Location Of Involvement Research Articles

How Are FIM Gains Improved after Intensive Rehabilitation for Cerebrovascular Diseases?

The purpose of this study was to determine functional independence measure (FIM) gains based on clinical factors after rehabilitation for cerebrovascular diseases, and to determine how FIM scores and FIM gains can predict rehabilitation outcomes. Of the 181 patients in the study 161 suffered strokes (cerebral infarction 107, cerebral hemorrhage 41, subarachnoid hemorrhage 12, subdural hematoma 1). There were also 12 traumatic brain injuries, and 8 other miscellaneous cases. Dementia, higher brain dysfunction, etiology, sex, age, history of cerebrovascular diseases, location involvement, disability severity, duration of hospitalization and period from onset to rehabilitation were analyzed using FIM. FIM gains decreased in relation to an increase in age. Patients with intermediate disability (FIM 41-80) on admission showed significantly higher FIM-total gain on discharge than others. Factors influencing FIM gain were revealed to be age, duration of hospitalization, FIM gain 4 weeks after admission, etiology, disability severity, dementia and past history of cerebrovascular diseases. Multiple regression analysis determined that significant factors to contribute FIM gain were duration of hospitalization, FIM gain at 4 weeks after admission, age, and disability severity. FIM scores and FIM gains could predict rehabilitation outcomes.

The Natural History of Eosinophilic Gastrointestinal Diseases Is Influenced by Age of Onset and Location of Involvement.

It is unknown whether concomitant esophageal involvement or anatomic location of eosinophilic infiltration affects the natural history of eosinophilic gastrointestinal disease (EGID). A retrospective cohort study was performed using the University of North Carolina EGID Clinicopathologic Database. Patients were adults and children with a prior EGID diagnosis based on clinicopathologic features. Demographics, clinical characteristics, treatment information, and procedural data were extracted from medical records. Clinical course and flare history were characterized. Among 97 patients, 43% had EGID + esophageal involvement and 57% had EGID only. Patients with esophageal involvement had a longer diagnostic delay preceding diagnosis (36.6 vs 11.6 months, P = 0.001), more dysphagia (50% vs 18%; P = 0.001), required more chronic therapy (77% vs 52%, P = 0.016), and exhibited more progressive disease (25% vs 6%, P = 0.027). A continuous disease course was most common in eosinophilic gastritis (78%) while patients with eosinophilic gastritis + eosinophilic enteritis (29%) and eosinophilic enteritis + eosinophilic colitis (50%) had the highest proportion of progressive and relapsing disease, respectively ( P = 0.045). A continuous disease course occurred more frequently in children (71%, P = 0.03) and those with single organ involvement (65%), whereas adults had more relapsing (39%) or progressive disease (18%). EGIDs with and without esophageal involvement display many similarities, although patients with esophageal involvement more frequently had dysphagia, had progressive disease courses, and required more chronic therapy. Location of involvement and age of onset affected the natural history with higher proportions of relapsing or progressive disease seen in adults and patients with small bowel or multiorgan involvement while a continuous disease course was more common in children and patients with gastric-only involvement.

Morphometric Assessment of Sclera and Ciliary Body in Patients with Noninfectious Anterior Scleritis: A Quantitative Study Using Ultrasound Biomicroscopy

ABSTRACT Background At present, the severity and grade of anterior scleritis are judged mainly based on the area and location of involvement, whether there is necrosis, etc. Quantitative measurement of sclera and surrounding tissues will help to accurately assess the severity of scleritis and provide quantitative indicators for the choice of treatment. Methods We retrospectively analyzed the thickness of sclera and ciliary bodies detected by ultrasound biological microscopy (UBM) in noninfectious anterior scleritis patients who subsequently were treated with topical or systemic treatment, and visited our hospital from March 2014 to March 2021. Age- and sex-matched normal individuals were used as controls. Results A total of 185 patients (50 males and 135 females) with noninfectious anterior scleritis and 84 (31 males and 53 females) controls were included. In patients with noninfectious scleritis, the thickness of sclera and the ciliary body were significantly greater than those in the control group (p < 0.05). Before treatment, the thickness of sclera and the ciliary body in systemic treatment group was significantly higher than that in topical treatment group (p < 0.05). After treatment, both thicknesses of sclera and the ciliary body decreased significantly (p < 0.05). The ratio of ciliary body thickness from the site of inflammation to the normal position was significantly higher in the systemic treatment group than in the topical treatment group. Conclusions UBM quantitatively shows a decrease in AST/CBT in patients with anterior scleritis after treatment. The ratio of ciliary body thickness at the site of information to that at the normal position may be a reference for the choice of treatment.

