Increased Sedimentation Rate Research Articles

Evaluation of Four Adult Visceral Leishmaniasis Cases.

Leishmania infantum is the species responsible for visceral leishmaniasis [(VL), kala-azar], which is observed sporadically mainly in pediatric age groups in the Aegean, Mediterranean and Central Anatolian regions of Türkiye. The aim of this study is to evaluate the diagnosis, clinic, laboratory results and treatments of four adult patients with VL who applied to our hospital. The patients were referred to our hospital to investigate hematological malignancy. In the study, the data of four patients (three men, one woman; age range: 30-40 years) who were diagnosed with VL and treated in the infectious diseases clinic of our hospital between January 2022 and April 2022 were evaluated retrospectively. The diagnosis of VL was made according to appropriate clinical and physical examination findings, biochemical and serological tests (indirect fluorescent antibody test and rK39 rapid antigen test) and polymerase chain reaction (PCR) results, as well as the presence of amastigote forms of the parasite in bone marrow samples. Serology positivity was found in all patients, and bone marrow positivity was found in two patients. According to the results of RT-PCR in all patients, it was determined that the species causing the disease was L. infantum/L. donovani. Initially, the most common symptoms were fever, fatigue, and abdominal distension. None of the patients had an immunosuppressive condition. It was understood that all the patients lived in the rural area of Syria's Idlib province. Hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia were found in all patients. The patients were treated with liposomal amphotericin-B (L-AMB). One patient did not come for follow-ups, the other three patients were found to have completely recovered in their follow-up. No recurrence was observed in any of the patients. In conclusion, VL should be considered in patients who apply to health institutions with complaints of fever, hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia.

Sweet Syndrome: Clinical Presentation, Malignancy Association, Autoinflammatory Disorders and Treatment Response in a Cohort of 93 Patients with Long-term Follow-up.

Sweet syndrome is a neutrophilic dermatosis associated with multiple disorders. This retrospective case-series study of patients with Sweet syndrome in a tertiary hospital in Spain from 2001 to 2021, explores clinicopathological characteristics of Sweet syndrome and variables associated with malignancy, presence of autoinflammatory disorders and differences between histological subtypes. A total of 93 patients were identified: 30% idiopathic, 34% malignancy-associated, 29% reactive to infections or drug-associated, and 6% with an autoimmune/inflammatory condition. Acute myeloid leukaemia was the most common malignancy (16/93) followed by myelodysplastic syndrome (7/93). Patients with acute myeloid leukaemia presented isolated flares, marked cytopaenia and rapid response to treatment, whereas myelodysplastic syndrome followed a chronic-recurrent course. The most frequent associated medications and inflammatory disorders were filgrastim and hydroxyurea (n = 2); and inflammatory bowel disease (n = 4). In addition, 3 patients were diagnosed with VEXAS syndrome. Male sex (p = 0.006), fever (p = 0.034), increased erythrocyte sedimentation rate (p < 0.001), anaemia (p < 0.001), and thrombocytopaenia (p < 0.001) were associated with malignancy. Histologically, patients were classified as classic (60%), histiocytoid (22.5%) or subcutaneous (15%), with pain (p = 0.011) and nodules (p < 0.001) being associated with subcutaneous-Sweet syndrome. Sweet syndrome in the context of cytopaenia should alert the presence of malignancy. An acquired autoinflammatory condition should be explored in relapsing Sweet syndrome with myelodysplastic syndrome. A minimum follow-up of 6 months is recommended.

Diagnostic potential of plasma CD30(+) small extracellular vesicles in Hodgkin lymphoma

Background. In current clinical practice, there are no reliable methods to stratify patients with a high risk of relapse or with a primary refractory form of Hodgkin lymphoma. Quantification of CD30-positive small extracellular vesicles (CD30(+)SEV) in plasma seems to be a possible approach to solve this issue. CD30(+)SEV can be quantified by the AuNP aptasensor technology based on the enzyme-mimetic properties of gold nanoparticles and the CD30-specific affinity of DNA aptamers.Aim. To quantify CD30(+)SEV in the plasma of patients with newly diagnosed Hodgkin lymphoma; to investigate the links between estimated parameter and clinical/morphological properties of disease and the effect of first two chemotherapy cycles.Material and methods. A semi-quantitative analysis of CD30(+)SEV in the plasma of patients with Hodgkin lymphoma (n = 55) was performed using the AuNP aptasensor. The relationship between the CD30(+)SEV concentration and the data of standard diagnostic approaches was evaluated through the r-Pearson correlation coefficient, the Mann–Whitney and Kruskal–Wallis criteria.Results. The plasma concentration of CD30(+)SEV in patients with Hodgkin lymphoma correlates with the quantity of CD30(+) cells in tissues of biopsied lymph nodes (r = 0.8) and the total lesion glycolysis estimated by PET/CT (r = 0.9). Patients with a relatively high concentration of CD30(+)SEV are characterized by an increase of erythrocyte sedimentation rate and leukocytosis compared with patients with a lower concentration of CD30(+)SEV. Two cycles of chemotherapy reduced CD30(+)SEV concentration, and this effect was more pronounced in patients treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regime than the BEACOPPesc (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, procarbazine).Conclusion. AuNP-aptasensor can be used for semi-quantitative assessment of CD30(+)SEV in plasma. The estimated CD30(+)SEV concentration correlates with the clinical and morphological parameters of patients with Hodgkin lymphoma and may reflect the severity of the disease. To assess the diagnostic and/or prognostic potential of developed technology, large-scale multicenter studies are required.

