Inflammatory Etiology Research Articles

Extremely high canine C-reactive protein concentrations\u2009>\u2009100\u2009mg/l\xa0\u2013 prevalence, etiology and prognostic significance

BackgroundIn human medicine, extremely high CRP (C-reactive protein) concentrations > 100 mg/l are indicators of bacterial infection and the need of antibiotic treatment. Similar decision limits for septic pneumonia are recommended for dogs but have not yet been evaluated for other organ systems. The aim of the retrospective study was to investigate the prevalence and evaluate dogs with CRP concentrations > 100 mg/l regarding the underlying etiology, the affected organ system and the prognostic significance.ResultsPrevalence of CRP > 100 mg/l was investigated in dogs presented between 2014 and 2015 and was 12%.For evaluation of etiology and organ systems, dogs with CRP > 100 mg/l presented between 2014 and 2016 were enrolled. Dogs were classified into 4 main disease categories, i.e. inflammatory, neoplastic, tissue damage or “diverse”. Diseases were assigned to the affected organ system. If an organ classification was not possible, dogs were classified as “multiple”. 147 dogs with CRP 101–368 mg/l were included and classified into disease categories: 86/147 (59%) with inflammatory etiology (among these, 23/86 non-infectious, 44/86 infectious (33/44 bacterial), 19/86 inflammation non-classifiable), 31/147 (21%) tissue damage, 17/147 (12%) neoplastic (all malignant) and 13/147 (9%) diverse diseases. The affected organ systems included 57/147 (39%) multiple, 30/147 (20%) trauma, 21/147 (14%) gastrointestinal tract, 10/147 (7%) musculoskeletal system, 8/147 (5%) respiratory tract, 7/147 (5%) urinary/reproductive tract, 6/147 (4%) skin/subcutis/ear, 6/147 (4%) central/peripheral nervous system and 2/147 (1%) heart. The disease group (p = 0.081) or organ system (p = 0.17) did not have an impact on CRP. Based on CRP, a detection of bacterial infection was not possible.The prognostic significance was investigated by determining the 3-months survival and hospitalization rate in a subgroup with known outcome. The 3-months survival rate was 46/73 (63%) while the majority 66/73 (90%) of patients was hospitalized.ConclusionsCRP concentrations > 100 mg/l are occasionally seen in a clinic population. They indicate a severe systemic disease of various etiologies with guarded prognosis. Extremely high CRP concentrations do not allow a conclusion of the underlying etiology or an identification of bacterial inflammation.

Facial palsy caused by an intrameatal metastatic disease - Reconstruction with an autologous sural nerve graft

Dysfunction of the facial nerve is frequently attributed to inflammation, followed by traumatic injury. Knowledge of the complex anatomical course of the facial nerve is critical to localize the site of pathology and for successful management. The multiplicity of etiologies and its complex anatomy often make facial paralysis a diagnostic challenge. Neoplasms are a fairly rare cause of peripheral facial palsy, and are frequently overlooked in search of the more frequent traumatic or inflammatory etiologies of facial paralysis. Isolated metastatic lesions to the cerebellopontine angle (CPA) and internal auditory canal (IAC) are extremely rare. Their accurate diagnosis is difficult, since they share common clinical and radiological characteristics with vestibular schwannomas. We report a case of a 63-year-old female with a rapidly progressive left-sided hearing loss and complete facial palsy. Magnetic resonance imaging revealed a left intrameatal lesion. A provisional diagnosis of intracanalicular schwannoma or meningioma was made, although the possibility of metastasis due to her rapid neurological deterioration was considered. The patient underwent a translabyrinthine complete removal of the tumor followed by facial nerve reconstruction. The final histopathological findings revealed a metastatic breast adenocarcinoma. To our knowledge only seven prior cases of an isolated metastatic CPA lesion have been reported. In patients without a known malignancy, a rapid progression of hearing loss, disequilibrium, and facial palsy might be the first sign of a metastatic CPA lesion.

