Early Initiation Of Treatment Research Articles

Acute mitral regurgitation causing right-sided pulmonary edema: a case report

A young female presented to our emergency department with sudden-onset shortness of breath and orthopnea. Her condition rapidly worsened. She developed severe respiratory failure and cardiogenic shock ensued. Noticeably, the patient's CT scan showed a unique pattern of right-sided unilateral pulmonary edema, a feature highly specific for severe mitral regurgitation. Echocardiography confirmed papillary muscle rupture and acute mitral valve prolapse to be the cause. Her condition improved significantly after mitral valve replacement and with respiratory and circulatory support, as well as with other heart failure treatment. The classic symptoms of acute left heart failure combined with the unique CT manifestation of predominantly right-sided pulmonary edema suggested severe mitral regurgitation. Prompt diagnosis and early initiation of treatment aimed at the underlying cause is of great significance in improving the patient's prognosis.

Effects of Current Therapies on Disease Progression in Fabry Disease: A Narrative Review for Better Patient Management in Clinical Practice.

Fabry disease (FD) is a rare lysosomal storage disorder that is characterized by renal, neurological, and cardiovascular dysfunction. Four treatments are currently available for patients with FD; three enzyme replacement therapies (ERTs; agalsidase alfa, agalsidase beta, and pegunigalsidase alfa) and one pharmacological chaperone (migalastat). This review focuses on the evidence for the benefits of ERTs and migalastat, and provides an overview of their impact on disease manifestations and quality of life (QoL). Agalsidase beta is associated with renal, neurological, and cardiovascular benefits, and may prevent renal disease progression. Agalsidase alfa provides stabilizing effects across all main organ systems, although minor sex-specific differences exist in patients with more advanced baseline disease. The benefits of agalsidase alfa and agalsidase beta are similar but depend on the extent of baseline disease. Some data indicate that agalsidase beta may be preferable over the longer term. Both agalsidase alfa and agalsidase beta are associated with improved gastrointestinal and pain symptoms, as well as improved QoL. Patients with advanced end-organ damage tend not to respond as optimally to ERTs as those who initiate ERTs before irreversible organ fibrosis develops, highlighting the need for early treatment initiation. Migalastat, which is only approved for patients with amenable missense gene variants, generally stabilizes renal parameters and provides cardiovascular benefits. Migalastat also improves diarrhea and pain, and stabilizes QoL (although ERT may be more effective for pain management), but the neurological effects of migalastat have not been studied. Real-world data raise concerns about effective in vivo amenability of some genetic variants. Future studies with direct treatment comparisons in patients with FD are needed.

Newborn Screening for Acid Sphingomyelinase Deficiency: Prevalence and Genotypic Findings in Italy

Acid sphingomyelinase deficiency (ASMD) is a rare lysosomal storage disorder with a broad clinical spectrum. Early diagnosis and initiation of treatment are crucial for improving outcomes, yet the disease often goes undiagnosed due to its rarity and phenotypic heterogeneity. This study aims to evaluate the feasibility and disease incidence of newborn screening (NBS) for ASMD in Italy. Dried blood spot samples from 275,011 newborns were collected between 2015 and 2024 at the Regional Center for Expanded NBS in Padua. Acid sphingomyelinase activity was assayed using tandem mass spectrometry. Deidentified samples with reduced enzyme activity underwent second-tier testing with LysoSM quantification and SMPD1 gene analysis. Two samples were identified with reduced sphingomyelinase activity and elevated LysoSM levels. Both carried two SMPD1 variants, suggesting a diagnosis of ASMD. Molecular findings included novel and previously reported variants, some of uncertain significance. The overall incidence was 1 in 137,506 newborns and the PPV was 100%. This study demonstrates the feasibility of NBS for ASMD in Italy and provides evidence of a higher disease incidence than clinically reported, suggesting ASMD is an underdiagnosed condition. Optimized screening algorithms and second-tier biomarker testing can enhance the accuracy of NBS for ASMD. The long-term follow-up of identified cases is necessary for genotype–phenotype correlation and improving patient management.

