Elevated Inflammatory Markers Research Articles

E17 Juvenile idiopathic arthritis: are girls less lucky?

Abstract Introduction Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. ∼3 million children and young adults worldwide have JIA, with higher prevalence rates in girls. Objectives Our objective was to assess the relationship between gender and disease characteristics. Methods A retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period from 1994 to 2022. We collected clinical, biological, and radiological disease characteristics from medical records. These parameters were compared according to gender. Results We have included 29 patients (17 women and 12 men). The mean age was 35.69 ± 11.72 [18–61] years. Symptoms began at an average age of 11.10 ± 4.25 [2–16] years and have been evolving since 24.48 ± 12.76 [1–47] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2, 8 patients had a normal BMI. Growth delay was noted in 3 cases. Sixteen patients (55.2%) had a polyarticular form. The presence of rheumatoid factor (RF), ACPA and anti-nuclear antibodies was noted in 12, 7 and 5 cases, respectively. At least one extra-articular manifestation was noted in 16 patients: ophthalmologic (n = 6), skin (n = 4), cardiac (n = 4), pulmonary (n = 3) and renal (n = 2) involvement. Osteoporosis was noted in 7 cases. Mean C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and haemoglobin value level 42.74 ± 63.37 [2–218] mg/l, 69.67 ± 36.23 [36–108] mm, and 11.31 ± 2.10 [6.5–15] g/dl. An elevation of inflammation markers was noted in 19 cases. Anaemia was noted in 20 cases. Bone erosions were noted in 18 cases. Hip and cervical spine involvement were noted in 14 and 4 cases, respectively. Our comparative study showed that rheumatoid factor positivity was significantly associated with female gender (73.3% vs 16.7%; P = 0.018). No other significant gender differences were identified when comparing the rest of the clinical, biological, and radiological variables. The correlation study concluded the following correlations of gender with haemoglobin level (r = -0.574; P = 0.001), rheumatoid factor positivity (r = 0.517; P = 0.016) and JIA subform (r = -0.482; P = 0.008). Conclusion A relationship of gender to rheumatoid factor positivity, haemoglobin level, and JIA subform was identified in our study. Larger-scale longitudinal studies would better investigate the influence of gender on JIA.

E14 Is there a correlation between inflammation and cardiovascular risk in juvenile idiopathic arthritis

Abstract Introduction Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease and, like any chronic inflammatory rheumatic disease, has an increased risk of cardiovascular disease compared with the general population. Objectives In this work, we investigated the relationship between inflammation and cardiovascular risk during JIA. Methods This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Clinical and biological parameters were collected. Cardiovascular risk factors (CVRF) were also assessed: family history of cardiovascular event, physical inactivity, smoking, arterial hypertension, diabetes, dyslipidaemia, obesity. Results We included 29 patients (17 females and 12 males) with an average age of 35.69 ± 11.72 [18–61] years, an average age of disease onset of 11.10 ± 4.25 [2–16] years and an average diagnostic delay of 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years. Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm/h. A biological inflammatory syndrome was noted in 65.5% of cases (n = 19). CVRF were present in 41.4% (n = 12) of cases: family history of cardiovascular event (n = 2 cases), physical inactivity (n = 5 cases), smoking (n = 3 cases), arterial hypertension (n = 4 cases), diabetes (n = 4 cases), dyslipidaemia (n = 4), and BMI ≥ 25 kg/m2 (n = 4). Our statistical study concluded that CVRF (all types) were more frequent in case of elevated inflammation markers (60% vs 15.4%; P = 0.016). In addition, the presence of biological inflammatory syndrome associated with smoking in our population (20% vs 0%; P = 0.048). In contrast, we found no significant difference when comparing the rest of CVRF according to the elevation of inflammation markers. Furthermore, we found a correlation between biological inflammation and the presence of CVRF (all type) (r = 0.456; P = 0.015). However, no correlation was found with the CVRF taken separately. Conclusion Inflammation is correlated with cardiovascular risk in JIA. Control of inflammation and modifiable CVRF is recommended in this disease.