P703 Comparison of infliximab and adalimumab therapies Persistence in patients with Ulcerative Colitis: Results from a Single Tertiary Turkish IBD Center Cohort

Abstract Background In the last 25 years, the introduction of biological therapies has been a significant milestone in the management of inflammatory bowel diseases. Despite the recent emergence of new biological therapies and small molecules, Anti-TNF agents still play a crucial role in treatment. In a number of countries, anti-TNF agents are still reimbursed as a first line treatment following either a failure or intolerance to conventional therapies such as thiopurines and aminosalycilates. Many studies have been conducted previously to compare the efficacy of these drugs, but a clear conclusion could not be reached. In this study, we aimed to compare the persistence of infliximab (IFX) to adalimumab (ADA) in the treatment of ulcerative colitis at a tertiary IBD center in Turkey. Methods This was a retrospective cohort analysis of patients with ulcerative colitis either received adalimumab or infliximab as a first line biologic treatment. A total of 234 patients were included to this analysis. Demographic information such as gender, age, montreal classification, smoking and prior medications were noted from patients electronic medical records. Weighted Kaplan-Meier and Cox models were used to assess the outcomes. Results Out of the 234 patients included in the study, 116 had used infliximab, and 118 had used adalimumab as a first-line treatment. Age and gender of the patients in both groups did not differ from each other statistically. 88% of the patients treated with adalimumab and 84% of the patients treated with infliximab were thiopurine experienced. Montreal classification did not differ between two groups (in IFX group, 73% of the patients had Montreal E3 involvement where as in ADA group, 66% of the patients had Montreal E3 involvement, p&amp;gt;0.05). Primary non-response rates were not different between IFX and ADA group, 13.6% vs 13.4% respectively. In addition, clinical response rates after first year were 60% and 53% respectively. Drug persistency rates of adalimumab and infliximab in moderate to severe ulcerative colitis patients were not statistically different from each other (Figure 1). Conclusion Neither clinical efficacy rates nor drug persistency rates of adalimumab and infliximab in ulcerative colitis treatment were not different from each other. Factors such as age, gender, location of involvement, concomitant therapies, and smoking did not alter the outcome.

The investigation of concomitant dermal and oral lichen planus in patients referred to Zahedan University centres

Lichen planus (LP) is a common chronic immunologic inflammatory epidermal and mucocutaneous disorder involving skin, oral mucosa and both sometimes, the main cause of which is still unknown. Due to the importance and its prevalence, this study was carried out in order to assess the association of oral and dermal lesions in patients referring to Dermatology Clinic and Department of Oral and Maxillofacial Diseases, Zahedan Dental School. In this descriptive study, a total of 99 patients with individual involvement of LP in skin or mucosa were selected among 6510 patients referring to Dermatology Clinic and Department of Oral and Maxillofacial Diseases, Zahedan Dental School. The selected cases were subjected to further and exact clinical examination along with interview, while in suspected lesions, the conducted histopatologic tests obtained by biopsy were used for the evaluation. A questionnaire was completed for each patient after taking history and physical examination, including history of systemic diseases, interacting medication, smoking habits, presence of oral and dermal lesions, the onset of mucosal and skin lesions and the treatment period, oral lesions signs and the patients complaint, involvement location, form, manner of distribution, oral lesion history as well as existence of amalgam restorations alongside the lesion chi-square used to assess differences for variables. The study revealed 38 percent association of oral and dermal lesions in the study population, while individual oral lesion was observed in 60.6 percent of patients and individual dermal lesions in 39.3 percent. The most reported symptom of oral lichen planus in the study population was the Oral ulcer, while the buccal mucosa was the most common site of involvement and erosive form was the high prevalent. The most reported symptom of dermal lichen planus in the study population was the Itching, while the Simultaneous hand and foot conflict was the most common site of involvement and Papular form was the high prevalent. High incidence of dermal and oral lichen planus association revealed throughout the study calls the attention for complete systemic examinations of the patients. As this study was carried out in the dermatology clinic, it seems that other studies in dental schools as well as throughout the public will be of necessity and importance to verify the results. According to this study, there was not a significant statistical relationship between LP and other variables.

