Positive Findings Research Articles

Age-specific incidence of joint disease in paediatric patients with haemophilia: A single-centre real-world outcome based on consecutive US examination.

Joint health is one of the most important factors contributing to a healthy life in patients with haemophilia. Recent study revealed that starting early prophylaxis was not enough to prevent joint disease in most paediatric patients with haemophilia. In this study, we aimed to determine the age-specific incidence of acute joint disease during childhood at single haemophilia treatment centre (HTC). The joint health in 48 patients was evaluated based on consecutive US testing for 5 years at annual multidisciplinary comprehensive care. During the study period, 23 patients (47.9%) had no joint disease since the initial examination, whereas 13 patients (27.0%) showed development from negative to positive findings. The incidence of joint disease increased with age: 0% in preschool, 5.3% in elementary school, 14.3% in junior high school and 35% beyond high school age. Among the 13 patients who developed joint disease, two experienced acquired synovitis that resolved during the follow-up period. Statistical analysis revealed that the patients who routinely underwent follow-up by the HTC exhibited a significantly lower incidence of joint disease than did those followed up at other institutions (p<.001). These results indicated that close check-up, including routine joint examination using US as well as frequent assessment of pharmacokinetic profile at the HTC, might play an important role in avoiding joint disease among paediatric patients with haemophilia.

Capsule Enteroscopy Using the Mirocam® versus OMOM® Systems: A Matched Case-Control Study.

Although several devices are available for small bowel capsule endoscopy, few studies have compared their visualization quality and diagnostic yield, despite users reporting subjective differences between them. This study aims to compare two widely used systems (Mirocam® MC1600 and OMOM® HD). Patients who underwent OMOM® HD capsule enteroscopy between August 2022 and February 2023 were prospectively included consecutively (cases). Controls were retrospectively selected from a database of patients who underwent Mirocam® MC1600 enteroscopy between March 2018 and July 2022 in a 1:1 ratio. Controls were matched for potential confounders (age, sex, indication, hospitalization, comorbidities, and opioid prescription). The small bowel cleanliness (global and divided by tertiles), the diagnostic yield (positive findings) and the transit times (TT) were compared. Overall, 214 patients were included (107:107). Global bowel preparation was similar between the OMOM® and Mirocam® groups. However, the average scores for each tertile were significantly higher when the OMOM® HD capsule was used (p < 0.05). Small bowel TT was shorter for OMOM® HD (265 ± 118 versus 307 ± 87 min, p = 0.020), while the diagnostic yield (55.0%) and relative distribution of lesions were similar. This study suggests that capsule characteristics, namely resolution, and illumination, systematically interfere with the perception of preparation quality. However, this did not affect the diagnostic yield.

Understanding Chest CT Scan Usage Among Adolescent Blunt Trauma Patients at Adult Trauma Centers.

The utility of chest computed tomography (CCT) is not well established in the diagnostic algorithm of adolescent blunt trauma patients. Our study's aim was to review CCT usage in the initial evaluation of adolescent blunt trauma. We retrospectively reviewed adolescent blunt trauma patients treated at our urban level 1 adult trauma center from 2015 to 2019. Our primary outcome was the rate of positive CCT findings. Univariate and multivariate logistic regression analyses were performed. There were 288 patients that met our inclusion criteria and 153 positive CCT and 135 negative CCT. There was no statistically significant difference between both groups in terms of age, gender, and race. Those with a positive CCT were found to have a statistically significant higher ISS than the negative CCT group (20.6 ± 12.3 vs 12.3 ± 7.6; P < .01). Those with a positive CCT were more likely to have a GCS <15 (40% vs 25%), have a positive CXR (38% vs 2%), have chest pain (16% vs 7%), and have an abnormal chest exam (27% vs 7%) than those with a negative CCT (P < .01). On multivariate analysis, positive CXR (P < .05, OR = 13.96) and ISS (P < .05, OR = 3.10) were independently associated with a positive CCT. While CCT may provide valuable information, clinical exam coupled with low-ionizing radiographic imaging (i.e., CXR) may sufficiently identify chest trauma after blunt mechanisms. This shift in management can potentially reduce the risk of radiation without compromising the care of adolescent trauma patients at adult trauma centers.