Elevated leukotriene B4 and 8-isoprostane in exhaled breath condensate from preterm-born infants

BackgroundInflammation and oxidative stress play a key role in the development of bronchopulmonary dysplasia (BPD), possibly contributing to persistent respiratory morbidity after preterm birth. We aimed to assess if inflammatory markers were elevated in exhaled breath condensate (EBC) of infants born very prematurely (< 32 weeks gestation) at 12–16 corrected months of age, and if increased levels were associated with BPD diagnosis and respiratory morbidity.MethodsEBC samples and respiratory questionnaires were collected from 15 term-born infants and 33 preterm-born infants, 12 with a neonatal BPD diagnosis. EBC samples were analysed for leukotriene B4 (inflammation) and 8-isoprostane (oxidative stress) concentrations using enzyme-linked immune-assays. Differences between groups were analysed by Kruskal-Wallis Test with post-hoc comparisons, independent samples t-test or Mann-Whitney U test depending on normality of the data.ResultsLeukotriene B4 and 8-isoprostane levels were elevated in exhaled breath condensate of preterm-born infants compared to those born at term (mean difference [95% CI]; 1.52 [0.45, 2.59], p = 0.02; 0.77 [0.52, 1.02], p < 0.001, respectively). Leukotriene B4 and 8-isoprostane levels were independent of BPD diagnosis and respiratory morbidity over the first year of life.ConclusionsInfants born very prematurely exhibit elevated markers of airway neutrophilic inflammation and oxidative stress beyond the first year of life, regardless of a neonatal diagnosis of chronic lung disease or respiratory morbidity during infancy. These findings may have implications for future lung health.Trial RegistrationN/A.

SO,MCT,OO,FO-ILE Is Associated With Better Side Effect Profile Than SO-ILE in Critically Ill Children Receiving Parenteral Nutrition.

This study aimed to evaluate the side effect profile of soybean oil lipid injectable emulsion -(SO-ILE) and soybean oil, medium-chain triglyceride, olive oil, fish oil lipid injectable emulsion (SO,MCT,OO,FO-ILE) in critically ill children requiring parenteral nutrition (PN). This is an observational study of children admitted to our pediatric intensive care unit requiring PN for ≥7 days. Patients were divided into 2 cohorts: SO,MCT,OO,FO-ILE (n = 34) and SO-ILE (n = 111). Outcomes included development of hypertriglyceridemia (HTG), intestinal failure-associated liver disease (IFALD), length of stay, and mortality. Logistic regression was performed after controlling for duration and maximum dose of lipids. The median maximum lipid dose was significantly higher in the SO,MCT,OO,FO-ILE cohort (2.7 vs 3 g/kg; p = 0.01). Prevalence of baseline HTG was similar in both cohorts. After excluding patients with baseline HTG, incidence of HTG upon PN introduction was higher in the SO-ILE cohort (51.2% vs 26.7%; p = 0.02). The SO-ILE cohort also had significantly higher triglyceride concentrations at peak and upon discontinuation of PN (p < 0.05). Direct bilirubin and C-reactive protein were significantly higher in the SO-ILE cohort after stopping PN. Five patients (3.4%) developed IFALD, 4 of whom were in the SO-ILE cohort (p = 0.85). Upon logistic regression, mortality rate and incidence of HTG remained significantly higher in the SO-ILE cohort (adjusted odds ratio, 2.3 [95% CI, 1.1-5.3]; p = 0.04; and adjusted odds ratio, 2.0 [95% CI, 1.3-5.1]; p = 0.03, respectively). In critically ill children requiring PN, SO-ILE was associated with a higher risk of HTG, -elevated direct bilirubin, inflammatory markers and mortality compared with SO,MCT,OO,FO-ILE.