Evaluation of Odontogenic Tumors Frequency in Biopsies Sent to Isfahan, Shiraz and Yazd Dental Schools

Introduction: Odontogenic cysts and tumors are lesions found in the upper and lower jaw and oral soft tissue. The understanding and correct diagnosis of odontogenic tumors is essential because they can be invasive or recurrent in nature and even rarely show malignant changes. The aim of this study was to evaluate the frequency of odontogenic tumors in Isfahan, Shiraz and Yazd cites.Materials &amp; Methods: This is a cross-sectional descriptive- analytical study that was performed in the mentioned centers. The records of registered samples from the first year of establishment to 2018 have been reviewed which is approximately 18,000 cases. Samples data were extracted and recorded based on sex, age, jaw and location of involvement in affected jaw. Data were analyzed using descriptive statistics and Chi-square test (p value &lt; 0.05).Results: In this study, a total of 498 odontogenic tumors were evaluated. The number of odontogenic tumors in Isfahan, Shiraz and Yazd cities was 313, 130 and 55, respectively. The mean age of the patients was 30.1 ± 15.9 and most of the patients were in the age group of 20 to 40 years and 53.4% were female. The most common sites of involvement were the right mandibular (29.1%) and then the left mandibular (28.3%) and the most common tumor was ameloblastoma (50.2%) and then complex odontoma (16.7%).Conclusion: Due to the frequency observed for odontogenic tumors, understanding the clinical and pathologic features of these lesions is essential for rapid and appropriate diagnosis and treatment.

Utility of high-resolution magnetic resonance vessel wall imaging in differentiating between atherosclerotic plaques, vasculitis, and arterial dissection

PurposeDifferentiating between atherosclerosis, vasculitis, and dissection is a diagnostic challenge because of inconclusive findings on conventional imaging and some overlap in the vessel wall patterns. The aim of this study was to determine whether vessel wall MRI patterns can differentiate between these vasculopathies.MethodsWe retrospectively reviewed 3T high-resolution vessel wall imaging studies of patients diagnosed with atherosclerotic plaques, vasculitis, and dissection. The patterns of involvement, wall enhancement, and T1 and T2 signals, as well as the specific patterns, were assessed and compared between the three diseases.ResultsFifty-nine patients with atherosclerosis (n = 33), vasculitis (n = 13), and dissection (n = 13) were enrolled. There were significant differences in the pattern of involvement between the three groups (P < 0.001), with concentric wall thickening in vasculitis patients (84.6%) and eccentric wall thickening in atherosclerosis (97%) and dissection (92.3%) patients. There was also a significant difference in the specific pattern (P < 0.001), with intimal flap (76.9%) and intramural hematoma (23.1%) in dissection patients and intraplaque hemorrhage (18.2%) in atherosclerosis patients. Furthermore, subgroup analysis showed a significant difference in the wall enhancement pattern between atherosclerosis and vasculitis patients (P < 0.05). Finally, there was a significant difference in the location of involvement between the three groups (P < 0.001).ConclusionBy using the pattern of involvement, wall enhancement, and specific patterns, vessel wall MRI can help differentiate between atherosclerosis, vasculitis, and dissection.

S1844 The Gallbladder Houdini: A Rare Presentation of Eosinophilic Cholecystitis and Gastroenteritis

