Predominant Clinical Presentation Research Articles

ANALYSIS OF LUMBO-SACRAL DISC PROLAPSE NEUROSURGICAL INTERVENTION

Background: Low back pain is a common cause of pain and there are many causes. Finding the exact cause of the pain can help guide treatment and management.
 Objective: To evaluate the clinical presentation, diagnosis and surgical outcome of the treated patients with lumbar-disc prolapse.
 Patients and Methods: Patients selection done using neuroimagings like plain radiographs and MRI Scan of lumbosacral spine. The surgical procedures applied were laminectomy, foraminatomy and evacuation of herniated disc material. Patients were analyzed postoperatively for outcome according to the symptoms resolved after surgery, objective clinical examinations and imaging studies.
 Results: Fifty five patients, 25 (45%) males and 30 (55%) females. Predominant clinical presentation were low back pain with radiation to leg 36(65.4%), neurogenic claudication in 15 patients (27%), and neurological deficit (foot drop) 4 about (7.2%). Seventy four percent (about 41) of the herniated disc were found at L4 L5 and L5 SI levels. Rate of complications were 12.7% (about 7) with 4 cases infections and 3 with dural tear repaired intraopertively being commonest. Excellent to good surgical outcome were found in 90% (about 50) of the cases.
 Conclusion: The results of the study depend mainly on selection of patients. Traditional laminectomy and discectomy still play a benefit for major group of patients. Foraminatomy, opening of roots foramen adds a benefit for the results.
 Keywords: Laminectomy, MRI, disc, prolapse.

Invasive mould disease in haematologic patients: comparison between fusariosis and aspergillosis

ObjectivesTo compare the epidemiology, clinical presentation, diagnosis, treatment, and outcome of haematologic patients with invasive aspergillosis (IA) or invasive fusariosis (IF). MethodsWe retrospectively reviewed the charts of 36 patients with IA and 26 with IF diagnosed between 2006 and 2017 in haematologic patients, and compared baseline characteristics, coexisting exposures, clinical manifestations, treatment, and the outcome. ResultsFever was more frequent in IF (96.2% vs. 63.9%, p 0.003), whereas pneumonia (88.9% vs. 50.0%, p 0.001) and sinusitis (63.9% vs. 38.5%, p 0.048) were more frequent in IA. Skin lesions and positive blood cultures occurred exclusively in patients with IF. Among patients with pneumonia, the halo sign was more frequent in IA (62.5% vs. 23.1%, p 0.02). Serum galactomannan was positive in 88.6% of patients with IA and in 73.3% with IF (p 0.18), with no differences in the median number of positive tests and galactomannan values. Positive serum galactomannan plus lung infiltrates was the predominant clinical presentation in IA and occurred in four of 13 patients with IF and lung involvement. The 30-day survival was 77.7% in IA and 46.1% in IF (p 0.01). ConclusionsIA and IF share the same epidemiologic scenario but different clinical presentations in the majority of cases, with disease in the airways in IA, and fever, metastatic skin lesions, and positive blood cultures in IF. However, a substantial proportion of patients with IF present with a clinical picture similar to IA, with fever, lung infiltrates, and positive serum galactomannan.

Interleukin-18 promoter polymorphisms and idiopathic Parkinson disease: an Egyptian study.

Etiology of sporadic Parkinson's disease (PD) is largely unknown. The contribution of genetic factors to the pathogenesis of PD is supported by the demonstration of high concordance in twins, increased risk among relatives of PD patients and existence of familial cases. This study aimed to examine the relation between interleukin 18 (IL-18) gene promoter polymorphisms and idiopathic PD, and its impact on clinical presentation and disease severity. 30 idiopathic PD patients and 15 age- and sex-matched healthy subjects were included. Disease severity was assessed using Unified Parkinson's Disease Rating Scale (UPDRS). Genetic testing for IL-18 gene promoter -607C/A single nucleotide polymorphisms (SNP) was done using real-time polymerase chain reaction (PCR) technique. A raised risk of PD development was found in patients with A/C and C/C genotypes of the site -607C/A (odds ratios = 1.83 and 1.98, respectively). The distribution of the genotypes showed no significant relation to gender or predominant clinical presentation. The age at onset of disease was significantly lower in C/C and A/A genotypes compared to A/C genotype (p = 0.001 and 0.04, respectively). Patients with A/A genotype showed significantly higher mentation score of UPDRS compared to patients with A/C and C/C genotypes (p = 0.003 and p = 0.002, respectively). Polymorphisms of IL-18 gene promoter increase the risk of developing idiopathic PD. The polymorphisms may affect phenotypic expression rather than being a direct cause of idiopathic PD.

