Inactive Cases Research Articles

Corneal topographic changes in thyroid eye disease

Background Thyroid eye disease (TED) causes lid retraction, extraocular muscle enlargement, and tear film changes, which can affect corneal topography. Aim To assess the corneal topographic changes associated with TED and relate these changes to disease activity and severity. Patients and methods This prospective cross-sectional case-control study was carried out on 50 eyes of 25 patients aged less than or equal to 50 years old, both sexes, diagnosed with TED and present or past serological evidence for thyroid disease (TED group). Patients were divided into two groups: the TED group: 30 eyes of 15 patients with TED and the control group: 20 eyes of 10 patients with age-matched and sex-matched without TED. Results In the TED group, axial proptosis was negatively correlated with minimal corneal thickness. Both upper and lower lid infrared meibography showed a positive correlation with axial proptosis. Active patients had considerably greater Baiocchi-Calossi-Versaci front and upper lid meibomian glands loss than inactive cases. In moderate to severe instances, upper and lower lid meibomian gland loss was much greater than in mild cases. Baiocchi-Calossi-Versaci front, Baiocchi-Calossi-Versaci back, Baiocchi-Calossi-Versaci total, and meibomian glands loss were considerably greater in TED than the control group. The TED group had significantly lower flat, steep, and average keratometry than the control group. Conclusion Corneal anterior surface flattening is the most characteristic topographic change in TED not related to disease activity or severity. TED increases meibomian gland loss, which is a major factor of ocular surface alteration in TED.

Pathways of ice multiplication in nimbostratus clouds during the Indian summer monsoon

The present study illustrates the microphysical parameters of nimbostratus clouds during the Indian summer monsoon using airborne and radar observations conducted as part of the Cloud Aerosol Interaction and Precipitation Enhancement Experiment (CAIPEEX), and simulations with the Weather Research and Forecasting (WRF) model. The study also analyzes the impact of secondary ice production (emphasizing the microphysical pathways of Hallett-Mossop (HM) as represented in the models) on cloud processes using model sensitivity simulations. The effect of possible pathways of riming during the HM process is the focus of the sensitivity simulations. Aircraft observations showed higher ice particle concentrations in the Hallett–Mossop zone (−3 °C to - 8 °C) along with the existence of smaller and larger cloud droplets, rimed needles, columns, and snow particles. Observations strongly suggested the active presence of the HM process in this cloud. The observed mean values of microphysical parameters including liquid water content, ice number concentrations, and maximum vertical velocity, agreed well with model simulations. The number concentration and water content of ice crystals and snow decreased in the HM zone during the HM inactive case. A reduction in rainfall is also observed in the absence of HM. HM increases convection as it causes a sudden increase in the number concentration of small ice particles, which causes rainwater to freeze quickly and water vapour to be consumed by diffusional growth. Latent heating is produced by both effects, which energizes the convection.

Platelet-to-lymphocyte ratio as a biomarker of systemic inflammation in systemic lupus erythematosus: A meta-analysis and systematic review.

The objective of this study was to evaluate the relationship between the platelet-to-lymphocyte ratio (PLR) and systemic lupus erythematosus (SLE). Additionally, the study aimed to establish an association between PLR and SLE disease activity, specifically lupus nephritis (LN). We conducted a comprehensive search across Medline, Embase, and Cochrane databases to identify relevant articles. Subsequently, we performed meta-analyses to compare PLR between SLE patients and controls, as well as active and inactive SLE cases, along with LN and non-LN groups. Furthermore, a meta-analysis was conducted on correlation coefficients between PLR and various parameters in SLE patients, including the SLE Disease Activity Index (SLEDAI), C3, C4, anti-dsDNA, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). In total, fifteen studies comprising 1,522 SLE patients and 1,424 controls were eligible for inclusion. The meta-analysis demonstrated a significant elevation of PLR in the SLE group compared to the control group (Standardized Mean Difference [SMD] = 0.604, 95% Confidence Interval [CI] = 0.299-0.909, p < 0.001). Upon stratification by ethnicity, an elevated PLR was observed in the SLE group among both Asian and Arab populations. Subgroup analysis based on sample size revealed consistently higher PLR in both small (n < 200) and large sample (n ≥ 200) SLE groups. Moreover, when considering disease activity, there was a noteworthy trend of increased PLR in the active disease group compared to the inactive group (SMD = 0.553, 95% CI = 0.000-1.106, p = 0.050). However, the meta-analysis did not demonstrate a significant distinction in PLR between the LN and non-LN groups. Notably, a positive association was established between PLR and SLEDAI (correlation coefficient = 0.325, 95% CI = 0.176-0.459, p < 0.001). Furthermore, PLR exhibited positive correlations with ESR, CRP, proteinuria, C3, and anti-dsDNA antibody levels. The outcomes of this meta-analysis underscored the elevated PLR in SLE patients, suggesting its potential as a biomarker for gauging systemic inflammation in SLE. Additionally, PLR exhibited correlations with SLEDAI, as well as with key indicators such as ESR, CRP, proteinuria, C3, and anti-dsDNA antibody levels.

