Initiation Of Appropriate Therapy Research Articles

Flow Cytometry as a Rapid and Valuable Method in Investigation of Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae Isolates.

Rapid detection of antimicrobial resistance is crucial for early initiation of appropriate therapy. The aim of this study was to investigate whether resistance to colistin, the last-resort antibiotic, in carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates can be detected accurately and rapidly by flow cytometry (FCM). The VITEK 2 automated system was used to identify 85 K. pneumoniae strains and to determine their resistance to carbapenems. The minimum inhibitory concentration (MIC) values for colistin in 85 CRKP strains were determined by broth microdilution (BMD), which is the reference method. In addition, FCM was used, combined with DiBAC4(3) fluorescent stain, to determine colistin susceptibility. The MIC₅₀ value of the strains, 80% of which were resistant to colistin by the BMD method, was 16 mg/L, and the MIC₉₀ value was 32 mg/L. When FCM was compared with the reference method, it was determined that the specificity was 94.1%, sensitivity was 100% of FCM, and Cohen's kappa value was 0.96. Colistin susceptibility results with FCM were obtained within an average of 2 h. These findings suggest that FCM holds great promise as a rapid and reliable alternative method for detecting colistin resistance in CRKP strains.

Incidental Findings are frequent in shoulder CT and MRI scans and increase with age

ObjectivesCT and MRI scans of the shoulder can lead to the identification of incidental findings (IF), which can have a major impact on the further treatment of the patient. The aim of this retrospective study was to record the prevalence of IF, incidentalomas (IT) and malignant IT for CT and MRI examinations of the shoulder and to investigate the effect of patient characteristics on the statistical occurrence of IF, IT and malignant IT. Materials and MethodsA total of 903 shoulder examinations (415 CT, 488 MRI) were retrospectively analyzed for the presence of IF, subsequently categorized (harmless IF, IT requiring clarification, malignant IT) and analyzed regarding patient characteristics. The statistical analysis was carried out using independent t- and chi-square tests. A significance level of p<0.05 was set. ResultsAmong the 903 patients evaluated (436 female, 467 male), 153 (16.9%) patients experienced IF (harmless IF: 101 (11.2%) patients, IT: 94 (10.4%), malignant IT: 4 (0.4%). The average age of the patients without IF and IT was significantly lower compared to the patients with IF and IT (p < 0.001). While IF occurred in 31.1% of the CT, IF was only detected in 4.9% of the MRI (p < 0.001). ConclusionIF have a high prevalence (16.9%), especially in CT examinations of the shoulder, which increases with age. The exact detection and initiation of appropriate therapy is of great clinical importance, as early detection of life-threatening diseases enables more effective treatment and a potential gain in health and lifespan.

Amoebic liver abscess in an adult Nigerian: A case report

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA. Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations. Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment. Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.

Overview of ADAMTS13 Protein in Diagnosis and Patient Management of TTP

The accurate diagnosis and effective management of Thrombotic Thrombocytopenic Purpura (TTP), a rare but life-threatening hematologic disorder, rely critically on the assessment of ADAMTS13 activity. ADAMTS13, a von Willebrand factor-cleaving protease, plays a pivotal role in the pathophysiology of TTP. This review synthesizes current understanding and recent advancements in the role of ADAMTS13 in the diagnosis and therapeutic monitoring of TTP, with a specific focus on the implementation of a fluorescence resonance energy transfer (FRET)-based assay for ADAMTS13 activity. Our retrospective analysis of 50 suspected TTP cases, including 19 confirmed diagnoses, revealed that the FRET-based assay significantly improved the sensitivity and specificity of TTP diagnosis compared to traditional qualitative methods. Furthermore, the FRET assay facilitated timely initiation of appropriate therapies and monitoring of disease activity, underscoring its utility in clinical practice. Our findings highlight the FRET-based ADAMTS13 activity assay's contribution to enhancing the diagnostic accuracy and management efficiency of TTP, suggesting its potential as a standard diagnostic tool in clinical settings. The review aims to provide a comprehensive overview for hematologists and laboratory medicine practitioners, encouraging the adoption of the FRET-based assay to improve patient outcomes in TTP management.