High Fibroblast Growth Factor 23 concentrations in experimental renal failure impair calcium handling in cardiomyocytes.

The overwhelming majority of patients with chronic kidney disease (CKD) die prematurely before reaching end‐stage renal disease, mainly due to cardiovascular causes, of which heart failure is the predominant clinical presentation. We hypothesized that CKD‐induced increases of plasma FGF23 impair cardiac diastolic and systolic function. To test this, mice were subjected to 5/6 nephrectomy (5/6Nx) or were injected with FGF23 for seven consecutive days. Six weeks after surgery, plasma FGF23 was higher in 5/6Nx mice compared to sham mice (720 ± 31 vs. 256 ± 3 pg/mL, respectively, P = 0.034). In cardiomyocytes isolated from both 5/6Nx and FGF23 injected animals the rise of cytosolic calcium during systole was slowed (−13% and −19%, respectively) as was the decay of cytosolic calcium during diastole (−15% and −21%, respectively) compared to controls. Furthermore, both groups had similarly decreased peak cytosolic calcium content during systole. Despite lower cytosolic calcium contents in CKD or FGF23 pretreated animals, no changes were observed in contractile parameters of cardiomyocytes between the groups. Expression of calcium handling proteins and cardiac troponin I phosphorylation were similar between groups. Blood pressure, the heart weight:tibia length ratio, α‐MHC/β‐MHC ratio and ANF mRNA expression, and systolic and diastolic function as measured by MRI did not differ between groups. In conclusion, the rapid, CKD‐induced rise in plasma FGF23 and the similar decrease in cardiomyocyte calcium transients in modeled kidney disease and following 1‐week treatment with FGF23 indicate that FGF23 partly mediates cardiomyocyte dysfunction in CKD.

Navigating the Pain, Psychosocial and Racial Dynamics of Hospitalized Patients with Sickle Cell Disease

Hospital readmissions are receiving more attention because of the implications on cost and quality of care. Many researchers and clinicians believe that a substantial number of readmissions are preventable as evidenced by the significant reductions achieved after the Hospital Readmission Reduction Program mandated by the Affordable Care Act. While sickle cell disease is not currently one of the diseases designated for inclusion in the Hospital Readmission Reduction Program, some of the lessons learned addressing hospital structural characteristics and processes of care can be applied to this population. Acute worsening of chronic pain is the predominant clinical presentation of patients with sickle cell disease to the hospital. Pain and the measurement of pain is subjective and there are no clearly defined objective clinical criteria or biomarkers to validate or refute the presence of acute sickle cell pain crisis. The current epidemic of nonmedical opioid use and medical opioid abuse combined with racial unrest and governmental oversight in the US worsens a wellknown atmosphere of mistrust on the part of both clinicians and patients with sickle cell disease. These dynamics force the need for a paradigm change in management of these patients.

Prevalence of dermatophytic fungal infections at Al-Kindi Hospital in Baghdad

Background: Dermatophytes are types of fungal infections affect skin, nails and hairs. These infections are predominant in moist and warm climate by which the growth of these organisms are sustained.Aim: find out the prevalence of dermatophytic infection among patients attending dermatological outpatient clinic at Al-Kindi Hospital in Baghdad.Result: Tinea .pedis was the most predominant clinical presentation reported in 31% of the sample.

A five-year experience with zoonotic Salmonella at a pediatric reference centre

Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis. To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay. Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010. Salmonella spp was isolated in 46 children younger than 15 years old. 18 were below 2 years old and 5 children below three months. 24% of the children had risk factors, such as HIV infection, oncological diseases and malnutrition; low birth weight and pneumonia were associated conditions. No deaths were reported. The serotypes more frequently found were: Typhimurium and Enteritidis. Most of the strains were susceptible to ampicillin and third generation of cephalosporins. Diarrhea with blood was the predominant clinical presentation, and there were no outbreaks. Typhimurium and Enteritidis were the most common serotypes. Based on the profiles of susceptibility antimicrobial, we could maintain the same recommendations until the moment suggested. we must consider the Salmonella infection in febrile children under risk of an invasive bacterial disease, with or without focal infection.

