Presumptive Clinical Diagnosis Research Articles

Unique Periocular Presentation of Tinea Faciei in an Adolescent Female: Case Report and Discussion

Dermatophytosis of the face, also known as tinea faciei, may have a variable clinical presentation. A presumed clinical diagnosis of dermatophytosis should be confirmed with microscopy, culture, and or real-time polymerase chain reaction (RT-PCR). Initially misdiagnosed after negative real-time polymerase chain reaction, we report a case of bilateral periocular tinea secondary to Trichophyton mentagrophytes, a dermatophyte often transmitted from guinea pigs and rabbits.

The long‐term outcomes of standing superficial keratectomy as the sole treatment of corneal B‐cell lymphoma in five horses in the UK: Clinical, histopathology, immunohistochemical and molecular findings

SummaryThis case report describes five horses with solitary corneal B‐cell lymphoma treated with superficial keratectomy as a sole treatment and their long‐term follow‐up. All five cases had a presumed clinical diagnosis of immune‐mediated keratitis (IMMK) which was initially responsive to immunosuppressive or immunomodulatory treatment. Between 6 and 71 months from the start of clinical disease, these cases became refractory to treatment. All five horses underwent superficial keratectomy under standing sedation and regional anaesthesia. A focal superficial keratectomy was performed in one horse to remove the affected area, and in the remaining four horses, the superficial cornea was removed in its entirety. Histopathology, immunohistochemistry (IHC) and polymerase chain reaction for antigen receptor rearrangements (PARR testing) were performed on all five keratectomy specimens. The histopathological and immunohistochemical findings indicated a florid stromal infiltrate of mitotically active, intermediate to large B‐lymphocytes amidst a variable background of chronic keratitis. In three of the five cases, the lymphocytes displayed prominent epitheliotropism. PARR testing confirmed rearrangements of, specifically, IGH2, IGH3 and KDE, indicating B‐cell clonal expansion consistent with B‐cell lymphoma. There has been no local recurrence in any of the five horses over 24–84 months of follow‐up and no clinical evidence of multicentric lymphoma. No adjunctive treatment was given post‐keratectomy and all eyes have remained comfortable and off treatment. Results of this report show that standing superficial keratectomy is a viable diagnostic tool and a long‐term treatment option for diffuse intermediate to large corneal B‐cell lymphoma.

Influence of white blood cells count on parasite density in Malaria in children aged 6 to 59 months in Benin