Long-term follow-up of children with chronic non-bacterial osteomyelitis—assessment of disease activity, risk factors, and outcome

IntroductionChronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone-disease of unknown origin. The National Pediatric Rheumatologic Database (NPRD) collects long-term data of children and adolescents with rheumatic diseases including CNO.ObjectiveTo assess characteristics, courses, and outcomes of CNO with onset in childhood and adolescence and to identify outcome predictors.MethodsFrom 2015 to 2021 patients with a confirmed diagnosis of CNO, who were registered in the NPRD during their first year of disease and at least one follow-up visit, were included in this analysis and observed for up to 4 years.ResultsFour hundred patients with recent diagnosis of CNO were enrolled in the NRPD during the study period. After 4 years, patient data documentation was sufficient to be analyzed in 81 patients. A significant decline of clinical and radiological lesions is reported: at inclusion in the registry, the mean number of clinical lesions was 2.0 and 3.0 MRI lesions per patient. A significant decrease of manifestations during 4 years of follow-up (mean clinical lesions 0.5, p < 0.001; mean MRI lesions 0.9 (p < 0.001)) was documented. A significant improvement of physician global disease activity (PGDA), patient-reported overall well-being, and childhood health assessment questionnaire (C-HAQ) was documented. Therapeutically, an increase of disease-modifying anti-rheumatic drugs over the years can be stated, while bisphosphonates rather seem to be considered as a therapeutic DMARD option in the first years of disease. Only 5–7% of the patients had a severe disease course as defined by a PGDA > = 4. Predictors associated with a severe disease course include the site of inflammation (pelvis, lower extremity, clavicle), increased erythrocyte sedimentation rate, and multifocal disease at first documentation. The previously published composite PedCNO disease activity score was analyzed revealing a PedCNO70 in 55% of the patients at 4YFU.ConclusionAn improvement of physician global disease activity (PGDA), patient reported overall well-being and imaging-defined disease activity measures was documented, suggesting that inactivity of CNO disease can be reached. PedCNO score and especially PGDA, MRI-defined lesions and in a number of patients also the C-HAQ seem to be reliable parameters for describing disease activity. The identification of risk factors at the beginning of the disease might influence treatment decision in the future.

Adhesion of Immunoglobulins to Band3 Promotes Increased Erythrocyte Sedimentation Rate in Multiple Myeloma

An increase in ESR can be seen in approximately 85% of patients with MM [1]. Therefore, ESR is often used as one of the sensitive indicators of active MM [1]. It is now widely accepted that the increase in ESR is related to the adhesion of immunoglobulins secreted by myeloma cells to erythrocytes [2, 3]. However, this explanation is descriptive and speculative and has not been confirmed by experimental data [3]. We applied peripheral blood erythrocyte samples from MM patients and used immunofluorescence/immunoprecipitation tandem protein analysis/molecular docking to determine the molecular mechanism by which all types of MM immunoglobulins can target and adhere to erythrocyte membrane Band3. This result, not only helps to explain the molecular mechanism of ESR acceleration in MM, but will also advance our understanding of the pathophysiologic changes that occur in ESR. At the same time, it may provide a new way to target protection of normal erythrocytes and targeted removal of erythrocyte-bound immunoglobulins.

Lessons learned from "the great mimicker disease": A retrospective study of 18 patients with scurvy.

