reduced ADAMTS13 activity on admission in patients with severe and critical COVID-19. The dynamic change in plasma VWF or the initial plasma levels of syndecan-1 on admission predict the 60-day survival. The findings suggest that the additional therapeutic strategies may be needed to alleviate endothelial activation and damage to improve survival and long-term complications in patients with severe and critical COVID-19. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Shoulder injury related to vaccine administration following SARS-CoV-2 inoculation: Case series and review of literature

IntroductionShoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines. Materials and methodsInclusion criteria was onset of symptoms within 48 h after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38–76), and 72.2% were women. ResultsIn many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment. ConclusionsShoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.

Assessment of Paranasal Sinus Pathology in Patients Presenting for Brain MRI as Referred From General Practice or Neurologist Physicians.

Objective The aim of this study is to assess the incidence and kinds of paranasal sinus pathology in patients presenting for brain MRI as referred from general practice or neurologist physicians in Qassim region, Saudi Arabia. Methods This cross-sectional study included 210 patients with different neurological indications and presentations who underwent an MRI of the brain and were evaluated by the consultant radiologist for the presence of any paranasal sinuses pathologies such as mucosal thickening, retention cyst, opacification, and ostiomeatal complex obliteration. The analysis was carried out using the chi-square test. Results A total of 210 cases underwent brain MRI to evaluate clinically suspected brain disorders; there were 138 (65.7 %) males and 72 (34.3%) females. Mucosal thickening was the commonest pathological finding (111 cases, 52.9%). retention cysts were present in around 14.3%, meaning 30 cases, and partial opacification was present in around 10%, representing 21 cases. Total opacification was present in three (1.4%) cases. Also, ostiomeatal complex obliteration was present in three (1.4%) cases. Paranasal pathological findings were more in those aged ≤ 35 years, with 75 (35.7%) cases. mucosal thickening, partial opacification, total opacification, and ostiomeatal complex obliteration were more in males, whereas retention cysts were equal in both genders. Conclusion Pathological paranasal sinuses findings commonly occur at brain MRI during neurological disorder evaluation. These findings are usually benign, and mucosal thickening is the commonest. The majority of the pathological findings were observed in those aged ≤ 35 years and in the male gender. Detecting pathological findings in paranasal sinuses helps diagnose lesions unrelated to the suspected neurological disease.

DIAGNOSTIC YIELD AND COMPLICATIONS USING ROBOTIC-ASSISTED NAVIGATION BRONCHOSCOPY FOR MIXED-DENSITY PULMONARY LESIONS

DIAGNOSTIC YIELD AND COMPLICATIONS USING ROBOTIC-ASSISTED NAVIGATION BRONCHOSCOPY FOR MIXED-DENSITY PULMONARY LESIONS

Histopathological Changes in Placenta of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) Infection and Maternal and Perinatal Outcome in COVID-19.

BackgroundWhether vertical transmission or placental pathology occurs after maternal infection during pregnancy remains unknown. There is a clear need for studies on the impact of COVID-19 on pregnancy outcome. A systemic inflammatory or hypercoagulable state may be the contributing factor for placental pathology.MethodsThe pregnant women with COVID-19 who delivered between May 2020 and May 2021 were followed and data were collected about pregnancy course and placentas were examined for macro- and microscopical changes and were compared to controls with non-infected women. ResultsPlacenta of COVID-19-infected females had increased prevalence of decidual arteriopathy and placental injury reflecting hypoxia and uteroplacental insufficiency within the intervillous space. Features of maternal vascular malperfusion such as increased syncytial knots were present in 100% cases. Fibrinoid necrosis was seen in 100% cases and increased focal perivillous fibrin depositions were presented in 37.7% cases. About one fourth infected placentas had evidence of villitis. Even after matching for comorbidities like preeclampsia, these changes were present.ConclusionThe most common pathological findings of the placenta of COVID-19 infections are signs of maternal and fetal malperfusion. Future studies should target infections in different stage of gestation, including first and second trimesters.

Pulmonary manifestations in long COVID

HintergrundPulmonale Manifestationen sind sehr häufige Folgeerscheinungen nach einer Severe-acute-respiratory-syndrome-coronavirus-type-2(SARS-CoV-2)-Infektion, die unter dem Begriff Long-COVID-Syndrom (COVID „coronavirus disease“) zusammengefasst werden.Ziel und MethodenZusammenfassung der aktuellen Literatur zu den pulmonalen Manifestationen mit einem Fokus auf Expertenempfehlungen.ErgebnisseDyspnoe ist nach der chronischen Fatigue das häufigste Symptom bei Patienten mit Long-COVID-Syndrom. Auffällige Befunde finden sich vor allem nach schwerem akutem COVID-19-Verlauf und beinhalten radiologische Veränderungen im Sinne interstitieller Lungenerkrankungen, restriktive lungenfunktionelle Befunde und Einschränkungen der Diffusionskapazität als häufigsten pathologischen Befund. Obwohl sich sowohl Beschwerden als auch pathologische pulmonale Befunde im Verlauf bessern, können einige Patienten noch Monate nach der akuten Infektion unter Auffälligkeiten leiden. Dabei ist die Relevanz der pathologischen Befunde sowie eine Beteiligung funktioneller respiratorischer Einschränkungen, einer kardiopulmonalen Dekonditionierung, nichtsomatischer Ursachen und vorbestehender Erkrankungen aktuell unklar. Die diagnostische Abklärung fokussiert entsprechend auf Risikopatienten und schließt neben einer bildgebenden und lungenfunktionellen Abklärung eine Belastungsuntersuchung und bei unklaren Befunden eine Echokardiographie zur Diagnose einer pulmonalvaskulären Komponente ein. Die therapeutischen Möglichkeiten beinhalten aktuell die leitliniengerechte Therapie von Ursachen der Beschwerden (beispielsweise interstitielle Lungenerkrankungen, Husten) und Rehabilitationsmaßnahmen.SchlussfolgerungDas aktuelle Wissen zum Krankheitsbild wird ständig erweitert, allerdings existieren aufgrund mangelnder Studienlage noch keine evidenzbasierten Leitlinien zur Diagnostik und Therapie pulmonaler Manifestationen beim Long-COVID-Syndrom.