For many years, the treatment of malaria was based on clinical presumptive diagnosis, making its differential diagnosis with other causes of hyperthermia difficult. This drug pressure has led to the emergence of Plasmodium strains resistant to the most commonly used antimalarial drugs. This is why in 2004, the health authorities decided to revise the policy of malaria management by adopting a new strategy based on the rational use of artemisininbased combination therapies after the biological confirmation of suspected malaria cases. The biological diagnosis is an essential part of malaria management. The gold standard technique for diagnosis is the thick drop combined with the calculation of parasite density (PD), which is determined on the basis of the number of parasites counted in a microscopic field against a proposed standard number of leukocytes. The number of leukocytes used to calculate the parasite density should ideally be the actual number of leukocytes in the patient per cubic millimetre of blood. However, in the absence of the availability of a blood count at the time of the thick drop, an average number of 8 000 leukocytes/mm3 was used by the World Health Organisation (WHO) to estimate the parasite density. Nonetheless, in Benin the average number of leukocytes adopted by the National Malaria Control Programme (PNLP) is 6 000/mm3. The aim of our study was to determine the impact of the leukocyte count on the calculation of the parasite density in cases of uncomplicated malaria. The study was a cross-sectional study with an analytical aim and took place in 2 hospitals in Benin, the Klouékanmey zone hospital in the south of Benin and the Djougou health centre in the north. It involved a population of 476 children aged between 6 and 59 months who were seen in consultation and in whom the clinical diagnosis of simple Plasmodium falciparum malaria was suspected. Children aged between 6 and 59 months, weighing at least 5 kg, with an axillary temperature ≥ 37.5°C at the time of consultation or a history of fever in the last 24 hours or other symptoms pointing to the diagnosis of malaria were included. Infestation was mono-specific for Plasmodium falciparum. Informed consent was required from the child's parents or guardian. The criteria for non-inclusion in our study were the presence of at least one sign of malaria severity, signs of severe malnutrition or a febrile state related to underlying infectious diseases other than malaria. Thick blood count and haemogram were systematically performed in all included children. Parasite density was calculated according to 3 methods, first using a weighted leukocyte count of 6 000/mm3 recommended by the Benin National Malaria Control Programme (PNLP), then a leukocyte count of 8 000/mm3 recommended by the World Health Organisation and finally the patient's actual leukocyte count obtained from the blood count. It should be noted that these different samples were respectively taken on the day of inclusion in compliance with the conditions of the pre-analytical phase in force in our medical biology laboratory. At the end of our study, 313 children, i.e. 65.76% of our study population had a positive white blood cell count with a positivity rate of 62.14% in Djougou, i.e. 174 children, and 70.9% in Klouékanmey, i.e. 139 children. The average leukocyte count in these children was 11,580/mm3. Among them, 205 children had an abnormal white blood cell count, i.e. 17 cases of leukopenia (5.43%) and 188 cases of hyperleukocytosis (60.06%). Using successively the average number of 6 000 leukocytes/mm3 proposed by the Benin PNLP and that of 8 000 leukocytes/mm3 proposed by the WHO, the average parasite densities were respectively 47,943 and 63,936 trophozoïtes/µl against 92,290 trophozoïtes/µl when the real number of leukocytes of the patients was used for the calculation of the PD. By using an average of 6 000 leukocytes/mm3 for PD calculation, 60% of the calculated PDs were underestimated and 6% were overestimated. Using an average of 8 000 leukocytes/mm3 resulted in 49% of PD being underestimated and 15% being overestimated. The difference between the three calculation methods was considered statistically significant (p value <0.05). The use of 6 000 or 8 000 coefficients for the estimation of parasitaemia could lead to a significant underestimation of the parasite load.

Foodborne botulism and the importance of recognizing the disease in the emergency department: a case report

BackgroundBotulism is a rare neuroparalytic disease that has only presented itself 19 times in the last 30 years in Belgium. Patients present to emergency services with a wide range of complaints. Foodborne botulism is a forgotten yet life-threatening disease.Case presentationWe describe a case of a Caucasian female in her 60s that presented to the emergency with reflux with nausea and spasmodic epigastric pain, no vomiting, dry mouth, and weakness in both legs. The symptoms started after ingestion of Atlantic wolffish. After exclusion of other more common causes, foodborne botulism was suspected. The patient was admitted to the intensive care unit for mechanical ventilation. Following treatment with trivalent botulinum antitoxin, she made a full neurologic recovery.ConclusionIt is important to rapidly recognize the possible diagnosis of botulism even if the neurological symptoms are not dominant. Rapid neurologic dysfunction and respiratory difficulties starts between 6 and 72 hours after ingestion. The decision to administer antitoxins should, however, be based on the presumptive clinical diagnosis and diagnosis should not delay therapy.

Challenges of acute febrile illness diagnosis in a national infectious diseases center in Rio de Janeiro: 16-year experience of syndromic surveillance

Acute febrile illnesses (AFI) are a frequent chief complaint in outpatients. Because the capacity to investigate the causative pathogen of AFIs is limited in low- and middle-income countries, patient management may be suboptimal. Understanding the distribution of causes of AFI can improve patient outcomes. This study aims to describe the most common etiologies diagnosed over a 16-years period in a national reference center for tropical diseases in a large urban center in Rio de Janeiro, Brazil. From August 2004-December 2019, 3591 patients > 12 years old, with AFI and/or rash were eligible. Complementary exams for etiological investigation were requested using syndromic classification as a decision guide. Results. Among the 3591 patients included, endemic arboviruses such as chikungunya (21%), dengue (15%) and zika (6%) were the most common laboratory-confirmed diagnosis, together with travel-related malaria (11%). Clinical presumptive diagnosis lacked sensitivity for emerging diseases such as zika (31%). Rickettsia disease and leptospirosis were rarely investigated and an infrequent finding when based purely on clinical features. Respiratory symptoms increased the odds for the diagnostic remaining inconclusive. Numerous patients did not have a conclusive etiologic diagnosis. Since syndromic classification used for standardization of etiological investigation and presumptive clinical diagnosis had moderate accuracy, it is necessary to incorporate new diagnostic technologies to improve diagnostic accuracy and surveillance capacity.

