Paraclinical Findings Research Articles

Evaluation of clinical and para-clinical parameters related to disease severity and mortality in patients with influenza in Isfahan, Iran; a cross sectional study

Introduction: Managing influenza (flu) due to its rapid transmission is a considerable challenge for the health system. Considering the variety of clinical symptoms in influenza and recognizing its symptoms in different conditions of patients can be effective in its management. Objectives: In the present cross-sectional study, we evaluate the relationship between clinical and para-clinical findings and the treatment measures observed at the time of hospitalization of influenza patients and their conditions at the time of discharge from the hospital. Patients and Methods: Our investigation was conducted from March 2019 to March 2021 in Alzahra hospital of Isfahan, Iran. The research population included influenza patients admitted to the infectious ward. Results: A total of 122 hospitalized influenza patients (n=122) were included in this research. The number of patients with influenza A and B was 44 and 78, respectively. There was a significant relationship between the type of influenza and the patient’s condition upon discharge (P=0.001). Influenza vaccination (P<0.001), diabetes (P=0.038), and cardiovascular disease (P=0.004) were significantly associated with the patient’s condition at discharge. According to our investigation, among the drugs used, oseltamivir significantly reduced mortality in patients receiving it (P<<0.001). There was a statistically significant difference between the variables of all chest radiology and the patient’s condition at the time of discharge (P<0.001). Furthermore, there was a statistically significant difference between the length of hospital stay (P=0.001), the number of white blood cells (P=0.001), the number of platelets (P=0.006), and the amount of C-reactive protein (CRP) (P<0.001) with the patient’s condition upon discharge. Conclusion: Among the comorbidities studied, diabetes and cardiovascular disease were significantly associated with mortality in patients with influenza. Vaccination significantly reduces mortality from influenza in high-risk patients. The antiviral drug oseltamivir is recommended as a useful drug for patients with the influenza. However, a multi-center study with larger sample size is necessary for a more conclusive result.

Detection of Borrelia burgdorferi sensu lato DNA in cerebrospinal fluid samples following pre-enrichment culture

Molecular methods for diagnosing Lyme neuroborreliosis (LNB) have shown suboptimal diagnostic sensitivities. The objective of this study was to improve the clinical sensitivity of PCR detection of Borrelia burgdorferi sensu lato spirochetes by inoculating cerebrospinal fluid (CSF) from patients suspected of LNB directly into culture medium at the time of lumbar puncture, with this pursuing enrichment of Borrelia spirochetes before PCR analysis. Adult patients with symptoms suggestive of LNB were prospectively enrolled at two hospitals in the Region of Southern Denmark. The CSF-culture samples were incubated for at least eight weeks. During this period, culture sample aliquots were analysed for the presence of Borrelia DNA by separate PCR protocols in two independent clinical laboratories. The included patients were diagnosed with definite (n=12) or possible (n=2) LNB, and non-LNB (n=171) based on clinical and paraclinical findings. Patients in the LNB and the non-LNB group had a median duration from symptom onset to lumbar puncture of 40 days (IQR [23–90] days) and 120 days (IQR [32–365] days), respectively. Pre-enrichment growth of Borrelia spirochetes was accomplished from three patients (21 %) in the LNB group. The positive culture samples were confirmed by both the digital droplet PCR and the real-time PCR methods employed. All CSF samples were PCR negative in the non-LNB group. The results of this study do not support the use of Borrelia-specific PCR as a general routine diagnostic tool in adults. Still, they suggest it may prove of additional value in selected patients with a limited time from symptom onset to sample collection.