Hyperammonemia in the Pediatric Emergency Department.

Hyperammonemia is a serious clinical condition associated with significant morbidity and mortality. In the pediatric population, this is often caused by urea cycle disorders, acute liver failure, or other less common underlying etiologies. Children and teens with hyperammonemia can have a broad range of clinical findings, including vomiting, respiratory distress, and changes in mental status. As ammonia levels worsen, this presentation can progress to respiratory failure, encephalopathy, cerebral edema, seizures, and death. Given the risk of neurologic damage, timely identification and management of hyperammonemia is critical and includes initial resuscitation, early consultation with subspecialists, and initiation of appropriate therapies. It is important for pediatric emergency medicine providers to understand the clinical findings, causes, diagnosis, and management of hyperammonemia because they play a key role in the provision of effective, multidisciplinary care of these patients.

Multimodality imaging in cerebral venous thrombosis: a synopsis for emergency radiologist.

Cerebral venous thrombosis (CVT) is an uncommon but potentially fatal condition which presents with a wide range of symptoms. Some of these presenting features are vague thus contributing to the delay in diagnosis. A prompt diagnosis and initiation of appropriate therapy are therefore of paramount importance. In this pictorial, we have tried to illustrate the direct and indirect imaging features of CVT in detail on multiple imaging modalities, along with the potential pitfalls of imaging.

A Rare Case of Triple Negative Essential Thrombocythemia Presenting with Splenic Infarction: A Diagnostic Conundrum

Introduction Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by significant thrombocytosis with high propensity for thrombosis formation as well as other vascular complications. Most myeloproliferative neoplasms including ET are associated with Janus kinase ( JAK2) mutation. Other commonly associated mutations include Calreticulin ( CALR) and Myeloproliferative leukemia virus oncogene ( MPL) mutations. About 17% of cases of ET lack mutations in these driver genes. This presents a clinical conundrum for clinicians on initiation of appropriate treatment for these patients. We report a rare presentation of triple-negative ET with splenic infarction. Case Summary A 66-year-old Hispanic female who presented with left sided abdominal pain that gradually worsened over the course of 1 week; she believed it was stomach cramps. Laboratory evaluations were pertinent for platelet counts of 2000 x 10 9/L, hemoglobin level was 10.9 g/dl, and leukocytosis (white blood cell count 13.2k/uL) without left shift. Further work-up with iron studies was unremarkable and molecular studies were negative for BCR-ABL 1, PDGFR alpha/beta, FGFR 1, JAK2 V617F (including exons 12-13), CALR and MPL. A bone marrow biopsy showed an increase in megakaryocytes with some atypical forms with “enlarged size and nuclear hyper lobulation, and mild patchy reticulin fibrosis” suggestive of myeloproliferative neoplasm. Computed Tomography of the abdomen and pelvis with contrast showed evidence of splenic infarct. The patient was started on oral aspirin 81mg and oral hydroxyurea 2000 mg daily. Due to poor response to hydroxyurea and aspirin, she eventually had two cycles of platelet apheresis, and her platelet count improved to 1000 x 10 9/L. A repeat bone marrow biopsy was subsequently done to confirm essential thrombocythemia. At the time of discharge, the patient was asymptomatic and platelet count had decreased to 892 × 10 9/L. Discussion Essential thrombocythemia (ET) is a rare but recognized cause of vascular complications including arterial and venous thrombosis. Triple negative ET is quite uncommon and can pose a great deal of diagnostic challenge which can impact timing of initiation of appropriate therapy. This clinical vignette exemplified the conundrum encountered in making a diagnosis of triple negative ET. Following the World Health Organization (WHO) 2016 criteria for diagnosis of ET, patient has to have all 4 of: sustained platelet counts &amp;gt;450 x 10 9/L, bone marrow biopsy showing increased number of enlarged and mature megakaryocytes with no significant increase or left shift of granulopoiesis or erythropoiesis, presence of driver mutations/clonal markers (including JAK2, CALR and MPL mutations) or absent of evidence of iron deficiency or cause for reactive thrombocytosis and not meeting WHO criteria for Polycythemia vera or other myeloid neoplasms. Our patient met criteria for ET with no driver mutation detected, hence triple negative ET. She was also classified as high-risk ET using the revised International Prognostic Score for Essential Thrombocytopenia (IPSET). Initial work up of this patient was not confirmatory of the essential thrombocythemia due to the bone marrow biopsy not clearly defining features as per WHO stipulations, thus, a more aggressive therapy was not pursued. This can pose a great deal of diagnostic challenge which can impact timing of initiation of appropriate therapy. This is not uncommon especially considering sampling challenge. Studies has shown that early initiation of cytoreductive therapy prophylactically in a high-risk patients can avert vascular complications of ET (including splenic infarction). The index patient responded slowly to platelet apheresis which can be an effective treatment in acute thrombotic complication of ET. Conclusion The diagnosis of triple negative essential thrombocythemia can pose a clinical challenge which impacts effective management of this myeloproliferative neoplasm. There is a dire need for further discussion on this conundrum to provide more applicable recommendations to avert the rare but fatal complications of ET. Platelet apheresis can be an option for emergency treatment in patients presenting with a major vascular complication like splenic infarction.

Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study.

The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants' proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care.

Abstract 16341: A Rare Case of Dual Cardiomyopathy: Acute Decompensated Heart Failure Secondary to Eosinophilic Myocarditis and Ischemic Cardiomyopathy

Introduction: Dual cardiomyopathy, characterized by the coexistence of two distinct forms of myocardial dysfunction, is a rare phenomenon with complex diagnostic and therapeutic challenges. We present a unique case of a patient with combined eosinophilic myocarditis and ischemic cardiomyopathy. Case Presentation: A 65-year-old female with history of peripheral eosinophilia presented with worsening dyspnea and abdominal pain. CT abdomen was notable for right renal artery thrombosis. Troponin I was elevated at 0.057 ng/ml and 0.056 ng/ml. Notably, her absolute eosinophil count was elevated to 20.34 K/mcL. EKG with LVH and repolarization abnormalities. TTE showed a severely reduced LVEF of 18% and severe global hypokinesis. Decision Making: Given her newly diagnosed cardiomyopathy, a cardiac MRI was obtained that demonstrated presence of two moderate-sized cylindrical thrombi in the LV and subendocardial late gadolinium enhancement in the basal to mid antero/inferoseptum and inferolateral wall, characteristic of both myocardial infarction and eosinophilic myocarditis (Figure 1). She underwent a coronary angiogram that revealed severe mid LAD and OM1 artery stenosis that required PCI. She was initiated on appropriate medical therapy including steroids with normalization of her peripheral eosinophilia and improvement in her clinical symptoms. Discussion: This case highlights the intricate interplay between eosinophilic myocarditis and underlying ischemic cardiomyopathy. The timely initiation of appropriate therapies, including corticosteroids for eosinophilic myocarditis and revascularization for ischemic cardiomyopathy, can lead to favorable outcomes in these complex cases. Figure 1: Cardiac MRI showing inferolateral LGE and Cylindrical LV thrombi.

Correlation of NT-proBNP levels with clinical and echocardiographic features in evaluation of patients admitted with heart failure

