Frequent Signs Research Articles

Validity of a rapid diagnostic programme for head and neck cancer

Introduction and objectives: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck (SCHN), the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours. MethodsA prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A “suspicion algorithm” was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the four years prior to the start of the study. Results199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP.Of the patients, 27% were diagnosed in stages I and II, and 73% in stages II and IV, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. ConclusionsThe implementation of a rapid diagnosis pathway for patients who, according to the algorithm created, had a suspected head and neck cancer, has not led to an increase in the diagnosis of these tumours in early stages or a decrease in diagnoses in advanced stages.

Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study.

BackgroundThe differential diagnosis of acute visceral diseases is a challenging clinical problem. Older literature suggests that patients with acute visceral problems show segmental signs such as hyperalgesia, skin resistance, or muscular defense as manifestations of referred visceral pain in somatic or visceral tissues with overlapping segmental innervation. According to these sources, the lateralization and segmental distribution of such signs may be used for differential diagnosis. Segmental signs and symptoms may be accompanied by spontaneous (visceral) pain, which, however, shows a nonsegmental distribution.ObjectiveThis study aimed to investigate the lateralization (ie, localization on one side of the body, in preference to the other) and segmental distribution (ie, surface ratio of the affected segments) of spontaneous pain and (referred) segmental signs in acute visceral diseases using digital pain drawing technology.MethodsWe recruited 208 emergency room patients that were presenting for acute medical problems considered by triage as related to internal organ disease. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and spontaneous visceral pain. They were further asked their segmental symptoms such as nausea, meteorism, and urinary retention. We collected spontaneous pain and segmental signs as digital drawings and segmental symptoms as binary values on a tablet PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated mean distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters, analyzing the segmental distribution of these signs and the lateralization.ResultsOf the 208 recruited patients, 110 (52.9%) were later diagnosed with a single-organ problem. These recruited patients had a mean age of 57.3 (SD 17.2) years, and 40.9% (85/208) were female. Of these 110 patients, 85 (77.3%) reported spontaneous visceral pain. Of the 110, 81 (73.6%) had at least 1 segmental sign, and the most frequent signs were hyperalgesia (46/81, 57%), and muscle resistance (39/81, 48%). While pain was distributed along the body midline, segmental signs for the heart, stomach, and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (37/110, 33.6%) further showed ipsilateral mydriasis.ConclusionsThis study underlines the usefulness of including digitally recorded segmental signs in bodily examinations of patients with acute medical problems.

Gall bladder ejection fractions in dogs investigated for chronic altered appetite: 14 cases (2015-2017).

To determine if gall bladder dysmotility occurs in dogs investigated for chronic altered appetite and to determine if gall bladder dysmotility warrants further investigation as a contributing factor to altered appetite. Case series of dogs investigated for chronic gastrointestinal disease. Gastrointestinal clinical signs were assessed before and after a 6-week hydrolysed protein diet. Gall bladder ejection fractions were determined at the end of the 6-week hydrolysed protein diet as part of an investigation that included a full blood cell count, biochemistry, abdominal X-rays and ultrasound. The gall bladder ejections fraction results of dogs with normal appetite were compared to dogs with general inappetence and dogs with diurnal inappetence in the morning. In this retrospective case series of 14 dogs, altered appetite was the most frequent and persistent clinical sign associated with chronic gastrointestinal disease. Nine dogs had suboptimal gall bladder function and this occurred in dogs with, and without, gravity-dependent biliary sludge. Gall bladder function and volumes of dogs in this study were comparable to those of dogs with nongravity-dependent gall bladder sludge or gall bladder mucoceles in other studies. There was an observable difference in gall bladder ejection fractions between groups defined by appetite but no statistically significant difference was present. Small sample sizes meant the effect size was large. Gall bladder dysmotility and distension can occur in the absence of gall bladder sludge and mucocoeles in younger dogs. Gall bladder dysmotility requires further investigation as a potential contributing factor to altered appetite in dogs.

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry.

AimsHypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co‐exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy.Methods and resultsThe European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012–2018. Three groups were examined: (i) women without hypertension (PPCM‐noHTN); (ii) women with hypertension but without pre‐eclampsia (PPCM‐HTN); (iii) women with pre‐eclampsia (PPCM‐PE). Maternal (6‐month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM‐noHTN, 99 (13.5%) had PPCM‐HTN and 184 (25.0%) had PPCM‐PE. Compared to women with PPCM‐noHTN, women with PPCM‐PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end‐diastolic diameter (57.4 ± 6.7 mm vs. 59.8 ± 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM‐noHTN, women with PPCM‐PE had a greater likelihood of left ventricular recovery (LVEF ≥ 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21–3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66–4.87).ConclusionDifferences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.

Caracterización de pacientes con dermatomiositis en un hospital universitario en Colombia

IntroductionDermatomyositis is an idiopathic inflammatory myopathy characterized by the presence of skin lesions; it is considered a heterogeneous disease, due to its clinical presentation, course, and prognosis. In Colombia there are few records that describe the clinical characteristics of these patients. MethodsCross-sectional study. Medical records of patients who consulted a university hospital in Colombia between January 2004 and December 2019 were reviewed. The records were obtained using databases from the dermatology, rheumatology, dermatopathology, and electrophysiology units, and CIE10 diagnostic codes. ResultsSeventy patients with a dermatomyositis diagnosis were found, 63 (90%) fulfilled the Bohan and Peter diagnostic criteria and 7 (10%) had amyopathic dermatomyositis, with an average age of 43 years (SD±15.3). Forty-eight were women (68.5%). The most frequent clinical signs were Gottron's papules 80%, periorbital violaceous (heliotrope) erythema with oedema 78.5% (n=55) and poikiloderma 75.7% (n=53). The most frequently found systemic manifestations were dysphagia (21.4%, n=15), interstitial lung disease (11.4%, n=8), and pulmonary hypertension (8.5%, n=6). Cancer was documented in 8.5% (n=6) of patients. ConclusionWe showed clinical information of patients with dermatomyositis in a referral hospital in Colombia. The data obtained is consistent with information from other case series worldwide.

Epidemiological Study of Dengue Hemorrhagic Fever (DHF) With Increased Incidence of Serum Glutamic Pyruvic Transaminase (SGPT) Levels at Aura Syifa Hospital Kediri

Dengue fever virus is an infectious disease that can infect others if bitten by Aedes aegypti mosquito. The virus has the potential to attack cells in the hepar organs so that the hepar is inflamed, swollen, and liver function is disrupted, and there is severe bleeding. The increase in transaminase enzymes as well as hepatomegaly is a frequent sign in dbd sufferers, thus reinforcing the notion that the course of dengue hemorrhagic fever (DHF) disease can affect hepar or liver organs. The presence of such events will increase the level of Serum Glutamic Pyruvic Transaminase (SGPT) and Serum Glutamic Oxaloacetic Transaminase (SGOT) in dengue fever patients. The purpose of this study is to find out the epidemiological study of Dengue dengue fever with the increase in SGPT and SGOT levels in dengue fever patients at Aura Syifa Kediri Hospital. This research method uses descriptive research design and total sampling technique for 1 month. Samples obtained for 1 month amounted to 15 samples. The results showed that from a sample of 15 respondents as many as 3 samples (20%) for high SGPT levels above normal and normal results as many as 12 samples (80%). The conclusion of this study shows that the value of SGPT levels has increased by 20% and is still above normal, but still have to be alert to small values.