Long noncoding RNAs (CTC-471J1.2, NeST) as epigenetic risk factors of active juvenile lupus nephritis: a case-control study

BackgroundMeasurement of the circulating levels of long-non-coding RNAs (lncRNAs) in lupus nephritis (LN) patients could dramatically explore more insights about the disease pathogenesis. Hence, we aimed to quantify the level of expression of CTC-471J1.2 and NeST in LN patients and to correlate it with the disease activity.MethodThis case-control study was conducted on a group of children with juvenile LN attending to Mansoura University Children’s Hospital (MUCH). Demographics, clinical, and laboratory findings were collected besides the measurement of lncRNAs by quantitative real-time PCR.ResultsThe expression level of lncRNAs-CTC-471J1.2 was significantly down-regulated in children with active LN versus inactive cases or controls. In contrast, the NeST was significantly up-regulated in active LN cases. A significant correlation was found between CTC-471J1.2 expression and LN activity parameters. Additionally, both lncRNAs showed a reasonable sensitivity and specificity in differentiation of active LN. A regression analysis model revealed that CTC-471J1.2 and NeST were independent predictors of active nephritis.ConclusionThe expression level of circulatory lncRNAs-CTC-471J1.2 and NeST can be used as sensitive and specific biomarkers for active LN. Furthermore, both could serve as predictors for nephritis activity.

A study on the clinical profile of patients with thyroid-related orbitopathy presenting to a tertiary eye care institute

Thyroid-associated orbitopathy is an autoimmune disorder that is the most frequent extrathyroidal involvement of Graves’ disease but sometimes occurs in euthyroid or hypothyroid patients. Patients with Thyroid associated disease present with chemosis, superior limbic keratoconjunctivitis, proptosis, lid retraction and oedema, restricted extraocular muscle, and dysthyroid optic neuropathy. This study was an observational cross-sectional study which included all the patients with all age groups who attended the Outpatient Department of a Tertiary Care Hospital, Ajmer, with signs and symptoms of thyroid-associated orbitopathy or diagnosed with thyroid-associated orbitopathy with no history of multiple endocrine disorder. 95 subjects satisfying the inclusion and exclusion criteria were enrolled in the study.The mean age of study participants was 43.93± 12.25 years. Age ranges from 21 years to 80 years. 59 (62.1%) were female. Among all patients 69 (72.6%) were hyperthyroid, 19 (20.0%) were euthyroid and 7 (7.4%) were euthyroid. 5 (5.2%) presented with dysthyroid optic neuropathy. 40(42.10%) cases were of active thyroid eye disease (TED) and the remaining 55 (57.8%) were inactive cases. Out of all active presenters, 30% were having Clinical Active Scoring (CAS) ≥4.Middleage group and female sex were the common clinical profile of the patients of TED. When active and Inactive TED groups were compared, findings such as Average CAS, dysthyroid optic neuropathy, average Hertel’s value, and presenting signs were significantly higher in the active group.