Scurvy is an uncommon medical condition that affects children and is caused by an inadequate intake of vitamin C. This study presents the characteristics of patients with scurvy to raise awareness of the diagnostic process in developing countries where laboratory testing for vitamin C levels is often not available. A retrospective study was performed from period of 2018 to 2023. Data extraction includes patient age, sex, body mass index, constitutional symptoms, musculoskeletal, mucosal, cutaneous symptoms, other accompanying disorders, anemia, erythrocyte sedimentation rate, C-reactive protein, radiographic examination, vitamin C dose, and duration of treatment. Descriptive statistical analysis was performed in this study. Eighteen cases (17 males, 1 female) of scurvy were referred to our institution. Thirteen of 18 patients were misdiagnosed before referral. The median age at presentation was 4.5 (range, 2-11) years. The average body mass index was 13.93 ± 0.63 kg/m2. Half of patients had healthy weight. All patients presented with lower limb pain and 17 of 18 with refusal to walk. The median onset of diagnosis was 11 (range 4-48) weeks. White line of Frankel was described in all patients. Seven had anemia and 6 of 18 had increase in erythrocyte sedimentation rate and/or C-reactive protein levels. Only one patient had ascorbic acid levels evaluation before treatment since it was not readily available in our country. Treatment length varied from 2 weeks to 6 months. The diagnosis of scurvy is frequently delayed due to its extreme rarity in modern society and its ability to mimic numerous other conditions. In children presenting with limb pain and/or reluctance to walk and pathognomonic radiological findings, physicians must prioritize scurvy as a differential diagnosis. In scurvy, vitamin C supplementation is curative.

Dilemma in diagnosing incomplete Kawasaki disease in a resource limited setting

Introduction and importance: Kawasaki disease (KD) is an acute febrile systemic vasculitis that predominantly affects small to medium sized vessels and mostly occurs in children below 5 years of age. The morbidity and mortality mostly occur due to cardiac involvement. Case presentation: The authors present a case of a 5-year-old male child from hilly region of Nepal who presented with fever for 7 days along with strawberry tongue and non-exudative conjunctivitis without rashes, extremity changes or lymphadenopathy. A suspicion of incomplete KD (IKD) was made. The notable investigation findings were increased erythrocyte sedimentation rate, C-reactive protein, leucocyte count and platelets. Echocardiography showed normal findings. Based on the clinical features and supplemental laboratory findings, a diagnosis of IKD was made. The patient improved after intravenous immunoglobulin and Aspirin. Clinical discussion: The main learning objective that the authors get from this case is the challenges in the diagnosis of IKD in the resource limited setting like Nepal. Whether or not to start intravenous immunoglobulin is a dilemma for the physician in most of the cases of suspected IKD, due to the high cost and poor availability of intravenous immunoglobulin in this setting. Hence, the use of inflammatory markers, supplemental laboratory findings together with the few diagnostic criteria met by the patient helps in making a diagnosis and institute timely treatment with intravenous immunoglobulin and aspirin. Conclusion: Diagnosis of KD in difficult in resource limited setting.

Tuberculosis Mimicking-Musculoskeletal Tumor of The Hand: An Uncommon Case of Extrapulmonary Tuberculosis

Background: Musculoskeletal extrapulmonary tuberculosis is accounting for only 10-15% of all cases. Current attention has been focused on hand tuberculosis due to its increasing prevalence. This study describes an unusual case of extrapulmonary tuberculosis that manifested as a soft tissue tumor of the hand.Case Report: A 17-year-old male presented with a painful swollen part of the 3rd finger of the left hand. The mass was irregular and suppurative, with discoloration and foul smell. Laboratory results showed anemia and increased erythrocyte sedimentation rate. The computed tomography scan showed an isodense soft tissue (size 2.19 cm x 1.59 cm x 4.21cm) across the distal to the proximal part of 3rd phalanx bone to the metacarpal region with a decrease of phalanx bone density with no sign of bone destruction or any periosteal reaction. The histopathology study revealed a chronic granulomatous structure surrounded by epitheloid cells, datia Langhans cells, and caseating necrosis. The acid-fast staining confirmed the presence of bacilliform bacteria.Discussion: Extrapulmonary tuberculosis typically results from secondary hematogenous dissemination and reactivation of the main foci. There are no specific tests to diagnose musculoskeletal tuberculosis preoperatively, leading to delayed diagnosis. Histopathological examination and culture are needed to confirm the diagnosis.Conclusions: Slow progression and multiple differential diagnoses frequently result in a delayed diagnosis, which leads to complications. Initial radical excision and anti-tuberculosis multidrug therapy provide excellent functional outcomes and recurrence prevention.