Background: Heart failure (HF) is one of the leading causes of hospitalizations in both developed as well as developing nations. The natriuretic peptide N-terminal pro-BNP (NT-proBNP) has long been used for diagnosing and managing HF. The study aimed to determine the correlation of NT-proBNP levels with clinical and echocardiographic features in evaluation of patients admitted with heart failure. Methods: This is retrospective observational study of 37 patients admitted to the hospital with acute onset dyspnea, over a period of 18 months. In addition to detailed history and physical examination, complete blood counts, random blood sugar, blood biochemistry, and electrocardiography (ECG), bedside echocardiography and x-ray chest were performed on admission to the hospital. Measurement of serum NT-proBNP level was performed as part of evaluation of dyspnea. Results: Average age of the study population was 64 years. The co morbidities among the patients were hypertension (91%), diabetes mellitus (68%), obstructive airway disease (21%), coronary artery disease (16%) and chronic kidney disease (4%). The mean NT-proBNP for each group was LVEF ≥ 50%= 2272, LVEF 40–49% = 8161.5, and LVEF &lt; 40% = 17302.7 (pg/ml). Conclusion: NT-proBNP levels are proven to be useful in diagnosing and management of heart failure. However, the levels can be affected by many factors such as age, renal function, anaemia and body mass. When interpreting NT-proBNP levels, these factors have to be taken into account while making clinical decision and initiation of appropriate therapy. Keywords: heart failure; natriuretic peptides; NT- proBNP; hypertension

CO-INFECTION OF INFLUENZA AND DENGUE VIRUSES IN A PATIENT WITH GRAM-NEGATIVE BACTEREMIA- A CASE REPORT

Co-infection with influenza and dengue virus is a rare occurrence, and when combined with gram-negative bacterial infection, can present a complex clinical picture. We present the case of a 68 years old male, with prostrate carcinoma and prior trans-urethral resection of the prostate 1-year ago, now presented with symptoms of profuse sweating and undocumented fever for 4 days. He was positive for both Influenza A and Dengue virus and developed Gram-negative bacteremia. The patient manifested pyrexia, chills, severe body aches, and laboratory investigations revealed thrombocytopenia and hemolytic anemia. Patient was managed with supportive care, intravenous antibiotics, and supplemental oxygen. After 2 weeks of hospital stay, patient was discharged. Early recognition and initiation of appropriate therapy can lead to a favorable outcome in such cases. Thus, co-infection with influenza, dengue, and gram-negative bacteria can present with a complex clinical picture and requires prompt diagnosis and management. Keywords: Co-infection, Dengue virus, Hypoxia, Influenza, Thrombocytopenia.

A case study of rhino orbito cerebral Mucormycosis (ROCM) in a diabetic patient reported from a multispeciality hospital in Tamil Nadu

ROCM is the most common type of Mucormycosis and it can rapidly spread from the paranasal sinuses to orbit and brain which can be fatal in most patients. Diabetes mellitus is the most common risk factor in India. As invasive fungal diseases present with nonspecific clinical features, increasing awareness and education among clinicians about this deadly enemy is very crucial for early diagnosis and prompt initiation of appropriate therapy. We are reporting a case study on ROCM in a Diabetic patient caused by species along with a short review on the taxonomy, risk factors, pathogenesis, clinical forms, diagnosis and management of mucormycosis. We hope that this will help in expanding awareness among medical community about mucormycosis which is a lethal opponent of patients with Diabetes Mellitus.

Guillain-Barre syndrome and pulmonary embolism in an adult female with COVID-19 infection in Ghana: A case report.

The coronavirus disease 2019 (COVID-19) pandemic began at the end of 2019 in Wuhan, the capital of Hubei Province, China. This novel coronavirus is classified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurological manifestations are commonly associated with moderate to severe COVID-19 infection. Guillain-Barré syndrome (GBS) is a rare immune-mediated postinfectious neuropathy but there has been an increase in the number of cases of GBS associated with COVID-19, supporting the present body of global evidence of the notable association between the 2 conditions. We present the first proven case of GBS and pulmonary embolism associated with COVID-19 infection in Ghana, West Africa. A 60-year-old apparently healthy female presented in August 2020 to the COVID-19 treatment center of the Korle-Bu Teaching Hospital in Accra, Ghana from a referral facility following a week's history of low-grade fever, chills, rhinorrhoea, and generalized flaccid limb weakness. A positive SARS-CoV-2 test result was recorded 3 days after the onset of symptoms and the patient had no known chronic medical condition. Following cerebrospinal fluid analysis, neurophysiological studies and a chest computed tomography pulmonary angiogram, Guillain-Barre syndrome and pulmonary embolism were confirmed. The patient was however managed supportively and then discharged after 12 days on admission, as he made mild improvement in muscular power and function. This case report adds to the body of evidence of the association between GBS and SARS-CoV-2 infection, particularly from West Africa. It further highlights the need to anticipate potential neurological complications of SARS-CoV-2, particularly GBS even in mild respiratory symptoms for prompt diagnosis and initiation of appropriate therapy to improve outcomes and avert long-term deficits.