Clinical Features and Paraclinical Findings in Patients with SARS CoV-2 Pneumonia and the Impact of Pulmonary Rehabilitation on the Instrumental Activities of Daily Living in POST-COVID-19 Patients

The functional sequelae grouped under the name "long COVID" most often bring the patient in front of a team of specialists in pulmonary rehabilitation. The aim of this study was to evaluate clinical features and paraclinical findings in patients with SARS CoV-2 (Severe Acute Respiratory Syndrome-Corona Virus-2) pneumonia and to also evaluate the impact of rehabilitation in this category of patients. This study included 106 patients diagnosed with SARS CoV-2. The division of the patients into two groups was performed based on the presence of SAR-CoV-2 pneumonia. Clinical symptoms, biochemical parameters, and pulmonary functional and radiological examinations were recorded and analyzed. The Lawton Instrumental Activities of Daily Living (IADL) scale was applied to all patients. Patients in group I were included in the pulmonary rehabilitation program. Among demographic characteristics, age over 50 years (50.9%; p = 0.027) and the female sex (66%; p = 0.042) were risk factors for pneumonia in patients with SARS CoV-2. Over 90% of the 26 patients included in the rehabilitation program were less able to feed, bathe, dress, and walk. After 2 weeks, approximately 50% of patients were able to eat, wash, and dress. It is important to provide longer rehabilitation programs in cases of moderate, severe, and very severe COVID-19 patients, in order to significantly improve patients' participation in daily activities and their quality of life.

Real-world nailfold videocapillaroscopy in a referral centre in north-western Colombia: A real-life cohort

IntroductionNailfold videocapillaroscopy is a non-invasive tool for the assessment of peripheral microcirculation, the main indication is the study of Raynaud's phenomenon, poorly standardized outside of this context. There is no clear information in real-life about the reasons for referral, the presence of clinical findings of autoimmune diseases, the frequency of patterns of autoantibodies, and specific capillaroscopic findings. ObjectiveThe purpose of this survey is to describe the sociodemographic, clinical, paraclinical, and angioscopy findings of a cohort of subjects referred to a capillaroscopy service in North-western Colombia. MethodsA retrospective study was conducted, from 2015 to 2018. Categorical variables were expressed in frequency and percentage and quantitative variables in mean and standard deviation or median with interquartile range, depending on the distribution of the data. ResultsA total of 318 capillaroscopies were performed for the first time. The main referral reason was Raynaud`s phenomenon (n = 134; 42.1%). The most frequent baseline capillaroscopic pattern found was normal (n = 123; 38.7%). Of the 12 capillaroscopies that presented a non-specific pattern at a 6-month follow-up, only one (8.3%) progressed to a scleroderma pattern. In the subjects with systemic sclerosis, the most frequent clinical finding was sclerodactyly (n = 34; 37.8%), and 42/44 individuals (95.4%) had positive antinuclear antibodies; the most frequent pattern was centromere (n = 27; 64.3%) ConclusionsIn a real-world setting, the main referral reason for capillaroscopy was Raynaud`s phenomenon; more than a third of the subjects had normal capillaroscopic findings. Sclerodactyly was the most frequent clinical finding in patients with scleroderma capillaroscopic pattern.

A case of a Young Multiple Myeloma Patient With Poor Prognostic Cytogenetics

Multiple myeloma is a hematologic malignancy and a subtype of plasma cell dyscrasias, which accounts for 13% of all hematologic malignancies. It mainly affects older adults and is diagnosed in only 2% of the young population under the age of 40 years. This report presents a 33-year-old man diagnosed with Multiple myeloma with 4 poor prognostic specifications consisting of amplification of the 1q21, Translocation of t(4;14), deletion of the 6q21 and 13q14, along with decreased chromosome count to 44, X,-Y. Even though the combination of 4 poor prognostic cytogenetics in young patients is rare, he responded significantly to the Bortezomib regimen. He was selected as a candidate for bone marrow transplantation. The treatments get interrupted 2 days after the first session of the fifth cycle due to an undesirable COVID-19 infection. After 20 days, the symptoms return, and paraclinical findings show signs of MM relapse.