MON-397 Potential Relationship Between Hypothyroidism and Bone Loss at Dental Implants

Introduction: Hypothyroidism (HT) is an endocrine condition with autoimmune and inflammatory etiologies. Studies have shown that both periodontal disease and peri-implant bone loss are bidirectionally influenced by systemic inflammatory conditions, such as diabetes, adverse pregnancy outcomes, cardiovascular disease, and osteoporosis.1 There also is evidence that HT is associated with decreased bone metabolism, depressed bone turnover, and a prolonged bone remodeling cycle.2 Consequently, the objective of this study was to determine if the severity of bone loss around dental implants is related to the presence of HT. Methods: Following IRB approval, medical, dental, and radiographic records of patients who received dental implant placement at a university-based postgraduate program in periodontics from 2000–2017 were reviewed (1480 implants; 635 patients). Rate of bone loss in mm/year was calculated from surgical implant placement and subsequent re-evaluation radiographs, with correction for radiographic distortion. Presence of HT was confirmed by review of patient medical records, clinical diagnosis of HT, and history of thyroid hormone supplementation. Populations were adjusted for smoking, diabetes, use of systemic steroids, presence of autoimmune disease (other than HT), and systemic inflammatory conditions. Calculations were performed using IBM SPSS Statistics v25. Results: Patients with HT had a decreased rate of crestal alveolar bone loss around dental implants. Specifically, patients with HT experienced peri-implant bone loss at a rate of 0.42 mm/year, while bone loss from patients without HT was 1.34 mm/year (68.7% decrease; mean difference = 0.92 mm/year, 95% confidence interval = 0.39–1.50 mm/year, P<0.002). There were no significant differences in patient oral hygiene, or in implant service time, among any of the groups studied (P>0.05). Conclusions: The results suggest that the rate of marginal alveolar bone loss at dental implants is significantly decreased in patients with HT, and occurs independently of any of the systemic conditions noted above. The findings imply that potential changes in bone metabolism and remodeling associated with HT might result in less peri-implant alveolar bone loss following implant placement surgery. As a result, there does not appear to be an increased risk of peri-implant crestal bone loss in patients with HT.

Topical Therapy of Periclitoral Lesions Associated With Dysuria and Pelvic Pain

Background: Chronic dysuria can be diagnostically challenging as it may be a symptom of a variety of conditions, including infectious, inflammatory, hormonal, and neoplastic etiologies. The evaluation of dysuria may encompass multiple diagnostic tests, including cultures, imaging, and instrumentation and lead to the potential overuse of antibiotics and analgesics. We sought to evaluate the association of dysuria and vulvar vestibule pain with periurethral anatomic lesions and response to treatment of same. Methods: Twelve women were referred for evaluation of chronic dysuria and periurethral or periclitoral burning. Patient ages ranged from 17 to 73 years (mean, 51; median, 46). All patients had a history of irritating urinary symptoms and dyspareunia and had failed courses of empiric antibiotics with negative urinary cultures. On physical examination, all patients were found to have tender punctate erythematous erosions of the midline periclitoral and periurethral mucosa. For 4 weeks, 3 patients were treated with topical estradiol cream and clobetasol to the periclitoral area and 9 were treated only with topical estradiol cream.

COPD exacerbation phenotypes in a real-world five year hospitalisation cohort.

COPD exacerbation phenotypes have been defined in research populations by predominantly infective or inflammatory aetiology. We sought to characterise this in patients admitted to our centre. Case-notes of consecutive patients discharged alive after treatment for acute COPD exacerbations between December 2012 and January 2017 were analysed. Data were collected on treatment, length of stay, C-reactive protein (CRP), eosinophil count and bacterial sputum culture positivity for potentially pathogenic microorganisms (PPM). 1029 exacerbations were included. There was an inverse correlation between CRP and eosinophil count (rho=-0.277, p<0.01). The proportion of eosinophilic exacerbations (eosinophils ≥0.3×109/L) was low (157, 15%). Median length of stay was longer in patients with a CRP >100mg/L (4d [3,8] vs 4d [2,7], p<0.01) or when given antibiotics (4d [2,8] vs 3d [1,6], p<0.001) and shorter if receiving corticosteroids (4d [2,6] vs 6d [3,7], p<0.001). Being sputum culture positive on first exacerbation was associated with sputum culture positivity in subsequent exacerbations. Patients with PPM in sputum culture had a significantly higher median CRP than culture negative patients (38mg/L [18.75, 57] v 18mg/L [8.5,45.5] p<0.05). Length of stay, eosinophil count and CRP were significantly correlated between exacerbation pairs. This real-world population found eosinophilic and high CRP exacerbations to be distinct and significantly stereotyped within individual patients across recurrent exacerbations. High CRP exacerbations are associated with greater healthcare utilisation and chance of sputum positivity with PPM. Eosinophilic exacerbations were associated with lower rate of readmission. Phenotype-driven treatment warrants further investigation in this population.

Imaging spectrum of mesenteric masses.

Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.

