Paraclinical Signs Research Articles

A rare case of peripheral facial paralysis associated with meningococcal meningitis - case report

Introduction. Meningococcal meningitis is a severe form of bacterial meningitis caused by the bacterium Neisseria meningitidis (N. meningitidis). It is a medical emergency and requires prompt treatment to prevent severe complications or death. Peripheral facial paralysis is one of the rare complications that can occur in this condition. Aim. This paper aimed to draw attention to the possibility of an unexpected complication in a child with meningococcal meningitis, which requires prompt clinical and paraclinical management. Materials and methods. We present the case of a 2-year and 8-month-old female patient who, in the context of meningococcal meningitis, develops peripheral facial paralysis, a very rare complication, especially in the pediatric population. Results. The patient initially presented with clinical and paraclinical signs of a respiratory viral infection. However, in a febrile context, she has two generalized tonic-clonic paroxysmal episodes, characterized by gaze fixation, each lasting 2-3 minutes, followed by spontaneous recovery. Laboratory tests revealed neutrophilia, anemia, and elevated inflammatory markers, while the cranio-cerebral CT scan showed no structural changes. Blood cultures were also collected, and treatment was initiated with third-generation cephalosporin antibiotics, along with supportive and symptomatic therapy. The following day, the patient exhibited signs of right-sided peripheral facial paralysis, and intravenous corticosteroid therapy was added to the treatment. Approximately 24 hours after admission, the blood culture tested positive for gram-negative cocci, suggesting meningococcal meningitis. A cerebral MRI was performed, revealing changes indicative of acute meningoencephalitis. The clinical and paraclinical course was slowly favorable, with a slight persistence of facial asymmetry and intermittent ataxic syndrome. Conclusions. Meningococcal meningitis remains a relevant pathology in the pediatric population, able of causing severe complications that can result in long-term disability for the patient. Prompt treatment is crucial when this condition is suspected.

Vitamin-Resistant Rickets Type 2 Hereditary Disorder: About a New Case

The Aim: The aim of the study is to resume the difficulties to diagnosis and to manage a rare type of rickets the vitamin-resistant type II. Introduction: Rickets is a disease of the skeleton of growing children due to a defect in bone mineralization. Much rarer is vitamin-resistant rickets secondary to genetic or acquired abnormalities of phosphocalcic metabolism. Pseudo-deficiency rickets type ll is a vitamin-resistant rickets due to an abnormality of the vitamin D receptor. Report Case: This a 3 years old boy of consanguineous parents, with totally alopecia who presented an inability to walk and stand. The paraclinical signs (radiological and biological ) also the character genetic mutation put the diagnosis of vitamin-resistant rickets type II. Discussion: Vitamin-resistant ricket type II is a rare disease, the alopecia and the normal level of plasma 25 OH vitamin D is very suggestive of the diagnosis. The management of the disease is very difficult and requires a long term multidisciplinary approach. Conclusion: Target gene therapy and genetic counselling offer hope of cure for children who do not respond to long-term high-dose replacement therapy.

Clinical protocol for the care of ophidiotoxicosis in canines in Colombia

Every year, according to the World Health Organization, nearly 5,000,000 million accidents due to snake bites are reported worldwide, of which it is estimated that 33.3% to 50% of cases present as poisoning. Ophidic accidents that include ophidiotoxicosis have care protocols of therapy with antivenom serums, which vary according to the genus and species of the snake. Although in Colombia there are protocols for the care of ophidiotoxicosis in humans described by health entities, the canine clinic lacks this information. The aim of this systematic review is to build a medical protocol for ophidiotoxicosis in canines based on information reported in Colombia or tropical countries with which similar venomous snakes are shared. For this action, the PRISMA protocol was used; in total, 57 articles and 10 official documents on protocols for the care of ophidic accidents in humans were reviewed, which allowed the possible to classify snakebite accidents in group 1 (Bothrops, Lachesis and Crotalus accidents) and group 2 (Micrurus accident), also establish a medical protocol for ophidiotoxicosis in each of the groups indicated in canines, depending on the severity of the clinical and paraclinical condition. In conclusion, the clinical and paraclinical signs of the canine, vasculotoxic or neurotoxic, allow us to identify the group to which the aggressor snake belongs (group 1 or group 2, respectively), and their severity guides the selection and dosage of antivenom therapy specific for the clinical management of ophidiotoxicosis in canines.