Antimicrobial susceptibility of bacterial uropathogens in a South African regional hospital.

Urinary tract infections are common bacterial infections affecting millions worldwide. Although treatment options for urinary tract infections are well established, with ciprofloxacin long considered one of the antibiotics of choice, increasing antibiotic resistance may delay the initiation of appropriate therapy. While this increase in antimicrobial resistance has been demonstrated in multiple studies around the world, there is a dearth of information from developing countries. This study aimed to describe the antimicrobial susceptibility patterns of commonly isolated bacterial uropathogens in a South African hospital. Antimicrobial susceptibility data of isolates obtained from urine specimens at the RK Khan Hospital, a regional hospital in KwaZulu-Natal, South Africa, between January 2018 and December 2020 were retrieved from the hospital's laboratory information system and analysed to determine the differences in resistance rates between the most frequently isolated bacterial uropathogens. Of the 3048 bacterial urinary pathogens isolated between 2018 and 2020, Escherichia coli (1603; 53%) was the most common, followed by Klebsiella spp. (437; 14%). Both E. coli and Klebsiella spp. showed high rates of resistance to amoxicillin/clavulanic acid (29.8% and 42.3%) and ciprofloxacin (37.7% and 30.4%). Nitrofurantoin resistance was low among E. coli (6.2%) but high among Klebsiella spp. (61.3%). E. coli and Klebsiella spp. in this study were highly resistant to amoxicillin/clavulanic acid and ciprofloxacin, two of the frequently prescribed oral treatment options. This study highlights the importance of regular local antimicrobial resistance surveillance to inform appropriate empiric therapy.

Frontiers in pathophysiology and management of thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is a fatal disease in which platelet-rich microthrombi cause end-organ ischemia and damage. TTP is caused by markedly reduced ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity. Hereditary or congenital TTP (cTTP) is caused by ADAMTS13 gene mutations. In acquired or immune TTP (iTTP), ADAMTS13 activity is reduced by anti-ADAMTS13 autoantibodies. TTP is characterized by thrombocytopenia, hemolytic anemia, fever, renal dysfunction, and neuropsychiatric symptoms. Therapeutic plasma exchange (TPE) and immunosuppressive therapy are the mainstays of treatment. As untreated TTP has a high mortality rate, immediate initiation of TPE is recommended when TTP is suspected. Conventionally, corticosteroids have been used for immunosuppressive therapy. Current drug therapies include rituximab, an anti-CD20 antibody that is effective in newly diagnosed cases and refractory cases, as well as for relapse prevention, and caplacizumab, an anti- von Willebrand factor (VWF) nanobody that inhibits the binding of platelets to VWF and prevents microthrombi formation. Recombinant human ADAMTS13 is a promising treatment for cTTP. Although these therapeutic advances have improved the outcomes of TTP, early diagnosis and prompt initiation of appropriate therapy are necessary to achieve these outcomes.

Consequences of rpoB mutations missed by the GenoType MTBDRplus assay in a programmatic setting in South Africa.