Epizootic and epidemiological situation of hemorrhagic ever with renal syndrome in the Rostov region (2020–2022)

Objective: evaluation of the epizootic and epidemiological situation for HFRS in the Rostov region. Materials and methods: from 2020 to 2022, an enzyme-linked immunosorbent assay was used to study the presence of hantavirus antigens in samples of small mammals and class G immunoglobulins in the blood sera of healthy donors. Results: epizootological monitoring conducted in 35 administrative districts of the region and in the vicinity of Rostov-on-Don (2157 animals, 15 species) revealed the circulation of hantaviruses in populations of small mammals. Infection with hantaviruses of six species of mammals was registered: house mouse, common vole, yellow-bellied mouse, European forest mouse, East European vole, small forest mouse. 1062 blood samples from residents of various regions of the region were tested. Class G antibodies to hantaviruses were detected in 7.0%, 4.5%, 7.1% in different years. Conclusions: the coincidence in the territories of Azovsky, Kamensky, Neklinovsky, Salsky, Morozovsky districts of positive findings of the hantavirus antigen in samples of small mammals and seropositive samples of donors suggests the presence of a natural focus of HFRS, the establishment of boundaries and activity of which needs further research.

Human umbilical cord mesenchymal stem cell‑derived exosomes improve ovarian function in natural aging by inhibiting apoptosis.

Prolonging the reproductive lifespan is beneficial for preserving the physical and psychological health of women. The transplantation of mesenchymal stem cell (MSC)‑derived exosomes (MSC‑Exos) has been reported to be a promising regenerative therapeutic strategy for restoring the function of aging ovaries. The present study thus evaluated the therapeutic efficacy of exosomes derived from human umbilical cord‑MSCs (hUCMSC‑Exos) in a mouse model of natural ovarian aging (NOA), and further investigated the role of exosomal microRNAs (miRNAs/miRs) in the mechanisms of this creative therapy. Specifically, following the administration of hUCMSC‑Exos in mice with NOA, ovarian function was found to improve, as indicated by the restoration of follicle numbers and hormone levels. These exosomes were found to exhibit the ability to inhibit PTEN expression and suppress apoptosis both invivo and invitro. Subsequently, miRNA sequencing of the exosomes was performed, following which bioinformatics analysis was used to identify the highly expressed miRNAs that are capable of targeting PTEN expression. Through high‑throughput sequencing and molecular analyses, miR‑21‑5p was found to be the highest in ranking in terms of expression, suggesting that hUCMSC‑Exos can preserve ovarian function by suppressing PTEN expression to inhibit apoptosis by delivering miR‑21‑5p. On the whole, the results of the present study suggest that the application of exosomes can be used to restore ovarian function in mice with NOA. These positive findings also suggest that the transplantation of exosomes derived from MSCs holds promise as an agent against ovarian aging.

Role of GeneXpert in Diagnosis of Smear Negative Pulmonary Tuberculosis

Abstract Background Pulmonary TB considered as a global health problem with specific concern in developing countries that need rapid methods in diagnosis with accurate results. Objective To evaluate the diagnostic yield of GeneXpert assay in diagnosis of TB infection in patients with negative sputum smear. Methods A total 346 cases with suspect clinical and radiological finding for TB infection was subjected to direct sputum analysis under microscope to find acid fast bacilli (AFB); the negative smear then subjected to GeneXpet assay analysis and sputum culture on LJ media. Results All cases with negative GeneXpert results, had negative culture, while 45 cases of 50 that had positive GeneXpert assay finding showed positive culture. The diagnostic yield of test was excellent (94.7%). The sensitivity, specificity, PPV and NPV were 100, 89.8, 90 and 100 respectively. Conclusion The performance of GeneXpert assay in diagnosing TB among smear negative patients was reasonable, and may fast the decision of treatment.