Pulmonary tuberculosis in a recent immigrant

An elderly patient with a history significant for recent immigration presented with acute onset hemoptysis and a focal infiltrate on chest x-ray. A broad differential for acute hemoptysis was considered including infectious, inflammatory, and neoplastic etiologies. Sputum samples revealed the presence of drug-susceptible M. tuberculosis and treatment guidelines were reviewed. The patient demonstrated response to first-line therapy, rifampin and isoniazid, and was subsequently discharged with follow-up chest x-ray. Tuberculosis is further discussed in the broader contexts of current Canadian screening guidelines, emerging drug-resistant strains, and the initiatives of the World Health Organization (WHO) to reduce its global burden.

Role of Matrix Metalloproteinase 9 in Ocular Surface Disorders.

(1) To explore the role and significance of Matrix Metalloproteinase 9 (MMP-9), a proteolytic enzyme, in various ocular surface diseases of inflammatory, infectious, and traumatic etiology (2), to further elucidate the molecular mechanisms responsible for its overexpression in ocular surface disease states, and (3) to discuss possible targets of therapeutic intervention. A literature review was conducted of primary sources from 1995 onward using search results populated from the US National Library of Medicine search database. MMP-9 overexpression has been found in in vitro and in vivo models of dry eye disease (DED), corneal ulceration, microbial keratitis, corneal neovascularization, ultraviolet light-induced radiation, and a host of additional surface pathologies. MMP-9 is involved in an intricate signal transduction cascade that includes induction by many proinflammatory molecules including interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-a), nuclear factor kappa light chain enhancer of activated B cells (NF-kB), platelet-activating factor, activator protein 1 (AP-1), and transforming growth factor beta (TGF-B). MMP-9 expression is blunted by a diverse array of molecular factors, such as tissue inhibitors of metalloproteinases, cyclosporine A (CyA), PES_103, epigalloccatechin-3-gallate (EGCG), N-acetylcysteine (NaC), ascorbate, tetracyclines, and corticosteroids. Inhibition of MMP-9 frequently led to improvement of ocular surface disease. Novel insights into the mechanistic action of MMP-9 provide potential for new therapeutic modulations of ocular surface diseases mediated by its overexpression.

Spontaneous gastric rupture presenting as severe pneumoperitoneum in a cat with presumed idiopathic gastric ulceration

An 11-year-old female British blue cat was referred for investigation of acute onset vomiting and marked abdominal enlargement. Diagnostic investigations confirmed a large volume of free gas within the abdomen...

Abstract TP207: Clinicoradiologic Discordance in Methamphetamine Vasculopathy-Associated Rhombencephalitis: Three New Cases of Temporal and Geographical Similarity

Introduction: Structural and functional imaging techniques have demonstrated CNS abnormalities due to methamphetamine use, however there are no prior reports of rhombencephalon involvement. Furthermore, clinicoradiologic discordance is unique to this case series. Methods: We report a case series of patients with a diagnosis of vasculopathy-associated rhombencephalitis out of proportion to clinical examination in the setting of methamphetamine use at our tertiary stroke center. Results: Three patients were evaluated within 3 months of each other for focal neurologic deficits with normal mental status at our tertiary stroke center. All admitted to recent methamphetamine use. MRI of the brain with and without contrast demonstrated T2 hyperintensity without enhancement or diffusion restriction involving primarily the pons, consistent with vasogenic edema or demyelination (Figure 1). Workup for infectious and inflammatory etiologies including CSF analysis was unremarkable. All patients had vessel imaging demonstrating extracranial vasculopathy; all had dissections of the vertebral arteries, one of which had an associated pseudoaneurysm (Figure 1). All of the patients had GCS of 15 and minimal to no improvement with various treatment. Conclusion: Vasculopathy-associated rhombencephalitis in the setting of acute methamphetamine use has not been reported previously. The temporal and geographic relationship among these cases is key to the suspected diagnosis that a methamphetamine adulterant has a leukotoxinogenic predilection for the rhombencephalon. The cause of significant clinicoradiologic discordance remains unclear. Further investigation into this association is needed.

A 6-Week, Prospective, Randomized, Single-Masked Study of Lifitegrast Ophthalmic Solution 5% Versus Thermal Pulsation Procedure for Treatment of Inflammatory Meibomian Gland Dysfunction