Long-term carbon sequestration in the Eocene of the Levant Basin through transport of organic carbon from nearshore to deep marine environments

This study addresses a specific component associated with mass transport complexes in marine systems: the role of hyperpycnal flows, dense shelf water cascading, submarine canyons, distributary channels, and other transport mechanisms in transferring organic matter from continental and shallow marine settings into deep-marine environments. We speculate that during the Eocene, allowing for only 0.1‰ of shelf carbon to be preserved through transport mechanisms would account for up to 13.7% of all organic carbon burial. As such, the potential to mobilize through this mechanism large quantities of organic carbon is significant.Our case study focuses on a 150 m Eocene sequence composed of organic-rich chalks interleaved with displaced neritic limestones. TOC values range between 1.5 and 14%, averaging 4.5%. Displaced limestones are composed of a variety of poorly cemented mud- and wackestones, with low-diversity assemblages of large benthic foraminifera associated with planktonic foraminifera, suggesting deposition under low-energy conditions within the oligophotic zone on the outer ramp. Transport overprints include soft-sediment deformation, partially lithified rip-ups, folds, small diapirs, bed-scale imbrication, brecciation and syn-sedimentary shear. These features indicate detachment, movement and emplacement following initial sedimentation, in some cases more than once. Emplacement occurs into a chalk facies that can vary in appearance from darker (higher TOC) and lighter (lower TOC) lithofacies.Combination between the sedimentological, petrophysical, and elemental analyses indicates shifts between autochthonous and allochthonous sedimentation, whereas the organic geochemical analysis reveals a correlation between modes of sedimentation and preservation/composition of organic matter. Organic richness seems to increase within intervals of allochthonous sedimentation, with lower TOC values within intervals of autochthonous sedimentation. Organic matter preservation is enhanced due to poor oxygenation of the sea floor, further depleted by rapid burial beneath mass-transport deposits, increasing sedimentation rates and thus organic matter preservation. Horizons rich in organic matter may be derived from three different sources: organic matter with a fingerprint of terrestrial sources (e.g., enhanced contribution of plant leaf waxes) transported from nearshore environments; an allochthonous marine fingerprint with sulfurized hopanoids, which seem to be reworked from pre-existing Cretaceous organic-rich carbonates entrained within fined-grained micro-turbidites in the para-autochthonous facies; and productivity-derived organic matter deposited on the seafloor of the deep marine environment.This study demonstrates how transport mechanisms allow for the long-term burial of organic carbon in marine systems. When taking into consideration similar processes reported to occur in the world oceans today, it is clear that sediment transport and long-term burial of organic carbon is a fundamental part of the global carbon cycle.

Low temperature and high pressure dramatically thicken the gas hydrate stability zone in rapidly formed sedimentary basins

Rapid sedimentation reduces the temperature and raises the pore pressure in sedimentary basins. During rapid sedimentation (>0.5 mm yr−1), cold sediment is buried fast and there is insufficient heat flow to keep the sediment at its steady state conductive equilibrium temperature. In addition, rapid deposition of low permeability mud results in overpressure due to the inability of the pore fluid to drain. It dramatically expands the thickness of the zone where hydrates are stable (the gas hydrate stability zone or GHSZ). We explore this effect with one-dimensional models. We then simulate the two-dimensional evolution of temperature and pressure of the Terrebonne Basin in the Gulf of Mexico. We use seismic, well data, and salt restoration to provide the initial and boundary conditions. We show that rapid burial reduces the geothermal gradient from ∼30 °C/km, which would be expected under equilibrium pressure and temperature, to as low as ∼10 °C/km; we also show that 25 MPa of overpressure is developed. This deepens the thickness of the GHSZ from ∼600 mbsf (its equilibrium depth) at the basin margin, to as much as 2000 mbsf basin-ward, in response to the increasing sedimentation rates. The model successfully simulates the deepening of the base of GHSZ that is interpreted from a bottom simulating reflection in the seismic data. The model and the observations suggest that the thickness of the GHSZ may be much thicker than commonly presumed and as a result the volume of carbon stored may be underestimated. Furthermore, the thickness of the hydrate stability will change significantly with time as sedimentation rate waxes and wanes implying that the hydrate stability zone is a dynamic component of the carbon cycle.

Development and validation of diagnostic and activity-assessing models for relapsing polychondritis based on laboratory parameters.