Evaluation of Clinical and Paraclinical Findings in Cases of Pregnancy Appendectomy in Ali Ebn-e Abitaleb Hospital Within 2015 - 2019

Background: Abdominal pain is one of the most common complaints during pregnancy and is always debated due to its numerous differential diagnoses. Acute appendicitis is the most common complication requiring surgery during pregnancy. Objectives: The present study aimed to investigate symptoms, signs, and paraclinical findings in cases of pregnancy appendectomy within 2015 - 2019. Methods: This retrospective study examined the frequency of appendectomy in pregnant women referring to Ali ibn Abi Talib Hospital of Zahedan in Iran. This study assessed 58 pregnant women who referred to Ali Ebne-e Abitaleb hospital and underwent appendectomy from April 2015 to March 2019. Finally, the data were evaluated in terms of age, gravidity, gestational age, body temperature, clinical symptoms, complications of appendectomy, type of surgery, and white blood cells (neutrophil). For data analysis, the information was entered into SPSS software (version 22). Results: In the present study, the most common symptoms and signs of patients were tenderness and right lower quadrant (RLQ) pain (87.93%), nausea (75.9%), leukocytosis (72.4%), migration of pain (65.5%), vomiting (58.6%), and anorexia (53.4%). Additionally, the most common appendicitis trimester for appendicitis in pregnancy was the second thermistor (62.1%). Conclusions: Tenderness in the RLQ area was the most important feature of appendicitis; however, nausea and leukocytosis were also common. Ultrasound was not a powerful imaging method due to the identification of less than half of the patients; nevertheless, the Alvarado score for acute appendicitis was helpful in numerous cases.

Torsion among Women with Acute Lower Abdominal Pain: A Retrospective Cross-Sectional Study.

Background: Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new algorithm for predicting the chance of ovarian torsion among women with acute lower abdominal pain. Methods: This diagnostic retrospective cross-sectional study was performed on all female individuals who were referred to Imam Hossein Medical Center, Tehran, Iran, with the chief complaint of acute lower abdominal pain, and underwent laparotomy between 2010 and 2016. Clinical and paraclinical findings were evaluated to construct a predictive model for ovarian torsion. The variables were compared in 2 groups. The first group included individuals with a final diagnosis of ovarian torsion and the second group included those individuals with any diagnosis other than ovarian torsion. All data were compared between these 2 groups using SPSS software Version 21 to find the related findings with a predictive value for ovarian torsion. Results: A total of 372 participants were evaluated, of whom 116 participants (31.2%) had ovarian torsion (case group) and 256 participants had other diagnoses for their lower abdominal pain (control group). Nausea and vomiting (p < 0.001), tenderness (p < 0.001), the size of ovarian mass (p = 0.004), and the percentage of polymorphonuclear (p < 0.001) showed significant relationships with ovarian torsion as the final diagnosis. Multiple logistic regression models were constructed to predict the factors affecting ovarian torsion, and a scoring system was designed to predict ovarian torsion, with a sensitivity of 77.59% (68.9%- 84.8%) and specificity of 74.61% (68.8% 79.8%). Conclusion: The proposed model is suitable for predicting ovarian torsion and its necessary information is readily available from individuals' history, examination findings, laboratory results, and an ultrasound exam.

Factors Affecting Incidence of Ventilator-Associated Pneumonia With Multidrug-Resistant Microbes in Intensive Care Unit

Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) microbes is one of the leading causes of hospital mortality. In this study, the risk factors of pneumonia with MDR microbes are investigated. This work was a retrospective study conducted at 2 academic centers and 3 intensive care units (ICUs). All patients who were clinically suspected VAP and had a positive microbial culture have been included in this study from late March 2018 to mid-June 2019. Patients were divided into 2 groups: MDR and non-MDR. Clinical and paraclinical (CBC, microbial culture, CXR) findings of these patients were recorded and reviewed. Then, using the multivariate analysis, the factors affecting the incidence of VAP with MDR microbes were investigated. Out of the 1854 patients admitted to the ICU, 110 of them have been diagnosed with VAP using X-ray and microbiological findings, and MDR microbes were separated in the culture of 85 patients. The mean age range of the patients was 60 ± 20 years and 75% of them were male. In univariate analysis, the factors affecting the incidence of MDR VAP were as follows: length of stay in the ICU, length of stay in other wards, history of admission in ward before ICU, duration of mechanical ventilation, and diabetes. In multivariate analysis, diabetes (odds ratio, 2.66; 95% confidence interval, 0.9–7.8; P = 0.002), history of admission in ward before ICU (odds ratio, 10.25; 95% confidence interval, 3.17–33.1), and a combination of the 3 factors related to the length of exposuring health care environment which named FAC, were independent risk factors of infection with MDR microbes. Hence, the FAC variable includes the length of stay in ICU, duration of mechanical ventilation, and length of stay in other wards.