Hsa-miR-21–5p reflects synovitis and tenosynovitis components of musculoskeletal ultrasonography Seven-joint scores in rheumatoid arthritis disease and predicts the disease flare

Rheumatoid arthritis (RA) is characterized by progressive joint destruction with subsequent serious disability. Objective biomarkers of RA course progression are lacking, which necessitates the discovery of activity indicators and predictors of the disease outcome. Musculoskeletal Ultrasound Seven-joint Score (MSUS7) is proposed as a reliable technique to evaluate radiographic RA progression. Homo sapiens-microRNA-21–5p (hsa-miR-21–5p) plays an important role during joint remodeling and the pro-inflammatory process driving RA progression. We aimed to evaluate plasma hsa-miR-21–5p as a noninvasive RA activity biomarker and to investigate if hsa-miR-21–5p is linked to MSUS7 components in the context of RA activity. This cross-sectional study included 71 RA patients classified into inactive (n = 36) and active (n = 35) groups according to the Disease Activity Score 28-joint count with ESR (DAS28-ESR). Joints were assessed by MSUS7. Gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) were used to rate the synovitis, tenosynovitis, and erosion in the joints. Plasma hsa-miR-21–5p expression was measured by real-time PCR. The absolute count of regulatory T cell (Treg) was calculated after Treg frequency was assessed by flow cytometry. Results: Hsa-miR-21 expression was significantly up-regulated in the active RA group with a median fold change of 51.6 in comparison to the inactive cases with a median fold change of 7.7 (p < 0.001). Hsa-miR-21–5p was positively correlated with DAS28-ESR, C reactive protein (CRP), and rheumatoid factor (r = 0.7, p < 0.001, r = 0. 0.6, p < 0.001, and r = 0.4, p = 0.002, respectively), while negatively correlated with Treg absolute count (r = −0.4, p < 0.001). Hsa-miR-21–5p levels were correlated with synovitis and tenosynovitis in GSUS (r = 0.4, p < 0.001, r = 0.3, p = 0.025, respectively) and in PDUS (r = 0.5, p < 0.001 and 0.4, p = 0.001, respectively). The hsa-miR-21–5p accurately distinguished RA activity [AUC 0.933, 94.3% sensitivity, and 86.1% specificity]. Logistic regression analysis revealed hsa-miR-21–5p as an independent predictor for RA flare (OR = 1.228, p = 0.004). Hsa-miR-21–5p was linked to synovitis and tenosynovitis components of the MSUS7. Up-regulated hsa-miR-21–5p can be utilized as a predictor for RA disease flare.

Evaluation of calprotectin and ischemia-modified albumin serum levels as biomarkers to measure disease activity in Behçet’s disease

BackgroundAlthough several cytokines and markers have been recognized to assess disease activity in Behçet’s disease (BD), they are not routinely utilized in daily practice. This study aimed at assessing the usefulness of calprotectin and ischemia-modified albumin (IMA) serum concentrations to measure disease activity in BD.ResultsThe active BD cases had significantly greater IMA serum levels than inactive BD cases (p = 0.013) and controls (p < 0.001). In addition, the inactive BD group had significantly higher IMA serum levels than controls (p < 0.001). The serum calprotectin levels in active and inactive BD groups were significantly greater compared to those measured in controls (p < 0.001). On the other hand, the difference in serum calprotectin concentration was insignificant between the active and inactive BD patients. Binary logistic regression analysis revealed that hs-CRP and IMA serum levels are the strongest predictors for the activity of the active BD (p = 0.011 and 0.005, respectively). ROC curve analysis for the ability of IMA serum level to discriminate between active and inactive BD groups revealed an AUC = 0.738.ConclusionSerum calprotectin and IMA concentrations were significantly elevated in BD. IMA was significantly greater among active BD cases in comparison to inactive BD cases indicating its potential importance as a new marker of activity in BD.Trial registrationTrial registration on ClinicalTrials.gov: NCT05868538.

Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: randomized controlled clinical trial

BackgroundNanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth.MethodsSixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents’ application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction).ResultsThere were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively).ConclusionP11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF.Trial registrationThis trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

Diffusion-Weighted Images and Contrast-Enhanced MRI in the Diagnosis of Different Stages of Multiple Sclerosis of the Central Nervous System.