Rifampicin resistance missed by commercial rapid molecular assays but detected by phenotypic assays may lead to discordant susceptibility results and affect patient management. This study was conducted to evaluate the causes of rifampicin resistance missed by the GenoType MTBDRplus and its impact on the programmatic management of tuberculosis in KwaZulu-Natal, South Africa. We analysed routine tuberculosis programme data from January 2014 to December 2014 on isolates showing rifampicin susceptibility on the GenoType MTBDRplus assay but resistance on the phenotypic agar proportion method. Whole-genome sequencing was performed on a subset of these isolates. Out of 505 patients with isoniazid mono-resistant tuberculosis on the MTBDRplus, 145 (28.7%) isolates showed both isoniazid and rifampicin resistance on the phenotypic assay. The mean time from MTBDRplus results to initiation of drug-resistant tuberculosis therapy was 93.7 days. 65.7% of the patients had received previous tuberculosis treatment. The most common mutations detected in the 36 sequenced isolates were I491F (16; 44.4%) and L452P (12; 33.3%). Among the 36 isolates, resistance to other anti-tuberculosis drugs was 69.4% for pyrazinamide, 83.3% for ethambutol, 69.4% for streptomycin, and 50% for ethionamide. Missed rifampicin resistance was mostly due to the I491F mutation located outside the MTBDRplus detection area and the L452P mutation, which was not included in the initial version 2 of the MTBDRplus. This led to substantial delays in the initiation of appropriate therapy. The previous tuberculosis treatment history and the high level of resistance to other anti-tuberculosis drugs suggest an accumulation of resistance.

Pictorial Review on Imaging Findings in Cerebral CTP in Patients with Acute Stroke and Its Mimics: A Primer for General Radiologists.

The imaging evaluation of computed tomography (CT), CT angiography (CTA), and CT perfusion (CTP) is of crucial importance in the setting of each emergency department for suspected cerebrovascular impairment. A fast and clear assignment of characteristic imaging findings of acute stroke and its differential diagnoses is essential for every radiologist. Different entities can mimic clinical signs of an acute stroke, thus the knowledge and fast identification of stroke mimics is important. A fast and clear assignment is necessary for a correct diagnosis and a rapid initiation of appropriate therapy. This pictorial review describes the most common imaging findings in CTP with clinical signs for acute stroke or other acute neurological disorders. The knowledge of these pictograms is therefore essential and should also be addressed in training and further education of radiologists.

Radial head and neck fractures in children and adolescents.

Radial head and neck fractures are a rare entity in pediatric patients. Due to specific characteristics of the blood supply and remodeling potential, the correct diagnosis and initiation of appropriate therapy are crucial for the outcome. Therefore, the aim of this retrospective observational study was to present the outcome of a series of pediatric patients with radial head and neck fractures. In total, 67 pediatric and adolescent patients with a fracture of the proximal radius admitted to a Level I Trauma Center (Germany) between 2005 and 2017 were included in this retrospective observational study. Patients were stratified in accordance with the classification of Judet modified by Metaizeau and with the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF). AO-PCCF fracture type of proximal radius was age-dependent. Epiphyseal axis angle and displacement angle correlated significantly. Fractures treated with a K-wire or embrochage centromedullaire elastique stable (ECMES) presented higher displacement angles. The duration of callus formation was dependent on both the reduction technique and fracture displacement. The range of motion after complete fracture consolidation was dependent on the Metaizeau type and reduction technique but independent of the duration of immobilization and physical therapy. Both the epiphyseal axis and displacement angle are suitable for measuring the initial fracture displacement in radiographs. Consolidation is dependent on the initial displacement and reduction technique. The mini-open approach leads to a worse reduction result, later callus formation, and a more restricted range of motion in terms of pronation. Furthermore, the range of motion at follow-up is independent of the duration of immobilization and physiotherapy.

Влияние нейропатического компонента болевого синдрома на клинико-лабораторную активность и качество жизни при псориатическом артрите