Outcome of Acquired Fanconi Syndrome Associated with Ingestion of Jerky Treats in 30 Dogs.

Acquired canine proximal renal tubulopathy (Fanconi syndrome) related to excessive ingestion of jerky treats has been recognized since 2007. This study aimed to improve knowledge about the syndrome's characteristics, especially long-term outcome. By reaching out to veterinarians and dog owners, dogs suspected of jerky induced Fanconi syndrome were identified. The dog's medical records were reviewed, and owners interviewed. Data was analyzed using linear mixed models (p &lt; 0.05 was considered statistically significant) and descriptive statistics are reported. Thirty dogs, median body weight 6.8 (range 1.2-59) kg and age 6.5 (0.5-14) years, were enrolled as suspected cases based on history of jerkey ingestion and confirmed normoglycemic/hypoglycemic glycosuria. Clinical signs included polydipsia (23/30), polyuria (21/30), lethargy (19/30), weight loss (15/30), hyporexia (11/30), vomiting (7/30), diarrhea (7/30) and no clinical signs (2/30). Para-clinical findings included azotemia (6/28), hypophosphatemia (9/25), metabolic acidosis (3/8), hypokalemia (6/20), proteinuria (13/26), aminoaciduria (4/4), hematuria (22/29) and ketonuria (7/27). Clinical signs resolved in 22/28 within 11 (0.3-52) weeks and glycosuria resolved in 28/30 within 6.5 (1-31) weeks. There were no associations between serum creatinine and urea and the amount/duration of jerky ingestion. Serum symmetric dimethylarginine concentrations were only available for a few dogs, therefore no conclusion was achieved on a possible association with duration of jerky ingestion. Apart from a larger percentage of dogs achieving complete recovery, the current findings are in agreement with previous reports.

Effects of Biologic Therapies on the Chance of COVID-19 Infection Among Rheumatoid Arthritis and Lupus Patients During the First Wave of the Pandemic.

Patients with rheumatic diseases taking immunosuppressive medications might be at an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of using combined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumatic diseases, there have been concerns that taking biological agents may have an additive effect on getting infected with COVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected with SARS-CoV-2 in rheumatoid and lupus patients compared to traditional DMARDs. We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosed with lupus and rheumatoid arthritis disease. COVID-19 infection was confirmed by the presence of symptoms and signs of the disease and para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scan or polymerase chain reaction (PCR) of COVID-19. Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) had systemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. No association was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was a significant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless of the type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered the chance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of disease than those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001), however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19. This study develops a better understanding of the risk of immunosuppressive medications for SARS-CoV-2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those taking exclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factors with the severity of COVID-19.

The comparison of the mortality rates of plasmapheresis/hemoperfusion therapy with current treatment among Covid-19 patients

BackgroundThere is no definitive treatment for COVID-19. Hemoperfusion and plasmapheresis have only been studied in a few cases of COVID-19. In this study, plasmapheresis-hemoperfusion and current treatment for COVID-19 patients were compared for mortality. MethodsIn this cross-sectional study, 103 patients with COVID-19 underwent hemoperfusion, plasmapheresis, and conventional medical treatment in educational hospitals in Ahvaz, Iran. A census method was used to include the patients in the study. The data from the hospital file were used to complete a checklist containing demographic information, clinical findings, and paraclinical findings for all patients. ResultsThere was not a statistically significant difference (P-value = 0.051) between the plasmapheresis group (78.8%), the hemoperfusion group (71.9%), and the current treatment group (52.6%) in mortality rates. Hemoperfusion had a median survival time of 18.9 days, plasmapheresis had a median survival time of 16.9 days, and current treatment had a median survival time of 13.5 days. In terms of patient survival time, there was no significant difference (P-value = 0.181). Multiple regression results showed that death rates in the hemoperfusion (P = 0.393) and plasmapheresis (P = 0.073) groups were not statistically different from those in the current treatment group. ConclusionAs a result of this study, there were no differences between the treatment groups in regard to death rates or patient survival times.