Relapsing polychondritis (RP) as a rare autoimmune disease is characterized by recurrent inflammation of the organs containing cartilage. Currently, no biomarkers have been integrated into clinical practice. This study aimed to construct and evaluate models based on laboratory parameters to aid in RP diagnosis, assess activity assessment, and explore associations with the pathological process. RP patients and healthy controls (HCs) were recruited at the Peking Union Medical College Hospital from July 2017 to July 2023. Clinical data including Relapsing Polychondritis Disease Activity Index (RPDAI) score and laboratory tests were collected. Differences in laboratory data between RP patients and HCs and active and inactive patients were analyzed. The discovery cohort (cohort 1) consisted of 78 RP patients and 94 HCs. A model based on monocyte counts and neutrophil to lymphocyte ratio (NLR) could effectively distinguish RP patients from HCs with an AUC of 0.845. Active RP patients exhibited increased erythrocyte sedimentation rate, complement 3, platelet to lymphocyte ratio (PLR), NLR, and C-reactive protein to albumin ratio (CAR) compared with stable patients, which were also positively correlated with RPDAI. Notably, CAR emerged as an independent risk factor of disease activity (OR = 4.422) and could identify active patients with an AUC of 0.758. To confirm the reliability and stability of the aforementioned models, a replication cohort (cohort 2) was enrolled, including 79 RP patients and 94 HCs. The monocyte-combined NLR and CAR showed a sensitivity of 0.886 and 0.577 and a specificity of 0.830 and 0.833 in RP diagnosis and activity prediction, respectively. Furthermore, lower natural killer cell levels in RP patients and higher B-cell levels in active patients may contribute to elucidating the pathological mechanisms of disease occurrence and exacerbation. The utilization of laboratory parameters provides cost-effective and valuable markers that can assist in RP diagnosis, identify disease activity, and elucidate pathogenic mechanisms.

Lymphoma Accompanyıng Pneumoconıosıs; Case Report

Non-Hodgkin Lymphoma (NHL) is the most common hematological malignancy, and Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological type. A 56-year-old male patient was admitted to our clinic with complaints of shortness of breath and fatigue for 1 month. It was learned in his professional history that he had been a dental technician for 30 years. He was diagnosed with pneumoconiosis in 2020 and his chest radiograph was q/t 3/3 according to the International Labor Organization (ILO) International Classification of pneumoconiosis radiographs. Laboratory examinations revealed an increase in erythrocyte sedimentation rate (ESR 50 mm/h) and serum lactate dehydrogenase (LDH 368 IU/L) levels. On thoracic computed tomography (CT), enlarged lymph nodes and lymphadenopathies (LAP) with local conglomeration and calcifications in the mediastinal, subcarinal and bilateral hilar areas were seen. Widely disseminated inhomogeneous mass-like consolidation areas, including internal calcifications, extending from the hilum to the parenchyma in both lungs, were observed more prominently in the right middle zone. Diffuse interstitial thickenings, infiltrations and centrilobular nodular density increases in both lungs, nodular consolidated areas with recessed contours and nodules and ground glass densities were observed, especially in the left upper zone. In the lateral part of the left 5th rib, a heterogeneous soft tissue mass of approximately 12x5 cm, causing cortical destruction, invading the surrounding soft tissues and muscle planes, and containing internal cystic-necrotic components was observed. On abdominal CT, enlarged lymph nodes and LAPs, some of which contain calcifications, were observed in the abdomen. The pathology result was reported as Diffuse B-Cell Lymphoma in the patient who underwent transthoracic biopsy due to radiographic appearances that are not typical for PMF. Here, we presented a case of pneumoconiosis with occupational carcinogen exposure and presenting with lymphoma.

ANALISIS KADAR FERRITIN SERUM DENGAN NILAI LAJU ENDAP DARAH PADA IBU HAMIL TRIMESTER II

Ferritin examination is an important measurement parameter used to measure the presence of iron in the body. Iron deficiency in the body will result in anemia. Anemia that often occurs in pregnant is iron deficiency anemia because the need for iron in pregnant. An increase in erythrocyte sedimentation rate occurs during pregnancy and can also be observed in pregnant. The purpose of this study was to determine the relationship between serum ferritin levels and the value of ESR in second trimester pregnant. This study was conducted at YPK Mandiri Hospital, samples were in the form of medical record data with 92 samples of second trimester pregnant who performed complete hematological examinations and ferritin levels. The results of this study indicate that second trimester pregnant who do complete blood checks and ferritin levels at YPK Mandiri Hospital with ferritin levels ranging from 2 - 219 ng/mL with an average level of 26.31 ng/mL and the value of the Blood Cessation Rate ranging from 5 - 105 mm / hour with an average of 35 mm / hour. This study uses the Spearman Rho test method, obtained a sig value of 0. 962 (&gt;0.05) with a correlation coefficient of 0.005 which means there is no correlation between ferritin levels and the value of the rate of blood absorption in second trimester pregnant.