Lesion topography of posterior cerebral artery infarcts

This study analyzed the topography of acute ischemic stroke in the posterior cerebral artery (PCA) territory. We studied 84 patients with unilateral ischemic PCA stroke. Patients were classified according to lesion levels as cortico-subcortical (superficial), combined (cortical and mesodiencephalic) or isolated thalamic. To receive a lesion map, data from acute MR and CT imaging were normalized and labelled automatically by mapping to stereotaxic anatomical atlases. Cortical lesions accounted for 41.7%, combined for 36.9%, and isolated thalamic lesions for 21.4%. The maximum overlay of ischemia and, thus, highest occurrence of PCA ischemic stroke was found in the ventral and medial occipito-temporal cortex and adjacent white matter association tracts. Dorsal and peripheral segments of the occipito-temporo-parietal region were only rarely lesioned. This configuration was similar in both hemispheres. Consistent with this lesion pattern, visual field defects (VFD) were the most frequent signs, followed by sensorimotor signs, dizziness and sopor, cognitive and oculomotor deficits, and ataxia. The three vascular subgroups differed not only by their anatomical lesion profile and lesion load, but also by their clinical manifestation; although patients with combined and thalamic lesions were sigificantly younger, they were more disabled than participants with cortical lesions. VFD were only found in cortical and combined, and oculomotor deficits only in mesodiencephalic lesions. White matter lesions were common in the cortico-subcortical and the combined group. Basal occipito-temporal and calcarine regions, and neighbouring white matter tracts have the highest risk of ischemia in acute PCA stroke.

Quantitative Evaluation of the Clinical Evolution of Traumatic Onycholysis after Laser Treatment

Nail disorders are the most frequent reason for visits to the podiatry clinic. Although they are not a severe health problem, these types of pathologies have a psychosocial impact on patients, affecting their self-esteem and leading to social and professional self-isolation that can cause anxiety and depression. Laser therapy is considered a potential treatment for nail disorders because it is a fast, easily applied treatment that avoids interaction with medication. However, the literature includes no definitive studies with scientific evidence about the efficacy of laser treatment in traumatic onycholysis, the most frequent clinical sign of nail disorders. Objective: We carried out an objective and quantitative study of the efficacy of laser in treating traumatic onycholysis to provide a new, non-invasive treatment for this pathology, and describe an objective method for its clinical evaluation and evolution. Methods: A strictly repetitive protocol of Nd:YAG 1064 nm laser (PinPointe FootLaser™, Spain) was applied to nails with idiopathic disorders, following the manufacturer’s instructions. The clinical evolution of nail dystrophy was quantitatively evaluated using the affected percentage of the longitudinal axis of the nail. Results: A significant improvement was obtained in nail appearance (dystrophy) in 100% of cases (p &lt; 0.006) after treatment with Nd:YAG 1064 nm laser. Conclusion: Treating traumatic onycholysis with Nd:YAG 1064 nm laser can be a good alternative to conventional pharmacological treatments.

Class II Skeletal Malocclusion and Prevalence of Temporomandibular Disorders. An Epidemiological Pilot Study on Growing Subjects.

The purpose of our work is to evaluate the correlation between skeletal Class II malocclusion and temporomandibular disorders, by assessing potential different frequency scores compared with Class I and Class III skeletal malocclusion, and to evaluate associated etiological and risk factors. Fifty-five subjects were examined, 35 females and 20 males, with a mean age of 18 ± 1.3 years, divided into two groups: those with TMD and those without TMD, and prevalence was evaluated in the two groups of Class II subjects. Symptoms and more frequent signs were also examined in the TMD group. Regarding Group A (subjects with the presence of TMD), we found that 48% have a Class II, 16% have Class I, and 28% have Class III. In the totality of the group A sample, only 8% were male subjects. In Group B (subjects without TMD), we found that 40% were females, with 26.7% in Class I, 10% in Class II, and 3.3% in Class III; the male subjects in this group (60%) were distributed with 33.3% in Class I, 16.7% in Class II, and 10% in Class III. Class II malocclusion is not a causal factor of TMD but may be considered a predisposing factor.

Impact of SARS-CoV-2 on neuropsychiatric disorders.

Evolving data show a variable expression of clinical neurological manifestations in patients suffering with coronavirus disease 2019 (COVID-19) from early disease onset. The most frequent symptoms and signs are fatigue, dizziness, impaired consciousness, ageusia, anosmia, radicular pain, and headache, as well as others. Based on the high number of series of cases reported, there is evidence for the implication of the immune system in the pathological mechanism of COVID-19. Although the exact role of the immunological mechanism is not elucidated, two main mechanisms are suggested which implicate the direct effect of severe acute respiratory syndrome coronavirus 2 infection in the central nervous system and neuroinflammation. In the context of neurological manifestations associated with COVID-19, neuropsychiatric disorders show an exacerbation and are described by symptoms and signs such as depression, anxiety, mood alterations, psychosis, post-traumatic stress disorder, delirium, and cognitive impairment, which appear to be common in COVID-19 survivors. A worsened score on psychopathological measures is seen in those with a history of psychiatric comorbidities. We review the neuropsychiatric manifestations associated with COVID-19 and some critical aspects of the innate and adaptive immune system involved in mental health disorders occurring in COVID-19.