Risk Factors Associated with Severe Disease and Intensive Care Unit Admission of Pregnant Patients with COVID-19 Infection-A Retrospective Study.

(1) Background: Pregnant patients with severe forms of coronavirus disease 2019 (COVID-19) can experience adverse pregnancy outcomes. The aim of this study was to retrospectively assess the risk factors associated with admission to the intensive care unit (ICU) of pregnant patients with COVID-19, as well as the pregnancy outcomes of these patients; (2) Methods: Medical records of 31 pregnant patients with COVID-19 admitted to three clinical hospitals from Romania, between October 2020 and November 2021 were examined. The patients were segregated into two groups depending on their clinical evolution: non-ICU admission (n = 19) or ICU admission (n = 12). Clinical and paraclinical findings were evaluated using univariate analysis, and the association of significant risk factors with maternal ICU admission was assessed using a multivariate analysis. Pregnancy outcomes of these patients were also recorded; (3) Results: Pulmonary disease, cough, dyspnea, leukocytosis, thrombocytosis, high serum values of transaminases, serum ferritin, and increased duration of hospital admission were identified as significant risk factors associated with maternal admission to the ICU. No significant differences regarding pregnancy outcomes were noted between the evaluated patients; (4) Conclusions: Specific risk factor identification in pregnant patients with severe forms of COVID-19 could improve the patient’s management.

When Treatment of Pulmonary Emphysema with Endobronchial Valves Did Not Work: Evaluation of Quantitative CT Analysis and Pulmonary Function Tests Before and After Valve Explantation.

PurposeTo investigate changes in quantitative CT analysis (QCT) and pulmonary function tests (PFT) in pulmonary emphysema patients who required premature removal of endobronchial valves (EBV).Patients and MethodsOur hospital’s medical records listed 274 patients with high-grade COPD (GOLD stages 3 and 4) and pulmonary emphysema who were treated with EBV to reduce lung volume. Prior to intervention, a complete evaluation was performed that included quantitative computed tomography analysis (QCT) of scans acquired at full inspiration and full expiration, pulmonary function tests (PFT), and paraclinical findings (6-minute walking distance test (6MWDT) and quality of life questionnaires). In 41 of these 274 patients, EBV treatment was unsuccessful and the valves had to be removed for various reasons. A total of 10 of these 41 patients ventured a second attempt at EBV therapy and underwent complete reevaluation. In our retrospective study, results from three time points were compared: Before EBV implantation (BL), after EBV implantation (TP2), and after EBV explantation (TP3). QCT parameters included lung volume, total emphysema score (TES, ie, the emphysema index) and the 15th percentile of lung attenuation (P15) for the whole lung and each lobe separately. Differences in these parameters between inspiration and expiration were calculated (Vol. Diff (%), TES Diff (%), P15 Diff (%)). The results of PFT and further clinical tests were taken from the patient’s records.ResultsWe found persistent therapy effect in the target lobe even after valve explantation together with a compensatory hyperinflation of the rest of the lung. As a result of these two divergent effects, the volume of the total lung remained rather constant. Furthermore, there was a slight deterioration of the emphysema score for the whole lung, whereas the TES of the target lobe persistently improved.ConclusionInterestingly, we found evidence that, contrary to our expectations, unsuccessful EBV therapy can have a persistent positive effect on target lobe QCT scores.

Treatment of giant cell arteritis - current approach and new possibilities.

Giant Cell Arteritis (GCA) is an autoimmune mediated systemic vasculitis affecting large arteries - the aorta and its branches. It has the highest incidence of all systemic vasculitides and manifests nearly exclusively in patients aged 50 or older. Amongst its non-specific and specific symptoms are headaches, mastication claudication or signs of rheumatic polymyalgia, a relatively common and immediate treatment requiring condition being acute vision loss due to optic ischemia. A GCA diagnosis is based on clinical and paraclinical findings and imaging techniques including PET/CT; with an important role still being played by histological verification from temporal artery biopsy. Treatment is based on immunosuppressive agents - systemic glucocorticoids, with adjunct therapy options being methotrexate and tocilizumab. Currently, there are also several clinical trials examining the efficacy of other modern biological agents in GCA.