The Role of Invasive Diagnostics of Systemic Connective Tissue Diseases in Respiratory Inflammation

Systemic connective tissue diseases (SCDs) are a group of diseases caused by inadequate autoimmune or immune complex reactions, manifested by damage to various organs and systems. Objective — to present our own experience and to propose an algorithm for the diagnosis of CTDs. Materials and methods. We carried out a clinical analysis of 55 newly diagnosed cases of CTDs in patients who were treated at the Department of Thoracic Surgery and Invasive Diagnostic Methods, from 2010 to 2023. For the purpose of histological verification of the diagnosis, 57 invasive interventions were performed on 55 patients, — 55 video thoracoscopic (VATS) and 2 endobronchial (EVUS) biopsies. Results and discussion. lesions of the cardiovascular system occurred in 30 (54.5%) patients, kidneys — in 26 patients (47.3 %), edematous syndrome — in 31 (56.4 %) patients, hyperthermia — in 22 (40.0 %), anemia — in 23 (41.8 %), increased erythrocyte sedimentation rate — in 34 (61.8 %) cases. As a result of 57 invasive interventions, 79 biopsies of various tissues were obtained: 41 (51.9 %) of the pleura, 25 (31.6 %) of the lung, 11 (13.9 %) of the pericardium, 2 (2.5 %) of the intrathoracic lymph nodes. An algorithm for the diagnosis of SCDs is proposed. Conclusions. Newly diagnosed patients with combined damage to the respiratory, cardiovascular and kidney systems without a history of chronic damage to any of them should be considered as a risk group for further diagnosis of SCDs. The use of VATS biopsies of affected tissues should be the standard of investigation along with immunological confirmation for establishing the type of SCDs. Identification of the type of SCDs should be carried out taking into account clinical manifestations based on the results of pathomorphological examination and serological verification of the diagnosis by specialized specialists.

Spanish cohort of VEXAS syndrome: clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism

BackgroundThe vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants.ObjectivesTo investigate the presence of VEXAS syndrome among patients with...

Identification of hydatid cysts and concomitant liver enzyme dysfunction in patients from Al-Najaf and Al-Diwaniyah City by conventional and phylogenetic methods

Hydatid cyst infection is a serious disease that affects humans who come into touch with the infective stage of the tapeworm Echinococcus granulosus, which is found all over the world. The current study used patient physical and laboratory examinations, X-ray imaging, ultrasonic inspection, and polymerase chain reaction (PCR) to identify hydatid cyst presence in patients from the Iraqi cities of Al-Najaf and Al-Diwaniyah and to identify hydatid cysts and concomitant liver enzyme dysfunction in patients from the Iraqi cities of Al-Najaf and AlDiwaniyah using conventional and phylogeny. Both strategies used partial gene sequencing (PGS) to target the E. granulosus antigen subunit B2 (EgB2) gene. The findings revealed an abdominal lump (6-7cm, left costal border), leukocytosis (12103/mm3), eosinophilia (84101/mm3), and an increased erythrocyte sedimentation rate (ESR) (35mm/hr), ultrasonic-detected splenic and liver cysts, and increased levels of alkaline phosphatase (ALP)= Mean standard error (MSE) (170.12.3 IU/l), Patients with such changes were then given surgical interventions to diagnose and remove cysts, which were identified as hydatid cysts (wheel-like, "rosette-like," or "honeycomb-like" cysts with cystic cavity-based "snowflakes" like protoscoleces, wavy or serpentine-like cystic membranes of punctured or solid-pseudotumor ball-like calcified degenerated cysts, respectively). The existence of hydatid cysts from the E. granulosus tapeworm was discovered by PCR. The PGS validated the results of the previous tests, yielding three nucleotide-sequence-based isolates that were identical to those from Brazil (bovine), Argentina (camelid), and Bengal (buffalo). The study found hydatid cyst infection in human patients in the Iraqi cities of Al-Najaf and Al-Diwaniyah, implying the presence of the adult form of the worm, Echinococcus granulosus tapeworms, in dogs in these areas. Keywords: Echinococcus granulosus, EgB2 gene, hydatid cysts.