Introduction Multiple sclerosis (MS) is one of the most prevalent disorders of the central nervous system (CNS), and it can be observed in the field of radiological cross-sectional magnetic resonance imaging (MRI). The prevalence of MS in Saudi Arabia has increased as compared to the past few years. MRI is the gold standard non-invasive modality of choice in MS diagnosis according to the National Multiple Sclerosis Society (NMSS), New York City. This study aimed to highlight the significance of using diffusion-weighted images (DWIs) and the use of contrast media in the MS protocol, as well as the importance of identifying the suitable time of imaging after contrast enhancement to detect active lesions. Methods A retrospective cross-sectional study was conducted of 100 MS patients with an age range of 17 to 56 years. The data set included 41 active cases and 59 inactive cases. All patients had an MRI standard protocol of both the brain and spine in addition to DWI sequence and contrast agent (CA) injection, with images taken in early and delayed time. Results Of the patients, 71% were female and 29% were male. Active MS disease was more significant at younger ages than at older ages. Active lesions were significantly enhanced in delayed contrast images and showed high signal intensity in both the DWI and apparent diffusion coefficient (ADC) map, while inactive lesions showed no enhancement after contrast injection and showed an iso-signal intensity in both the DWI and ADC map. Conclusion The use of CA has developed over the years in the diagnosis of MS patients. In this study, the relationship between active lesions, DWI, and delayed contrast enhancement is very strong. In future research, we recommend adding a DWI sequence for the suspected active MS spine lesions in addition to delayed enhancement time in active MS after contrast injection to increase MRI sensitivity toward active MS lesions of the brain and spinal cord as well.

The Association of Urinary MCP-1 with Disease Activity of Lupus Nephritis

Background: The association of urinary MCP-1 (Monocyte Chemoattractant Protein-1) with disease activity in lupus nephritis (LN) has been a subject of significant interest. MCP-1 is a chemokine involved in the recruitment and activation of monocytes, which play a critical role in the pathogenesis of LN. Objective: To assess association of Urinary MCP-1 with disease activity of lupus nephritis. Method: This cross sectional study was conducted in the Department of Nephrology, Dhaka Medical College Hospital, Dhaka from January, 2017 to June, 2018. This cross sectional study was performed on 60 biopsy proven lupus nephritis patients and 30 age and sex matched apparently healthy control subjects. All the patients were recruited as per inclusion and exclusion criteria. Diagnosed SLE patients who had renal involvement and undergone renal biopsy for standard clinical indications were recruited by purposive sampling and divided into two groups of active and inactive LN as per operational definition. Results: During the study, The urinary MCP-1 was higher in active LN patients compared to the inactive group and both were higher than the level in the control. Plus, highest Sensitivity and specificity of uMCP-1 observed at cutoff value 433 pg/ml, where sensitivity was 0.967 and specificity was 0.900. Among 30 active lupus nephritis cases raised uMCP-1 was found in 29 cases and among 30 inactive lupus nephritis cases raised uMCP-1 was found in 3 cases. uMCP-1 showed very good agreement in diagnosis of lupus nephritis activity according to Kappa statistics. uMCP-1 in diagnosis of lupus nephritis activity showed accuracy, sensitivity, specificity, PPV and NPV were 0.933, 0.967, 0.900, 0.906 and 0.964 respectively. Conclusion: In conclusion, urinary MCP-1 holds great promise as a useful biomarker for the determination of lupus nephritis activity. Its association with disease activity, predictive value for treatment response and renal outcomes, and non-invasive nature make it an ...

Evaluation of circulating miR-16-5p and miR-223-5p in association with musculoskeletal ultrasonography seven-joint score in the assessment of rheumatoid arthritis activity

Rheumatoid arthritis (RA) is characterized by ongoing joint destruction. MicroRNAs (miRs) are blood-based biomarkers linked to RA pathogenesis. The musculoskeletal ultrasonography seven-joint score (US7) is an objective tool to assess RA activity. We aimed to evaluate miR-223 and miR-16 roles in monitoring RA activity and to investigate if there is a link between their plasma levels and US7 score. This study enrolled 76 RA patients classified according to Disease Activity Score 28-joint count with erythrocyte sediment rate (DAS28-ESR) to inactive cases (n = 38) and active cases (n = 38). Each patient's joint was scored for synovial proliferation (gray-scale ultrasound 'GSUS7') and vascularization (power Doppler ultrasound 'PDUS7'). Real-time quantitative PCR was used to measure the expression levels of miR-16 and miR-223 in plasma. When compared to inactive group, the active group revealed significant upregulation of miR-16 and miR-223, (P = 0.001 and P = 0.02, respectively). miR-16 and miR-223 levels were correlated with synovitis PDUS7 (r = 0.34, p < 0.01 and r= 0.25, P = 0.03, respectively). miR-16 was also positively correlated with synovitis GSUS7 (r= 0.42, p < 0.001). miR-223 upregulation discriminated active from inactive RA patients at AUC = 0.64, with 76% sensitivity and 50% specificity at cutoff > 2.8-fold change), whereas miR-16 distinguished the two groups at AUC = 0.78 with 87% sensitivity and 53% specificity at cutoff >38.27-fold change. In conclusion, upregulated miR-16 may have more potential to serve as activity biomarkers than miR-223 in RA. The miR-16 level was linked to synovitis GSUS7 and synovitis PDUS7 changes but miR-223 only linked to synovitis PDUS.