Epidemiological and Prognostic Assessment of Nosocomial Infections in the Surgical Emergency Resuscitation Department IBN Tofail Hospital

Nosocomial infection is an infection acquired in a healthcare establishment. It is acquired more than 48 hours after admission [1]. Intensive care units are considered a reservoir of multi-resistant bacteria due to the critical condition of patients and the practice of certain invasive care [2]. NI constitute a public health problem marked by high morbidity and mortality. The objectives of our study are:  Detail the epidemiological profile of IN  List ATB-resistant germs  Determine the main prognostic factors We carried out a prospective study from January to June 2022 including patients hospitalized during the period in the HIT RUCH department. Patients whose stay was less than 48 hours were excluded. The diagnosis of IN was suggested based on clinical and paraclinical signs and then confirmed by bacteriological analyses. The resistance profile of the germs to ATB was reported by the results of the antibiogram. Among the 92 patients who stayed more than 48 hours in intensive care, 19 presented with IN, an incidence of 20.65%, of which 89% were male and the median age was 51.7 years. The time to IN acquisition was 5.1 days. IN at the pulmonary site were predominant with a percentage of 36.84%. The germs responsible for IN were dominated by BGN including acinetobacter baumanii with 42.1% and its resistance to ATB was 100% to C3G, 65.6% to amikacin; CGP germs were represented by staphylococcus aureus with 15%. IN-related mortality was 42%. It appears in the light of our results that IN and resistance of germs to ATB are worrying. Judicious use of ATB, hand washing and use of sterile equipment are essential to reduce the incidence of nosocomial infection.

Pediatric Ischemic Stroke: Clinical and Paraclinical Manifestations—Algorithms for Diagnosis and Treatment

Childhood stroke can lead to lifelong disability. Developing algorithms for timely recognition of clinical and paraclinical signs is crucial to ensure prompt stroke diagnosis and minimize decision-making time. This study aimed to characterize clinical and paraclinical symptoms of childhood and neonatal stroke as relevant diagnostic criteria encountered in clinical practice, in order to develop algorithms for prompt stroke diagnosis. The analysis included data from 402 pediatric case histories from 2010 to 2016 and 108 prospective stroke cases from 2017 to 2020. Stroke cases were predominantly diagnosed in newborns, with 362 (71%, 95% CI 68.99–73.01) cases occurring within the first 28 days of birth, and 148 (29%, 95% CI 26.99–31.01) cases occurring after 28 days. The findings of the study enable the development of algorithms for timely stroke recognition, facilitating the selection of optimal treatment options for newborns and children of various age groups. Logistic regression serves as the basis for deriving these algorithms, aiming to initiate early treatment and reduce lifelong morbidity and mortality in children. The study outcomes include the formulation of algorithms for timely recognition of newborn stroke, with plans to adopt these algorithms and train a fuzzy classifier-based diagnostic model using machine learning techniques for efficient stroke recognition.