Dynamic Changes in Neutrophils Anti-Apoptic Chemokines and Cytokines Influence the Outcome of COVID-19 in Sudanese Patients

Background: SARS-CoV-2 virus is causing a global pandemic that has so far affected more than 179 million individuals with more than 3.8 million deaths. COVID-19 is an acute respiratory syndrome presented by respiratory and hematological dysfunctions with evidence of multiorgan pathology. Studies have shown that COVID-19 is marked by neutrophilia, lymphopenia, thrombocytopenia and induction of intense chemokine/ cytokine response causing cytokine storm. IL-6, IL-8 and IL-10 have been identified as biomarkers of severe COVID-19.This manuscript aimed to analyze the dynamic changes of the neutrophil and chemokine/ cytokine response in relation to outcome of COVID-19 in Sudanese COVID-19 patients. Methods: Thirty three (33) confirmed COVID-19 patients and 8 contact controls were enrolled in this study. Fifteen patients were males. The age of the patients ranged between 23 and 86 years with mean age of 54.5, while 4 males and 4 females were enrolled as control with age range 32- 44 years. The patients were admitted as moderate or severe COVID-19 cases. Clinical and laboratory investigations were done for all participants. Twenty chemokines/ cytokines were measured in plasma samples collected at the day of admission and day 12 post-admission using microarray. The patients were followed for 4 weeks the duration of the hospitalization and were categorized into three groups according to the outcome of the management: recovered, died or developed renal complications. The data was analyzed to determine the dynamic of the changes of neutrophils and chemokine/ cytokines in relation to the outcome of the disease. Findings: The most frequent clinical signs were fever, cough, headache, fatigue, loss of taste and/ or smell. COVID-19 was confirmed by RT PCR, X-ray of Ct scan of the lungs. The hematology investigations showed neutrophilia, lymphopenia, thrombocytopenia, disturbed liver and renal functions. The neutrophil/ lymphocyte ratio was elevated. Analysis of the first samples showed the production of both pro and anti-inflammatory chemokines/cytokines. IL-6, IL-8 and IL-10 were elevated compared with the contact controls and were identified as biomarkers for COVID-19. During the follow up: 18 patients recovered, 11 died and 4 developed renal failure and required dialysis. Analysis of the samples collected at Day 12 showed dynamic changes in neutrophil count, neutrophil: lymphocyte ration, and the chemokine/ cytokine levels compared with the first samples. There was a minor decrease in neutrophil/ lymphocyte ratio specially among patients who died. There was a significant elevation of neutrophil anti-apoptic chemokines/ cytokines specially among patients who died. IL-6, IL-8 and IL-10 were markers of fatal outcome of CPOVID-19 patients, while IL-1β, IL-4 and TNFα were markers of renal impairment. Interpretation: COVID-19 is marked by elevations of neutrophil, proinflammatory chemokines/ cytokines and elevation of neutrophil anti-apoptic mediators. The data suggest a significant role of neutrophil in the severity and the outcome of CPVID-19. Elevated IL-6, IL-8 and IL-10 were biomarkers of severe and fatal outcome of COVID-19 while elevated IL-1β, IL-4 and TNFα were biomarkers of renal impairment in moderate and severe COVIUD-19 patients . Funding Information: This research was commissioned by the National institute for Health Research (NIHR) Global Health Research Programme (16/136/33) using UK AID from the UK Government. Declaration of Interests: All authors declare no competing interest in the conducted study. Ethics Approval Statement: This study received ethical approval from Khartoum State Ministry of health ethics committee. Written consents were obtained from the participants before their enrollment in the study.

