Paraclinical Changes Research Articles

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward.

although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54-76) vs. 65 (52.5-71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2-5) vs. 2 (1-4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0-6) vs. 0 (0-2), p < 0.001, r = 0.328]. empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.

SARS-CoV-2-induced myopathy: Clinical aspects, paraclinical changes, and therapeutic options

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a considerable global effect, posing notable challenges for clinicians, the pandemic becoming one of the most imperative international health emergencies lately. Among other more frequent manifestations, SARS-CoV-2 disease may also give rise to skeletal muscle involvement. Viral-induced skeletal muscle involvement is a potentially severe manifestation of COVID-19 (Coronavirus Disease 2019) and may be either acute, or in the context of “long-COVID”. The present review aimed to illustrate few aspects about pathomechanisms, clinical and paraclinical frames, and treatment options for SARS-CoV-2-induced muscle involvement. Notably, it has been stated that SARS-CoV-2 may have the ability to invade muscle myocytes directly, the disease having a variety of clinical manifestations, from myalgia and muscle weakness to rhabdomyolysis. Nevertheless, it is also important to take into account that most of patients with severe forms receiving mechanical ventilation for more than one week may have complications such as CIM (critical illness myopathy) and/or CIP (critical illness polyneuropathy) that may be clinically similar to SARS-CoV-2-induced myositis, yet may be differentiated paraclinically from it. Additionally, it was hypothesized that SARS-CoV-2 infection may constitute a trigger for autoimmune diseases such as polymyositis/ dermatomyositis. Presently, there are no diagnosis criteria and no specific therapeutic strategy for SARS-CoV-2-induced myositis.

Increasing Trends in Obesity-Related Cardiovascular Risk Factors in Romanian Children and Adolescents-Retrospective Study.

Childhood obesity has become a global public health issue and its assessment is essential, as an obese child is a future overweight or obese adult. Obesity is no longer a matter of exercising more and eating less, with several factors coming into play and dictating the pattern of fat accumulation and the ease/difficulty of reducing it. In the current paper, we aimed to analyze the cardiovascular impact of obesity in a large number of patients alongside the paraclinical changes that occur due to weight gain, and to perform an analysis on the increase in prevalence throughout our research. The main cardiovascular conditions identified were hypertension (15.36%), septal or concentric hypertrophic cardiomyopathy (11.15%), atherosclerosis risk (13.04%), and hypercholesterolemia (20.94%). We have used echocardiography to measure the thickness of epicardial adipose tissue (useful for assessing the patient's cardiovascular risk), and we observed that it was greater in children with moderate and severe obesity alongside diastolic dysfunction of the left ventricle in the whole group, without any connection with hypertension or coronary impairment. Obese children will be affected by increased cardiovascular mortality and morbidity in adulthood and they may experience early cardiovascular dysfunction. We want to strongly underline the importance and necessity of programs for the early detection and prevention of obesity and its complications, especially since interesting phenomena such as the "obesity paradox" exist and prove that obesity is far less understood than it is at a first glance.

Paraclinical Changes Occurring in Dairy Cows with Spontaneous Subacute Ruminal Acidosis under Field Conditions.

Simple SummarySubacute ruminal acidosis is a nutritional disorder that negatively impacts the health, performance, and welfare of dairy cows. This disease evolves subclinically over a long period of time, and finding suitable and easy-to-use biomarkers for early diagnosis is still a challenge for dairy practitioners. This study aimed to investigate the patterns of paraclinical changes and provide valuable data for more accurately identifying subacute ruminal acidosis under field conditions. Changes in certain blood and milk biochemical parameters were identified in this study, which, taken together, could provide a pattern of biochemical changes that would allow the easier identification of subacute ruminal acidosis in dairy cows under field conditions.This study was undertaken to investigate the changes in the blood and milk biochemical parameters found in naturally occurring and long-lasting spontaneous subacute ruminal acidosis (SARA), with the aim of identifying the patterns of paraclinical changes and providing valuable data for more accurately identifying SARA in cows under field conditions. The study was conducted on a dairy herd with a history of the occurrence of SARA-associated clinical signs. Twelve cows, between 20 and 150 days in milk, were randomly selected and subsequently subjected to venous blood, milk, and ruminal fluid collection. The mean pH value of the ruminal fluid was 5.56 ± 0.32, and 58% (7/12) of the tested cows were SARA positive (ruminal pH ≤ 5.5). The albumin, calcium, and phosphorus serum concentration values were significantly lower (p < 0.05) in the SARA group than in the group of healthy cows. Serum aspartate aminotransferase (AST) and glutamate dehydrogenase (GLDH) activity were significantly higher in the SARA cows (p < 0.05) than in the group of healthy cows. The mean values of milk fat, milk protein content, and milk fat-to-protein ratio were significantly lower (p < 0.05) in the tested cows of the SARA group than in the healthy group of cows. In conclusion, the results of the current study indicate that long-term SARA triggered by a high-concentrate diet is associated with clinically significant changes in both the blood composition (hypoalbuminemia, hypocalcemia, and increased serum AST and GLDH activity) and the milk composition (decreased fat and protein percentage and milk fat-to-protein ratio). Altogether, the obtained results provide a more reliable pattern of paraclinical changes and useful insights for detecting SARA in dairy cows under field conditions.