Difficulties in the treatment of acute sepsis

SUMMARY. The problem of acute sepsis as a polyetiological acyclic disease with peculiar clinical symptoms and diagnostic difficulties, which requires special treatment, is considered. Acute sepsis is the main and most common clinical form of this disease. The predictors of acute sepsis and the variety of clinical manifestations of its two classical stages – septicemia and septicopyemia – are characterized in detail. A typical case of acute sepsis, which was diagnosed only later, is given. In this regard, etiotropic therapy was delayed. Therefore, despite powerful etiotropic therapy, the disease was not limited to acute sepsis, but continued in the form of infectious (septic) endocarditis. The septic nature of infectious endocarditis is due to the presence and persistence of a septic focus in the endocardium, as well as the course of the disease in the form of continuous growth of local inflammatory and destructive changes in primary septic foci and general infectious-metastatic, thromboembolic and immune complex manifestations, which in the absence of special treatment lead to an inevitable fatal outcome, that is, the development of a disease such as sepsis acyclicity. The diagnosis of infective endocarditis is based on the detection of initially reasonably suspicious clinical and then evident paraclinical signs of the disease. Classical clinical and morphological signs of infectious endocarditis, as well as general principles of therapy of such patients, are given.

Brain-Derived Neurotrophic Factor in Multiple Sclerosis Disability: A Prospective Study.

Multiple sclerosis (MS) is a demyelinating central nervous system disease that leads to neurological disability. Brain-derived neurotrophic factors (BDNFs) are neurotrophins involved in neurodegenerative disorders. This study analysed the relationship between serum BDNF, neurological disability and different MS treatments. We included 63 people with MS (PwMS), with relapsing-remitting MS or clinically isolated syndrome, and 16 healthy controls (HCs). We analysed the serum levels of BDNF and MS specific disability tests (Expanded Disability Status Scale, timed 25-foot walk test, nine-hole peg test), at baseline (V0) and after one year of interferon beta1a or teriflunomide treatment (V1). Baseline BDNF values were not different between the PwMS and HCs (p = 0.85). The BDNF levels were higher in PwMS vs. HCs after treatment (p = 0.003). BDNF was not related to last-year relapses or by the disease duration (all p > 0.05). The overall values for the PwMS decreased after one year (p < 0.001). Both treatments implied a similar reduction. BDNF was not related to neurological disability (p > 0.05). BDNF values were not influenced by the lesion burden, active lesions, or new lesions on MRI (p > 0.05). In our cohort, the PwMS had higher BDNF levels compared to the HCs after one year of treatment. BDNF was not related to clinical or paraclinical disease severity signs.

Albuminuria as a marker of systemic congestion and a predictor of poor long-term prognosis in acute decompensated heart failure

Aim. To identify the relationship of different albuminuria levels with paraclinical signs of congestion on admission and discharge and with the prognosis of acute decompensated heart failure (ADHF).Material and methods. Patients hospitalized with ADHF were included. Albuminu­ria level was assessed on admission and discharge. Patients were divided into groups according to albuminuria level (A1, A2, A3) according to KDIGO guidelines. Among the congestion parameters, the following were assessed: N-terminal pro-brain natriuretic peptide (NT-proBNP), lung ultrasound examination (BLUE protocol), venous congestion according to the VExUS ultrasound protocol (inferior vena cava, portal, hepatic and renal veins). The primary endpoint was a composite of all-cause death and rehospitalization for ADHF within 180 days of discharge.Results. The final analysis included 180 patients. The prevalence of A1, A2 and A3 albuminuria at admission was 50%, 39%, 11%, respectively. A greater degree of albu­minuria was associated with worse renal function at admission and discharge. Pati­ents with increased albuminuria on admission had higher NT-proBNP and a greater number of B-lines on pulmonary ultrasound in on admission and discharge, and a higher degree of complex venous congestion and renal vein congestion on VExUS on admission. A3 albuminuria at admission and discharge was associated with an increased risk of poor long-term prognosis (hazard ratio (HR) 3,551; 95% confidence interval (CI) 1,593-7,914; p=0,002), (HR 4,362; 95% CI 1,623-11,726; p=0,004).Conclusion. In patients with ADHF, the albuminuria level on admission is associated with the severity of congestion upon admission and discharge. A3 albuminuria at admission and at discharge is a predictor of long-term poor prognosis within 180 days after discharge.