Epileptic phenotypes in autoimmune encephalitis: from acute symptomatic seizures to autoimmune-associated epilepsy

ObjectiveTo describe the clinical and paraclinical findings, treatment options and long-term outcomes in autoimmune encephalitis (AE), with a close look to epilepsy.MethodsIn this retrospective observational cohort study, we enrolled patients...

PNEUMONIA SEVERITY INDEX COMPARED TO CURB-65 IN PREDICTING THE OUTCOME OF COMMUNITY ACQUIRED PNEUMONIA -A PROSPECTIVE STUDY

Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia. Objectives: Tocompare the efficacy of PSI and CURB 65 scoring systems in prognosticating the outcome in cases of CAP. Methods: This is a prospective study conducted over a period of one year on 150 patients who presented with community acquired pneumonia on the grounds of their clinical and paraclinical findings in our institution under the Department of respiratory Medicine, and fulfilling the inclusion and exclusion criteria. The patients were classified as per CURB 65 and PSI system and their outcome compared. Results: We studied 150 patients with community-acquired pneumonia (114 men, 36 women). In our study 100 % of patients in CURB 65 class 4 and 5 required ICU admission and death was 84.6% and 100% respectively. Majority of patients of PSI class 4 and 5 needed ICU admission 67% and 96% respectively and death was 16% and 58% respectively. The sensitivity and specificity of CURB-65 class ≥3 in predicting mortality were 79% and 89%, respectively (AUC 0.92). As for pneumonia severity index class ≥4, the rates were 79% and 84%, respectively (AUC 0.86). The mortality rate and need for ICU admission increased progressively with increasing scores. Conclusion: CURB-65 seems to be the preferred method to predict mortality and need for ICU admission in patients with community-acquired pneumonia.

Discriminating between Lyme neuroborreliosis and other central nervous system infections by use of biomarkers CXCL13 and IL-6

CXCL13 in cerebrospinal fluid has gradually become an established biomarker for Lyme neuroborreliosis (LNB), however the diagnostic performance of CXCL13 may be improved by the addition of IL-6, a non-specific infection biomarker. The aim of this study was to measure the concentrations of CXCL13 and IL-6 in cerebrospinal fluid, in the attempt to evaluate the diagnostic performance of these two biomarkers, in the differentiation between definite and possible LNB, as well as between LNB and other neuroinfections. This study used a cross-sectional design to quantify the levels of CXCL13 and IL-6 in cerebrospinal fluid (CSF) specimens from consecutive patients examined for central nervous system (CNS) infections at Lillebaelt Hospital in the Region of Southern Denmark. CXCL13 and IL-6 were measured simultaneously using the Bio-Plex 200 multiplex Cytokine Immunoassay System (Bio-Rad). Based on clinical and paraclinical findings, we grouped patients into six separate groups: definite LNB, possible LNB, Viral CNS infection, non-Borrelia Bacterial CNS infection, Other CNS disease (with pleocytosis) and Negative (without pleocytosis). A combined interpretation of four variables (leukocyte cell counts, protein concentration, CXCL13 and IL-6 concentrations in CSF) is presented using principal component cluster analysis. We included by chart review 390 patients discharged with definite LNB (n = 31), possible LNB (n = 10), confirmed Viral or non-Borrelia Bacterial CNS infection (n = 34), Other CNS disease (n = 58), and Negative (n = 257) for CXCL13 and IL-6 analysis. Principal component analysis (PCA) revealed three distinct clusters based on leukocyte cell counts, protein concentration, CXCL13 and IL-6 concentrations in CSF from 380 included patients (10 possible LNB patients excluded). The clusters clearly differentiate the groups: definite LNB, non-Borrelia Bacterial CNS infection and Negative (without pleocytosis). A receiver operating characteristic (ROC) curve comparing LNB patients (n = 31) and all non-LNB conditions with CSF pleocytosis (n = 99) indicated an optimal CXCL13 cut-off value of 50.7 pg/mL, resulting in a sensitivity and a specificity of 93.6 and 91.1%, respectively. The ROC analysis comparing patients with confirmed non-LNB CNS infection (n = 34) and all others with CSF pleocytosis (n = 97) resulted in an optimal IL-6 cut-off value of 111.5 pg/mL, yielding a sensitivity and a specificity of 78.8% and 82.5% respectively. Of the ten possible LNB patients, three cases (with CXCL13 levels above cut-off) fall within the LNB cluster, and one case is just outside, providing some laboratory support for the diagnosis of LNB. The remaining six possible LNB patients (with CXCL13 levels below the 50.7 cut-off) had little support for the diagnosis of LNB in the PCA-plot. The results of this study confirm that CXCL13 is a valuable supplement for diagnosis of LNB, and that the combination of CXCL13 and IL-6 may be used to differentiate cases of LNB from other CNS infections. Furthermore, IL-6 can be of differential diagnostic value when evaluating patients with possible LNB.