Child with SARS-CoV-2 infection and acute lymfoblastic leukemia

Introduction. Coronavirus disease 2019 (COVID-19) frequently leads to asymptomatic or mild infectious disease evolution in children. Case presentation. We present the case of a 3 year old girl, known with acute lymphoblastic leukemia in chemotherapy treatment at that time. She had an asymptomatic form of COVID-19 but with important paraclinical changes. The evolution was favorable under the treatment initiated with antibiotics, corticotherapy, gastric protector and symptomatic treatment if necessary. Conclusion. Management of children with COVID-19 and other comorbidities remains a challenge given the few data currently in the literature.

Dermatosis neutrofílica de las palmas, una presentación y asociación poco frecuente

La dermatosis neutrofílica acral (síndrome de Sweet localizado) fue descrita inicialmente como una manifestación cutánea de predominio en el dorso de las manos, con características histopatológicas de una vasculitis leucocitoclástica. Posteriormente se describió la presencia de neutrófilos y los cambios paraclínicos de una dermatosis neutrofílica localizada. Esta entidad se asocia a la presencia de infecciones, enfermedades autoinmunitarias, fármacos y neoplasias. Reportamos el caso de una mujer de 69 años con antecedente de carcinoma papilar de tiroides con nódulos dolorosos en palmas compatibles con síndrome de Sweet localizado.

Clinical and paraclinical changes in experimental colisepticemia in neonatal calves

The present study aim was to assess changes in clinical signs and plasma cytokines in calves experimentally infected with Escherchia coli and use them as a tool to diagnose colisepticemia. Ten healthy Holstein-Frisian bull calves were used for this experimental study. Experimental colisepticemia was induced in calves with intravenous injection of 1.5 × 109 CFU of O111:H8 strain of E.coli. Clinical scores were recorded before induction of septicemia, every 30 minutes for 8 hours, every hour from 8 till 12 h, every 3 hours from 12 till 24 hours after bacterial challenge. Blood samples were collected to determine plasma concentration of tumor necrosis factor-α (TNF-α) and gamma interferon gamma (IFN-γ) before and after E.coli IV injection. Blood culture was performed before and after bacterial challenge to confirm colisepticemia. The present study showed that total clinical score of the calves increased with a simultaneous significant rise in plasma concentration of TNF-α and INF-γ during septicemia period (P&amp;lt; 0.05). Changes in the heart and respiratory rate during septicemia and using clinical scoring are not enough to assess the magnitude of infection and disease progress; therefore, it is recommended some laboratory tests be used for better evaluation of clinical status of the septic calves

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review

ObjectiveSulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran. MethodsA literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched. ResultsSearch of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments. ConclusionsSM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.

Effect of Phenobarbital on Nitric Oxide Level in Term Newborn Infants with Perinatal Asphyxia.

Perinatal asphyxia (PA) is very significant in perinatal medicine due to the involvement of the central nervous system. This study was conducted to investigate the biochemical, clinical, and paraclinical changes associated with phenobarbital administration in neonates with PA. In this prospective, case-control study, 30 neonates with PA in two groups of 15 each (case and control) were investigated. The case group received 20 mg/kg intravenous phenobarbital within six hours of birth, and the control group did not receive phenobarbital. Serum concentrations of nitric oxide (NO) were measured at enrollment and one week after birth in the two groups. Clinical, electroencephalography, and magnetic resonance imaging findings of the two groups were compared. At enrollment, the two groups did not differ in clinical severity, seizure incidence, or NO concentration. After one week, NO concentration was significantly lower in the case group (p < 0.050), but there was no significant difference in other variables between the two groups. Early administration of phenobarbital in term neonates with PA could protect them against encephalopathy.