Adrenal Gland Necrosis in Pregnancy: How to Manage? Case Series at Nantes University Hospital and Literature Review.

Adrenal necrosis is a rare but serious cause of abdominal pain of thrombotic origin during pregnancy. There is often a delay in diagnosis and treatment. The objective was to specify the clinical and paraclinical signs suggestive of adrenal necrosis, making it possible to improve the delay in diagnostic. The secondary objective was to establish a multidisciplinary protocol regarding management. This is a case report of pregnant women with a radiological diagnosis of adrenal gland necrosis. In parallel, we carried out a systematic review in the same period. We studied these patients' clinical, biological and radiological data. We included eight patients with a computed tomography scan diagnosis of adrenal necrosis and fifteen articles in the literature describing twenty-four cases. All the patients presented with the same symptoms. The treatment was based on curative anticoagulation. The diagnosis of adrenal gland necrosis is worth suggesting in view of the array of sudden morphine-resistant abdominal pain associated with a biological inflammatory syndrome. The diagnosis is based on the computed tomography scan. Three to six months of curative anticoagulation is recommended as well as a thrombophilia and endocrinological assessment to rule out adrenal insufficiency.

Tachycardie ventriculaire récidivante révélant une sarcoïdose cardiaque

Sarcoidosis is an inflammatory disease whose diagnosis is suggested by clinical and paraclinical signs and confirmed by histological evidence showing granulomatosis without caseous necrosis. The clinical presentation is sometimes misleading and the diagnosis difficult to confirm. We report here the case of a young woman with cardiac sarcoidosis of difficult diagnosis, revealed by a myocardial infarction with normal coronary angiography and recurrent ventricular tachycardia. Multimodal imaging, combined with left ventricular endomyocardial biopsies guided by electrophysiological analysis and endocavitary mapping, finally confirmed the diagnosis, and allowed effective medical treatment.

The impact of sleeve gastrectomy on polycystic ovarian syndrome: a single-center 1-year cohort study.

Obesity is one of the risk factors for polycystic ovarian syndrome (PCOS), and weight loss is the mainstay of treatment. This study investigates the effects of sleeve gastrectomy on clinical and paraclinical signs and symptoms of PCOS patients referred to a tertiary hospital. Female patients with a definite diagnosis of PCOS and body mass index (BMI) > 40kg/m2 who were candidates for sleeve gastrectomy were enrolled in this cohort study and followed for 1year postoperatively. Clinical signs and symptoms of PCOS, sonographic examination, and laboratory hormonal assessments were assessed preoperatively and 1year following surgery. Fifty patients enrolled in the study. The mean age of patients was 31.69 ± 9.54years. The mean BMI before and after the surgery was 44.28 ± 3.03 and 29.37 ± 2.41kg/m2, respectively. Oligomenorrhea was improved in 66% of patients. According to the sonographic criteria, PCOS was improved in 74% of patients. After a year post-operation, while the mean serum levels of the follicular stimulating hormone (FSH), testosterone, and dehydroepiandrostenedione have improved significantly in all patients (p < 0.001 in all), the significant decrease in serum luteinizing hormone (LH), LH/ FSH ratio, and estrogen was only noted in patients with improved clinical response (p < 0.05, p < 0.001, and p < 0.001 respectively). Weight loss and improvements in hyperandrogenism following sleeve gastrectomy result in clinical and paraclinical improvement of PCOS signs and symptoms, including oligomenorrhea and ovulation induction.