Meibomian gland dysfunction (MGD) is present in most cases of dry eye disease. MGD involves both inflammatory and obstructive etiologies. We compared efficacy and safety of treatment to reduce inflammation (lifitegrast) versus obstruction [thermal pulsation procedure (TPP)] in patients with inflammatory MGD over 42 days. This was a single-center, 6-week, prospective, randomized, single-masked study of adults with inflammatory MGD, defined as having all of the following: burning, stinging, dryness; thickened secretions or occlusion of glands; eyelid redness; and elevated matrix metalloproteinase-9. Patients received lifitegrast ophthalmic solution 5% twice daily for 42 days or one TPP treatment at day 0. Seven symptoms and 8 objective measures of dry eye disease were assessed. Overall, 40 of 50 randomized patients (80%) were women with mean (SD) age 65.8 (8.9) years. Lifitegrast-treated (n = 25) versus TPP-treated (n = 25) patients had greater improvement from baseline to day 42 in eye dryness [mean (SD) change from baseline: -1.05 (0.79), lifitegrast; -0.48 (0.96), TPP; P = 0.0340], corneal staining [-0.55 (0.80), lifitegrast; 0.12 (1.09), TPP; P = 0.0230], and eyelid redness [-0.77 (0.43), lifitegrast; -0.38 (0.58), TPP; P = 0.0115]; trend favored lifitegrast for best corrected visual acuity and gland patency. Unexpectedly, TPP treatment did not improve lipid layer thickness or gland patency compared with lifitegrast. No adverse events were reported. Although MGD is often considered a disease of gland obstruction, these findings demonstrate antiinflammatory treatment with lifitegrast significantly improved patient symptoms and signs compared with treatment for obstruction (TPP). Lifitegrast should be included in treatment for inflammatory MGD.

Spinal Epidural Abscess.

Spinal Epidural Abscess.

COVID-19 ve Sitokin Fırtınası

Although the etiopathogenesis of infections has been largely illuminated by technical and scientific developments in the past century; many issues are still not clear today. The word “there is no disease, there is a patient” is stil valid today. Because the immune response of the host is as important as the virulence of the pathogen in infections and disease course can vary a lot according to the person. Cytokine Storm is seen exactly in a group of diseases where the host response is very prominent. For this reason, Cytokine Storm Syndrome (CSS) is mostly mentioned. CSS emerging due to different inflammatory etiologies; it is an overwhelming systemic inflammation, hemodynamic imbalance, multiple organ failure, and potentially leading to death. After being first seen in Influenza in 2003 as a viral agent, CSS was seen in SARS-Cov, MERS-CoV and SARS-CoV2, which were found to be the las thuman disease from the Corona viridea family.The novel coronavirus SARS-CoV2 causes COVID-19, a pandemic threatening millions. Uncontrolled production of pro-inflammatory mediators contributes to, acut respiratory distress syndrome (ARDS) and cytokine storm syndrome in COVID-19.

Retrospective analysis of the spread of cat chlamydia and features of its treatment with a drug based on azithromycin

The Chlamydiales order bacteria are eukaryotic cells obligate intracellular parasites. The major purpose of the research was to study the prevalence, clinical progression and treatment of Chlamydia in cats with an azithromycin-based drug. A total of 3,388 samples for chlamydia were studied in 2019, of which 243 proved to be positive. Chlamydia was diagnosed using the polymerase chain reaction (PCR) technique. The Azithronit drug was administered 0.5 ml per animal, 1 time per day, for 7 days. Hematological parameters were determined using the IDEXX Laser Cyte hematological analyzer, while the biochemical parameters were determined using the IDEXX Catalist analyzer (USA). In Moscow, chlamydial infection plays a significant role in the cats inflammatory eye diseases etiology. The overall infection rate of the Moscow cat population totalled 7.2%. In young animals, the incidence was higher (28.3%) than in adults (19.5%). In terms of gender, the incidence of chlamydia in female cats (56%) was higher than in males (44%). The main forms of chlamydia manifestations were those of purulent and serous conjunctivitis - 69.8% and 20.5%, respectively, keratitis - 8.7%. The treatment with azithromycin-based drugs requires only a single daily administration for 7 days to ensure the clinical signs elimination.

Premature vascular disease in young adult stroke: a pathology-based case series.

The prevalence of modifiable vascular risk factors is increasing in young adults and may contribute to the growing frequency of stroke in this population. The neuropathology and end-organ damage profile of young adult stroke patients with clinically advanced atherosclerosis or arteriosclerosis has not been studied. This retrospective study included patients aged 18-60years admitted to our hospital from 1995 to 2017 with recurrent ischemic or hemorrhagic strokes, fatal stroke, or stroke associated with advanced small vessel disease (SVD) on brain MRI, who had no evidence for structural, genetic, inflammatory, or infectious etiology for stroke, and had adequate pathological materials available for analysis. The presence of atherosclerosis, arteriolosclerosis, left ventricular hypertrophy, and nephrosclerosis was evaluated. Twelve patients (mean age 47 ± 9years, range 31-57years, 67% male) met inclusion criteria. Four had fatal intracerebral hemorrhage (ICH), three had recurrent non-fatal ICH, one had ICH with advanced SVD on MRI, and four had recurrent ischemic strokes including two with transient ischemic attacks. Pathological studies showed moderate/severe atherosclerosis in 64% and moderate/severe arteriolosclerosis in 42% of patients. Pathological data to evaluate end-organ damage were available for nine patients; eight showed left ventricular hypertrophy and all showed nephrosclerosis. Young adult stroke patients with recurrent stroke, fatal stroke, or SVD on imaging have advanced atherosclerosis and arteriolosclerosis-related pathological changes in multiple organ systems. Aggressive control of atherosclerosis risk factors is warranted even in young individuals.