ON THE ISSUE OF SEPSIS DIAGNOSTICS IN INFANTS

Introduction. Severe bacterial infections and bacterial sepsis remain one of the most topical problems in modern medicine. Stable high lethal outcome and continuous tendency to the growth of sickness rate are often caused by untimely making the diagnosis and administration of treatment respectively. In recent years C-reactive protein (CRP) and other proteins of acute inflammatory phase are used as biomarkers to diagnose sepsis. At the same time the problem of early diagnostics of purulent-septic diseases in infants cannot be considered completely solved. Objective. To improve diagnostics and treatment of generalized purulent-septic diseases in children, diagnostic and prognostic value of clinical-paraclinical signs in sick infants should be studied. Materials and methods. 19 infants hospitalized in the infectious department for infants of Chernivtsi Regional Pediatric Clinical Hospital (RPCH) for generalized infectious-inflammatory diseases were examined. The group of comparison included 29 infants with various somatic pathology (anemia, energy-protein insufficiency, rickets etc.). In addition to generally excepted methods all the infants underwent a comprehensive clinical-paraclinical examination including immunologic tests of I-II levels, detection of protein content of acute inflammatory phase. Results of the study. A high specificity and at the same time low sensitivity of the peripheral blood leukocytosis more than 10,5 g/L and stab neutrophil shifting of leukogram more than 12% to confirm sepsis of infants were found. The content of immunoglobulin G more than 10,0 g/L in the blood serum was characterized by a high specificity as well, although unreliable signs of clinical-epidemic risk. The content of C-reactive protein more than 10,0 mg/L in the blood serum of patients with sepsis was found in 72,0% of cases, the content of α-1-antitrypsin more than 3,7 g/L in the blood serum – in 71,4%, and concentration of ferritin over 54,0 ng/ml – in 80% of children. In the group of comparison the concentration of proteins in acute inflammatory phase was found in 35,7; 45,5 and 25,5% respectively (рφ 10 mg/ml and ferritin>54,0 ng/ml in the blood serum of infants was 4,7 and 12,0 respectively with 95% confidence interval (CI 1,3-17,1 and 0,2-181,0; χ2=10,9 and 10,0), which proved statistical reliability of the paraclinical changes indicated. None of the mentioned paraclinical signs taken separately is characterized by a high sensitivity and specificity in the diagnostics of sepsis in infants, and it requires a necessity of a comprehensive diagnostic approach. Considering the results obtained, we suggested to use a diagnostic pair of clinical-paraclinical signs to diagnose sepsis in infants: the results of spontaneous variant of nitro blue tetrazolium (NBT) test of neutrophil granulocytes in the blood increasing 17% of formazan-positive cells, and the content of C-reactive protein of the blood serum 10 mg/ml and more. There are the following indices of diagnostics value of the suggested complex of examinations: specificity – 64,0%, sensitivity – 92,0%, predicted value of a positive result – 75%, predicted value of a negative result – 88,0%. An attributive risk of septic process in infants with the indices mentioned was 62,0%, a relative risk – 5,7, and the correlation of chances was 2. Conclusions. 1.To diagnose sepsis in infants a comprehensive approach should be used, because none of separately taken clinical-paraclinical signs is characterized by synchronous high indices of diagnostic value and reliable risk of present generalized purulent-septic disease. 2.With the aim to find sepsis in infants a diagnostics complex of paraclinical signs is recommended to be used: the content of 17,0% and more of formazan-positive neutrophils in spontaneous NBT-test in combination with the values of C-reactive protein content in the blood serum of 10,0 mg and more.

Impact of glatiramer acetate on paraclinical markers of neuroprotection in multiple sclerosis: A prospective observational clinical trial

Data from in vitro and animal studies support a neuroprotective role of glatiramer acetate (GA) in multiple sclerosis (MS). We investigated prospectively whether treatment with GA leads to clinical and paraclinical changes associated with neuroprotection in patients with relapsing-remitting (RR) MS. Primary aim of this clinical study was to determine serum BDNF levels in RR-MS patients who were started on GA as compared to patients who remained therapy-naive throughout 24months. Secondary outcomes included relapses and EDSS, cognition, quality of life, fatigue and depression, BDNF expression levels on peripheral immune cells (FACS, RT-PCR), serum anti-myelin basic peptide (MBP) antibody status, evoked potential and cerebral MRI studies. While GA treatment did not alter serum levels or expression levels on peripheral immune cells of BDNF over time it resulted in a transient increase of serum IgG antibody response to MBP, mainly due to subtype IgG1 (p<0.05), after 3months. However, no significant differences were found between GA treated and therapy-naive patients with regard to serum BDNF and intracellular BDNF expression levels, nerve conduction (including median and tibial nerve somatosensory, pattern-shift visual and upper and lower limb motor evoked potentials) or MRI (including volume of hyperintense lesions, volume of hypointense lesions after CE, mean diffusivity and fractional anisotropy) outcome parameters. In conclusion, our findings do not support a major impact of GA treatment on paraclinical markers of neuroprotection in human RR-MS.