Heterogeneity in Kidney Histology and Its Clinical Indicators in Type 2 Diabetes Mellitus: A Retrospective Study

We analyzed the clinical profile and kidney biopsy of a total of 66 type 2 diabetes patients. Based on kidney histology, they were divided into-Class I (Diabetic Nephropathy), Class II (Non-diabetic kidney disease), and Class III (Mixed lesion). Demographic data, clinical presentation, and laboratory values were collected and analyzed. This study tried to examine the heterogeneity in kidney disease, its clinical indicator, and the role of kidney biopsy in the diagnosis of kidney disease in diabetes. Class I consisted of 36(54.5%), class II 17(25.8%), and class III 13(19.7%) patients. The commonest clinical presentation was nephrotic syndrome 33(50%) followed by chronic kidney disease 16(24.4%) and asymptomatic urinary abnormality 8(12.1%). Diabetic retinopathy (DR) was present in 27(41%) cases. DR was significantly higher in the class I patients (p < 0.05). Specificity and positive predictive values of DR for DN were 0.83 and 0.81, respectively (sensitivity 0.61; negative predictive values 0.64). The Association of the duration of diabetes and the level of proteinuria with DN was statistically not significant (p > 0.05). Idiopathic MN (6) and Amyloidosis (2) were the most common isolated NDKD; whereas diffuse proliferative glomerulonephritis (DPGN) (7) was the commonest NDKD in mixed disease. Another common form of NDKD in mixed disease was Thrombotic Microangiopathy (2) and IgA nephropathy (2). NDKD was observed in 5(18.5%) cases in presence of DR. We noted biopsy-proven DN even in 14(35.9%) cases without DR, in 4(50%) cases with microalbuminuria and 14(38.9%) cases with a short duration of diabetes. Almost half (45%) of cases with atypical presentation have non-diabetic kidney disease (NDKD), though even among these cases with atypical presentation diabetic nephropathy (either alone or in mixed form) is commonly seen in 74.2% of cases. DN has been seen in a subset of cases without DR, with microalbuminuria, and with a short duration of diabetes. Clinical indicators were insensitive in distinguishing DN Vs NDKD. Hence, a kidney biopsy may be a potential tool for the accurate diagnosis of kidney disease.

Applying fuzzy qualitative comparative analysis to identify typical symptoms of COVID-19 infection in a primary care unit, Rio de Janeiro, Brazil

This study aims to identify a set of symptoms that could be predictive of SARS-CoV-2 cases in the triage of Primary Care services with the contribution of Qualitative Comparative Analysis (QCA) using Fuzzy Sets (fsQCA). A cross-sectional study was carried out in a Primary Health Care Unit/FIOCRUZ from 09/17/2020 to 05/05/2021. The study population was suspect cases that performed diagnostic tests for COVID-19. We collected information about the symptoms to identify which configurations are associated with positive and negative cases. For analysis, we used fsQCA to explain the outcomes “being a positive case” and “not being a positive case”. The solution term “loss of taste or smell and no headache” showed the highest degree of association with the positive result (consistency = 0.81). The solution term “absence of loss of taste or smell combined with the absence of fever” showed the highest degree of association (consistency = 0,79) and is the one that proportionally best explains the negative result. Our results may be useful to the presumptive clinical diagnosis of COVID-19 in scenarios where access to diagnostic tests is not available. We used an innovative method used in complex problems in Public Health, the fsQCA.