Detection of influenza A, B and subtypes A (H1N1) pdm09, A (H3N2) viruses by multiple qrt-pcr in clinical samples

To describe the clinical and epidemiological characteristics of patients diagnosed with epidermolysis bullosa (EB) at the Instituto Nacional de Salud (INSN) in Lima, Peru; a National Reference Center for this disease. . Observational, descriptive and transversal study. We reviewed the clinical histories and laboratory tests of patients diagnosed with EB treated in INSN from 1993 to 2015. 93 patients were registered. The average age was 7.9 ± 5.6 years; 53.8% (n = 50) were boys. Clinical forms corresponded to dystrophic EB with 41 (44.1%) cases, simple EB with 39 (41.9%) union EB cases with 8 (8.6%) and Kindler syndrome with 4 (4.3%) cases. The clinical form could not be identified in a case. A total of 48 cases (51.6%) came from Lima and Callao, and 45 cases (48.4%) from other provinces of the country. Extracutaneous manifestations involved gastrointestinal (44.1%), ocular (37.6%), odontogenic (87.1%), and nutritional (79.6%) involvement, as well as pseudosindactilia (16.1%). Chronic malnutrition (71.6%), acute malnutrition (17.6%) and anemia (62.4%) were found. Mortality corresponded to 6 cases (6.5%). 93 cases of EB were reported in INSN, the predominant clinical presentation was the dystrophic form.

Epidermolysis bullosa in peru: clinical and epidemiological study of patients treated in a national reference pediatric hospital, 1993-2015

To describe the clinical and epidemiological characteristics of patients diagnosed with epidermolysis bullosa (EB) at the Instituto Nacional de Salud (INSN) in Lima, Peru; a National Reference Center for this disease. Observational, descriptive and transversal study. We reviewed the clinical histories and laboratory tests of patients diagnosed with EB treated in INSN from 1993 to 2015. 93 patients were registered. The average age was 7.9 ± 5.6 years; 53.8% (n = 50) were boys. Clinical forms corresponded to dystrophic EB with 41 (44.1%) cases, simple EB with 39 (41.9%), union EB cases with 8 (8.6%) and Kindler syndrome with 4 (4.3%) cases. The clinical form could not be identified in a case. A total of 48 cases (51.6%) came from Lima and Callao, and 45 cases (48.4%) from other provinces of the country. Extracutaneous manifestations involved gastrointestinal (44.1%), ocular (37.6%), odontogenic (87.1%), and nutritional (79.6%) involvement, as well as pseudosindactilia (16.1%). Chronic malnutrition (71.6%), acute malnutrition (17.6%) and anemia (62.4%) were found. Mortality corresponded to 6 cases (6.5%). 93 cases of EB were reported in INSN, the predominant clinical presentation was the dystrophic form.

Multimodality Management of Cavernous Sinus Hemangiomas-An Institutional Experience.

Objective Cavernous sinus hemangiomas (CSHs) are benign lesions accounting for less than 2% of the cavernous sinus tumors. They provide a formidable surgical challenge because of their vascularity and their being surrounded by critical neurovascular structures. In this study, one of the largest in available literature, we analyze our experience in the management of these unusual tumors and review the available literature. Materials This is a retrospective analysis of patients who were managed surgically (both microsurgical and Gamma knife radiosurgery [GKRS]) for CSH at our Institution from 2007 to 2015. Complete demographic, clinical-radiologic surgical records were analyzed. Follow-up data were collected from the hospital records. Results Total 23 patients were managed. Among these, 15 patients underwent microsurgery (group 1) whereas 8 underwent GKRS (group 2). Predominant clinical presentation in both the groups included headache and involvement of multiple cranial nerves. Five patients in group 1 had deteriorating vision. The volume of tumors ranged from 29 to 115 cm 3 (mean = 64.57 cm 3 ) in group 1 and from 2.1 to 11.6 cm 3 in group 2. GKRS was performed with a mean dose of 13 Gy, an average isodose line of 50% with an average coverage of 96%. In group 1, the follow-up period ranged from 6 to 62 months (mean = 29.4 months). The extraocular movement (EOM) preservation rate in our series was not favorable, as most patients presented late with large tumors and established deficits. Recurrence/residual tumor was seen in two cases. In group 2, the follow-up was 5 to 48 months. All of them showed significant reduction in size. Conclusion Both surgery and radiosurgery are highly effective in the management of CSHs. They are complementary to each other, with individual characteristics-the size and volume of the lesion-being the main factors in deciding the choice of treatment.