Nail Folds Capillaries Abnormalities Association with Type 2 Diabetes Progression and Correlation with Diabetic Retinopathy

Abstract Background Retinopathy is regarded one of the most important complications of diabetes that occurs after long duration of the disease with untight glycemic control, and it is regarded as one of the preventable causes of blindness so proper evaluation of diabetic patients and their complications can prevent blindness. Aim of the Work to assess the capillaroscopic changes in type 2 diabetes mellitus patients and correlate the findings to the microvascular complication of the retina (diabetic retinopathy). Patients and Methods Our study was conducted on 62 patients of type 2 diabetes mellitus (16 male, 46 female) their ages above 18 years lies between (36-66) years. All patients were subjected to full history taking and thorough clinical examination. Results Nailfold capillaroscopy imaging revealed that 31 patients with positive capillaroscopic findings had branched and tortuous capillaries, 34 patients had hemorrhage,5 patients with dilated apical capillary, 46 patients had elongated capillaries,16 with normal capillary length and 48 patients with dilated capillary width capillary. Fundus examination revealed 26 patients with DR and 36 patients nonDR. Our study reported that DR patients had higher duration of diabetes more than non-DR patients. Also, DR patients showed higher levels of HbA1c more than the non-DR patients. Patients with diabetic retinopathy show high percentages of tortuous, branched capillaries. 46.2% of the DR patients had precapillary edema verses 19.4% of the non-DR patients. The mean capillary width in the DR group of patients was 27.68 ± 5.7 verses 23.02 ± 3.29 in the non-DR patients which indicate that patients with DR had more wide capillaries than the non-DR patients. Higher fasting glucose levels were detected in the DR patients than the non-DR patients. Branched, tortuous capillaries, hemorrhage and dilated apical capillaries are documented in the patients with higher median diabetic years 15-20 years in the DR group of patients. Tortuosity, precapillary edema and dilated apical capillaries are positive in patients with higher median diabetic years. (24) patients documented to have DR with HbA1c ≥7% and only 2 DR patients with HbA1c &amp;lt;7. (29) patients had tortuous capillaries with HbA1c ≥7 verses 2 patients had tortuous capillaries with HbA1c &amp;lt;7. Also, (19) patients had precapillary edema in HbA1c ≥7 group while (0) patient had precapillary edema in the HbA1c &amp;lt;7 group. Capillary width and branched capillaries are found to be a predictor of diabetic retinopathy in multivariant analysis. Conclusion nailfold capillaroscopy is regarded a helpful noninvasive newly emerging tool to assess the capillaroscopic changes in diabetic patients as an indicator to diabetic complication development such as diabetic retinopathy.

Role of 68Ga-Labelled PSMA PET/CT in Assessment and Staging of Prostate Cancer

Background Prostate cancer (PCa) is the most common worldwide tumor in men with increasing incidence. Aim of the Work The purpose of our study is to evaluate the potential role of 68Ga-labelled PSMA PET/CT in assessment and staging of prostate cancer and correlate those positive findings with biopsy. Patients and Methods Thirty patients with pathologically confirmed prostate cancer who underwent PET/CT study. They were selected from Department of Radiology at Ain Shams University Hospital from November 2020 to May 2021. The patients’ ages ranged between 53 and 89 years old (mean age 66.43 ± 8.9 years). All patients underwent a 68Ga-PSMA PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value (SUVmax) for primary prostatic tumor and extraprostatic metastases. The diagnostic sensitivity and specificity of 68Ga-PSMA PET/CT for diagnosis and staging of PC were established by histopathology as the reference standard. Results Median SUVmax for the primary tumor was 12.88 (range, 6.7–25). Nineteen patients had associated PSMAavid lymph nodes, median SUVmax for those was 11 (range, 3.7–29). 68Ga-PSMA PET/CT detected extraprostatic metastases in 19 (63.3%) patients. The most common site of extraprostatic metastases was the bone (17 patients). The sensitivity of 68Ga-PSMA PET/CT examination in the diagnosis of PC was 90.9% and specificity was 68.4%. Conclusion 68Ga-PSMA PET/CT is a valuable tool with high diagnostic sensitivity and good specificity for diagnosis and staging of patients with newly diagnosed PC.