Efficacy and safety of edoxaban in patients with cardioembolic stroke

Ischemic strokes due to cardiogenic embolism are associated with an increased risk of death or permanent disability, which emphasizes the importance of their prevention. Edoxaban is a Xa inhibitor that is widely used globally as a new oral anticoagulant to prevent thromboembolic complications in patients with atrial fibrillation and an increased risk of stroke. The purpose of this review is to summarize data on the efficacy and safety of edoxaban in the secondary stroke prevention. The literature review was conducted using PubMed and Medscape databases to search for publications on clinical trials and clinical guidelines on oral anticoagulant treatment for stroke prevention. The results of clinical trials show that in patients with atrial fibrillation, edoxaban is non-inferior to warfarin in efficacy for primary and secondary stroke prevention, but compared to warfarin, edoxaban treatment is much safer (significantly reduces the risk of serious bleedings, including intracranial ones). The safety profile of edoxaban makes it one of the best drugs for the treatment of elderly patients and those with chronic kidney disease. In general, the results of recent clinical trials indicate that in cardioembolic stroke due to atrial fibrillation, the early initiation of treatment with direct oral anticoagulants is safe and reduces the risk of recurrent embolic events. Timely determination of the etiological subtype of ischemic stroke, in particular the detection of paroxysmal atrial fibrillation, and consideration of individual patient characteristics are the key to an optimal secondary prevention strategy that minimizes the risk of recurrent brain damage and improves the quality of life after stroke.

History and Development of the Society of Heart Failure Specialists (On the 25th Anniversary of the Society).

During the 25 years of the existence of the Russian Society of Experts in Heart Failure, it has become the most numerous and authoritative medical association. The Society has representative offices in 52 regions of Russia, and its active members amount to more than 4,000 various specialists. More than 200 Schools, regional conferences, and annual Congresses have been held annually. Dozens of clinical studies have been performed under the auspices of the Society, and the Cardiology journal has been published. This article also outlines the following new promising areas for the development of the Society: widespread introduction of modern clinical guidelines into clinical practice; transition to personalized medicine based on phenotyping of patients with heart failure; acceleration of heart failure diagnostics and earlier initiation of treatment with recommended doses; transition to remote follow-up of heart failure outpatients.

Painful mycetoma: a study to understand the risk factors in patients visiting the Mycetoma Research Centre (MRC) in Khartoum, Sudan.

Mycetoma, a neglected tropical disease endemic to Sudan, is traditionally characterized as a painless condition. However, recent studies reporting painful mycetoma lesions have challenged this assumption. With limited reports in the medical literature regarding pain in mycetoma, this study was conducted to investigate the risk factors for painful mycetoma lesions in patients visiting the Mycetoma Research Centre (MRC) in Khartoum, Sudan. This cross-sectional study aimed to identify the risk factors for painful mycetoma lesions. The study analyzed electronic records of 481 patients with confirmed mycetoma, seen between 1991 and 2020, using a systematic sampling approach. The study found that pain was more likely to occur in cases with bone destruction, secondary bacterial infection and actinomycete infection (OR=1.762, 1.815 and 1.259, respectively). Additionally, pain was more frequently observed in patients aged 45y and older. Smaller mycetoma lesions, measuring less than 5cm, were less likely to cause pain, and this was identified as a significant risk factor for painful mycetoma lesions (β coefficient=-1.294). The findings suggested that pain in mycetoma is typically associated with the severity of the condition. Therefore, early initiation of appropriate treatment may help reduce pain. Furthermore, careful differentiation between actinomycetes and eumycetes is essential for the timely and accurate diagnosis of mycetoma.