Background: psoriatic arthritis (PA), even in cases with timely initiation of appropriate therapy, is inevitably associated with pain syndrome which includes a neuropathic component. The neuropathic pain (NP) can be considered as a complication of chronic arthropathy, simulating insufficient efficacy of anti-rheumatoid drugs. Aim: to estimate the prevalence of NP in patients with PA and to determine the correlation between NP and patient gender, activity, disease duration, central sensitization (CS) and quality of life. Patients and Methods: the study included 88 patients with PA. The number of tender joints (TJ) and the number of swollen joints (SJ) were counted in all patients. Also, pain intensity was evaluated by the visual analogue scale (VAS) and the level of C-reactive protein (CRP) was measured. The disease activity in patients with PA was assessed using the DAPSA index. A neurologist relied on the PainDETECT questionnaire to identify NP, CS and quality of life in the patients (SF-36). If PainDETECT was above 19 scores, the patients underwent physical examination to confirm NP. Results: patients with PA were split into two groups: with NP (NP+) — 18 (20.4%) subjects and without NP (NP-) — 60 (79.6%) subjects. The NP+ group consisted of older patients (p=0.001), with higher mean VAS scores for paint severity (р=0.008) and a higher mean number of TJ (р=0.014). No differences were found between the groups as regards the mean level of CRP (р=0.880), the mean DAPSA index value (p=0.213), the mean disease duration (p=0,385), and the mean number of SJ (р=0.197). According to the SF-36 questionnaire, the quality of life (QoL) was reduced in all patients. In NP+ group the mean values of the physical component of quality of life were significantly lower than in NP- group (p=0,012). However, such significant difference was not found for the values of psychological component (р=0.239). The prevalence of clinically important CS was significantly higher in the NP+ group patients (р=0.005). Conclusion: the prevalence of NP was common among PA patients which, to a certain extent, may "overestimate" the disease activity due to the patient's subjective judgements about PA severity, serve as a sign of chronic inflammation and reduce quality of life. KEYWORDS: psoriatic arthritis, neuropathic pain, chronic pain syndrome, quality of life, central sensitization, erosive arthritis. FOR CITATION: Akulinushkina E.Yu., Ivanova L.V., Yakupova S.P., Yakupov E.Z. Impact of the neuropathic component of pain syndrome on clinical and laboratory activity and quality of life in patients with psoriatic arthritis. Russian Medical Inquiry. 2023;7(3):113–117 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-113-117.

378. Utility of CMV Quantitative PCR in Tissue Biopsy for the Diagnosis of CMV Gastrointestinal Disease among Solid Organ Transplant Recipients

Abstract Background Cytomegalovirus (CMV) infection is an important cause of morbidity after solid organ transplantation (SOT). Rapid and accurate diagnosis of gastrointestinal (GI) CMV disease is central to the early initiation of appropriate therapy. Currently, the diagnosis mainly relies on histopathology on formalin-fixed GI tissue biopsy. CMV diagnosis by quantitative polymerase chain reaction (qPCR) on tissue biopsy is not routinely performed for the diagnosis of tissue invasive disease, but potentially holds many practical advantages over the gold standard including a rapid turnaround time and providing a quantitative objective result. Methods We compared the performance of CMV qPCR on fresh GI biopsy with tissue biopsy histopathology for the diagnosis of GI CMV disease. Results A total of 62 SOT patients with GI symptoms underwent endoscopic assessment with GI biopsy analyses for both histopathology and tissue CMV qPCR. Twelve patients (19.4%) had proven CMV disease on histopathology. Among them, all had a positive qPCR on biopsy (median value of log 7.7 and 5.4 x107 copies/mL), and all had a positive serum CMV PCR (median value of log 4.5 and 3.4 x104 copies/mL). Of the 49 remaining patients with negative histopathology, 26 (53%) had CMV qPCR positive tissue biopsy specimens with a median log 4.3 and 2.0 x104 copies/mL. Of these 26 patients with histopathology negative/CMV qPCR positive tissue biopsies, 10 had positive serum CMV qPCR. Twenty-four patients were negative for all three tests: histopathology, CMV qPCR on tissue biopsy, and CMV viremia. ROC analysis for optimal threshold value for CMV qPCR on tissue biopsy for diagnosis of confirmed CMV GI disease is 104 824 copies/mL (sensitivity 100%, specificity 82%, area under ROC 0.91). Conclusion Our study shows that tissue biopsy CMV qPCR is highly sensitive (sensitivity of 100%) for the diagnosis of CMV GI disease. As such, tissue CMV qPCR may be a useful adjunctive diagnostic tool for the rapid diagnosis of CMV GI disease. Disclosures All Authors: No reported disclosures.