Use of PET/CT in Diagnosis and Staging of Malignant Pleural Mesothelioma

Background The pleural space is formed by two pleural membranes: the parietal pleura and the visceral pleura. Each is comprised of a single layer of mesothelial cells, a basement membrane, and a layer of connective tissue which contains blood vessels and lymphatics. Various benign, malignant, and tumor-like conditions can involve the pleura. Malignant neoplasms are more common than benign neoplasms. Pleural tumors can have a varied imaging spectrum – may be unilateral or bilateral, calcified, or noncalcified, and focal or diffuse. Aim of the Work To elucidate the role of PET/CT in diagnosing and staging of malignant pleural mesothelioma (MPM) patients. Patients and Methods A cross sectional analysis of all cases of malignant mesothelioma referred to Elmaadi Military hospital during the period from Nov. 2020 to Jun. 2021 for assessment of the role of F18-FDG PET/CT in staging, restaging and monitor of therapy response compared to CT. The total number of patients with mesothelioma was 30 patients, 20 males and 10 females. Results In the present study, 27 patients out of 30 patients evaluated with PET/CT showed positive findings at primary sites in pleura and accurately localized tumor sites in them. Also 9 patients of them had local lesions in pleura only with 6 patients had loco-regional lesions. Furthermore 12 patients had loco-regional and metastatic lesions. We demonstrate that PET/CT has high sensitivity than CT in detecting MPM lesions specially intrathoracic lymph node and extrathoracic metastasis as (37% vs. 18 %) of PET/CT and CT respectively. Conclusion FDG PET/CT increases the accuracy of overall staging in patients with MPM and significantly improves the selection of patients for curative surgical resection. Specifically, FDG PET/CT is particularly useful in identifying mediastinal lymph node involvement and detection of distant metastases.

Impact of Indoor Air Quality and Breathing on Back and Neck Pain: A Systematic Review.

Back pain and neck pain are important public health concerns and are among the most common and disabling conditions globally. However, the relationships among indoor air quality (IAQ), breathing parameters (pulmonary function, respiratory disorders), and back pain and neck pain have not been adequately assessed. The purpose of this study was to systematically review the literature about the impact of IAQ and breathing parameters on back pain and neck pain (PROSPERO ID: CRD42022380515). CINAHL, EMBASE, PEDRo, and PubMed databases were searched through January 19, 2023. Inclusion criteria for study eligibility were observational studies (except case reports) or randomized controlled trials (RCTs), published in peer-reviewed journals in the English language, human research, original research, examined the relationships between IAQ, or breathing parameters with back pain or neck pain. Review procedures were conducted and reported according to PRISMA recommendations. Empirical evidence statements were developed for observational studies, and grades of evidence statements were developed for RCTs. Sixty-seven eligible studies were found (54 observational studies and 13 RCTs) that enrolled 345,832 participants. None of the studies assessed the combined impact of IAQ and breathing parameters on back pain or neck pain. No level 1 studies were found, which precludes making strong statements about causality and strong recommendations about the efficacy of IAQ and breathing exercise interventions for reducing pain and disability related to back pain and neck pain. Evidence indicates that poor IAQ and respiratory disorders are related to an increased risk of back pain and neck pain. Conflicting evidence exists about the association between pulmonary function with back pain and neck pain. Evidence for breathing exercise interventions was mixed with numerous limitations. This review provides preliminary evidence on the relationships of IAQ and breathing parameters with back pain and neck pain, which can be used to guide future research and clinical implementation efforts. Assuming positive findings in subsequent research, a wide range of stakeholders involved with this complex human-building-environment interface can be equipped to address IAQ and breathingparameters, along with other established risk factors to help those suffering from back pain and neck pain.

UHPLC-ToF-MS as a High-Resolution Mass Spectrometry Tool for Veterinary Drug Quantification in Milk

Milk is one of the most widely consumed foods in the world, despite the increasing consumption of plant-based alternatives. Although rich in nutrients and believed by consumers to be free of undesirable contaminants, milk, whether of animal or plant origin, is not always free from residues of chemical substances, including veterinary medicines. For instance, in intensive livestock production, antibiotics are often used to treat animals or, illicitly, to improve their growth performance, which can lead to their presence in the final food. Additionally, the continuous use of veterinary drugs in intensive animal production can lead to their occurrence in agricultural soils and therefore are absorbed by plants as another source of entering the food chain. An effective and accurate multi-detection quantitative screening method to analyze 89 antibiotics in milk was optimized by ultra-high-performance liquid chromatography coupled with a time-of-flight detector (UHPLC-ToF-MS) and further validated in accordance with the Commission Implementing Regulation (CIR) 808/2021 and the International Council for Harmonization (ICH) guidelines on the validation of analytical procedures. Apart from the specific parameters required by CIR 808/2021, the aim was to access the lower limits of the method, limits of detection (LoD) and quantification (LoQ), regardless of the maximum residue limits (MRLs) defined in the legislation. The method was then applied in the analysis of 32 supermarket samples, resulting in four positive findings, including one plant-based sample. The antibiotics found were from the macrolides and sulphonamides families. Nevertheless, the concentrations detected were below the established maximum residue level (MRL).