CSF Biofire-assisted Rapid Diagnosis of a Case of Cryptococcal Meningoen-cephalitis: A Case Report

CSF Biofire-assisted Rapid Diagnosis of a Case of Cryptococcal Meningoen-cephalitis: A Case Report

Importance of early treatment and quantitative evaluation of enzyme replacement therapy for Pompe disease: alglucosidase alfa post-marketing surveillance additional analysis

We conducted an additional analysis using the data from the post-marketing surveillance of Alglucosidase alfa for Pompe disease. We aimed to investigate the changes in the percentage of predicted forced vital capacity (%FVC) and the changes in the distance of the 6-min walk test (6MWT) by overall improvement and to investigate the %FVC change by the duration from symptom onset to survey registration (shorter/longer groups) using a linear mixed model. Thirty-seven and eighteen survey participants had %FVC and 6MWT data available, respectively; of the patients whose overall improvement was rated as "relatively improved," %FVC and 6MWT worsened in 71.4% and 66.7%, respectively. The %FVC at the survey registration estimated using a linear mixed model was significantly higher in the shorter group than in the longer group (P = 0.0413). The estimated slope of %FVC was significantly lower in the shorter group than in the longer group (P = 0.0051). These results suggest the importance of early treatment initiation and quantitative evaluation of each symptom.

Time between the first symptom, diagnosis and treatment of multiple sclerosis in a Brazilian cohort. The impact of early diagnosis

IntroductionMultiple Sclerosis (MS) diagnosis can be challenging, especially in populations where the disease is rare. In Brazil, the average prevalence is 14/100,000 inhabitants, lower than the worldwide. Early treatment initiation can markedly reduce disease activity and accumulation of disability. Therefore, delayed diagnosis and access to disease modifying therapy (DMT) can have a negative impact on the course of MS. ObjectivesThe aim of this study was to estimate the mean time between the first relapse, the diagnosis of MS and initiation of treatment in a cohort of Brazilian MS patients. Material and methodWe retrospectively analyzed the medical records of MS patients who met the 2017 McDonald diagnostic criteria followed in a MS reference center in Belo Horizonte, Minas Gerais. We assessed demographic and clinical data with focus on time to first symptom, time to diagnosis and treatment begging. The last Expanded Disability Status Scale (EDSS) was collected to access disability.The program GraphPad Prism 8.4.3. was used for the statistical analysis. ResultsData of 66 patients were analyzed, 77 % (51) were women. The mean age of the first symptom, diagnosis and DMT initiation was, respectively, 30,06 (± 12,43), 35,2 (± 13,59) and 36,10 (± 13,89) years. In 32 (46,38 %) patients the diagnosis was early (<1 year of disease), in 18 (26,09 %) between 1 and 5 years and in 19 (27,54 %) after to five years. Once the diagnosis was established, 65,5 % had access to DMT within 6 months and 79,71 % in the first year.Patients with diagnosis in the two first years had their first symptom at a younger age (p < 0.05). Comparing these two groups, patients with an earlier diagnosis presented less disability (EDSS: 3,5 vs 1,5; p < 0.05). ConclusionMS diagnosis can be challenging especially in low prevalence population of diseased and developing countries. Our study demonstrated the importance of early recognition of MS and its precocious intervention, impacting in reducing of disability a long term

Unit-Based Correlates of Marginal Food Insecurity Among US Soldiers.

Although studies have addressed food insecurity among veterans, few have focused on active-duty soldiers or on variables associated with the military occupational context. We examined the link between marginal food insecurity (defined as anxiety over food sufficiency or shortage of food in the house) among US soldiers and demographic, behavioral health, and unit-related factors. We analyzed survey data from 6343 active-duty soldiers using χ2 tests, generalized linear mixed-effect models, and adjusted odds ratios (AORs) to identify significant differences between soldiers categorized as marginally food insecure versus those who were not. In a fully adjusted model taking unit into account, marginal food insecurity was associated with preferring not to report gender (vs reporting being male) (AOR = 1.39; 95% CI, 1.08-1.78), being married/in a relationship (vs being single) (AOR = 1.22; 95% CI, 1.06-1.40), junior enlisted rank (vs noncommissioned officer: AOR = 0.45; 95% CI, 0.37-0.54; and vs officer: AOR = 0.13; 95% CI, 0.09-0.19), less time in unit (vs more time) (AOR = 0.99; 95% CI, 0.99-1.00), screening positive for depression (vs not) (AOR = 2.67; 95% CI, 2.30-3.11), screening positive for hazardous drinking (vs not) (AOR = 1.34; 95% CI, 1.11-1.63), and lack of reported unit-related social support (vs support) (AOR = 0.52; 95% CI, 0.45-0.59). In this sample, more than 1 in 5 US soldiers reported marginal food insecurity. In addition to supporting households with financial and food assistance and targeting junior enlisted personnel, policy makers and leaders should prioritize soldiers who are married or in a relationship, who are new to their unit, and who screen positive for depression and hazardous drinking, and they should encourage units to take care of unit members who need support. Policy makers and leaders can use these study results to direct prevention and early intervention initiatives.