Study of clinico-histopathological correlation of papulosquamous disorders at tertiary care hospital

The papulosquamous skin disorders are a diverse set of conditions that constitute the most common diseases seen by dermatologists. There is a lot of overlap in the appearance and distribution of lesions, which makes diagnosis challenging. The skin, the body's largest organ, responds to pathogenic stimuli in a restricted number of ways. As a result, histological patterns in clinically distinct lesions may be similar. A thorough histological evaluation is considered the gold standard in diagnosing skin disorders, but it has limits, and without clinical information, a definitive specific diagnosis is often impossible. In many circumstances, a diagnosis might be made by comparing histopathological and clinical findings.A Prospective study was carried out in the Department of Dermatology from September 2019 to September 2021. Patients presenting with clinically papulosquamous disorder were photographed and a presumptive clinical diagnosis was made based on clinical features; which was confirmed by histopathological examination and correlation between clinical and histopathological findings was studied. The study included 202 patients in which clinico-histopathological correlation was done. In 88.11% cases a positive correlation was established whereas a negative correlation was obtained in 11.89%cases. Psoriasis constituted the highest cases 64(31.68%) followed by lichen planus 52(25.74%).Majority of the papulosquamous disorders have an overlapping clinical presentation as skin reacts in a limited pattern towards any pathologic stimuli. There is a need for clear clinical information and a description of the lesion to assist the histopathologist in arriving at a conclusive diagnosis, which is the gold standard, to overcome the associated complexity in diagnosing and commencing the right treatment. For a more accurate differentiation of various papulosquamous disorders, histopathology is very crucial for appropriate medical management. This is clearly seen and supported by the present study.

ABNORMAL VAGINAL DISCHARGE IN REPRODUCTIVE AGE GROUP WOMEN WITH SPECIAL IMPLICATION TO ANTIFUNGAL SUSCEPTIBILITY OF CANDIDA SPECIES

Introduction And Background: Vaginal discharge is a common complaint in reproductive age group women2. Vaginal discharge is one of the common reasons in women of reproductive age group seeking gynecological consultation. It is the second most common clinical problem after menstrual disorders. Globally, it is estimated that one in ten women will present with vaginal discharge in the course of one year and approximately, ten million office visits each year are attributed to vaginal discharge complaints. The prevalence of vaginal discharge in India is estimated to be 30%3. Ÿ Abnormal vaginal discharge predisposes to significant morbidity to the women in the form of pelvic inflammatory disease, infertility, endometriosis, cuff cellulitis, urethral syndrome, pregnancy loss, and preterm labour.5 Ÿ Certain conditions such as prolonged use of combined oral contraceptive, pregnancy, malnutrition, diabetes, neutropenia, prolonged antibiotic therapy, candida become pathogenic and causes candidiasis.8 Ÿ Isolation, identification, characterization, and susceptibility of candida species became critical management of fungal infections.9 Need For The Study: The study was done to emphasize the role of laboratory investigations in patients with vaginitis, as presumptive clinical diagnosis alone can lead to false interpretation and treatment mismanagement. TheMethods: present study is a cross sectional observational study conducted from January 2019 to February 2020 for about a period of one year among 300 women aged 15-49 years with vaginal discharge attending gynecology OPD, Government Maternity Hospital, Tirupati. This study included 300 subjects with a mean age of 30.4 ± 7.26 years. Nearly halfResults: of (49.33%) our study population was aged between 25 to 34years, a majority (47%) of women had bacterial vaginosis, followed by Candida in 39.33%, trichomonas vaginalis in 14.33%, mixed infections in 6.67% and 6% with no organisms. Among Candida species, 48.31% of participants had candida albicans, 23.73% had candida tropicalis, 19.49% had candida krusei, and 8.47% had candida glabrata, and of them 38.33% participants had voriconazole sensitivity, 32.33% participants had ketoconazole sensitivity, 26% participants had clotrimazole sensitivity, and 21.33% participants had fluconazole sensitivity. Among 118 candida infected 106 (89.83%) participants came for follow-up, of which symptoms subsided in 90 (84.91%) participants. In conclusion, our study with 300 women patients complaining ofConclusion: vaginal discharge found a majority of them belonging to the sexually active age group. Vaginal discharge was more prevalent in lower economic status and rural areas. Bacterial vaginosis was the most common and frequent etiology, followed by Candida. TV was the least common etiology for vaginal discharge.