WTP3.11 The impact of inpatient Magnetic Resonance Cholangiopancreatography on total length of hospital stay

Abstract Aims Magnetic resonance cholangiopancreatography (MRCP) is a frequently performed inpatient imaging modality to rule out bile duct stones (BDS). The aim of the study was to quantify the time delays from request of MRCP to its execution. Methods A retrospective cohort study of all consecutive adult inpatient MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, indications for MRCP, system timestamps for MRCP scans and length of stay (LOS) were analysed. Peak liver function test values were used pre-MRCP. Results A total of 302 patients were identified, 181 (59.9%) were female. Median age was 65 (IQR 50-76) and median Scottish Index of Multiple Deprivation score was 5 (IQR 3-8). 59 (19.5 %) MRCPs were performed for jaundice and 55 (18.2 %) were for gallstone pancreatitis. 104 (34.3%) had proven bile duct stones (BDS). Ultrasound and/or CT evidence of dilated bile ducts was strongly correlated with positive MRCP findings (p&amp;lt;0.001). Patient age, gender, bilirubin and alkaline phosphatase levels were not predictive for BDS. 112 (37.1%) were urgent requests. The median wait time for urgent MRCP was 1.0 days (IQR 0.6- 1.8) compared to 1.2 days (IQR 0.9- 2.7) for routine requests. Median LOS was 5.9 days (IQR 3.6-10.9). Conclusion Inpatient MRCP does not significantly impact total LOS. We conclude that patients with high risk factors for BDS should undergo MRCP as inpatients to mitigate complications of BDS.

Mineralocorticoid receptor antagonists in cardiovascular translational biology.

This review examines the role of mineralocorticoid receptor antagonists (MRAs) in cardiovascular biology and the molecular mechanisms involved in mineralocorticoid receptor antagonism. The data discussed suggest that MRAs can play an important role in decreasing the impact of inflammation and fibrosis on cardiorenal outcomes. Evidence derived from major randomized clinical trials demonstrates that steroidal MRAs reduce mortality in patients with heart failure and reduced ejection fraction. Initial positive findings observed in patients with chronic kidney disease and type 2 diabetes (T2D) indicate the possible mechanisms of action of nonsteroidal MRAs, and the clinical benefits for patients with cardiorenal disease and T2D. This article supports the application of basic science concepts to expand our understanding of the molecular mechanisms of action involved in pathophysiology. This approach encourages the development of treatment options before diseases clinically manifest. Video Abstract: http://links.lww.com/CAEN/A42.

Molecular Characterization of Class A-ESBLs, Class B-MBLs, Class C-AmpC, and Class D-OXA Carbapenemases in MDR Acinetobacter baumannii Clinical Isolates in a Tertiary Care Hospital, West Bengal, India.