A Multi-Faceted Analysis of the Factors Influencing Adolescents’ Career Aspirations: Recommendations for Policy

ABSTRACT This study explored factors influencing high school students’ career aspirations in Qatar, using the Systems Theory Framework to examine the interplay of intrapersonal, social and environmental factors. A newly-developed online survey, completed by 1,640 students, underwent rigorous validation through Exploratory Factor Analysis (EFA), which resulted in seven factor loadings. Structural Equation Modeling (SEM) supported the model’s fit, and Multivariate Analysis of Variance (MANOVA) revealed significant career pathways. This study offers a nuanced understanding of these influences, and provides insights with important implications for educational policy and early intervention initiatives.

Emphysematous Spinous Osteomyelitis and Acute Pyelonephritis in Diabetic Patient.

Spontaneous emphysematous osteomyelitis with concurrent pyelonephritis is exceedingly rare and fatal entity that needs prompt diagnosis. Imaging play a crucial role in its diagnosis. We present a case of 52 years old woman known case of diabetes and hypertension presenting to ER with high grade fever and right flank pain. CT scan abdomen and pelvis revealed intraosseous gas extending in epidural space and in retro peritoneum, suggesting emphysematous osteomyelitis, which was later confirmed by E coli in blood culture. Right kidney was also swollen and enlarged with surrounding perinephric stranding. Our case also highlights the importance of radiological imaging in Emergency settings particularly in patients with comorbid. Being familiar with this rare entity thus can help in early diagnosis and initiation of treatment.

Parental Knowledge and Awareness Regarding Early Orthodontic Consultation in Children: A Cross-Sectional Study.

The present study aimed to assess parental knowledge and awareness of early orthodontic consultation in children. This cross-sectional study was conducted among parents of schoolchildren who were randomly selected from public schools in the Al Ahsa region of Saudi Arabia, using a convenience sampling technique. Data were collected using a prevalidated, pretested study questionnaire distributed to parents through the schoolchildren. The questionnaire focused on the demographic data, knowledge, and awareness of parents regarding their children's need for orthodontic consultation. Descriptive statistics and the Chi-square test were used to analyze the quantitative data collected. More than 50% of the study participants exhibited a good perception of most of the aspects of early orthodontic consultation in children. However, only 42.8% of study subjects exhibited awareness of space maintainers and their use in a growing child, while only 37.5% knew that the first orthodontic visit should be at seven years of age. The age of the participants as well as their educational level were found to be important demographic factors influencing knowledge and awareness of the need for early orthodontic consultation (p<0.05). The present study found that there were knowledge and awareness gaps among Saudi parents regarding early orthodontic consultation, including those on the need for space maintainers and the age of initial orthodontic consultation. There exists a need for a targeted focus on creating awareness amongst younger and lesser-educated parents, which can largely improve the awareness pertaining to early orthodontic treatment initiation in children.

Underutilization of Influenza Antiviral Treatment Among Children and Adolescents at Higher Risk for Influenza-Associated Complications - United States, 2023-2024.