Clinical diagnostic accuracy of respiratory failure in critically ill hematopoietic stem cell transplant patients.

Acute respiratory failure (ARF) is a frequent complication following hematopoietic cell transplantation (HCT). We aimed to characterize the etiologies of ARF in patients who died in the intensive care unit following HCT based on autopsy findings. We then evaluated agreement between the clinical and pathologic diagnosis. We performed a chart review of all HCT patients who died and underwent autopsy in our ICUbetween 2006-2016. We evaluated the presumed clinical diagnosis and confidence in the diagnosis by chart review, the pathologic diagnosis on autopsy, and whether the clinical-pathologic diagnoses were concordant. When there was discordance, we evaluated whether knowledge of the pathology could have changed management. Thirteen patients underwent autopsy after dying. Infection was the presumed cause in 11/13 cases. The clinical and pathologic diagnoses were concordant in 6/13(46%). In the seven discordant cases (all clinically diagnosed as infection), autopsy revealed two non-infectious inflammatory causes, one post-transplant lymphoproliferative disorder, and three non-bacterial infectious etiology. Pathologic findings may have changed management in 7/13(54%) cases. In a subset of HCT-recipients who died from respiratory failure, discordance wasfrequent between clinical and pathologic diagnoses. The risks and benefits of obtaining tissue toimprove our diagnostic accuracy requires further evaluation.

CD30 + Primary intestinal T-cell lymphoma (unclassified) masquerading as chronic inflammation: a case report

BackgroundPrimary intestinal T-cell lymphomas are uncommon malignancies that pose a diagnostic dilemma, because the clinical features and imaging findings commonly overlap with those encountered in inflammatory bowel diseases.Case presentationThe current clinical case report describes the clinical history, laboratory findings and histopathological analysis from a patient with non-specific gastrointestinal symptoms with a presumptive clinical diagnosis of inflammatory bowel disease, and two intestinal biopsy specimens with non-specific findings. Due to the persistent symptoms a third biopsy was consistent with primary intestinal T-cell lymphoma, a diagnosis that was elusive for months after the initial presentation. Clinical correlation with laboratory and histopathological findings is required to establish a definitive diagnosis and to further stratify the patients. In addition, the neoplastic cells featured partial expression of CD30, which had relevant therapeutic implications.ConclusionsSuspicion for an intestinal T-cell lymphoproliferative disorder should always exist in patients with persistent abdominal symptoms with no clear etiology. The current discussion provides a summary and review of the key diagnostic histological features for the classification of primary intestinal T-cell lymphomas. In addition, the discussion describes how specific the histological findings are relevant for the clinical management decisions.

Analysis of Factors Potentially Influencing Diagnostic Yield Among Computed Tomography-Guided Biopsies for Bone Lesions.

This study aimed to investigate patient-specific, lesion-related, and technical factors that potentially influence diagnostic yield of computed tomography (CT)-guided biopsies of bone lesions. Computed tomography-guided bone lesion biopsies performed over a 2-year period were retrospectively reviewed, including image review and electronic medical records for pathology reports and clinical follow-up. Lesions were tabulated by prebiopsy CT and magnetic resonance imaging features. Patients with nondiagnostic biopsies were assessed for presumptive clinical diagnosis and management. Nondiagnostic pathology results were obtained in 31 of 156 cases (19.87%), among which diagnoses were confirmed by other tissue sampling in 9; clinical follow-up of up to 2 years yielded no diagnosis in 10 and presumptive diagnoses in 12. The nondiagnostic biopsy rate of long bone lesions was higher than that of other bone lesions (odds ratio, 3.46; 95% confidence interval, 1.32-9.09). There were no significant differences in patient American Society of Anesthesiologists class, mean body mass index, sedation method, number of cores, or needle gauge between diagnostic and nondiagnostic biopsy cohorts. Diagnostic yield was not significantly different between occult, lytic, or sclerotic lesions. There was no difference in diagnostic yield regarding presence of cortical break, gadolinium enhancement, or lesion depth. Magnetic resonance imaging was obtained before biopsy in significantly more nondiagnostic cases compared with diagnostic cases ( P = 0.027). Computed tomography-guided biopsies had a nondiagnostic rate of 19.87%, and lesions in the long bones of the extremities were disproportionately common among this group. There was no significant association between biopsy results and several patient-specific, lesion-related, and technical factors.