Inflammation-related proteins as biomarkers of treatment-related behavioral symptoms: A longitudinal study of breast cancer patients and age-matched controls

BackgroundBehavioral symptoms in breast cancer (BC) survivors have been attributed to cancer treatment and resulting inflammation. However, studies linking behavioral symptoms to BC treatment have observed patients only after some treatment. Our prospective study with pre-treatment baseline investigates post-treatment changes in inflammation-related biomarkers and whether those changes correlate with changes in symptoms. MethodsParticipants were postmenopausal women, newly-diagnosed with stage 0–3 BC before any treatment (n = 173 “patients”), and age-matched women without cancer (n = 77 “controls”), who were assessed on plasma markers [soluble tumor necrosis factor receptor type 2 (sTNF-RII), interleukin (IL)-6, IL-1 receptor antagonist (IL-1RA), C-reactive protein (CRP)]) and symptoms (Physical Functioning, Pain, Attention/concentration, Perceived Cognitive Problems, Fatigue, Sleep Insufficiency, Depression). Participants were assessed again 1 month, 1 year, and 2 years after completing primary treatment or similar interval in controls. Generalized linear mixed models tested 4 treatments (surgery alone or with chemotherapy, radiation, or both) for association with change per marker. Joint models tested change per marker for association with change per symptom. Models considered demographic, socioeconomic, and clinical covariates. False Discovery Rate method controlled risk of error from multiple hypotheses. ResultsAt one month post-completion of treatment, sTNF-RII and IL-6 were elevated by all BC treatments, as were IL-1RA and CRP after surgery alone (all, p < 0.05). By 1 year, markers’ average values returned to baseline. Throughout 2-year follow-up, increase-from-baseline in sTNF-RII, IL-1RA, and IL-6 coincided with worsened Physical Functioning, and increase-from-baseline in sTNF-RII coincided with increased Pain (all, p < 0.01). These biomarker-symptom associations (excepting IL-6) were exclusive to patients. No other symptoms worsened, and baseline Fatigue and Depression improved in all participants. ConclusionsBC treatment, even surgery, is associated with transient elevation in inflammatory markers. In patients post-treatment, increase-from-baseline in sTNF-RII accompanies increased Pain and decreased Physical Functioning, suggesting that sTNF-RII merits development as a clinical biomarker in BC patients.

Are persons living with diagnosed HIV capable of mounting a strong inflammatory response to the new coronavirus?

The impact of COVID-19 on persons living with diagnosed HIV (PLWDH) remains incompletely understood. It's unclear whether an impaired immune system offers protection against mounting cytokine storm. Retrospective matched cohort study of COVID-19 hospitalized individuals in New York State (NYS). Medical records were abstracted and analyzed for 853 PLWDH hospitalized with COVID-19 in NYS and 1621 HIV-negative controls. Preexisting comorbidities and inflammatory markers measured within 24h of hospital admission were abstracted. PLWDH were significantly less likely to have elevated inflammatory markers compared to matched controls. Elevated WBC occurred in 23.3% of PLWDH vs 30.1% of controls (p = .0002), elevated CRP in 37.4% of PLWDH vs 43.2% of controls (p = .03), elevated ferritin in 73.4% of PLWDH vs 78.9% of controls (p = .004). There was an inverse but not statistically significant relationship between the frequency of elevated inflammatory markers and HIV disease stage, with greatest percent of PLWDH with elevated WBC, LDH, CRP, and ferritin among PLWDH with HIV disease stage 1. PLWDH had lower inflammatory marker elevation during COVID-19 infection compared to matched controls. PLWDH with low CD4 were less likely to mount a cytokine storm in the setting of impaired immune function.

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers.