Introduction: Eosinophilic gastroenteritis (EG) is an inflammatory condition with eosinophilic infiltration of the GI tract, but biliary tract involvement is rare. We report a rare case of EG with concurrent eosinophilic cholecystitis. Case Description/Methods: A 24 y/o WF with a history of Samter’s triad (nasal polyposis, asthma, aspirin allergy) managed with dupilumab, presented to the ER with chronic LUQ abdominal pain, N/V, dysphagia, diarrhea, and weight loss. Lab revealed normal LFTs and an elevated WBC to 13.6k with 9.2% eosinophils (eos). RUQ US showed fatty liver and cholelithiasis with normal caliber CBD. She underwent laparoscopic cholecystectomy with surgical pathology revealing early acute on chronic cholecystitis and cholelithiasis with extensive eosinophilic inflammation. She noted persistent symptoms with follow up labs showing increasing WBC to 26k with 67% eos. Repeat CT scan was unremarkable. Initial EGD showed gastritis with distal esophageal biopsies showing 100 eos/hpf. She was started on PPI. Repeat EGD showed gastritis and duodenitis with biopsies remarkable for eosinophilia of the stomach and proximal small bowel. Colonoscopy with TI intubation was endoscopically normal with normal biopsies of the TI and colon. She was started on PPI for eosinophilic esophagitis and a prednisone taper for eosinophilic gastroenteritis with symptom resolution. Discussion: The prevalence of EG is highest in children but can occur in adults often with concomitant atopic disease in the 3rd-5th decades. The clinical presentation varies, depending on the depth of inflammation (mucosal, muscular, or serosa) and location of involvement and may include abdominal pain, N/V, diarrhea, and weight loss. Diagnosis is based on pathology obtained during endoscopy or surgery. It is prudent to obtain multiple biopsies given patchy disease and consider transmural biopsies to identify processes limited to the muscular layer. Imaging can show non-specific inflammation. Peripheral eosinophilia is present in ∼80% of cases. The mainstay of therapy is corticosteroids, with a 90% symptomatic response. Azathioprine can be considered as a steroid sparing agent. Eosinophilic cholecystitis has rarely been reported in the literature but often in association with other illnesses. We present a unique case of eosinophilic cholecystitis in a patient with concurrent eosinophilic gastroenteritis. Upon review of the literature only 5 other similar cases have been described.

Spatial Evaluation of Oral Lichen Planus Patients Referred to Shiraz Dental School, Iran: a Medical Geography Approach.

Oral lichen planus (OLP) is an important inflammatory disease concerning its tendency to malignancy. The etiopathogenesis of this disease is still unknown. Medical geography uses geographic techniques to study factors related to location that cause uneven distribution of disease. This study was conducted to map OLP in patients referred to Shiraz Dental School with medical geography techniques and investigate any possible relationship between the number of dentists and health-centers in different regions of Fars province with the number of referrals. In this cross-sectional study, we evaluated the records of OLP patients referred to Shiraz Dental School from 2007 to 2018. Age, sex, place of residence, occupation, level of education, location of involvement, duration, and cutaneous involvement were recorded. The number of dentists and healthcare centers was obtained from the statistical records of Fars province. A Geographic Information System was used for the assessment of the spatial distribution of OLP. Ordinary least squares (OLS) and geographically weighted regression (GWR) indices were used for evaluating the relationship between the number of dentists and health centers with the number of referrals. From 1006 records, 457 were studied, from which 71% were female (age range of 41-60). The regression coefficient was 0.937 for the number of dentists in each county compared to OLP referrals indicating a strong relationship. The regression coefficient was 0.983 for the number of health-centers. According to GWR analyses in Shiraz neighboring counties like Marvdasht, Sepidan, and Sarvestan, there is a positive relationship between the number of dentists and OLP patients. The results revealed that dentists and health care centers had a good cognition of referring patients with OLP (as a premalignant lesion) for definite diagnosis in Fars counties. But both groups need more education in this matter. Moreover, referrals from settlements near Shiraz were more common because of their easier access.

333 A modified delphi consensus exercise: developing a skin-directed Stevens-Johnson Syndrome/toxic epidermal necrolysis scoring system

While SCORTEN and ABCD-10 are available to provide a patient prognosis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), they are not intended to assess the severity, progression, or improvement in disease throughout the hospitalization. A skin-directed instrument is needed. A modified Delphi consensus using RAND/UCLA appropriateness criteria was initiated with a core group of members who have published in the topic. A two-part consensus was determined to be needed to first establish agreement on the optimal design for a cutaneous scoring instrument, terminology, morphologies, and locations of involvement. Fifty-four dermatology hospitalists agreed to participate in this study. After one round for part one, all questions and statements reached consensus. Participants consistently agreed on the need of such an instrument and that certain locations including the head and neck, chest, upper back, ocular mucosa, and oral mucosa were almost always affected by SJS/TEN. Participants also agreed on morphologic terminology and that morphologies could be differentiated into blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions. The second part of the study will establish agreement on time course, progression, and weighting assessments and is in progress. The Delphi consensus has established that there is widespread agreement among expert dermatologists that there is a need for a skin directed scoring system, widespread agreement that specific morphologies can be differentiated consistently on both cutaneous and mucosal surfaces, and that some areas of the body are almost always affected when SJS/TEN occurs. This undertaking has so far revealed best practices as well as areas of uncertainty with SJS/TEN to help develop the framework for an SJS/TEN skin-directed scoring instrument.

Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster.

ObjectiveTo analyze the influencing factors of motor dysfunction in patients with limb herpes zoster and to construct a nomogram to predict the risk of this complication.MethodsA total of 213 patients with limb herpes zoster in the First Hospital of Jiaxing from January 2015 to June 2020 were enrolled. The muscle strength of the affected limb was evaluated by the Medical Research Council (MRC) score. The muscle strength of the affected limb was less than grade 5, and lower than that of the contralateral limb (normal side) was defined as motor dysfunction. Univariate and multivariate logistic regression analyses were used to determine the influencing factors of motor dysfunction in patients with limb herpes zoster. The nomogram of the risk of motor dysfunction was drawn by R software. Discrimination and calibration of the prediction model were assessed by using the C-index and calibration plot. Internal validation was assessed by using bootstrapping validation.ResultsThere were 58 cases in the motor dysfunction group and 155 cases in the nonmotor dysfunction group, and univariate analysis showed that the location of involvement (OR = 4.095, 95% CI: 2.097–8.466, P = 0.017), whether or not diseases were combined (OR = 0.520, 95% CI: 0.281–0.959, P = 0.036) and the number of affected centrums (OR = 0.336, 95% CI: 0.177–0.632, P = 0.001) were associated with the occurrence of motor dysfunction in patients with limb herpes zoster. Multivariate logistic regression analysis showed that upper limb involvement (OR = 3.811, 95% CI: 1.829–8.387, P = 0.001), noncombined diseases (OR = 0.493, 95% CI: 0.249–0.969, P = 0.041) and the number of affected centrums ≤3 (OR = 0.439, 95% CI: 0.218–0.881, P = 0.020) were independent influencing factors of this complication. The prediction model displayed good discrimination with a C-index of 0.72 and good calibration. A high C-index value of 0.71 could still be reached in the interval validation.ConclusionThis study used the clinical data available to establish a nomogram model for motor dysfunction of limb herpes zoster and found that motor dysfunction is more likely to occur in patient who meets upper limb involvement, combined diseases and the number of affected centrums >3. This kind of high-risk group should be intervened as soon as possible.

S1710 A Rare Presentation of Isolated Colonic Polyps Causing Pseudo-Obstruction in a Patient With Neurofibromatosis

Introduction: Isolated large intestinal involvement of neurofibromatosis is a fairly rare clinical finding. Herein, we present a case of colonic ganglioneuromas causing pseudo-obstruction in a patient with neurofibromatosis without other gastrointestinal tract findings. Case Description/Methods: A 59-year-old male with a history of neurofibromatosis and gastroesophageal reflux disease (GERD) on pantoprazole presented to our clinic for a follow-up visit. Despite medical management, he reported worsening of his GERD symptoms, namely epigastric pain and bloating. He was scheduled for surveillance esophagogastroduodenoscopy (EGD) and colonoscopy for colon cancer screening. On the morning of the procedure, he was afebrile and vital signs were stable upon arrival. EGD showed gastritis, but was otherwise unremarkable. Colonoscopy revealed a ∼7cm pedunculated polyp in the ascending colon and a 4cm flat polyp and 1 pedunculated polyp in the transverse colon. Pathology from the polyps showed submucosal lipomas as well as ganglioneuroma with associated acute colonic ulceration. Due to the size and location of the ascending colon polyp, it was thought to be contributing to his symptoms of obstruction. At a recent clinic follow-up visit, he was doing well and endorsed improvement in his reflux, bloating, and epigastric pain. He was also having regular bowel movements and denied constipation. The patient was scheduled for repeat surveillance colonoscopy to be performed in 2 years. Discussion: Neurofibromatosis type 1 (NF-1), also referred to as von Recklinghausen disease, is an autosomal dominant disorder caused by mutations in the NF-1 tumor suppressor gene. While the clinical presentation of NF-1 varies based on the specific mutation, common presenting symptoms include café-au-lait spots, Lisch nodules, neurofibromas, and optic gliomas. Gastrointestinal involvement has also been reported ranging from neurofibromas in the liver to the bowel. Inflammatory fibroid polyps are most commonly found in the stomach and small intestine; isolated colonic polyps are rarer, but case reports have documented findings of neurofibromas in the large intestine. Our patient has a unique presentation of polyps associated with NF solely found in the colon. Based on the location of involvement, symptoms may include abdominal pain, distension, and constipation. It is important that these patients undergo routine surveillance due to the risk of malignant transformation.Figure 1.: ∼7cm pedunculated polyp in the ascending colon.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years\u2019 experience from a single center in Turkey

BackgroundThe aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience.MethodsThis is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max).ResultsOverall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %).ConclusionsThe physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.