E08 Single center study of Systemic Juvenile Idiopathic Arthritis in Moroccan patients

Abstract Introduction Juvenile idiopathic arthritis (JIA) is the most common rheumatological disorder in childhood. About 10% to 20% of children with JIA have a rare and serious subtype called systemic juvenile idiopathic arthritis (SJIA). SJIA differs from other subtypes in that it’s the only one considered an autoinflammatory rather than autoimmune disease because of the association with systemic features and is therefore treated differently with anti-IL1 and anti-IL6. Objectives To describe epidemiological data of SJIA in Moroccan patients taking into account environmental conditions. To compare existing criteria (ILAR, Fautrel, Yamaguchi) to the new Pediatric Rheumatology International Trials Organization (PRINTO) classification currently in the process of validation. Patient and methods Retrospective prospective study conducted between January 2019 and December 2022. SJIA was diagnosed based on one of the four classification criteria ILAR, Fautrel, Yamaguchi or PRINTO Classification after ruling out infectious disease, immunodeficiency and malignancy whenever necessary. Complete remission was defined as the absence of clinical signs and inflammatory syndrome. Partial remission was defined as the absence of active clinical signs with persistence of inflammatory syndrome. Results Nine SIJA (44% male) patients were enrolled. The mean age at diagnosis was 4 years 8 months, the mean time to diagnosis was 4.8 months (range 1 – 24 months), the average follow up period was 16.4 months. At the time of diagnosis, the most common findings were typical fever (100%), arthritis (66%), skin rash (55%), 2 patients had pericarditis and one had macrophage activation syndrome (MAS), there was no renal or pulmonary involvement. Laboratory data showed in all patients, high level of C-reactive protein at mean value of 183 mg/l, increased erythrocyte sedimentation rate at mean of 88 mm first h, hyperleukocytosis at mean of 17 000 WBC/mm3 with high neutrophil counts at a mean of 12 297/mm3 and thrombocytosis at a mean of 625 000/mm3. To rule out other diagnosis, para clinical evaluation showed a positive antinuclear antibody in one patient without pathogenic significance, a bone marrow count performed in 3 patients, showed normal count in 2 patients and hemophagocytosis in one patient and immunoglobulins assay performed in 3 patients was normal. Of the 9 patients, 4 met all the criteria, 2 were diagnosed based on Yamaguchi criteria and one on Fautrel criteria, one fulfilled all criteria except ILAR and the last fulfilled only ILAR and new PRINTO classification. One patient was treated with corticosteroid pulse therapy for MAS and then oral corticosteroids with complete remission. Another received corticosteroids and biotherapy [tocilizumab (TCZ)] upfront due to late consultation and severe form with complete remission. Seven patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) of which one achieved partial remission with a delay of 2 months of follow up and 6 required adjunctions of another medication: corticosteroids (4), MTX (2), biotherapy (5) [anakinra (5), Switch TCZ (2)] with complete remission. The last patient reached complete remission under corticosteroids, Triamcinolone Hexacetonide knee infiltration and methotrexate. Anakinra was the most common first-line biologic treatment choice (n = 5), and 2 of them need switch to Tocilizumab to achieve remission. One of the 2 patients with pericarditis needed a rescue drainage. Outcome was favorable in all patients except one who had a relapse with final remission, and articular sequel in 3 patients. Discussion and conclusion SJIA is a rare but serious condition with high risk of morbidity related to arthritis and mortality from MAS and pericarditis. The latter features turn into a good prognosis with early diagnosis and treatment, as we have done. It can occur any time during childhood, but it most commonly starts at around the age of two years, unlike our patients who were older. No predominance ratio is reported as we have noted. SJIA is referred to as Still disease by some authors justifying the new PRINTO classification and the specific treatment. In our study, Yamaguchi criteria seem to be the most sensitive (7/9 fulfilled) followed by New PRINTO classification and Fautrel criteria (6/9 fulfilled), ILAR criteria are the less sensitive (5/9 fulfilled) what can delay diagnosis and treatment. Our study showed the benefit of biological agent, 66% of patients achieved remission with at least one biological agent and we concluded that Anti-IL1 drugs are mostly preferred for ongoing systemic inflammation. However Anti-IL-6 agents are very efficient in patients with a polyarticular course.

Prevalence and risk factors associated with psoriatic arthritis among patients with psoriasis.