Development of the Fabry Disease Patient-Reported Outcome (FD-PRO): a new instrument to measure the symptoms and impacts of Fabry Disease

BackgroundThe systematic collection of disease-specific symptoms and impacts on the lives of patients with Fabry Disease (FD) can offer unique insights into the patient experience, yet no disease-specific tool to measure FD symptoms exists. This study describes the development of the Fabry Disease Patient-Reported Outcome (FD-PRO).MethodsA targeted literature search, interviews with key opinion leaders (KOLs), and concept elicitation (CE) interviews with patients identified the most frequent signs and symptoms associated with FD and their impact on daily life. Cognitive interviews evaluated patients’ ability to understand the FD-PRO instructions and respond to the items on the draft FD-PRO instrument.ResultsThe targeted literature search identified key signs and symptoms in domains that were confirmed in KOL interviews. In CE interviews with 37 treated and treatment-naïve patients, neuropathic pain symptoms (95% treated, 82% treatment-naïve), temperature intolerance (95% treated, 88% treatment-naïve), energy difficulties (95% treated, 94% treatment-naïve), hearing/vision impairment (95% treated, 71% treatment-naïve), and gastrointestinal symptoms (80% treated, 59% treatment-naïve) were most frequently mentioned. Results were similar for men and women in both treated and treatment-naïve groups. While treatment-naïve patients in general expressed fewer and milder symptoms compared to treated patients, the overall sets of symptoms expressed by the two groups were similar. The most severe symptoms were neuropathic pain, stomach pain, burning pain, and fatigue. The most bothersome symptoms were stomach pain, breathing difficulty, fatigue, neuropathic pain, and constipation. The most frequent impacts were in the work/school limitations domain for both treated and treatment-naïve patients. The impacts with the highest difficulty ratings were stress, limited outdoor activity, and guilt. Cognitive interviews with 14 treated and treatment-naïve patients resulted in the refinement of FD-PRO items and language.ConclusionsThe FD-PRO is a novel, disease-specific instrument that measures the patient experience in Fabry disease. Such tools are valuable in capturing the burden of disease in patients with FD and demonstrating the value of treatment in clinical trials.

Real-World Patterns of First-Line Hydroxyurea Treatment Among Patients with Essential Thrombocythemia in US Community Oncology Practices