Microinvasive oral squamous cell carcinoma- A clinicopathological study

Abstract:Background and objectives: Microinvasive oral squamous cell carcinoma is an early stage malignancy characterized by invasion of superficial lamina propria without invasion of deeper structures. These lesions have a varied clinical presentation, minimal lymphatic involvement and a better prognosis. However, there is no clear consensus on its diagnosis and subsequent management. The aim of this study is to assess the depth of invasion of confirmed cases of microinvasive oral squamous cell carcinoma using special stains and immunohistochemistry with clinical correlation of these lesions.Method: Tissue specimen of clinically diagnosed cases of oral leukoplakia (n=90), oral submucous fibrosis (n=60) and oral carcinoma (n=50) were microscopically evaluated for the presence of microinvasion by two independent examiners. The next step involved confirming the basement membrane breach by using Periodic acid Schiff (PAS) stain for evaluating the integrity of basement membrane. The confirmed cases were assessed using special stain and immunohistochemistry to measure the depth of invasion and were further correlated with the clinical features.Results: A total of 29 cases were confirmed as microinvasive OSCC. These included clinically diagnosed 11 cases of leukoplakia, 7 cases of OSMF and 11 cases of carcinoma. Median age at diagnosis was 46 yrs; males (69%) were more affected than females (31%). The predominant risk factor was tobacco chewing alone (31.03%) which was in the form of gutkha and arecanut; common site was buccal mucosa (76%); predominant clinical presentation was a patch; and histopathology revealed varying grades of epithelial dysplasia. The mean depth of invasion was 31.29 µm (0.03 mm) with the range being 16.91 – 66.6 µm (0.02 – 0.07 mm).Conclusion: The study suggest that depth of invasion could be a reliable marker to assess microinvasion and that severity of epithelial dysplasia is not a pre-requisite for microinvasive carcinoma.Keywords: Microinvasion; Oral squamous cell carcinoma; Epithelial dysplasia; Depth of invasion; Oral leukoplakia; Potentially malignant disorders

Surgical management and outcome of juvenile nasopharyngeal angiofibroma in a single centre: A fifteen year experience

IntroductionJuvenile nasopharyngeal angiofibroma (JNA) is a locally aggressive benign vascular tumour exclusively amongst adolescence males. General characteristics, management and outcomes of 11 cases of JNA presented to our centre between 2000 till 2015 were studied and evaluated. ObjectiveThis is a retrospective study to determine general characteristics, management and outcomes amongst the local population of Kelantan, Malaysia. Methods11 patients from the local population of Kelantan who presented between 2000 till 2015 were evaluated respectively. Demographical data, clinical presentation, duration of symptoms, stage of disease, surgical approach and outcomes of these 11 patients were reviewed and collected from the medical record office at our centre. ResultsAll 11 patients were Malay male with the average age at diagnosis being 15years (range 11–21) years. Among the local population, predominant clinical presentation includes nasal obstruction followed by spontaneous painless epistaxis. All 11 patients were subjected to embolization prior to surgery. Surgery was the first line treatment for all our patients. Our patients were mostly subjected to endoscopic approach (37%) and combined approach (36%). Recurrence were seen in 5 patients (64%). 2 patients underwent radiotherapy one of which was combined with chemotherapy due to intracranial involvement. None of our patients sustained major intra- or post-operative complications. ConclusionsSurgery combined with preoperative embolization is the main modality of treatment at our centre. Based on our observation, patients delay and refusal of surgery, ineffective embolization have led to recurrence. Timely diagnosis and management together with patients co-operation is critical for successful outcome.

Factors associated with smoking among tuberculosis patients in Spain.

BackgroundTo determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013.MethodsMulticenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI).ResultsWe analyzed 5,846 cases (62 % men, mean age 39 years, 33 % foreigners). 23.4 % were alcohol abuser, 1.3 % were injected drug users (IDU), 4.6 % were co-infected with HIV, and 7.5 % had a history of TB treatment. 6.6 % and 0.8 % showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71 %) with a cavitary radiological pattern in 32.8 % of cases. 82 % of cases were confirmed microbiologically, and 54 % were smear-positive microscopy.2,300 (39.3 %) patients were smokers. The following factors were associated with smoking: male sex (OR = 2.26;CI:1.97;2.60), Spanish origin (OR = 2.79;CI:2.40–3.24), alcoholism (OR = 2.85;CI:2.46;3.31), IDU (OR = 2.78;CI:1.48;5.52), homelessness (OR = 1.99;CI:1.14–3.57), pulmonary TB (OR = 1.61;CI:1.16;2.24), cavitary radiological pattern (OR = 1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR = 1.39;CI:1.14;1.17).ConclusionsThe prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers.