Idiopathic Encapsulating Peritonitis as Unusual Cause of Bowel Obstruction Discovered Intraoperative: A Case Report

Idiopathic sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by total or patial encasement of the intestines by a fibrocollagenous coccon-like a membrane. Early clinical features of this condition are generally non-specific and are frequently not recognized until the patient develops signs of small bowel obstruction. We report the observation of an adult patient operated for an acute bowel obstruction, in which the diagnosis of sclerosing encapsulating peritonitis (SEP) was made intraoperative. A good understanding of SEP and a better awareness of its clinical, paraclinical and therapeutic findings may aid to establish better management of this rare condition.

Endocrine Hypertension – a Multifaceted Disease

Abstract Secondary hypertension with an endocrine-associated condition—pheochromocytoma, primary aldosteronism (PA), Cushing's syndrome, acromegaly, congenital adrenal hyperplasia, hypo- and hyperthyroidism, renin-secreting tumors, and hyperparathyroidism— represents a small but heterogeneous group of potentially reversible forms of hypertension. High clinical suspicion is the cornerstone of diagnosing these different patterns of often severe and refractory hypertension. We report a series of 3 cases of endocrine secondary hypertension with particular clinical presentations and paraclinical findings in which the accurate diagnosis led to successful treatment of high blood pressure.

Evaluation of the Prevalence of Intracerebral Hemorrhage and Related Factors in Patients with Acute Ischemic Stroke Receiving Tissue Plasminogen Activator

Background: Stroke is one of the most common causes of disability. Based on reports, recombinant tissue plasminogen activator (rtPA) remains the only drug approved for the treatment of ischemic stroke and reduction of associated disabilities. One of the most common complications of this treatment is intracerebral hemorrhage (ICH), which can lead to mortality and aggravate initial symptoms. Objectives: The present study aimed to evaluate the prevalence of hemogenic factors and the most important complication inhibiting the receiving of treatment (i.e., ICH). Methods: In total, 300 patients treated with rtPA, ICH was measured by using a CT scan, and the hemorrhage level was determined. Moreover, data analysis was performed in SPSS to compare the two groups in terms of demographic, clinical, and paraclinical findings, including age, gender, blood glucose level, the NIHSS score, early CT scores, history of diabetes, myocardial infarction and stroke, hypertension, aspirin use, and smoking status. Results: Intracerebral hemorrhage was detected in 35 out of 300 patients. The mean age of the ICH group was 74 ± 14 years and significantly higher than the non-ICH group (68 ± 14 years) (P = 0.007). The mean NIHSS score was estimated at 15 ± 5 and 12 ± 5 in the ICH and non-ICH groups, respectively (P = 0.001). More bleeding was observed in patients with the upper one-third lesion of the infarct in the MCA arterial territory (P = 0.027). Conclusions: The prevalence of cerebral hemorrhage was 11.7% with 7.6% symptomatic ICH.