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by excessive clonal platelet production. Hydroxyurea (HU) is the recommended first-line cytoreductive treatment for ET. The objective of this study was to describe first-line HU treatment patterns and discontinuation among patients with ET in real-world US clinical practices.Methods: Data were extracted from medical charts of patients with an ET diagnosis who received cytoreductive therapy at community oncology/hematology clinics between June 1, 2011, and September 15, 2016 (study period). Demographics, clinical characteristics (ie, blood counts, symptoms, thrombotic events), and HU treatment patterns were evaluated. Data on HU treatment patterns included start date, signs/symptoms at treatment start, starting dose, dose change, most stable (longest duration) dose, and reasons for discontinuation. Kaplan-Meier estimates of HU discontinuation rates over time were reported.Results: 755 patients from 50 oncology/hematology practices who had HU as first-line cytoreductive therapy were included in this study. Most (65.4%) of the patients were diagnosed within the 3 years preceding the end of study period (ie, September 15, 2016). Mean (SD) age was 68.6 (11.5) years; 50.9% of patients were female. The median time from diagnosis to HU initiation was 0.3 months, and from HU initiation to the end-of-study follow-up (the most recent visit) was 20.2 months. The most frequent signs and symptoms at HU initiation were fatigue (48.6%), headache (16.0%), and splenomegaly (12.7%). The median duration of HU was 18.6 months, with 81.1% still on HU at the end of study period. The mean (SD) starting dose and stable dose were 1024.2 (522.3) mg/d and 1388.9 (726.5) mg/d, respectively. Only a small proportion (17.8%) of patients received HU doses >2000 mg/d. At the most recent visit, 27.6% of HU users had ≥1 ET symptom, with 20.3% reporting fatigue; 36.8% and 9.0% of patients had platelet counts ≥400 × 109/L and white blood cell (WBC) counts ≥10 × 109/L, respectively. 33 patients (4.4%) had died by the end of study period, with heart attack (n=10 [30.3%]) and hematologic malignancy (n=9 [27.3%]) being the most common causes of death.82 patients (10.9%) discontinued first-line HU treatment during the median follow-up of 20.2 months from HU initiation. Kaplan-Meier estimates of 1-, 3-, and 5-year discontinuation rates were 5.8%, 14.5%, and 20.7%, respectively. Among patients who discontinued, the median duration of HU treatment was 13.1 months. The most common physician-reported reasons for HU discontinuation were intolerance (35.4%), resistance (23.8%), progression to acute myeloid leukemia (9.8%), and progression to myelofibrosis (7.3%). At the most recent visit, 48.8% of patients who discontinued HU had ≥1 ET symptom; 51.9% and 33.8% had platelet counts ≥400 × 109/L and WBC counts ≥10 × 109/L, respectively; and 6.1% had ≥1 thrombotic event. In contrast, 25.0% of patients who continued HU had ≥1 ET symptom, with 18.7% reporting fatigue; 35.5% and 12.9% of patients had platelet counts ≥400 × 109/L and WBC counts ≥10 × 109/L, respectively. Upon HU discontinuation, 3.6% reinitiated HU at a later time, 36.6% used another cytoreductive therapy (anagrelide or ruxolitinib), and 59.8% did not receive any further treatment.Conclusions: The HU discontinuation rate among patients with ET increased over time, with a rate of 14.5% at 3 years. Intolerance or resistance were the primary reported reasons for discontinuation of HU. Almost two-thirds of patients with ET did not receive further treatment after HU discontinuation. A substantial proportion of patients who continued HU treatment still had elevated blood counts and symptoms. These patients may benefit from alternative management strategies. DisclosuresYu:Incyte Corporation: Employment, Equity Ownership. Colucci:Incyte Corporation: Employment, Equity Ownership. Paranagama:Incyte Corporation: Employment, Equity Ownership. Sivaraman:Incyte Corporation: Employment, Equity Ownership. Atanasov:Incyte Corporation: Consultancy. Hanna:Incyte Corporation: Consultancy. Tang:Incyte Corporation: Consultancy. Parasuraman:Incyte Corporation: Employment, Equity Ownership.

Temporal lobe epilepsy: A never-ending story

IntroductionSemiology and anatomo-electroclinical correlations remain invaluable for maintaining the level of excellence in temporal lobe epilepsy (TLE) surgery, in parallel to the constantly evolving technical progress. The aim of this study was to address semiological frequent and not so frequent signs, rarities and red flags in a long follow-up surgical series of patients suffering from TLE. MethodsPatients operated within the boundaries of the TL at our center, with presurgical video-EEG recorded seizures and seizure free after a postoperative follow-up of at least 24 months were included. Ictal semiology was systematically described and new red flags were explored by comparing with a second group of patients with the same inclusion criteria but whose outcome had been unfavorable (Engel II-IV). ResultsSixty-two patients were included, 46 seizure free and 16 with outcome Engel II-IV. Most seizure-free patients had a classical semiological presentation including aura (69.6%, abdominal the most frequent), followed by loss of responsiveness (90.2%) oral automatisms (90.7%), ipsilateral gestural automatisms (53.5%), contralateral upper limb dystonia (37.5%) or immobility (39.1%), and early ipsilateral non-versive head orientation (33.3%). More infrequent presentations were also present in the group of seizure-free patients: ictal language disturbance (13%), maintenance of responsiveness during seizures (9.8%), and contralateral rhythmic non manipulative automatism (6.9%). The presence of an isolated viscerosensory and/or psychic aura was significantly more frequent in the seizure-free group (p = 0.017), as well as oroalimentary automatisms (p = 0.005). Two signs were only present in the group with outcome Engel II-IV, constituting possible red flags (0.06 < p < 0.07): inferior limbs stepping-like automatisms and postictal dysarthria. ConclusionAn adequate clinical exam during seizures and a careful analysis of video recordings allow to recognize infrequent but well-characterized ictal signs that are part of the range of semiology in TLE, together with the most frequent and classical ictal presentations. Special attention to the localization hypothesis must be paid in the absence of oroalimentary automatisms or when the signs classified as possible red flags emerge.