Management of Primary Focal Hyperhidrosis: An Algorithmic Approach.

Hyperhidrosis (HH) is defined as perspiration beyond the level required to maintain temperature regulation. HH affects nearly 4.8% of the population in the United States. It can have a great impact on patient&rsquo;s quality of life by disturbing daily activity, performance, confidence, social interactions, and mental health. In the majority of patients with HH (93%), the etiology of excess sweating is idiopathic, which classifies it as primary focal HH. Mild HH may be controlled with topical antiperspirants and lifestyle modifications. Based on the location of involvement, iontophoresis and botulinum toxin may be considered if the patient does not respond to topical therapies. Despite minimizing sweating, chronic use of systemic anticholinergics, in particular oxybutynin, may result in detrimental adverse effects such as dementia. Local surgery, radiofrequency, microwave, and lasers are other potential modalities for HH. Sympathectomy can be a last resort for the treatment of focal HH of the palmar, plantar, axillary, and craniofacial areas after failure of less invasive therapeutic options. In this review, we conducted a comprehensive search in the PubMed electronic database to summarize an algorithmic approach for the treatment of HH. This can help broaden options for managing this difficult disease. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5774.

Intravascular Large B Cell Lymphoma: A Rare Case Report

Diffuse Large B-Cell Lymphoma is characterized by the infiltration of small vessels by lymphoid cells. These cells are not seen in the systemic circulation. Depending on the involvement location, it may present with different clinics such as central nervous system and skin involvement. Therefore, diagnosis may delay. Diagnosis is based on pathology. Herein we present a rare patient who initially presented with cellulitis and was ultimately diagnosed with Intravascular Large B Cell Lymphoma. With this case, we aim that lymphoma infiltration should be considered in skin lesions that are difficult to diagnose.

A new biological marker in inflammatory bowel disease: Pentraxin 3

Aim: Pentraxin 3 is a molecule that is known to show inflammation, however few studies with contradictory results have been conducted in current literature in Inflammatory Bowel Disease patients regarding PTX3. We aimed to investigate whether PTX3 can be used in the discrimination of Crohn’s disese and Ulcerative colitis patients and whether there is a correlation of PTX3 with disease activity, involved intestinal segments and their length. Method: Ethical committee approval was obtained for this a prospective, single-centered, single-blind study. IBD patients who were older than 18 years old, without pregnancy, malignancy, acute/chronic infections or inflammatory diseases were included. Healthy volunteers were included in study as a control group. PTX3 levels were measured in the blood. Shapiro-Wilk, Mann-Whitney U, Kruskal Wallis, Bonferroni-Dunn, Spearman tests were used with NCSS 2007 program. Results: The median age of the 56 male and 42 female participants was 37 years (25 CD, 43 UK and 30 controls). In the UK group, PTX3, which did not have relationship with the Trulove Witts score or the Mayo score; was a statistically significant higher in patients with pancolitis. There was no relationship between PTX3 levels and involvement, behavior pattern, CDAI scores and activity of the disease in CD group. Conclusion:PTX3 is not an appropriate biomarker for monitoring the activation of İBD and it can’t distinguish two subtypes from eachother. PTX3 is insufficient to indicate both the behavior pattern and the location of involvement in CD patients. Only, until the control endoscopy times of the patients with UK, it can be monitored whether the disease affects the entire colon by following the PTX3 levels in the interim period.