Paraclinical Investigations of Electroacupuncture Analgesia in a Rabbit Ovariohysterectomy

The aim of this study is to investigate paraclinical changes in glycemia, serum cortisol, and adrenocorticotropic hormone (ACTH) due to electroacupuncture analgesia (EAA) in a rabbit undergoing an ovariohysterectomy. Seven clinically healthy New Zealand white rabbits were used in this study. Local and systemic analgesia was represented by EAA. Blood samples were collected at preoperative, operative, and postoperative times. At the operative time, increased cortisolemia does not promote a proportional increase in glycemia even though it is correlated with an increased level of ACTH. EAA follows the stress mechanism, which is coordinated by neuroendocrine activity. EAA in a rabbit ovariohysterectomy underscores the crucial involvement of the hypothalamus–pituitary–adrenal axis with a direct influence on paraclinical changes, including changes in glycemia, cortisol, and ACTH, which are specific for stress changes.

Spider bite (latrodectism) in Mashhad, Iran

Spider (Latrodectus tredecimguttatus) bites are relatively common in North East Iran. They induce morbidity and rarely mortality. We aimed to investigate clinical, electrocardiographic and para-clinical changes in patients with this bite. All consecutive patients admitted with suspected spider bites between September 2005 and September 2006 were studied prospectively. Spider bites accounted for 56 cases (0.5% of all poisoning, 21% of all admitted envenomated). The patients' mean (SD) age was 32 (16) years. The most common findings were pain (90%) mainly in their back (45%), stomach (35%), lower limbs (33%), upper limbs (19%) and chest (14%). Other clinical findings included were sweating (55%), chills (29%), dyspnea (25%), flushing (14%), spasm (12%), headache (12%), nausea (12%) and vertigo (12%). On electrocardiograph (ECG); ST segments were depressed in 25% of cases in at least two of the pre-cordial leads. Laboratory findings were in normal ranges. All the patients recovered following supportive and symptomatic treatment (no anti-toxin available in Iran), with a mean hospitalization period of 1.9 (1.3) days. Spider (L. Tredecimguttatus) bite is relatively common in Mashhad, which induces latrodectism with relatively different findings and cardiac toxicity. ECG monitoring should be considered, particularly when specific anti-toxin is not available.

Effect of Experimental Distal Ileal Obstruction on Clinical, Hematological, Serum and Urine Biochemical Parameters in Sheep

Mostaghni, K., Badiei, K. and Jafary, A.M. 2007. Effect of experimental distal ileal obstruction on clinical, hematological, serum and urine biochemical parameters in sheep. J. Appl. Anim. Res., 32: 33–36. To determine clinical and paraclinical changes in blood and urine following experimental distal ileal obstruction in sheep, 7 Iranian crossbred male sheep (2–2.5 years, 45–50 kg) were used. A polyethylene tube reinforced with braided cotton tape was surgically placed around the ileum 8 to 10 cm cranial to the ileocecal valve one week prior to the experiments. Both ends of the tube were brought out through the opening in abdominal wall, which were tightened on day 0. Observations were recorded for 6 days. At the end of experiment the animals became lethargic, anorexic, weak and dehydrated. There was a significant (P<0.05) increase in temperature, respiratory and heart rate as well as in hematocrit, total protein, RBC and WBC counts. Metabolic acidosis was seen in experimental sheep. Significant increases (P<0.05) were detectable in serum concentrations of urea nitrogen and creatinine. There was a significant decrease (P<0.05) in urinary concentrations of urea nitrogen and creatinine as well as in urinary pH. In conclusion, distal ileal obstruction in sheep leads to dehydration, tachypnea, tachycardia, azotemia and metabolic acidosis.

Klinische Bedeutung der Klassifikation der hypertensiven Erkrankungen in der Schwangerschaft

In a prospective study we found a hypertonic disease in 5.26% of the pregnant women. The course of pregnancy and delivery in women with chronic hypertension (22.1%) and in women with a pregnancy hypertension (53.3%) was without complications; delivery of eutrophic children was on term. Pregnant women with pre-eclampsia (19.7%) had an early birth of dystrophic, retarded children (below the 10th percentile). The acidosis morbidity (36.4%) and the frequency of Caesarean section (79.2%) were significantly increased compared to other hypertension types. More often we found pathological para-clinical changes. The perinatal mortality occurred in women with pre-eclampsia in 10.4%. It was not increased in all other hypertension types. The emphasis in prepartal monitoring should be on women suffering from pre-eclampsia.