Background Acinetobacter calcoaceticus baumannii (ACB) complex has become a major concern nowadays because of its increasing involvement in several severe infections associated with catheter-related bloodstream and urinary tract infections, ventilator-associated pneumonia, cerebrospinal shunt-related meningitis, and wound infections. Multiple drug-resistant (MDR) ACB cases have been described with an increasing trend where at least it is resistant to a minimum of three antimicrobial groups. The mortality rate associated with A. baumannii is significantly higher than all Acinetobacterspp. isolates with the most prevalence seen in India and Thailand. The rapid spread of high resistance to most potent antimicrobial drugs is due to its ability to incorporate resistance determinants despite multifactorial reasons such as alteration in permeability of cell membrane by either losing expression of outer membrane porins or excess production of efflux pumps. This study aims to characterize resistance determinants responsible for MDR at the genetic level and emphasizes the use of genotyping in routine diagnosis as genotype analysis is reliable and valid. Methodology A total of 289 ACB complex clinical isolates were included in this study. The study for species-level identification of A. baumannii was conducted at the Department of Microbiology, IQ City Medical College Hospital, Durgapur, West Bengal. In addition, the detection of encoded genes associated with class A-extended spectrum beta-lactamases (i.e., CTX-M, KPC, SHV, and TEM genes), class B-metallo-β-lactamases (i.e., IMP, NDM, and VIM genes), Class C-AmpC cephalosporinase, and classD-OXA carbapenemases (i.e., blaOXA-10/11, blaOXA-24, blaOXA-48, blaOXA-58, blaOXA-143, and blaOXA-235was done using real-time polymerase chain reaction. Results All 289 non-repetitive ACB complex clinical isolates were confirmed as A. baumannii, of which 277 (96%) isolates were MDR. There were no findings of blaCTX-M, blaKPC, blaSHV, blaTEM, blaIMP, blaVIM, blaAmpC, blaOXA-10/11, blaOXA-24, blaOXA-48, blaOXA-58, blaOXA-143, and blaOXA-235 genes in our study. However, there were four (1.44%) positive findings of the blaNDM gene. All MDR isolates (n = 277) were positive for the blaOXA-51 gene. In addition, blaOXA-23 was positive in 269 (97.12%) isolates. Conclusions The oxacillinase production corresponding to blaOXA-23 and blaOXA-51 were the most prevalent antibiotic resistance determinants among MDR A. baumanniiin our study. Four (1.44%) isolates had the multiple genes blaOXA-51, blaOXA-23, and blaNDM that shows the coexistence of diverse genetic elements involved in MDR A. baumannii, resulting in total resistance except for a few potent drugs such as colistin and tigecycline. Genotyping is helpful in determining the contribution of the isolates in understanding their association with encoded genes, which, in turn, helps in designing effective surveillance and control strategies in the management of such MDR isolates.

Serological Detection, Isolation and Molecular Confirmation of Parainfluenza Virus-3 in Camels, Iraq

The objectives of this study were to detect and isolate the Parainfluenza-3 virus (PIV-3) in camels with naturally developed respiratory illness and to determine the titer of the isolates using the virus titration. Therefore, an overall 100 nasal swabs and jugular vein blood samples were collected from diseased camels in four districts in Wasit province (Iraq) from December (2019) to March (2020). The swabs were subjected to six subsequent passages on bovine kidney cell culture (BKCC) to isolate the virus and to confirm infection by molecular PCR assay. Fever (40°C), abundant runny nasal discharge, ocular discharge, coughing, depression, increased respiratory rate, abnormal breath sounds, and mainly wheezing are the most observed clinical signs. Positive findings were involved 24% by ELISA and 37% by RT-PCR. The age group from 1-2 years old showed a high infection rate, while the lower level was in the 4-6 years old group. Regarding season, the infection rate was high in winter compared to spring. Sheik Saad city appeared to have a higher infection rate than other districts. The positive samples inoculated into the Bovine kidney cell culture (BKCC) revealed the cytopathic effects (CPE) after three successive passages, which appeared as clumping and rounding with the progression of infection time at the 4th passage. Elongation and giant cell formation were shown in some isolates after the 5th and 6th passages until they reached complete detachments of the cells from the cell sheet. The titer of viral tissue culture infective dose (TCID50) of the 3rd passage was determined in BKCC cells at 10–3/0.05 ml, and the high titer was shown at the 5th and the 6th passages equal to 10-5/ 0.05 ml. In conclusion, PIV-3 is widespread among camels infected with respiratory illness; therefore, studies are necessary to detect the prevalence rate among camels in other Iraqi regions. Keywords: PIV-3, Fusion protein gene, Hemagglutination protein gene, ELISA, PCR

In case you haven't heard…

Can a simple addition to your diet lower the risk of depression? Researchers of a new study published in the journal Clinical Nutrition seem to think so. Adults who consumed nuts every day were less likely to report taking antidepressants or getting diagnosed with depression, they said, Metro news reported. Data was gathered from the UK Biobank, an online database of medical and lifestyle records of around 500,000 residents of the United Kingdom. The positive finding was seen in middle‐aged and older adults who consumed walnuts, almonds, Brazil nuts, cashews, hazelnuts and pistachios daily. Although the findings do not explain why this happens, the researchers speculate that anti‐inflammatory and antioxidant properties of nuts may have a protective effect. Questionnaires were used to assess nut consumption. Over the course of the study, self‐reported doctors’ diagnoses of depression or antidepressant use were recorded. One of the results revealed that those who had a low‐to‐moderate nut consumption — defined as one serving of 30 grams per day — had a 17% lower risk of depression, compared to those who did not eat nuts. “This study builds on the growing literature in nutritional psychology showing diet to be a factor in mood disorders,” said Jenna Macciochi, Ph.D., senior lecturer in immunology at the University of Sussex, who was not involved in the research.