Clinico-haemato-biochemical and Pathological Alteration of Pyometra in Canines

Background: Pyometra is a pathological state of the compromised uterus of grown-up to old, diestrum bitches. Pyometra is easy to identify but can be more challenging when there is no vaginal discharge. In the present study, an attempt was made to find out the pathogen involvement and clinico-haemato-biochemical alteration in bitches affected with Pyometra. Methods: Twelve bitches with a history of inappetence, polydipsia, dirty vaginal discharge, occasional vomition irrespective of breeds and age groups were clinically examined and diagnosed as pyometra. The presumptive clinical diagnosis was based on case history, clinical signs, vaginal cytology, abdominal ultrasonography or radiography, gross examination of a pus-filled uterus after the ovariohysterectomy. Result: Vaginal examination revealed brown chocolate malodorous vaginal discharge with discolouration of the perivulval tissue. Abdominal ultrasound showed hyperplasia with echogenic material in the uterine wall along with distended uterine horns containing a large volume of cellular contents. Radiographic imaging revealed cranio-dorsal displacement of the small intestine and a twisted uniform tubular opacity with a distended uterus. The vaginal cytology revealed a large number of degenerated neutrophils, intermediate and parabasal cells. Escherichia coli were the major pathogen isolated from the pyometra uteri of bitches. The surface of the endometrium was columnar ciliated epithelium, with hyperplasia of subepithelial tissue and thick muscularis. The haemato-biochemical evaluation in pyometra infected bitches revealed decreased haemoglobin (Hb), packed cell volume (PCV), total erythrocytic count (TEC) and lymphocyte count indicating the microcytic hypochromic type of anaemia. Leucocytosis with a predominant absolute neutrophilia and lymphocytosis were consistently found in canine pyometra. There was a significantly elevated profile of blood urea nitrogen, creatinine, transaminases and alkaline phosphatase as well as total proteins observed in pyometric female dogs as compared to healthy ones which may have diagnostic and prognostic importance, which also indicated damage of vital organ caused by bacterial endotoxins. The haemato-biochemical indices correlating with imaging techniques, vaginal cytology and histopathological examination can serve as good prognostic markers in bitches with pyometra.

Clinico-pathological Alterations of Pyometra in Cat

Background: Pyometra is an infectious condition characterized by a pus-filled uterus, which basically developed due to hormonal, anatomical and physiological changes and the inside environment of the queen uterus help to grow the opportunistic pathogen. The aim of the present study was made to assess the haemato-biochemical changes of pyometra in infected queens. Methods: The study was carried out in 12 clinical cases of cat with a history of lethargy, depression, inappetence, polydipsia, occasional vomition and vaginal discharge, presented for treatment at Teaching Veterinary Clinical Complex, College of Veterinary Sciences and A.H., Central Agricultural University, Aizawl, Mizoram. The presumptive clinical diagnosis of pyometra was made based on history, clinical signs and imaging techniques. The involvement of the pathogen was further confirmed by microbial examination of the pus-filled uterus after the ovariohysterectomy. Result: The study revealed alterations in the total erythrocyte count, haemoglobin and packed cell volume in pyometra cases. The leucogram revealed leucocytosis, neutrophilia and lymphopenia. Biochemical analysis revealed hyperprotenemia, increased liver enzymes and BUN and creatinine. The major pathogens involved in pyometra infected queens are Escherichia coli, Staphylococcus, Streptococcus, Pseudomonas, Proteus and Pasteurella. The analysis of various parameters indicated that haemato-biochemical analysis may be good prognostic markers for feline pyometra.

Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

BackgroundEsophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.MethodsThis prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.DiscussionThis study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.Trial registrationThis study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393.

Clinical and laboratory profile of patients with presumptive clinical diagnosis of acute bacterial meningitis and its short-term complications.