Radioproteomics for Discriminating the Activity and Inactivity of Immune Checkpoint Molecules in Breast Cancer

Radioproteomics studies investigating the relationship between lesion phenotype and proteins have been progressed. The purpose of this study was to develop a radioproteomics method for discriminating between active and inactive immune checkpoint molecules based on lesion phenotype. From the public database TCGA-BRCA, mRNA and fat suppression contrast-enhanced T1-weighted images of 49 patients with breast cancer were selected for the experiment. Using mRNA, we defined cases with active (10 cases) and inactive (39 cases) immune checkpoint molecules. To discriminate these cases using lesion phenotype, 275 radiomics features were measured from the tumor area. After selecting 3 radiomics features by using Lasso, logistic regression was employed to discriminate between active and inactive cases of immune checkpoint molecules. Evaluation of ROC analysis showed that the AUC was 0.81. Patients whose immune cell function is being braked by immune checkpoint molecules are likely to respond to immune checkpoint inhibitors when their activity is inhibited. Therefore, our results may be applied to predict the effects of immune checkpoint inhibitors in breast cancer treatment.

Coexistence of tubo-ovarian abscess and carcinoid tumor of the appendix in a sexually inactive girl: a case report

BackgroundTubo-ovarian abscess (TOA) is mostly a sequela of pelvic inflammatory disease (PID) which is seen in sexually active women. Although very rare, TOA could be seen in virgin adolescent girls. Fifteen cases of TOA were reported in virgin girls in English literature. Only one of these cases was suspected to be due to appendicitis. Herein, we present the first case of coexistence of tubo-ovarian abscess and carcinoid tumor of the appendix in a sexually inactive girl.Case presentationA 13-year-old girl presented with abdominal pain and fever. Ultrasonography reported that there was a 63×48 mm sized, heterogeneous, thick-walled, dense-content complicated cyst in the right ovary which was thought to be a hemorrhagic cyst and a tubular structure, measuring 12 mm in its thickest part which was thought to be the appendix. During the operation, a TOA was observed in the right adnexal region. The thick, edematous appendix which was lying separately was excised. The TOA was evacuated; a drain was placed. The appendix pathology was reported as “carcinoid tumor.”ConclusionWe present the first case of TAO with carcinoid tumor of appendix and the second case of TAO that was suspected to be due to appendicitis. When the sexually inactive TOA cases including our case were reviewed, we found that the median age was 15 years (12–47 years) and 11 of 16 cases (69%) were under 18 years of age. The presenting symptoms were abdominal or pelvic pain in all cases, fever in 11 cases (69%), vomiting in 6 cases (38%), dysuria in 5 cases (31%), and diarrhea in 3 cases (19%). Both perforated appendicitis and TOA patients have the same clinic presentation such as fever, abdominal tenderness, increased leukocyte count, increased inflammatory markers. The differential diagnosis can be achieved by radiological examinations such as ultrasonography, computerized tomography or magnetic resonance imaging.