Annually, tens of thousands of U.S. children and adolescents are hospitalized with seasonal influenza virus infection. Both influenza vaccination and early initiation of antiviral treatment can reduce complications of influenza. Using data from two U.S. influenza surveillance networks for children and adolescents aged <18 years with medically attended, laboratory-confirmed influenza for whom antiviral treatment is recommended, the percentage who received treatment was calculated. Trends in antiviral treatment of children and adolescents hospitalized with influenza from the 2017-18 to the 2023-2024 influenza seasons were also examined. Since 2017-18, when 70%-86% of hospitalized children and adolescents with influenza received antiviral treatment, the proportion receiving treatment notably declined. Among children and adolescents with influenza during the 2023-24 season, 52%-59% of those hospitalized received antiviral treatment. During the 2023-24 season, 31% of those at higher risk for influenza complications seen in the outpatient setting in one network were prescribed antiviral treatment. These findings demonstrate that influenza antiviral treatment is underutilized among children and adolescents who could benefit from treatment. All hospitalized children and adolescents, and those at higher risk for influenza complications in the outpatient setting, should receive antiviral treatment as soon as possible for suspected or confirmed influenza.

Exploring Cardiac Variability in Hypereosinophilia: Clinical Insights and Echocardiographic Findings

Introduction: The cardiac manifestations of hypereosinophilia include mainly endomyocardial fibrosis, which is the most frequently observed form. However, eosinophilic cardiopathy can manifest itself in different ways, affecting the various layers of the heart and presenting a variety of clinical and echocardiographic presentations. Aim: The aim of our study is to describe the various aspects of cardiac involvement observed in hypereosinophilia, based on our case series and data from the literature. Methods: This is a retrospective, descriptive study of five observations illustrating the diversity of eosinophilic cardiopathy, from the cardiology department of the Mohammed VI University Hospital in Marrakech, over a period of 12 months. Results: Over the period of the study, five patients presented with cardiac damage in the context of hypereosinophilia. The mean age was 53.8 years, with a predominance of women (sex ratio 0.66). In the majority of cases, the discovery of cardiac involvement was incidental to a cardiovascular check-up requested during the course of their medical condition. All cases had high levels of hypereosinophilia, with an average of 5681. These observations illustrate the wide variety of aetiologies of hypereosinophilia, all of which were represented: 3 cases of Churg-Strauss syndrome, 1 case of idiopathic hypereosinophilia syndrome, and 1 case of DRESS syndrome. The cardiac disorders observed were hypokinetic cardiomyopathy at the dilated stage in 60% of cases, acute eosinophilic myocarditis in 20%, and acute pericarditis in the remaining cases. The outcome was marked by an improvement in the FE in 60% of cases, stabilisation in 20%, and a fatal outcome in the remainder. Treatment is based on symptomatic therapy of the CHF and treatment of the underlying aetiology. Discussion and Conclusion: Eosinophils are cytotoxic through the release of granular proteins that initially attack the endocardium, leading to thrombosis and embolic events. Subsequently, this aggression contributes to fibrosis and valvular complications. Cardiac damage can also manifest itself as potentially serious acute myocarditis or pericarditis, which can progress to cardiac tamponade. These cardiac disorders and the diversity of possible aetiologies serve as a reminder that vital prognosis may be at stake in the acute phase, and to emphasise that functional prognosis depends on early echocardiographic screening and rapid initiation of treatment to limit the risk of thrombo-embolic and fibrosing complications.

The experience of organizing control of management of oncological patients

The problem of timely final diagnosis, early initiation of treatment and optimal management of patients with malignant neoplasms is very actual. The purpose of the study is to analyze experience of managing patients with malignant neoplasms in the largest private medical organization. The sociological survey of 412 oncologists, surgeons, including coloproctologists and obstetrician-gynecologists working in clinics of Medsi Group of Companies in Moscow and Moscow Oblast was carried out. In 2023, in all clinics of Medsi Group of Companies functioning in Russia, after establishment of diagnosis of malignant neoplasm, 45.7% of these patients continued examination and treatment within the framework of this medical organization. In Moscow, Medsi Group of Companies JSC organized specialized competence center for patients of oncological profile where specialists determine further tactics of patient management. In each clinic of Medsi Group of Companies, position of senior oncologist is allocated, ensuring control of timely clinical diagnosis and routing of patients to the next stage of treatment. The patient transition to each of subsequent stages of treatment or refusal of patient to continue treatment is recorded on oncological desktop in the medical information system "Medialog". Thus, is minimized probability of losing control over patient management in medical organization.