Hemophagocytic lymphohistiocytosis: presentation and outcome of twenty-one patients at a single institution

IntroductionHemophagocytic lymphohistiocytosis comprises a systemic hyperactivation of macrophages that requires prompt recognition of symptoms and early treatment. Objective and MethodIn this context, we described clinical and laboratory characteristics, therapeutic modality and outcome of 21 patients with HLH treated at a pediatric oncology hospital between January 2000 and February 2019. ResultsHLH mainly affected females, fever was the most frequent clinical sign and hyperferritinemia was the most prevalent laboratory abnormality. All patients were admitted to the intensive care unit (ICU) at some point. Fifteen (71.4%) patients presented resolution criteria and eight (53.3%) of them presented reactivation. The mortality rate was 57.1% and the mean time between diagnosis and death was 9.98 months. The 5-year overall survival (OS) was 36.7%. We observed a significant difference in prognosis associated with reactivation of HLH. These patients demonstrated an estimated 5-year OS of 25%, while all patients that did not reactivate were alive until the end of the follow-up. ConclusionIn conclusion, HLH is a rare disease with a high mortality rate, especially in patients with disease reactivation and those with familial- or immunodeficiency-associated forms, which makes early recognition and genetic testing crucial for appropriate management and prompt SCT indication.

Clinico-Laboratory Features and Associated Factors of Lupus Mesenteric Vasculitis.

IntroductionLupus mesenteric vasculitis (LMV) is a rare but potentially life-threatening clinical entity in systemic lupus erythematosus (SLE) patients.ObjectiveThe present study was initiated to explore the clinical features and associated factors of LMV in SLE patients.MethodsWe conducted a retrospective study on 50 cases of SLE patients with lupus mesenteric vasculitis (LMV) from January 2010 to December 2019 and 89 cases of non-LMV-SLE patients with similar demographic and comorbidities were included as control. All the data regarding clinical features, laboratory findings, and treatment were reviewed independently by two experts in the field. Both univariate and multivariate logistic regression analyses were employed to identify the associated factors of LMV.ResultsThe incidence of LMV was 2.9% among hospitalized SLE patients in the current study. The most frequent symptom and physical sign of LMV were respectively abdominal pain (48, 96%) and abdominal tenderness (45, 90%). Through univariate and subsequent multivariate analysis, oral ulcer (OR, 4.25; P = 0.024), urinary tract involvement (OR, 5.23; P = 0.021), and elevated D-dimer (OR, 1.121; P = 0.008) were demonstrated to be positively associated with LMV, while percentage of lymphocytes (OR, 0.928; P = 0.004) and complement 3 (OR, 0.048; P = 0.008) were negatively correlated with LMV.ConclusionsOral ulcer, urinary tract involvement, reduced percentage of lymphocytes and complement 3, elevated D-dimer could be associated factors for LMV in SLE patients.

Understanding progressive multifocal leukoencephalopathy: links between milky-way appearance and mismatch T2/FLAIR.