Remote orthopaedic consultations for primary care patients by a large-scale telemedicine service

Abstract Backgrounds Telemedicine was implemented in Brazil to support primary care practitioners. As orthopedic complaints are frequent in primary health care (PHC), this study aimed to analyze the profile of orthopedic teleconsultations requested by PHC health professionals. Methods This observational, transversal study analyzed consecutive orthopedic teleconsultations from March/17 to July/19. Teleconsultations were classified as: character (educational or assistance), focus of the doubt (diagnosis, treatment or rehabilitation) and the location of involvement (muscle, bone, joint). Sex of the patients, professional category of the professionals who requested and the ones who responded teleconsultations, and Human Development Indexes (HDI) of the cities were accessed. Results Throughout the study, 415 teleconsultations were accessed from 112 municipalities with an HDI average of 0.651. The professionals who requested most of the teleconsultations were nurses (47%) and physicians (35%) and the ones who answered were mostly internal medicine physicians (61%) and orthopedists (34%). Most doubts were related to assistance of a specific patient (66%). Of those, the majority were female (59%). In 68% of the teleconsultations, there was a request for assistance in patient treatment, 38% for diagnosis and 25% for rehabilitation. Doubts were more often related to bones (46%) and joints (24%). Of those who specified the complaint, 17% were about general pain,14% low back pain and 4% fracture. The main subspecialties were spine (23%), foot (19%) and knee (11%). In 9% of cases, there was an indication for referral for in-person orthopaedic consultation. Conclusions Teleconsultation helps to identify the most frequent doubts in PHC. Most of those were solved in PHC with no need for referral, what evidenced the great potential of using teleconsultations in clinical practice, as a useful tool to qualify the referral to the specialist. Key messages Importance of telehealth tools for a public health system, especially for a country where the distance is a barrier to access healthcare services. Teleconsultation have been proven to be an effective strategy to qualify the referral to the specialist.

Soft Computing for Scalability in Context Aware Location based Services

Ubiquitous computing blended with context awareness gives user the facility of “anywhere anytime” computing. Location based services represents a class of context aware computing. Involvement of location as the primary input in location based services triggered concerns for user’s privacy. Most of the privacy work in domain of location based services relies on obfuscation strategy along with K anonymity. The proposed work acknowledges the idea of calculating value of K for K anonymity using context factors in fuzzy format. However, with increasing number of these fuzzy context factors resulting in more fuzzy rules, the system will tend to get slower. In order to address this issue, requirement is to reduce the size of rule base without hampering the performance much. Goal of the proposed work is to attain scalability and high performance for the above said system. Towards this, reduction of number of rules in the rule base, of fuzzy inference system has been done using Fuzzy C Means and Genetic Algorithm. Results of reduced rule base have been compared with the results of exhaustive rule base. It has been identified that number of rules can be reduced up to considerable extent with comparable performances and acceptable level of error.

Poster 132: Location of Involvement in Pediatric Patients with Cerebral Palsy and the Relationship to Development of Scoliosis: A Retrospective Cross-Sectional Analysis

Poster 132: Location of Involvement in Pediatric Patients with Cerebral Palsy and the Relationship to Development of Scoliosis: A Retrospective Cross-Sectional Analysis

Topographic MRI evaluation of the sacroiliac joints in patients with axial spondyloarthritis

ObjectiveTo evaluate the imaging features of spondyloarthritis in magnetic resonance imaging (MRI) of the sacroiliac (SI) joint and topography (in thirds) and affected margin, considering that this issue is rarely addressed in the literature. MethodsA cross-sectional study evaluating MRI (1.5T) of SI in 16 patients with axial spondyloarthritis, for the presence of acute (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic (erosions, subchondral bone sclerosis, bony bridges, and fatty infiltration) changes, performed by two blinded radiologists. MRI findings were correlated with clinical data, including age, duration of disease, medications, HLA-B27, BASDAI, ASDAS-ESR and ASDAS-CRP, BASMI, BASFI, and mSASSS. ResultsBone edema pattern and erosions were predominant in the upper third of SI (p=0.050 and p=0.0014, respectively). There was a correlation between disease duration and structural changes by affected third (p=0.028–0.037), as well as between the presence of bone bridges with BASMI (p=0.028) and mSASSS (p=0.014). Patients with osteitis in the lower third showed higher values for ASDAS (ESR: p=0.011 and PCR: p=0.017). ConclusionChronic inflammatory changes and the pattern of bone edema predominated in the upper third of SI, but a simultaneous involvement of middle or lower thirds of the joint was also noted. The location of involvement in the upper third of SI is insufficient to differentiate between degeneration and inflammation.