The “Electronic Pediatrician (EPed®)” – A clinically tested prototype software for computer-assisted pathophysiologic diagnosis and treatment of ill children

BackgroundKnowledge-based systems (KBS) are software applications based on a knowledge base and an inference engine. Various experimental KBS for computer-assisted medical diagnosis (CAMD) and treatment were started to be used since 70 s (VisualDx, GIDEON, DXPlain, CADUCEUS, Internist-I, Mycin etc). ObjectivesThis article briefly presents and tests the “Electronic Pediatrician (EPed)”, a prototype medical user-interface-based stand-alone KBS software created by the author (in Romanian language) that offers both a computer-assisted pathophysiologic diagnosis and treatment of ill children. EPed currently covers the most frequent (and mainly infectious) respiratory, digestive, renal and central nervous system pediatric diseases treated in the Department of Pediatric Infectious Diseases (DPID) of the County Emergency Hospital of Târgoviște town (Dâmbovița County, Romania). MethodsEPed uses a new type of pathophysiologically-based diagnosis algorithm, which combines the relative incidences of diseases and the degree of covering any clinical picture of any patient. EPed was tested by a retrospective study in which the author has chosen 34 clinical child cases diagnosed and treated in DPID in the period of pandemics. The diagnoses predicted by EPed for each tested patient in part was compared to the diagnoses established by the clinician for each patient, so that to test the diagnostic accuracy of EPed. ResultsThe real diagnoses of the 34 children tested were found to occupy an average list-index of 12 (varying from 1 to 57) in the lists of EPed-predicted diagnoses for each case in part (based on the clinical and paraclinical signs inputs), which is considered an acceptable result for a demo version. ConclusionsThe diagnostic accuracy of EPed was acceptable and is perfectible in the future by using other formulas of scoring which combine the relative incidences of diseases and the degree of covering the clinical picture of a patient. EPed is the first pathophysiologically-based KBS focused on general pediatrics (mainly on pediatric infectious diseases) written in Romanian.

Epidemiological, clinical, therapeutic features and predictors of death among COVID-19 patients hospitalized in Parakou: a cross-sectional study in Northern Benin

BackgroundCOVID-19 is an emerging contagious infection with polymorphic clinical manifestations. The purpose of this study was to describe the epidemiological, clinical, therapeutic features and identify the predictors of mortality among COVID-19 hospitalized cases in Parakou.MethodsThis was a cross-sectional, descriptive and analytic study. Systematic recruitment was used to include all patients hospitalized with COVID-19 from May 8, 2020, to December 31, 2021, whose medical records were available and usable. The variables studied were clinical and paraclinical signs, diagnostic and therapeutic means, evolution under treatment and prognostic factors. This study was approved by the Local Ethical Committee. The data were analyzed using Stata/MP 14.1 software.ResultsA total of 198 cases of COVID-19 were identified, 117 of whom were men. The mean age was 51.53 ± 19.51 years. The presenting signs were fever 146 (74.11%), cough 157 (79.70%) and dyspnea 118 (53.90%). It was severe COVID-19 in 108 cases (54.55%). Therapeutically, 95 patients (47.98%) had received the combination of Lopinavir/ritonavir and Ribavirin and 95 others (47.98%) received chloroquine. Recovery was noted in 151 (76.26%) patients. Mortality rate was 18.18%. Predictors of death were high blood pressure, presence of signs of severity, high-concentration mask ventilation used, and elevated transaminases.ConclusionCOVID-19 was a reality in Parakou, with a significant number of severe cases requiring hospitalization. Several factors are associated with the prognosis of the disease.

Analysis of clinical and paraclinical findings in children with community-acquired pneumonia and comorbid chronic tonsillitis