Psoriatic arthritis is a chronic, autoimmune inflammatory arthritis that occurs with psoriasis and has profound impact on patients' physical and psychological well-being. This study aims to determine the prevalence and risk factors associated with psoriatic arthritis among patients with psoriasis. A single-center, cross-sectional study was conducted over a 12-month period at the Dermatology Clinic, Hospital Pulau Pinang, Malaysia involving all consecutive psoriasis patients. CASPAR (ClASsification of Psoriatic ARthritis) criteria were used to diagnose psoriatic arthritis. A total of 360 patients with psoriasis were recruited, of whom 107 (29.7%) had psoriatic arthritis. Psoriatic arthritis patients had equal gender distribution and the mean age of arthritis onset was 40.7 ± 12.8 years. Psoriasis preceded arthritis in 81.3% of patients (n = 87) with a mean latency interval of 10.5 years. Polyarthropathy was the predominant subtype affecting 46.8% (n = 50) of patients, followed by oligoarthropathy (22.4%, n = 24), axial joint disease (5.6%, n = 6), predominant distal interphalangeal joint disease (2.8%, n = 3), and mixed subtype (22.4%, n = 24). Enthesitis and dactylitis occurred in 12.1% (n = 13) and 20.6% (n = 22) of arthritis patients, respectively, and deformity was present in 37.4% (n = 40). Psoriatic arthritis was significantly associated with being an ever smoker (adjusted odds ratio [aOR] 0.41; 95% confidence interval [CI] 0.18-0.91, p = .029), genital psoriasis (aOR 2.25; 95% CI 1.17-4.33, p = .015), and increased erythrocyte sedimentation rate (ESR) (aOR 1.02; 95% CI 1.01-1.04, p = .005) and C-reactive protein [CRP] (aOR 1.04; 95% CI 1.00-1.08, p = .040). Our study showed a high prevalence of psoriatic arthritis among the psoriasis cohort. Genital involvement, and increased ESR and CRP were associated with psoriatic arthritis among patients with psoriasis.

Demographic Characteristics besides Clinical and Laboratory Manifestations of Children with Visceral Leishmaniasis in Rasht, Northern Iran.

Visceral leishmaniasis (Kala-azar) is an inherently dangerous and progressive disease that can be seen in many parts of the world, including Iran. Therefore, we decided to conduct this study on children with Kala-azar in Rasht-Iran. In this descriptive study, the hospital records of all children with Kala-azar disease admitted to 17 Shahrivar Hospital, Rasht-Iran from 2009 to 2021 were reviewed. Required information were collected from patients' records and descriptive statistical analysis was done using SPSS version 24 statistical software. A total of 22 children with visceral leishmaniasis were admitted to 17 Shahrivar Hospital during the study period. The average age of the children was 2.93 ± 3.32 years. Most of them (59.1%) were boys and lived in the foothills (59.1%). The most common season for children to get the disease was spring (45.5%), and the average duration of the disease until hospitalization was 16.5 ± 13.54 days. In this study, the most common clinical manifestations included fever (90.9%), splenomegaly (77.3%), hepatomegaly (50%), weakness and restlessness (27.3%), and vomiting (18.2%). The most common laboratory findings were anemia (90.9%), leukopenia (59.1%), increased erythrocyte sedimentation rate (ESR) (75%), and increased C-reactive protein (CRP) (75%). 72.7% of the children were treated with liposomal amphotericin and others with glucantime, which were all successful. The results of our studies were consistent with most studies in Iran and other countries. These findings can help in the diagnosis and management of children with Kalaazar and better control of the disease in the province.

Sediment transport trend and its influencing factors in coastal bedrock island sea areas-a case study of Chudao island, China

Coastal bedrock islands sea areas have a unique natural environment, frequent human activities, and complex sedimentary dynamic processes. In this paper, we select the Chudao Island sea area off the coast of Shandong Peninsula, China, as a typical research area to investigate the sediment transport trends and influencing factors by means of high-precision bathymetric survey, high-density sediment sampling, grain-size trend analysis and hydrodynamic numerical modeling. Results and analysis indicate that the grain size parameters including mean grain-size, sorting coefficient and skewness are zonal distributed, roughly parallel to the isobaths. While the overall sediment transport trend is from island shore to sea, with several convergence centers near the loop centers of bottom flow and at the edge of the agriculture area. The near-bottom flow velocity is primary factor that controlling the significance of sediment transport trend, while the flow decides the general patterns of sediment transport trend and sediment distribution. Submarine topography can either directly transport sediments down its slope, or indirectly affect the direction of sediment transport by constraining the near-bottom flow from shallow to deep waters. Besides the natural factors of bottom flow and submarine topography, human activities represented by aquaculture also affect the sediment transport trend in coastal bedrock island sea areas. First, the increased sedimentation rate caused by organic matters and the diffusion of scallop fragments may cause sediment coarsening. Second, the artificial aquaculture facilities can reduce flow velocity and therefore hinder the initiation, suspension and transport of sediment near the aquaculture areas. Our methods and findings provide high-resolution details to insight into the sediment transport trends to improve the understanding of the modern sediment dynamics in small-scale coastal bedrock island sea areas and provide reference for corresponding engineering and agriculture activities.