Magnetic-controlled capsule endoscopy performance in aging patients

BackgroundThe increasing elderly population and wide use of magnetic capsule endoscopy (MCE) have led to more attention to elderly patients.AimThe aim of this study was to assess the performance (including transit time, cleanliness score, positive findings and safety) of MCE in aging patients (≥ 60 years), especially patients over 80 years old.MethodsConsecutive patients of ≥ 60 years undergoing MCE at our center from August 2017 to August 2022 were classified into the oldest (≥ 80 years) and the older (60–79 years) groups. Esophageal transit time (ETT), gastric examination time (GET), small bowel transit time (SITT), and the quality of gastric preparation were compared. Information on examination indications, subjective discomforts, adverse events, and MCE outcomes were compared.ResultsOf 293 enrolled patients, 128 patients were in the oldest group and 165 patients were in the older group. ETT and GET were longer in the oldest group, whereas SITT was slightly longer in the oldest patients. Visualization scores were significantly lower in the body and antrum in the oldest patients. The total visualization score was lower in the older group compared with the oldest group; however, the difference was not significant. Cleanliness scores at the fundus and antrum and total cleanliness scores were lower in the oldest patients compared with the older patients. Positive findings and ulcers and erosions in the small intestine were more common in the oldest group. One patient had nausea during the gastric examination. Capsule retention in the cecum occurred in one case.ConclusionMCE was feasible and safe for aging patients. ETT and GET were markedly longer and gastric cleanliness and visualization were worse, while overall small intestine-positive findings were higher in the oldest patients compared with the older patients.

A retrospective study on the direct immunofluorescence findings in pigmented purpuric dermatosis.

Pigmented purpuric dermatosis (PPD) is characterized by grouped petechiae, purpuric macules, and pigmentation in the bilateral lower extremities. It runs a chronic and relapsing course. Pathophysiology is poorly understood, but it has been proposed to be an immune-complex disease or capillaritis. This study aimed to determine the incidence and patterns of positive direct immunofluorescence (DIF) findings in patients with clinically and histopathologically confirmed PPD. The association between DIF deposition type and clinical profile was also analyzed. Patients with a clinical and histopathologic PPD diagnosis who had undergone DIF studies at a tertiary medical center with attached dermatopathology and immunofluorescence diagnostic centers between January 2002 and December 2021 were included in this study. Data on age, sex, disease duration, comorbidities, and drug intake were collected from medical records. There were 65 patients who satisfied the inclusion criteria. Among them, 58 (89%) had at least one positive finding and 53 (82%) were vascular deposition of immunoglobulin (Ig), complement, or fibrinogen. The most common vascular deposition was fibrinogen (71%) followed by C3 (62%), IgM (18%), IgA (6%), and IgG (3%). Fibrinogen deposition was associated with hypertension (p < 0.03). There was no association between vascular DIF deposition of IgG, IgA, and C3, with age, sex, comorbidities, disease duration, and drug history. The most common DIF findings in PPD were vascular deposition of fibrinogen and C3, with or without Ig presence. DIF findings supported a vascular origin in PPD but not an immune complex-mediated disease. Hypertension was associated with fibrinogen deposition and may play a role in its pathophysiology.