P44 An acutely unwell and rare presentation of systemic lupus erythematosus; a case report

Abstract Introduction Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystem involvement. The condition has varying clinical presentations from mild mucocutaneous manifestations to severe multiorgan and central nervous system involvement. It is challenging to diagnose someone with SLE during acute admission. Apart from infection and malignancies, autoimmune and connective tissue diseases should always be one of our differentials in an acutely unwell patient with multisystem involvement. This case demonstrates how unwell and rare a patient with SLE can present. We also acknowledge the need to further understand and raise awareness of this uncommon condition. Case description A 48 year old Thai lady with no known medical illness presented with 2-3 weeks history of viral like illness. On admission, she was tachycardic, hypotensive and hypoxic. Clinical examination revealed bi-basal crepitations and elevated JVP. Her ECG showed sinus tachycardia. Admission bloods showed anemia, raised white cell count, lymphopenia, thrombocytopenia, raised inflammatory markers and acute kidney injury (AKI). CT scan revealed evidence of pericardial effusion with small free fluid in abdomen and pelvis. ECHO showed large pericardial effusion and pericardiocentesis was performed which drained purulent fluid. Blood culture was positive for E. Coli. 3rd Day blood tests were strongly positive for CTD screening. She was reviewed by the rheumatology team and was diagnosed as acute presentation of SLE causing serositis having fulfilled the SLICC criteria with E. Coli bacteremia. SLE DAI – 2K score was 11. She reported history of Raynaud’s since moving to UK, hair loss and two miscarriages in the past. She denied history of oral ulcers, facial rash or significant joint involvement. Renal team advised that AKI was due to infection rather than lupus. She was commenced on high dose oral prednisolone (40 mg/day) and antibiotics. Her condition responded to steroids and subsequently was commenced on mycophenolate as outpatient. Discussion SLE is an autoimmune disease that affects multiple organ systems. Symptoms and signs can vary although majority of patients present with cutaneous manifestation. Most of the clinical manifestations of the disease are due to abnormal inflammatory response. Patients with SLE are usually diagnosed at outpatient settings although they can present acutely unwell as seen in this patient. Serositis refers to inflammation of serous tissue which includes pleura, pericardium and peritoneum. It is considerably a rare condition which is only seen in only around 10% of patients with SLE. Patients can present with shortness of breath, abdominal pain, diarrhoea, fatigue chest pain and even cardiac tamponade. Due to the heterogeneity of SLE presentations, it is challenging for clinicians to diagnose and manage the symptoms. Besides infection and malignancies, it is always important to consider connective tissue disease as one of the differentials in an acutely unwell patient presenting with multisystem involvement. SLICC criteria can be used as a diagnosing tool for SLE which includes clinical and immunological criteria. SLEDAI-2K score can be used to assess disease activity. Her biochemical parameters as well as clinical symptoms drastically improved following steroid initiation. Early recognition and treatment initiation can improve mortality and morbidity significantly. Despite how unwell she was during admission; she improved quickly and was discharged relatively early. Her condition continues to improve on DMARDs, and she is on regular clinic follow up. Key learning points • A good clinical history and examination is essential and aids reaching a diagnosis. As reflected in this case, our patient was a female at childbearing age, south Asian (non-Caucasian ethnicity) who presented with multisystem involvement. Her initial finding of serositis, acute kidney injury, anemia, raised ESR and E. coli bacteremia were not fitting with a typical sepsis picture. There should be strong grounds for considering SLE during such clinical presentations. Suspecting SLE in an acute setting is really challenging due to various reasons, like wide symptomology of SLE, minimal exposure of SLE to physicians and their tendency of leaning towards other common conditions, like sepsis. As SLE is mostly diagnosed as outpatient, inpatient presentations are rare. Furthermore, blood results for connective tissue disease which is a major criteria for diagnosis, can take between 3 to 5 working days to be reported. However, early and appropriate consideration of autoimmune conditions as differentials of an acutely ill patient with multisystem involvement can expedite the process of diagnosis, involvement of related specialty and commencement of appropriate treatment. This approach will benefit patients producing favourable outcomes and minimal hospital stay.