Resident Perspectives

Resident Perspectives

Cellular Spindled Histiocytic Pseudotumor: A Benign Mimic of Spindle Cell Neoplasia of the Breast.

Cellular spindled histiocytic pseudotumor (CSHPT) is an exuberant, dense histiocytic proliferation seen in the setting of mammary fat necrosis. CSHPT has a broad histologic differential diagnosis, including benign, malignant, and inflammatory etiologies. To highlight the most important histologic and immunohistochemical findings of CSHPT and provide comparisons to entities within the broad differential diagnosis. Recently published literature regarding CSHPT and other diagnostic considerations. CSHPT is a benign histiocytic proliferation with a broad differential diagnosis, for which comprehensive ancillary studies may be required to exclude malignant and infectious entities.

Effects of fish oil supplement on psoriasis: a meta-analysis of randomized controlled trials

BackgroundFish oils, which contain omega-3 polyunsaturated fatty acids as the active ingredients, possess anti-inflammatory activities and may have therapeutic potential in diseases with an inflammatory etiology. Fish oil supplement has been advocated for treating psoriasis which is a chronic inflammatory dermatosis.ObjectiveWe aimed to investigate the effects of fish oil supplement on psoriasis.MethodsWe searched CENTRAL, Embase and MEDLINE on 24 January 2018 for randomized control trials (RCTs) on the effects of fish oil supplement in treating psoriasis. The Cochrane Collaboration’s tool was used to assess the risk of bias of included RCTs. We performed a random-effects model meta-analysis to obtain the pooled treatment effect estimates.ResultsWe included 13 RCTs with 625 participants. Three RCTs involving 337 participants provided usable data for meta-analysis. Fish oil supplement did not significantly reduce the severity of psoriasis when assessed by Psoriasis Area and Severity Index score (mean difference − 0.28; 95% confidence interval − 1.74 to 1.19).ConclusionThe current evidence does not support the use of fish oil supplement in treating psoriasis.

Acute Transverse and Flaccid Myelitis in Children.

The etiologies of myelitis in children are broad, and our understanding of inflammatory myelopathies in the pediatric population continues to evolve. Acute flaccid myelitis (AFM), increasingly linked to enterovirus infections, has risen in incidence over recent years. As with other infectious myelopathies, AFM can be challenging to distinguish from inflammatory causes of acute transverse myelitis (ATM) at initial presentation. This review outlines an approach to the treatment of children presenting with myelopathy of suspected inflammatory etiology, with attention to how management may differ in the specific case of acute flaccid myelitis. Although high-quality evidence is limited, intravenous corticosteroids, intravenous immunoglobulin, and plasma exchange have important roles in the acute management of ATM. Spinal cord injury in AFM, though similar to ATM in clinical presentation, is largely mediated by direct infection as opposed to a primary inflammatory process, and treatment with corticosteroids may worsen outcomes. Awareness of the distinguishing clinical features of AFM and the underlying inflammatory conditions that commonly manifest with ATM is essential to judicious selection of appropriate acute (and potentially chronic) therapies in children presenting with myelitis.

Magnetic resonance vessel wall imaging in cerebrovascular diseases

Cerebrovascular diseases manifest as abnormalities of and disruption to the intracranial vasculature and its capacity to carry blood to the brain. However, the pathogenesis of many cerebrovascular diseases begins in the vessel wall. Traditional luminal and perfusion imaging techniques do not provide adequate information regarding the differentiation, onset, or progression of disease. Intracranial high-resolution MR vessel wall imaging (VWI) has emerged as an invaluable technique for understanding and evaluating cerebrovascular diseases. The location and pattern of contrast enhancement in intracranial VWI provides new insight into the inflammatory etiology of cerebrovascular diseases and has potential to permit earlier diagnosis and treatment. In this report, technical considerations of VWI are discussed and current applications of VWI in vascular malformations, blunt cerebrovascular injury/dissection, and steno-occlusive cerebrovascular vasculopathies are reviewed.