Characteristics of Pediatric Tuberculosis Patients at Simpang Lima Gumul Hospital, Kediri, East Java

Introduction: Pediatric tuberculosis can cause a variety of problems, including growth failure, disability, and death. In 2021, WHO recorded 10.6 million individuals had tuberculosis globally, with pediatric tuberculosis accounting for 11% of these cases. Indonesia is the second highest high-burden country for tuberculosis, according to the WHO. Children with tuberculosis often present non-specific and uncommon symptoms, making diagnosis challenging and frequently delayed. This study aims to present an overview of the characteristics of pediatric tuberculosis patients at Simpang Lima Gumul Hospital in Kediri, East Java. Material and Methods: This was a descriptive retrospective study with a cross-sectional method. Pediatric tuberculosis patients who received treatment at the Simpang Lima Gumul Hospital in Kediri, East Java, were the subject of research. We compiled pediatric tuberculosis patients' demographic data and clinical characteristics using medical records. Results: Sixty-one children included in the study. Most of them were male (56%) between 1 to 5 years old (52%). Seventy-two percent had a positive tuberculin skin test; chronic cough was noted in 69% of cases. An adult contact history of tuberculosis was reported in 64% of cases, while 61% had radiographic findings from TB. 52% also had fever, 51% had lymphadenopathy, and 72% had good nutritional status. Conclusion: Tuberculosis occurs most commonly in male children 1 to 5 years of age. The most common symptoms of pediatric tuberculosis include a positive tuberculin skin test, chronic cough, contact with adults with tuberculosis, positive radiographic findings, fever, and lymphadenopathy.

E58 The rheumatologic masquerader: a case report on SLE-dermatomyositis-systemic scleroderma overlap syndrome

Abstract Introduction Juvenile dermatomyositis is an autoimmune connective tissue disorder characterized by idiopathic inflammatory myopathy primarily affecting the skin and muscles(1, 2). It may occur alone or in overlap syndromes usually with systemic scleroderma, systemic lupus erythematosus (SLE) and mixed connective tissue disease(3, 4). There is need to further describe and characterize cases encountered in different set ups. Objective To describe a case of dermatomyositis-scleroderma overlap in an African male adolescent. Methods We carried out a retrospective chart review to ascertain clinical features and management strategies. Results We present a case of a 17- year old African male patient who presented with a diagnosis of systemic lupus erythematosus made at a peripheral facility in February 2021, and started on azathioprine 50 mg daily, hydroxychloroquine 200 mg daily and prednisolone 5 mg twice daily. He presented on 30th November 2022 with a 2-year history of bilateral elbow, knee, ankle pain and swelling with an 8-month history of bilateral proximal upper and lower limb muscle weakness. Review of systems revealed alopecia, occasional fever and hyperpigmentation over his proximal interphalangeal and metacarpophalangeal joints that has since evolved to hypopigmentation. Positive examination findings included fine sparse hair, heliotrope rash, Gottron's papule, salt and pepper skin rash, hardening of the skin over the arm and thighs with a rodnan score 3/3 over the phalanges, nodular non tender lesions in the abdominal subcutaneous tissue and dactylitis with fixed flexion deformities of both elbows. He had bilateral flexion contractures of both elbows and knees with dactylitic fingers. Laboratory investigations showed an elevated CRP 94 mg/l, elevated lactate dehydrogenase 458 U/l, elevated creatine kinase 492U/l, positive antinuclear antibodies (1:640 titres) with a nuclear coarse and large speckled pattern, positive double stranded DNA antibodies and weak positive anti SM, anti RNP and PCNA antibodies. Myositis panel was positive for MDA5 and OJ. Pelvic MRI showed features of proximal inflammatory myositis. The childhood myositis assessment scale revealed a score of 25/52. ECHO and chest radiograph were normal. Pulmonary function test showed a low FEV 1 and FVC in keeping with a restrictive lung picture. Gastroenterology review revealed gastritis with no other stigmata of autoimmune disease. Management has consisted of monthly therapy with intravenous immunoglobulin. Azathioprine therapy was switched with mycophenolate mofetil 1 gram twelve hourly. He was advised on sunscreen protection. Physiotherapy and occupational therapy has been ongoing. Three months of follow up has led to the resolution of the flexion knee contractures, improved functionality in activities of daily living and a rodnan score of 2/3 over the phalanges. Conclusion SLE-juvenile dermatomyositis and systemic scleroderma can occur as an overlap syndrome and a definitive diagnosis remains elusive to many clinicians. A thorough history and comprehensive physical examination remains key to establishing a correct diagnosis. Early patient referral to paediatric rheumatologist for prompt appropriate treatment can avert debilitating morbidity and mortality.