METABOLIC SYNDROME AND THYROID DYSFUNCTION IN PATIENTS WITH ACROMEGALY IN SULAIMANI

Background &#x0D; Acromegaly is a chronic endocrinology disorder caused by the over-production of growth hormone (GH) predominantly by a pituitary adenoma. Acromegaly is associated with metabolic changes and thyroid dysfunction (ThD) in the body. However, the frequency of metabolic syndrome (MtS) in acromegaly patients is unknown, and studies assessing the frequency of different ThD types in acromegaly cases were few.&#x0D; Objectives &#x0D; To analyze the frequencies of MtS and ThD in patients with acromegaly in comparison to controls in Sulaimani city, to find the frequencies of MtS and ThDs in active cases compared to inactive cases in acromegaly patients, and to assess the relationship between the cumulative exposure to Insulin-like Growth Factor 1 (IGF-1) with ThD and MtS in acromegaly.&#x0D; Patients and Methods&#x0D; In this case-control study, 82 subjects were enrolled, which included 22 patients with acromegaly who visited the Sulaimani endocrinology center from August 2021 to February 2022 and 60 control subjects. The mean age of cases was 47.55 [11.50] years, with 7 (31.8%) male and 15 (68.2%) female. Thyroid function test, clinical, and biochemical parameters of MtS were measured in both groups in addition to IGF1. Chi-square test, Student T-test, and ANOVA were used in data analysis. Correlation between quantitative variables determined by Pearson correlation, with a P-value ≤ 0.05, is significant&#x0D; Results&#x0D; Out of 22 patients with acromegaly, 68.2% were euthyroid, 9.1% had primary hypothyroidism, 18.2% had central hypothyroidism, and 4.5% had hyperthyroidism, which is significantly higher than the control group (p-value =0.002). MtS frequency is 68.18% in cases, significantly higher than control, p-value=0.011. Most MtS and ThD parameters were significantly higher in acromegaly patients than in controls, P-value &lt; 0.001. No significant correlation between the last IGF1 and other parameters existed except free T3, which has a significant negative correlation with IGF1, P &lt; 0.05. &#x0D; Conclusion&#x0D; In acromegaly, the frequency of MtS is high (68.18%), and the frequency of ThD is 31.8%. Both MtS and ThDs are more common in patients compared to controls. No significant relationship exists between disease activity and the presence of MtS or ThD. Because both MtS and ThDs increase the metabolic markers, consequently increasing cardiovascular disease (CVD) morbidity and mortality in cases.

Adrenocortical Tumors and Pheochromocytoma/Paraganglioma Initially Mistaken as Neuroblastoma-Experiences From the GPOH-MET Registry.

In children and adolescents, neuroblastoma (NBL), pheochromocytoma (PCC), and adrenocortical tumors (ACT) can arise from the adrenal gland. It may be difficult to distinguish between these three entities including associated extra-adrenal tumors (paraganglioma, PGL). Precise discrimination, however, is of crucial importance for management. Biopsy in ACT or PCC is potentially harmful and should be avoided whenever possible. We herein report data on 10 children and adolescents with ACT and five with PCC/PGL, previously mistaken as NBL. Two patients with adrenocortical carcinoma died due to disease progression. Two (2/9, missing data in one patient) patients with a final diagnosis of ACT clearly presented with obvious clinical signs and symptoms of steroid hormone excess, while seven patients did not. Blood analyses indicated increased levels of steroid hormones in one additional patient; however, urinary steroid metabolome analysis was not performed in any patient. Two (2/10) patients underwent tumor biopsy, and in two others tumor rupture occurred intraoperatively. In 6/10 patients, ACT diagnosis was only established by a reference pediatric pathology laboratory. Four (4/5) patients with a final diagnosis of PCC/PGL presented with clinical signs and symptoms of catecholamine excess. Urine tests indicated possible catecholamine excess in two patients, while no testing was carried out in three patients. Measurements of plasma metanephrines were not performed in any patient. None of the five patients with PCC/PGL received adrenergic blockers before surgery. In four patients, PCC/PGL diagnosis was established by a local pathologist, and in one patient diagnosis was revised to PGL by a pediatric reference pathologist. Genetic testing, performed in three out of five patients with PCC/PGL, indicated pathogenic variants of PCC/PGL susceptibility genes. The differential diagnosis of adrenal neoplasias and associated extra-adrenal tumors in children and adolescents may be challenging, necessitating interdisciplinary and multidisciplinary efforts. In ambiguous and/or hormonally inactive cases through comprehensive biochemical testing, microscopical complete tumor resection by an experienced surgeon is vital to preventing poor outcome in children and adolescents with ACT and/or PCC/PGL. Finally, specimens need to be assessed by an experienced pediatric pathologist to establish diagnosis.

Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis.