BACKGROUND The incidence of papillary muscle rupture (PMR), a mechanical complication of acute myocardial infarction, has decreased in the reperfusion era; however, its fatality rate remains high. Timely recognition and prompt initiation of treatment for PMR are important to avoid prolonged cardiogenic shock; however, the symptoms of PMR are nonspecific, and early diagnosis is often difficult. CASE REPORT A 72-year-old woman with nausea for 2 days presented with ST-segment elevation myocardial infarction with obstruction of the obtuse marginal branch and 75% stenosis of the first diagonal branch. Percutaneous coronary intervention was performed to revascularize the obtuse marginal lesion, which was over thrombolysis in myocardial infarction grade 2 flow. After percutaneous coronary intervention, the patient developed fever, an elevated C-reactive protein level, and an increased neutrophil-to-lymphocyte ratio (NLR). The patient showed no signs of infection but elevated inflammatory marker levels, with C-reactive protein rising to 39.32 mg/dL and NLR to 15. On postoperative day 4, the patient's clinical condition rapidly deteriorated, resulting in circulatory failure. Transthoracic echocardiography showed anterolateral PMR, and urgent surgical mitral valve replacement was performed. On day 32, the patient was discharged from the hospital, and at the 1-year follow-up, she remained in good health. CONCLUSIONS When there are multiple lesions, including the obtuse marginal and diagonal branches, anterolateral PMR should be suspected as the cause of cardiogenic shock. Performing point-of-care echocardiography and closely monitoring C-reactive protein levels and NLR can be helpful to detect PMR early.

Toxicity of anesthetic gases: exposure in operating rooms and influence on the environment.

Nitrous oxide, sevoflurane, isoflurane and desflurane are commonly used to provide anesthesia during surgical procedures. However, usage of inhaled anesthetics is not without its risks. Occupational exposure to those gases might have a harmful effect on medical personnel working not only at operating theaters, but also on post-operative wards and intensive care units. Long term exposure to volatile anesthetics may lead to liver and kidney damage and elevated plasma inflammatory markers. Episodes of misscarriage, preterm birth or congenital malformations have been observed in pregnant women. Neurotoxicity of these drugs also has been evidenced by recent studies. What is more, anesthetics are greenhouse gases that contribute to the climate crisis. Some of the gaseous anesthetics stay in the atmosphere for even 114 years after being released from the hospital environment. The aim of this paper is to review the dangers of occupational exposure to inhaled anesthetics and their impact on the environment, as well as to take a closer look at alternatives that could potentially replace the use of gaseous anesthetics.

A case of Epstein–Barr virus infection presenting with facial nerve palsy following the precursor condition of hemophagocytic lymphohistiocytosis

AbstractA 25‐year‐old man with infectious mononucleosis caused by Epstein–Barr virus infection developed facial nerve palsy. He was admitted to the hospital due to prolonged fever with liver enzyme elevations, diagnosed as primary Epstein–Barr virus infection. During conservative management, his fever and liver dysfunction persisted, with elevated serum inflammatory marker levels, and the precursor state of Epstein–Barr virus‐associated hemophagocytic lymphohistiocytosis was suspected. Although his symptoms and liver dysfunction trended toward amelioration after short‐term prednisolone, left‐sided facial palsy developed acutely. Facial palsy was considered Epstein–Barr virus infection‐related, and he recovered within 1 month following additional steroid therapy. Given the presence of the precursor condition of hemophagocytic lymphohistiocytosis just prior to facial palsy, hypercytokinemia was considered a possible pathogenic mechanism for the facial palsy. In patients with Epstein–Barr virus infection, facial palsy may occur independently of the recovery of other symptoms, and cytokine disturbance may affect its development.

Susceptibility of nucleotide-binding oligomerization domain 2 mutations to Whipple's disease.