Histopathological Patterns of Ovarian Tumours: A Hospital Based Study

Background: - Ovary is the site for more than two dozen different tumours with its varied histopathological patterns. Relative frequency of these histopathological patterns is different for Western and Asian countries. Ovarian cancer is one of the most frequent causes of death from gynaecological malignancies. Aims and Objectives: - A hospital based study to determine the histopathological patterns of ovarian tumours. Material and Methods: - The present study is based on the histopathological analysis of 70 specimens of clinically and radiologically diagnosed ovarian tumours presented at Patholgy department of Tezpur Medical College and Hospital, Tezpur, Assam for histopatholcical examination in the period of two years from June 1, 2014 to May 31, 2016. Result and observations: - Out of 70 ovarian tumours, 46 (65.71%) were benign tumour, 2 (2.86%) were borderline and 22 (31.43%) were malignant tumour. Among benign tumours, benign cystic teratoma (30.00%) was the commonest followed by serous cystadenoma (22.86%) and mucinous cystadenoma (8.57%). Among the malignant tumours, the most common type was serous cystadenocarcinoma. Surface epithelial tumour (57.14%) was the commonest tumour according to the histogenesis followed by germ cell tumour (34.29%), sex cord tumours (7.14%) and metastatic tumour (1.43%). The mean age of the subjects was 35.2 years, ranging from 8 to 70 years. Abdominal mass was the most predominant clinical presentation. Conclusion:- Ovarian tumours need histopathological examination for proper diagnosis and follow up of patients. This study gives the histopathological pattern of ovarian tumours of the cases that attended our institute with different clinical presentations. As it is a hospital based study, it might not reflect the exact scenario of the population at large.

An experience of 108 cases of Esophagectomy using left Thoracolaparotomy and cervical anastomosis with feeding Jejunostomy, without gastric drainage procedure

Objective: To study efficacy and safety of esophagectomy using left thoracolaparotomy and left neck anastomosis with feeding jejunostomy, but no gastric drainage procedure. Design: An observational descriptive study. Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2002 to September 2004. Subjects and Methods: Computerized clinical data of 108 surgically treated patients during twenty eight months was retrospectively analyzed. Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical procedure and surgical outcome. Results: A total of 108 patients underwent esophagectomy through left thoracolaparotomy and left neck incision. Male: Female was 72: 36, age range was 18 - 72 years with a mean age of 42.3 years. The predominant clinical presentation was dysphagia. Tumor level was upper third of thoracic esophagus in 3 (2.7%), middle third in 48 (44.4%) and lower third in 57 (52.7%) patients. Tumor histology was squamous cell carcinoma in 72 (66.6%) and adenocarcinoma in 36 (33.3%) patients. The mean operative time was 155 (25+/-) minutes. Postoperative morbidity was 19.4% (21/108). The complications were anastomotic leak in 7(6.5%), Hoarseness in 6(5.5%), aspiration in 3(2.7%); reopening in 1(0.9%) and stricture in 4(3.7%) patients. The overall mortality was 8.3% (9/108). Deaths were due to anastomotic leak in 3(2.7%) tracheal injury in 2(1.85%), respiratory failure in 2(1.85%) and pulmonary embolism in 2(1.85%) patients. 28 patients were lost to follow-up while incisional hernia was seen in 1, hoarseness in 3 and stricture in 3 patients over a last one month to 2 years follow-up. Recurrence occurred in 3/108 (2.77%); one developed malignant ascities, after 4 months, one developed nodule in hypopharynx after 18 months, and one developed a subcutaneous nodule on the back after 14 months. Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the esophagus. A 30 day mortality of 8.3% in a large series of 108 oesophagectomies with 2.7% recurrence and 19.4% morbidity speak volumes for the technique. Omitting a gastric drainage procedure does not adversely effect the outcome, while routine placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition. Neck anastomosis gives a generous tumor free margin, a s a 11 except one resection margin was free o f tumor. T his i s further consolidated by only 3 cases of recurrence out of 80, with 28 being lost to follow up.