Worldwide, one million cases of bacterial meningitis are estimated to occur and 200,000 of them die annually. Case fatality rates vary with age at the time of illness and the species of bacterium causing infection. In view of variable clinical features and complication rates in various studies, the present study was planned to assess the clinical and laboratory profile of patients with acute bacterial meningitis and analyze the therapeutic response and short-term sequelae. This study was conducted in the department of pediatrics at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. A total of 50 pediatric patients with signs and symptoms of acute bacterial meningitis who satisfied the inclusion or selection criteria were enrolled in the study. Appropriate statistical tests were applied for analysis and trial registry was done with PGIMS. In the present study, slightly more males (54%) were found than females (46%). The sequelae and mortality were 33.3%, 26.1% and 7.4%, 8.7% in males and females, respectively. There were higher chances of sequelae or mortality in males as compared to females (OR 1.289, 95% CI 0.073-6.11, P > 0.05). Predominant cells were polymorphonuclear (PMN) cells except in >120 months age group where both PMN (50%) and mononuclear (50%) cells were equally visualized. Mean CSF protein was slightly higher in 2-24 months age group. We compared the group with sequelae with the group with no sequelae and found neurological deficit (P < 0.01), and presence of complications (P < 0.01) were significantly associated with sequelae.

Inflammatory leukoencephalopathy mimicking hereditary disease

ObjectivesTo report patients with presumed autoimmune/inflammatory leukoencephalopathies. MethodsThis was a retrospective case series focused on immunologic, genetic, imaging, and histologic investigations of a presumptive clinical diagnosis of autoimmune/inflammatory leukoencephalopathy. ResultsFive patients had brain MRI with symmetric white-matter abnormalities like genetic leukodystrophies. However, in contrast to genetic disorders, all had subacute onset of symptoms within median of 16 weeks and severe neurologic disability within 3 years. Cerebrospinal fluid, histopathology, or both showed inflammation and extensive investigations for alternative etiologies were negative. One patient had an antibody biomarker positive for glial fibrillary acidic protein. Four of 5 improved or stabilized with immunotherapy. ConclusionsInflammatory and autoimmune leukoencephalopathies are a potential mimic of genetic leukodystrophies. Evidence of inflammation in CSF and on brain pathology, exclusion of alternative diagnoses, and response to immunotherapy led to this working diagnosis in these patients although further studies in larger numbers of patients are needed.

Essential Thrombocythemia Versus Pre-Fibrotic/Early Primary Myelofibrosis: Discrimination By Laboratory and Clinical Data