Lymphocytic Interstitial Pneumonia with Varied Association: Case Series

Lymphocytic interstitial pneumonia (LIP) is an unusual variant of interstitial lung disease with unknown incidence and prevalence. It is often seen in patients with autoimmune diseases and in immune-compromised individuals, and is associated with specific infections; rarely, it is idiopathic. Idiopathic LIP has a male preponderance, while the secondary form is more common in females. It is characterized by dense infiltration of polyclonal lymphocytes, plasma cells, and histiocytes in the interstitial and alveolar spaces. Early diagnosis and treatment initiation are crucial for a favorable prognosis. Here, we present four cases of LIP with variable associations, emphasizing the importance of clinical examination, imaging, and, whenever needed, a transbronchial lung biopsy for accurate diagnosis.

Urinary Lipoarabinomannan (LAM) in HIV sero-negative miliary tuberculosis patients.

BackgroundTuberculosis (TB) is the leading cause of death from infectious diseases worldwide next to COVID. Miliary presentation is a form of TB that can cause 100% mortality without treatment. Due to lack of a gold standard test, a systematic approach of high index of clinical suspicion and efforts at demonstrating Mycobacterium tuberculosis is imperative to early treatment initiation and mortality reduction. This study is designed to find the diagnostic value of urinary LAM using cage nanotechnology a new class of sandwich ELISA technique in HIV sero-negative miliary PTB patients. ResultsThis is a case-control study done in a tertiary care hospital. Fifty HIV sero-negative patients with clinical presentation of miliary TB and fifty asymptomatic individuals as controls were enrolled. Mean urinary LAM value among the miliary TB patients was 1.82±0.45 mg/L and control group was 0.48±0.18 mg/L. Miliary TB patients had urinary LAM sensitivity and specificity of 98% and 96%. ConclusionThe patients with urinary LAM values between 0.48 to 1.88 mg/L are most likely to have miliary TB. Patients with urinary LAM value of >1.88 mg/L will be likely to have microbiologically confirmed miliary TB and urinary LAM values less than 0.48 mg/L are less likely to have microbiologically confirmed miliary TB

Study of the epidemiological and serological aspects of toxoplasmosis in pregnant women and newborns treated in the city of Blumenau, Santa Catarina, Brazil

Toxoplasmosis is a disease caused by the protozoan parasite Toxoplasma gondii, with greater relevance in developing countries, capable of leading to serious complications in pregnant women and immunocompromised patients. Gestational toxoplasmosis, in most cases, occurs when a woman acquires a primary T. gondii infection during pregnancy, posing a risk of fetal sequelae or even fetal death, the disease being of compulsory notification in Brazil. The objectives of this study were to assess the epidemiological status of gestational and congenital toxoplasmosis in the city of Blumenau/SC and to increase knowledge about its prevalence in the region. To achieve this, an analysis of city data recorded in the Blumenau/SC Epidemiological Surveillance Service database was conducted between the years 2019 to 2021. During the study period, the city of Blumenau presented lower prevalence of gestational toxoplasmosis (2.93/1,000 pregnant women) and congenital toxoplasmosis (2.31/10,000 live births) than other regions of Brazil. Proper adherence to prenatal care and its screening protocols, as well as the early initiation of treatment, can result in a low incidence of congenital infections even in tropical areas with high seroprevalence. Rapid and accessible immunoglobulin G avidity testing allows for the exclusion of suspected cases without the need for invasive tests or unnecessary treatments. Education, on the other hand, plays a crucial role in disease prevention and should focus on encouraging proper prenatal care and providing adequate information about the disease. Finally, treatment adherence should be monitored and promoted. KEY WORDS: Pregnancy complications; infectious; public health; toxoplasmosis, congenital; toxoplasmosis; epidemiology.