Whipple's disease (WD) results from infection of the bacteria Tropheryma whipplei (TW). This disease is characterized by macrophage infiltration of intestinal mucosa and primarily affects Caucasian males. Genetic studies of host susceptibility are scarce. Nucleotide-binding oligomerization domain containing protein 2 (NOD2) is an innate immune sensor, resides mainly in monocytes/macrophages and contributes to defence against infection and inflammatory regulation. NOD2 mutations are associated with autoinflammatory diseases. We report the association of NOD2 mutations with TW and WD for the first time. A multicentre, retrospective study of three patients with WD was conducted. Patients received extensive multidisciplinary evaluations and were cared for by the authors. NOD2 and its association with infection and inflammation were schematically represented. All patients were Caucasian men and presented with years of autoinflammatory phenotypes, including recurrent fever, rash, inflammatory arthritis, gastrointestinal symptoms and elevated inflammatory markers. All patients underwent molecular testing using a gene panel for periodic fever syndromes and were identified to carry NOD2 mutations associated with NOD2-associated autoinflammatory disease. Despite initially negative gastrointestinal evaluations, repeat endoscopy with duodenal tissue biopsy ultimately confirmed WD. After initial ceftriaxone and maintenance with doxycycline and/or HCQ, symptoms were largely controlled, though mild relapses occurred in follow-up. Both NOD2 and TW/WD are intensively involved in monocytes/macrophages. WD is regarded as a macrophage disease. NOD2 leucin-rich repeat-associated mutations in monocytes/macrophages cause functional impairment of these cells and consequently may make the host susceptible for TW infection and WD, especially in the setting of immunosuppression.

Nanotube patterning reduces macrophage inflammatory response via nuclear mechanotransduction

The inflammatory immune environment surrounding titanium bone implants determines the formation of osseointegration, and nanopatterning on implant surfaces modulates the immune microenvironment in the implant region. Among many related mechanisms, the mechanism by which nanopatterning controls macrophage inflammatory response still needs to be elucidated. In this paper, we found that inhibition of the nuclear envelope protein lamin A/C by titania nanotubes (TNTs) reduced the macrophage inflammatory response. Knockdown of lamin A/C reduced macrophage inflammatory marker expression, while overexpression of lamin A/C significantly elevated inflammatory marker expression. We further found that suppression of lamin A/C by TNTs limited actin polymerization, thereby reducing the nuclear translocation of the actin-dependent transcriptional cofactor MRTF-A, which subsequently reduced the inflammatory response. In addition, emerin, which is a key link between lamin A/C and actin, was delocalized from the nucleus in response to mechanical stimulation by TNTs, resulting in reduced actin organization. Under inflammatory conditions, TNTs exerted favourable osteoimmunomodulatory effects on the osteogenic differentiation of mouse bone marrow-derived stem cells (mBMSCs) in vitro and osseointegration in vivo. This study shows and confirms for the first time that lamin A/C-mediated nuclear mechanotransduction controls macrophage inflammatory response, and this study provides a theoretical basis for the future design of immunomodulatory nanomorphologies on the surface of metallic bone implants.

Multisystemic inflammatory syndrome in children after severe acute respiratory syndrome coronavirus 2 infection: a clinical analysis of four cases

To investigate the clinical features and treatment strategies of multisystemic inflammatory syndrome in children (MIS-C) after severe acute respiratory syndrome coronavirus 2 infection. A retrospective analysis was performed on the medical data of four children with MIS-C who were admitted to the Department of Cardiology, Xuzhou Children's Hospital, Xuzhou Medical Universityfrom January to February 2023. All four children had multiple organ involvements and elevated inflammatory markers, with a poor response to standard therapy for Kawasaki disease after admission. Two children were treated with intravenous immunoglobulin therapy pulse therapy twice, and all four children were treated with glucocorticoids. The children had a good prognosis after the treatment. MIS-C often appears within 4-6 weeks or a longer time after severe acute respiratory syndrome coronavirus 2 infection, and anti-inflammatory therapy in addition to the standard treatment regimen for Kawasaki disease can help to achieve a favorable treatment outcome.

A novel in vitro model to study prolonged Pseudomonas aeruginosa infection in the cystic fibrosis bronchial epithelium.