Magnetic resonance imaging is essential to diagnose progressive multifocal leukoencephalopathy. The broad radiological spectrum may partially be explained by genetic viral mutations and their differential neurotropism. Recent pharmacovigilance-magnetic resonance imaging studies have provided new insight into pathophysiology and radiological markers of early stages. However, how lesions evolve and why certain anatomical locations are more frequently affected remains unknown. We aim to describe a new sign - T2/fluid-attenutated inversion recovery mismatch - as a complementary marker of cavitated lesions and propose a link with the milky-way appearance, a key early sign. Furthermore, we hypothesise viral dissemination routes. We conducted a retrospective longitudinal study from January 2010 to January 2020, to analyse clinical and magnetic resonance imaging features of 13 progressive multifocal leukoencephalopathy individuals at the symptomatic stage (mean age 58.3 years (SD ± 16.8) - 61.5% were women). The most prevalent pathology was HIV (61.5%) and motor deficit prevailed regarding other symptoms (76.9%). Frontal lobes (76.9%), middle cerebellar peduncle (61.5%), cerebellum (61.5%), and pons (53.8%) were most commonly affected, and the cortico-ponto-cerebellar pathway seemed involved in these patients. Five patients had a pure radiological pattern. Milky-way appearance was the most frequent radiological sign (58.3%). Five patients with milky-way appearance had concomitantly T2/fluid-attenuated inversion recovery mismatch (P = 0.02). This sign showed high sensitivity and specificity (100-71%, P = 0.02) to assess evolved lesions besides diffusion. The possible tract-dependent spread, as well as clinical and genetic, have implications on the MRI variability of progressive multifocal leukoencephalopathy. The milky-way appearance could reflect a transitional phase towards evolved lesions, the latter demonstrated by T2/fluid-attenuated inversion recovery mismatch. Both could be key magnetic resonance imaging signs to diagnose progressive multifocal leukoencephalopathy at the symptomatic stage.

English

BACKGROUND Allergic conjunctivitis (AC) is a common eye condition that is frequent in childhood. The prevalence of allergic diseases in children aged 6 to 14 years varies significantly from 0.3 % to 20.5 %, and is gradually increasing.1 It is associated with several allergic diseases affecting the ocular surface and it is the most common ocular condition encountered in clinical practice. This study was conducted to determine the prevalence, ocular manifestations of allergic conjunctivitis, and associated comorbidities among school-going children in Western Odisha. METHODS A total of 1502 children from 10 schools of Burla, participated in this crosssectional observational study. Data collection started in September 2018 up to September 2019. All the children underwent meticulous history taking for symptoms of allergic conjunctivitis and any other associated comorbidities, a structured validated questionnaire was used to collect demographic and medical data. Visual assessment, and slit-lamp examination were done to look for signs of allergic conjunctivitis and any associated complications. Interpretation and data analysis was done using Epi Info Software and a chi-square test was used to analyse significant associations among categorical variables. RESULTS The prevalence of allergic conjunctivitis was found to be 29.16 % with a males to female ratio of 1.02: 1. Children aged 13 – 16 years recorded the highest number of cases which was 43.60 %. The commonest presenting symptom was itching (100 %), Papillae were the most frequent sign (97.71 %), Seasonal allergic conjunctivitis (SAC) was the most common type of AC reported (59.36 %), and allergic rhinitis (17.8 %) was the most common associated comorbidity. CONCLUSIONS The prevalence of Allergic conjunctivitis is high among children aged 5 - 16 yrs. There is a lack of treatment seeking behaviour inspite of such high frequency. Early identification &amp; treatment of patients would help curb complications, improve the child’s quality of life and thus the ophthalmic health of the community. KEYWORDS Allergic Conjunctivitis, Ocular Comorbidities, SAC

Prurigo strophulus: Epidemiological, clinical aspects and environmental factors among children in Yaoundé, Cameroon (Sub-Saharan Africa).

BackgroundPrurigo Strophulus (PS) is a chronic and recurrent inflammatory disease caused by a hypersensitivity reaction to arthropod bites. The objective of this study was to determine the prevalence of PS and its clinical characteristic in our context.MethodsWe performed a cross‐sectional study during February to May 2017 in Dermatology's units of six hospitals in Yaoundé. Children with clinical signs of PS were included. A questionnaire was administered for data collection.ResultsA total of 112 children (62 boys and 50 girls) were included in the study, with a median age of 2 years; with range varied from 5 months to 16 years. The prevalence of PS was 5.4%. The most represented age group was 0–5 years (78.6%). PS lesions were most often located in exposed areas of body such as lower limbs (101/112; 90.2%), upper limbs (85/112; 75.9%) and face (19.6%). Papule‐vesicle (87.5%) was the predominant type of lesions.ConclusionPS is a common disease in Yaoundé (Cameroon). Papule‐vesicle lesions are the most frequent signs. It is usually found in exposure areas of body.

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia.

Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia. A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization's case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected. Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria. Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.