Among coronavirus disease 2019 (COVID‐19) patients, physically active individuals may be at lower risk of fatal outcomes. However, to date, no meta‐analysis has been carried out to investigate the relationship between physical activity (PA) and fatal outcomes in patients with COVID‐19. Therefore, this meta‐analysis aims to explore the hospitalisation, intensive care unit (ICU) admissions, and mortality rates of COVID‐19 patients with a history of PA participation before the onset of the pandemic, and to evaluate the reliability of the evidence. A systematic search of MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and medRxiv was conducted for articles published up to January 2022. A random‐effects meta‐analysis was performed to compare disease severity and mortality rates of COVID‐19 patients in physically active and inactive cases. Twelve studies involving 1,256,609 patients (991,268 physically active and 265,341 inactive cases) with COVID‐19, were included in the pooled analysis. The overall meta‐analysis compared with inactive controls showed significant associations between PA with reduction in COVID‐19 hospitalisation (risk ratio (RR) = 0.58, 95% confidence intervals (CI) 0.46–0.73, P = 0.001), ICU admissions (RR = 0.65, 95% CI 0.52–0.81, P = 0.001) and mortality (RR = 0.47, 95% CI 0.38–0.59, P = 0.001). The protective effect of PA on COVID‐19 hospitalisation and mortality could be attributable to the types of exercise such as resistance exercise (RR = 0.27, 95% CI 0.15–0.49, P = 0.001) and endurance exercise (RR = 0.41, 95% CI 0.23–0.74, P = 0.003), respectively. Physical activity is associated with decreased hospitalisation, ICU admissions, and mortality rates of patients with COVID‐19. Moreover, COVID‐19 patients with a history of resistance and endurance exercises experience a lower rate of hospitalisation and mortality, respectively. Further studies are warranted to determine the biological mechanisms underlying these findings.

Efficacy, safety, and predictors of response to infliximab therapy for ulcerative colitis

Background Using infliximab (IFX), an antitumor necrosis factors antibody, has dramatically increased therapeutic choices for ulcerative colitis (UC). This study assessed IFX therapy’s efficacy, safety, and action predictor variables for UC. Patients and methods This prospective interventional study was done on 50 patients with UC. Patients underwent colonoscopy, biopsy, complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) before start of IFX and after 8 weeks. Patients started 5 mg/kg IFX infusion at 0, 2, and 6 weeks and then every eight weeks. After 6 months, cases were subjected to colonoscopy, biopsy, CRP, complete blood count, and ESR to assess IFX therapy. Results After therapy, hemoglobin and inactive UC cases (90%) increased significantly and white blood cell, ESR, and CRP decreased significantly than before treatment, without significant difference in platelet count. IFX treatment was associated with improvement in 90% of cases. There was a significant relation between improvement and colonoscopy, histopathology finding, and CRP after treatment (P&lt;0.001) as the majority of cases had inactive UC, UC chronic phase with mild inflammation, and negative CRP after therapy. There was a nonsignificant relation between improvement and disease extension and severity (mayo clinic score) after the period. Conclusions Active UC cases treated by IFX had a better mucosal healing and clinical responses, corrected of anemia and thrombocytopenia and normalized acute-phase reaction.

Non Inferiority Study to Prevent Hepatitis B Vertical Infection, Non Randomized Clinical Trial

Background: Hepatitis B is a vaccine-preventable liver infection caused by the Hepatitis B Virus (HBV). Hepatitis B (HB) is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected. Aim of the study: To identify the efficacy of hepatitis B immunoglobulin with hepatitis B vaccine versus hepatitis B vaccine alone to prevent the HB vertical infection. Method: An quasi-experimental clinical trial was used, 114 new born were included in the control group and 114 newborn were included in the intervention group, both groups were given HB vaccine but the control group HB vaccine combined with hepatitis B immunoglobulin, all of the subjects were born to mother positive HBV and negative HBeAg indicating inactive HBV cases. Results: Revealed that the used regimens were effective to interrupt mother to child transmission of HBV, the geometric mean titration was higher (207.64 IU/L) among the infants were included in the control group versus (180.87 IU/L) to the infants were included in the intervention group, non-protective rate was 6.6%, relative risk 2.63. Conclusion: Hepatitis B vaccine alone is not inferior to HB vaccine combined with HBIG to prevent the infection and both regimens were effective.