Pseudomonas aeruginosa (PA) is known to chronically infect airways of people with cystic fibrosis (CF) by early adulthood. PA infections can lead to increased airway inflammation and lung tissue damage, ultimately contributing to decreased lung function and quality of life. Existing models of PA infection in vitro commonly utilize 1-6-hour time courses. However, these relatively early time points may not encompass downstream airway cell signaling in response to the chronic PA infections observed in people with cystic fibrosis. To fill this gap in knowledge, the aim of this study was to establish an in vitro model that allows for PA infection of CF bronchial epithelial cells, cultured at the air liquid interface, for 24 hours. Our model shows with an inoculum of 2 x 102 CFUs of PA for 24 hours pro-inflammatory markers such as interleukin 6 and interleukin 8 are upregulated with little decrease in CF bronchial epithelial cell survival or monolayer confluency. Additionally, immunoblotting for phosphorylated phospholipase C gamma, a well-known downstream protein of fibroblast growth factor receptor signaling, showed significantly elevated levels after 24 hours with PA infection that were not seen at earlier timepoints. Finally, inhibition of phospholipase C shows significant downregulation of interleukin 8. Our data suggest that this newly developed in vitro "prolonged PA infection model" recapitulates the elevated inflammatory markers observed in CF, without compromising cell survival. This extended period of PA growth on CF bronchial epithelial cells will have impact on further studies of cell signaling and microbiological studies that were not possible in previous models using shorter PA exposures.

A case of VEXAS syndrome presenting with unusual bone marrow granulomas: a diagnostic dilemma

BackgroundVEXAS is a recently described inflammatory disease caused by mutations in the UBA1 gene. Symptoms are diverse and include fevers, cartilaginous inflammation, lung inflammation, vasculitis, neutrophilic dermatoses, and macrocytic anemia. Cytoplasmic inclusions in myeloid and erythroid progenitors in the bone marrow are a hallmark feature. Here we report the first case of VEXAS with non-caseating granulomas in the bone marrow.Case presentationA 62-year-old Asian male presented with fevers, erythema nodosum, inflammatory arthritis, and periorbital inflammation. Labs were significant for persistently elevated inflammatory markers and macrocytic anemia. Over the years his symptoms and inflammatory markers only improved with glucocorticoids and recurred when prednisone dose was lowered below 15–20 mg daily. He underwent bone marrow biopsy showing non-caseating granulomas and PET scan showing hilar/mediastinal lymphadenopathy. He was initially diagnosed with IgG4-related disease (treated with rituximab) and later sarcoidosis (treated with infliximab). After failing these agents, the possibility of VEXAS was considered and later confirmed by molecular testing.ConclusionsTo the best of our knowledge, this is the first observation of non-caseating granulomas in VEXAS, a cautionary reminder of its non-specificity since misinterpretation can lead to diagnostic delay. VEXAS should be in the differential in patients with symptoms of chronic inflammation responding positively to steroids (but not to B-cell depletion or TNF inhibition), which is in line with previous literature.

Septic arthritis and transient synovitis of the hip

Differentiating between septic arthritis and transient synovitis can be challenging but is very important as alate diagnosis of septic arthritis can lead to sepsis and joint damage. For correct diagnosis and prediction of complications, the right combination of physical examination, laboratory and radiological studies is needed. Hip ultrasound is easy to learn and has ahigh sensitivity for joint effusion. Faster diagnosis and therapy are possible due to increasing use of ultrasound. Magnetic resonance imaging (MRI) is primarily used to rule out co-infections (osteomyelitis, pyomyositis) and differential diagnoses. X‑ray is typically nonremarkable in septic arthritis. Routine use of ultrasound in nontraumatic pediatric hip pain. Generous use of MRI in case of elevated inflammatory markers or inconclusive clinical findings. Using only few sequences may be appropriate to avoid sedation, primarily fluid sensitive sequences (fat-saturated T2, TIRM, STIR), in case of positive findings, accompanied by T1-weighted images.

Diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression was useful in a patient with isolated myocardial abscess confined to the right atrial wall: a case report

BackgroundMyocardial abscess is often associated with infective endocarditis (IE), and isolated myocardial abscess without IE is rare. Echocardiography and computed tomography (CT) are often used to diagnose myocardial abscess; however, to the best of our knowledge, diffusion-weighted whole-body magnetic resonance imaging with background body signal suppression (DWIBS) has not been used. Here, we present a case of myocardial abscess without IE that was diagnosed using DWIBS.Case presentation: A 72-year-old Japanese man with a history of hypertension, dyslipidemia, and retinitis pigmentosa presented to our hospital with malaise and a fever lasting 10 days. Blood test results showed elevated inflammatory marker levels (white blood cell count 18,700/µL and C-reactive protein level 23.0 mg/dL). Infection was suspected; however, the source of the infection could not be identified. DWIBS, which was performed on day 7 of admission to determine the source of infection, showed a high signal surrounding the right wall, suggesting inflammation. Contrast-enhanced CT performed on day 1 of hospitalization revealed a low-density area in the same region; however, the pathological implications of this finding could not be determined. Based on DWIBS findings, we concluded that the condition presented as a myocardial abscess that was confined specifically to the right atrial wall. Three sets of blood cultures revealed negative findings, and echocardiography showed no vegetation or valve regurgitation. Therefore, the patient was diagnosed with an isolated myocardial abscess uncomplicated with IE. An electrocardiogram on admission showed no P waves, and the patient had a junctional rhythm. However, on day 20 of hospitalization, he developed a complete atrioventricular block. After complete myocardial abscess healing following antibiotic treatment was confirmed, the patient underwent pacemaker implantation. Ten months after surgery, the patient had no signs of infection recurrence.ConclusionsBased on history and physical examination alone, diagnosis of an isolated myocardial abscess can be challenging. In addition to CT and echocardiography, DWIBS might be helpful for the diagnosis of myocardial abscesses.

Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients. Methods Data of n = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included. Results The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count ( p = 0.02), higher serum creatinine ( p = 0.004), higher C-reactive protein ( p = 0.001), higher ferritin ( p < 0.001), and serum lactate dehydrogenase ( p = 0.009). Age-adjusted hospital mortality ( p = 0.007), duration of hospital stay ( p < 0.001), and duration of intensive care unit stay ( p < 0.001) were significantly higher in the second subphenotype. Conclusion Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes.

Cerebrovascular disease in patients with COVID-19 infection: a case series from Lebanon.

COVID-19 has been associated with a variety of multi-organs complications, with an increasing proportion of patients presenting with neurologic manifestations. There is still an uncertainty in the relationship between stroke and COVID-19. Therefore, in this study, the authors report 18 cases of acute stroke occurring in the setting of COVID-19 infection, including 11 ischaemic strokes and 7 haemorrhagic strokes and identified in a Lebanese tertiary hospital. In this case series, patients with ischaemic and haemorrhagic stroke had elevated markers of inflammation and coagulation. Ischaemic stroke patients were treated with different regimens of anti-platelets, anticoagulants, and thrombolytic therapies. Death was the most common outcome observed and was associated with the severity of COVID-19 infection.

A new mimicker of the multisystem inflammatory syndrome in children: Influenza

Multisystem inflammatory syndrome in children (MIS-C) might present a severe clinical course that clinicians should promptly treat. However, distinguishing other illnesses similar to MIS-C could be confusing. Here, we presented a two-year-old boy diagnosed with MIS-C owing to three days of fever, gastrointestinal findings, mucosal involvement, and elevated inflammatory markers, whose respiratory virus panel resulted in influenza A.

Posterior Wall Acetabular Fracture After Low-Energy Trauma Masquerading as Infection: A Case Report.

A 12-year-old adolescent boy presented after a low-energy fall with groin pain, inability to bear weight, painful passive range of motion, fever, elevated inflammatory markers, and upper respiratory symptoms. Initial radiographs did not demonstrate any abnormality, and magnetic resonance imaging suggested infection. Posterior wall acetabular fracture was not diagnosed until a computed tomography-guided biopsy was performed. Pediatric acetabular fractures are exceedingly rare. They can be difficult to diagnose after low-energy trauma as symptoms mimic infectious hip pathologies. Children presenting with infectious hip symptomology and a history of trauma may benefit from more extensive trauma imaging before costly and invasive infectious diagnostic procedures.