Epidemiological, clinical and diagnostic aspects of sheep conidiobolomycosis in Brazil

ABSTRACT: Conidiobolomycosis is an emerging disease caused by fungi of the cosmopolitan genus Conidiobolus . Particular strains of Conidiobolus coronatus, Conidiobolus incongruus and Conidiobolus lamprauges , mainly from tropical or sub-tropical origin, cause the mycosis in humans and animals, domestic or wild. Lesions are usually granulomatous and necrotic in character, presenting two clinical forms: rhinofacial and nasopharyngeal. This review includes the main features of the disease in sheep, with an emphasis on the epidemiology, clinical aspects, and diagnosis of infections caused by Conidiobolus spp. in Brazil. In this country, the disease is endemic in the Northeast and Midwest, affecting predominantly woolless sheep breeds and occasioning death in the majority of the studied cases. The species responsible for infections of sheep are C. coronatus and C. lamprauges and the predominant clinical presentation is nasopharyngeal. These fungal infections are very important, since they compromise the health status of the sheep flock and cause serious economic losses to the sheep industry. Thus, research is needed to investigate faster tools for diagnosis and effective methods for the control and treatment of conidiobolomycosis.

Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome

Background/Aims: We aimed to prospectively assess the diagnostic accuracy of the revised criteria for behavioural variant frontotemporal dementia (bvFTD) among subjects presenting with a frontal lobe syndrome in middle-late adulthood. Methods: Patients were included based on a predominant behavioural clinical presentation, a Frontal Behavioural Inventory (FBI) score of ≥11 and/or a Stereotypy Rating Inventory (SRI) score of ≥10. At baseline, the fulfilment of the international consensus criteria for behavioural variant FTD (FTDC) was systematically recorded. The 2-year follow-up consensus diagnosis was used as the gold standard to calculate sensitivity and specificity of the FTDC criteria for possible and probable bvFTD. Results: Two-year follow-up data were available for 116 patients (85%). Two-year follow-up consensus diagnoses consisted of probable/definite bvFTD (n = 27), other dementia (n = 30), psychiatric disorders (n = 46) and other neurological disorders (n = 13). Sensitivity for possible bvFTD was 85% (95% CI 70-95%) at a specificity of 27% (95% CI 19-37%). Sensitivity for probable bvFTD was 85% (95% CI 69-95%), whereas their specificity was 82% (95% CI 73-89%). Conclusions: We found a good diagnostic accuracy for FTDC probable bvFTD. However, the specificity for FTDC possible bvFTD was low. Our results reflect the symptomatic overlap between bvFTD, other neurological conditions and psychiatric disorders, and the relevance of adding neuroimaging to the diagnostic process.

Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ​⁎ 28 Mutation

Pegvisomant (PEGv) is a growth hormone receptor antagonist approved for the treatment of acromegaly; one of its documented adverse effects is reversible elevation of hepatic enzymes. We report a 39-year-old male acromegalic patient with a pituitary macroadenoma who underwent transsphenoidal surgery. The patient's condition improved but GH and IGF-I levels did not normalize; as a consequence, we first administered dopamine agonists and then somatostatin receptor ligands (SRLs) with poor response. PEGv 15 mg every other day was added to lanreotide 120 mg monthly. The patient developed a severe hepatitis five months after starting the combination therapy. Elevated ferritin, iron, and transferrin saturation suggested probable hepatitis due to haemochromatosis. We performed a liver biopsy which showed an acute cholestatic hepatitis consistent with toxic etiology. A heterozygous genotype UGT1A1 ⁎ 28 polymorphism associated with Gilbert's syndrome was also found in this Argentine patient. The predominant clinical presentation resembled an acute cholestatic hepatitis associated with severe hemosiderosis, a different and new pattern of PEGv hepatotoxicity.

Intramedullary spinal cord abscess – an unusual presentation

Intramedullary spinal cord abscess (ISCA) is a rare infection in children. It is usually associated with congenital neuro-ectodermal abnormalities. Spastic paraparesis is the predominant clinical presentation. We report a child of ISCA who presented with acute flaccid paralysis of both lower limbs, an unusual presentation and yet showed significant neurological improvement.

Cardiac magnetic resonance differences in ventricular function and delayed enhancement according to clinical presentation in Chagas disease

Background Chagas disease is a parasitosis caused by the protozoan Trypanosoma cruzi. It is endemic in Latin America, nevertheless it has spread to other regions of the world due to migration. Up to 30% of the infected patients progress to the chronic phase, with a 5-year mortality of 50% due to heart failure or ventricular arrhythmias. We aimed to compare ventricular function and delayed enhancement (DE) according to the predominant clinical presentation in Chronic Chagas disease (CCD) either ventricular tachycardia (VT) or heart failure (HF), as well as to compare CCD with the undetermined and subclinical phases.