Background. Respiratory morbidity is the most frequent cause for children consulting a doctor, accounting for about one-quarter of primary care consultations. The current research aimed to analyze the clinical and paraclinical features of community-acquired pneumonia (CAP) with comorbid chronic tonsillitis in children and to assess the prognostic value of the proposed diagnostic procedures to optimize the management of patients. Materials and methods. The study was conducted at the Pulmonology and Allergology and Infectious Department of the Municipal Medical Establishment “Chernivtsi Regional Children’s Clinical Hospital”, Ukraine. Clinical group I included 20 children (mean age 9.40 ± 1.56 years) with uncomplicated community-acquired pneumonia and concomitant chronic tonsillitis, and the clinical group II consisted of 16 patients (mean age 9.60 ± 1.13 years) with CAP without concomitant pathology of the upper respiratory tract. Results. Community-acquired pneumonia in children with comorbid chronic tonsillitis is characterized by an intense proinflammatory response in the airways, which manifests itself in fever (odds ratio (OR) 6.0), malaise and fatigue (OR 14.3), persistent cough and dyspnea (OR 3.7), leukocytosis (OR 2.0), high levels of acute phase proteins (OR 4.5), activation of the oxidative protein modification according to the exhaled breath condensate examination (OR 6.0–30.0), and more frequent fungal-bacterial association according to the microbiological examination of sputum and oropharyngeal swab (OR 11.1). The obtained data suggest that parenteral antibiotic therapy was used in 20 % of patients from group I and 12.5 % from group II, while 6.3 % of children from group II received only oral antibiotics. In children with CAP and chronic tonsillitis versus comparison group, the ОR of receiving parenteral antibiotic therapy for longer than 7 days reached 10.0, and the OR of oral antibiotic therapy for longer than 5 days reached 4.0. Conclusions. The results obtained from the study show that children with CAP and comorbid chronic tonsillitis have more pronounced clinical symptoms, accompanied by paraclinical signs of inflammation that last longer during hospital treatment and require comprehensive therapy (OR 3.3) of longer duration (OR 4.0–10.0).

Non-Hodgkin's Malignant Lymphomas of the Palatine Tonsils: A Case Report

The palatine tonsils are the first extra-nodal localization of cervicofacial non-Hodgkin's malignant lymphomas. It is a rare localization and most often a type B lymphoma. This case highlights the difficulty of making an early diagnosis, given the non-specificity of clinical and paraclinical signs, and the fact that only anatomopathological examination can confirm the diagnosis. Chemotherapy is the only treatment for chemo sensitive forms of the disease. Prognosis is generally good, depending on sensitivity to treatment and stage of disease.

CLINICAL, PARACLINICAL FEATURES OF PATIENTS WITH CYTOMEGALOVIRUS DISEASE AT THE NATIONAL HOSPITAL FOR TROPICAL DISEASES 2020 - 2022

Objectives: To describe the clinical and paraclinical characteristics of patients with CMV disease at the National Hospital for Tropical Diseases.Subjects and methods: Retrospective combined with a prospective cohort study on 58 patients diagnosed with CMV disease treated at the National Hospital of Tropical Diseases in 2 years from January 2020 to June 2022.Results: In a total of 58 patients with CMV disease, 56.9% of patients were male and the mean age was 45.57 ± 15.7 years. HIV (55.17%), history of prolonged corticoid therapy (20.7%), diabetes (10.34%), alcoholism (3.45%), transplantation (1.72%) were major comorbidities. Common clinical symptoms were:fever (74.13%), low visual acuity (37.93%), weight loss (31.03%), productive cough (31.03%), headache(27.59%), lymphadenopathy (24.14%), dry cough (22.41%). 43.1% had monocytosis status, most patientshad normal white blood cell (WBC) count, and slightly increased inflammation markers (ESR, CRP, PCT).The interquartile range of T-CD4 was48 (11.75 - 215), and 60% of patients had T-CD4 countless than 100cells/µL. There was no difference between two groups of HIV and non-HIV patients in sex ratio. The HIVgroup had higher mean age than non-HIV. Low visual acuity, lymphadenopathy, and weight loss were more frequent in the HIV group, and liver damage was only seen in the non-HIV group.Conclusion: The study showed that the clinical and paraclinical signs of CMV disease are diverse, nonspecific and need to be considered for screening in patients with suspected symptoms with a history of HIV, prolonged corticoid, diabetes, alcoholism, or transplantation.