A116 CLINICAL OUTCOMES OF PATIENTS UNDERGOING BALLOON-ASSISTED ENDOSCOPY FOR SUSPECTED SMALL BOWEL BLEEDING

Abstract Background Obscure gastrointestinal bleeding (OGIB) accounts for approximately 50% of all GI bleeds. This refers to bleeding from an unknown etiology despite initial investigations with upper endoscopy and colonoscopy, of which 75–80% is attributed to a small bowel source, also termed as small bowel bleeding. Various diagnostic and therapeutic modalities have been used to investigate sources of OGIB. Balloon-assisted enteroscopy (BAE) is a useful procedure for managing small bowel bleeding, with reported diagnostic and therapeutic rates up to 87% and 80%, respectively. Aims The aims of this study are to evaluate the outcomes of patients with OGIB who have undergone BAE, as well as to explore correlations between the timing of BAE and clinical outcomes. Methods We performed a retrospective review of 342 patients who underwent BAE at a tertiary referral centre between 2016 to 2021, of which 116 underwent evaluation for OGIB. Aside from gender and age, preprocedural variables including endoscopy indication, timing from video capsule endoscopy (VCE) and overt GI bleed were collected to allow for further stratification of data. Endoscopic variables including modality, findings, and therapeutic interventions were used to calculate diagnostic and therapeutic yields. Furthermore, the association between timing of BAE after VCE and clinical outcomes including rebleeding rate, diagnostics and therapeutic yields were assessed. All data analyses were performed with SPSS. Results The overall diagnostic yield was 70.3%. Patients with active overt bleeding were found to have a higher yield compared to those with occult and inactive overt bleeding (78.6% vs 72.5% vs 64.6%, respectively). Amongst all OGIB presentations, the most common findings were vascular lesions including angiodysplasia, arteriovenous malformations, and dieulafoy lesions. The majority of lesions were found within the proximal jejunum. Subgroup analysis did not show a statistically significant difference in diagnostic yields between BAE with and without prior VCE (75.9% vs 77.8, P = 0.605). The therapeutic yield was 51.1% with a higher yield found in those presenting with active overt bleeds compared to occult and inactive overt cases. Compared to BAE performed after 30 days of overt GI bleeding, those completed within 30 days was found to have a higher diagnostic and therapeutic rate (80.0% vs 60.0%, 70.0 vs 30.0%, respectively). Conclusions Balloon-assisted enteroscopy continues to be an effective diagnostic and therapeutic modality for the investigation of obscure gastrointestinal bleeding. Our retrospective study shows a higher diagnostic and therapeutic rate in those presenting with active overt GI bleed as well as those who underwent BAE within 30 days of overt GI bleeding Funding Agencies None

Serum levels of fetuin-A as a novel biomarker for disease activity in patients with Takayasu arteritis and granulomatous polyangiitis.

The aim of the present study was to investigate serum fetuin-A (Fet-A) levels in patients with Takayasu arteritis (TA) and granulomatous polyangiitis (GPA) and to analyze the relationship between serum Fet-A levels and disease activity scores. Thirty-two TA and 28 GPA patients presented to the rheumatology clinic at Gazi University and met the criteria of American College of Rheumatology 1990 and 2012 International Chapell Hill meeting, respectively, and 20 healthy control subjects were included in the present study. We collected data on serum C-reactive protein (CRP), albumin, calcium, and phosphate levels as well as erythrocyte sedimentation rates. Calcification risk index (CRI) was calculated for each patient. The Birmingham Vasculitis Activity Score (BVAS) and Indian Takayasu Clinical Activity Score (ITAS), were used to assess disease activity in GPA and TA patients respectively. Serum Fet-A levels were significantly lower in the overall vasculitis group compared to control group (p = 0.015). In subgroup analysis, Fet-A levels were significantly lower in those with active disease, compared to control group (p = 0.001, for active TA (n = 18) and GPA (n = 17), respectively). However, there was no significant difference in serum Fet-A levels in inactive cases versus control subjects (p = 0.061, for inactive TA (n = 14) and GPA (n = 11), respectively). Serum Fet-A levels negatively correlated with BVAS (r = - 0.675) and ITAS scores (r = - 0.385), as well as with CRP and CRI. Our results suggest that serum Fet-A level could be a novel biomarker for assessment of activity status in patients with GPA or TA. Key Points • Serum Fetuin-A is negative acute phase protein and systemic calcification inhibitor synthesized in hepatocytes and secreted by various inflammation. • Serum Fetuin-A was negatively correlated with CRP, BVAS, and ITAS scores and significantly decreased in vasculitis patients with high disease activity. • Serum Fetuin-A could be a promising and useful biomarker for the assessment of disease activity for vasculitis, also that it might also be a predictor of long-term cardiovascular progression.