Tophaceous Gout in Adults: Case Report and Review of the Literature

Gout is a microcrystalline arthropathy resulting from the deposition of sodium urate microcrystals in the articular and periarticular tissues, and even in the extra-articular tissues. It affects mainly men and its mechanism is at the origin of a delay in diagnosis, and consequently its severe forms can occur. We report a case of tophaceous gout in a 59 year old adult, with no family history of gout. Gout, whose first attack was at the age of 40, was polyarticular and affected the left wrist, elbows, knees, ankles and the left big toe. The diagnosis was based on clinical signs (tophi at the elbows, ankles, hands, and auricles) and paraclinical signs ( hyperuricemia at 620 ʯmol/l With normal at150-360 ʯmol/l in women and 310-420 ʯmol/l in men, presence of sodium urate cristals in the puncture fluid of the right knee, double- contour image on ultrasonography) by the ACR/Eular classification criteria. The background treatment was based on 120mg of Febuxostat per day with a favorable follow-up marked by the regression of signs.

Managing the moral expansion of medicine

Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing.

Investigating hypozincemia and validity of plasma zinc measurements in infected patients

Hypozincemia is a well-known phenomenon in patients with infection caused by the activation of the acute phase response (APR). Zn status is still based upon plasma Zn levels in venous blood samples. Recent trials have questioned the validity of this measurement in infected patients. The aim of this study was to assess plasma levels of Zn, albumin and Zinc-binding capacity in patients during and following infection. Furthermore, to assess if an assay for albumin-corrected Zn could potentially replace or add knowledge to existing tools for assessment of Zinc-status. A prospective clinical observational trial was conducted. Associations between P-Zn, -Albumin, -Albumin-corrected Zn and Zn binding capacity were analyzed. Analyzes were based upon two venous blood samples drawn during and following infection, respectively. Twenty-three patients admitted to a medical ward showing paraclinical signs of infection were included in the study. Significantly lower levels of Zn and albumin were found during infection compared with the levels post-infection. These findings corresponded to the changes found in Zn binding capacity. About 52% of patients were deemed Zn deficient by plasma Zn levels during infection but after applying the correction for P-Albumin, all patients were found to be within normal ranges of Zn levels. Furthermore, we found no statistically significant difference between albumin-corrected Zn during infection and P-Zn post-infection. The new assay was found to accurately estimate the ‘true’ Zn levels in infected patients. Based on our findings, we propose albumin-corrected P-Zn as a promising new tool, which may result in more precise diagnostics and treatment.

Loa loa in the Vitreous Cavity of the Eye: A Case Report and State of Art.

ABSTRACT.Loa loa is a filarial nematode responsible for loiasis, endemic to West–Central Africa south of the Sahara and transmitted by flies. This study reports a case of L. loa in the vitreous cavity of the eye of a young patient, along with an in-depth literature review. A 22-year-old woman from Cameroon who migrated from Cameroon to Italy was referred to the Emergency Ophthalmology Department at Policlinico di Bari in July 2021 with the presence of a moving parasite in the subconjunctiva of the left eye. A recent onset of a papular lesion on the dorsal surface of the right wrist and a nodular lesion in the scapular region were detected. L. loa filariasis was diagnosed based on anamnestic data, clinical and paraclinical signs, and a parasitological test confirming the presence of microfilariae in two blood samples collected in the morning of two different days. Because of the unavailability of diethylcarbamazine (DEC), albendazole (ALB) 200 mg twice daily was administered for 21 days. A mild exacerbation of pruritus occurred during treatment, but resolved with the use of an antihistamine. A single dose of 12 mg ivermectin was prescribed at the end of the treatment with albendazole. Unlike other endemic parasite infections, L. loa is not included in the Global Program to Eliminate Lymphatic Filariasis, because it is not mentioned in the WHO and CDC list of neglected tropical diseases. This can result in an overall risk of lack of attention and studies on loiasis, with lack of data on global burden of the disease.