In clinical practice there is an active interest to evaluate whether laboratory or clinical parameters would help to distinguish WHO-defined essential thrombocythemia (ET) and pre-fibrotic / early primary myelofibrosis (pre-PMF) in patients presenting with thrombocytosis given the very different outcome and treatment options.A first step in this direction was initiated by Carobbio et al. (Am J Hematol.2012;87:203-204), who used hemoglobin (Hb) level, white blood cell (WBC) count and serum lactate dehydrogenase (LDH) level in a dichotomized fashion, resulting in a step-by-step algorithm (the so-called Bergamo algorithm).The aim of the present study was to extend and improve this algorithm. In addition to the laboratory parameters, leftshift in the peripheral blood cell count (presence of single erythroblasts or myelocytes, metamyelocytes, promyelocytes or myeloblasts) and splenomegaly were also tested as presumptive parameters. The second, more important approach was to look not necessarily at each parameter in a stepwise order, but to develop a logistic regression model.Only patients diagnosed with ET or pre-PMF according to the 2008 WHO diagnostic criteria with a complete dataset (age at diagnosis, complete blood counts, left-shift, LDH-levels and presence of splenomegaly), consistent diagnosis between bone marrow (BM) morphology and clinical findings, platelet count greater than 450 x 109/L and no evidence for masked/early stages of polycythemia vera were eligible for this study. These criteria were met by 359 patients who were included in the study.Results from the first application of the Bergamo algorithm on our cohort are given in Table 1. The expanded algorithm, which includes leftshift and splenomegaly increased sensitivity with regard to pre-PMF and the number of undetermined cases could be reduced to 93 (Table 1).In an alternative approach, a logistic regression model was used, which weights the information contained in the laboratory parameters and in the dichotomous variable splenomegaly in an optimal, data-driven way and exploits the full information of the continuous laboratory parameters, instead of dichotomizing them. Leftshift was removed from the final model due to obvious negligibility for the sake of model parsimony.While step-by-step procedures deliver a prediction in the form of a patient's direct classification into either ET or pre-PMF (or undetermined), a logistic regression model transforms each set of a patient's characteristics into a predicted probability for pre-PMF. The final model's calibration plot shows a good agreement between observed and shrunk predicted pre-PMF probabilities; accordingly, the Hosmer-Lemeshow test shows a non-significant test result (p=0.255).The predicted shrunk pre-PMF probability can be used as a prediction score ranging from 0 (ET) to 1 (pre-PMF). It is calculated using the following formula:Score = 1 / [1+exp(-21.01-0.249*Hb+0.613*log2(WBC) + 2.63*log2(LDH) +1.04*Splenomegaly)]Here, log2 denotes the binary logarithm (1 is inserted for presence of splenomegaly, zero otherwise). To transform this score into a dichotomous classification rule (ET vs. pre-PMF) a cutoff equal to 0.438 is proposed which leads to approximately equal sensitivity and specificity in our data.Utilizing only dichotomized laboratory parameters we could reproduce the results of the Bergamo algorithm yielding a sensitivity and specificity of about 50% among our study cohort. Expanding these parameters by leftshift and splenomegaly, we achieved an increase of these values and provide predictions also for previously undetermined cases. Finally, we demonstrated that a risk score formula based on statistical modeling is able to exploit the information contained in the same predictor variables in a much more efficient way (Table 1). Although, according to the WHO criteria, BM biopsy examination persists as an integral part of the final diagnosis, laboratory parameters may provide clinicians with additional information to suspect pre-PMF in a patient with a presumptive clinical diagnosis of ET. However, in this context it should be underscored that our formula and the proposed cutoff for the resulting score need to be externally validated in other large cohorts of patients presenting with thrombocythemic myeloproliferative neoplasms, and most important, in prospective clinical trials. [Display omitted] DisclosuresKrauth:Celgene: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Amgen: Honoraria; BMS: Honoraria; Janssen Cilag: Honoraria; AOP Orphan Pharmaceuticals AG: Honoraria. Gisslinger:AOP Orphan Pharmaceuticals AG: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; PharmaEssentia: Consultancy, Honoraria; Janssen Cilag: Honoraria; Shire: Honoraria; Takeda: Honoraria.

Risk and protective factors for post-traumatic stress among New Zealand police personnel: a cross sectional study

PurposeThe purpose of this research was to examine which factors increase the risk of post-traumatic stress in police officers to assist with identifying strategies that will minimize its occurrence.Design/methodology/approachThis study of constabulary and non-constabulary members of the New Zealand Police has been based on an 80-question electronic survey, which was sent to all serving, resigned and retired members of the New Zealand Police Association, which number approximately 18,000. The survey included a series of questions that measured the post-traumatic stress that participants experienced.FindingsVariables associated with post-traumatic stress were examined using logistic regression modeling techniques. The study found that post-traumatic stress was prevalent among serving, resigned and retired police members and exposure to trauma, especially prolonged exposure, was significantly associated with post-traumatic stress. More than 49% of participants were found to have some post-traumatic stress symptoms and more than 14% of participants indicated a presumptive clinical diagnosis of post-traumatic stress.Research limitations/implicationsThe limitations of the research included not include questions relating to the Social Provisions Scale (SPS) and General Health Questionnaire, nor did it include police officer recruits. A further limitation was that it was a cross-sectional study.Originality/valueAn understanding as to which variables influence or increase post-traumatic stress disorder is important for police officers and the police institution. The findings from this study indicate that exposure to trauma is strongly associated with high levels of post-traumatic stress, while good sleep and relaxation decrease the influence of such variables.

Impact of malaria diagnostic refresher training programme on competencies and skills in malaria diagnosis among medical laboratory professionals: evidence from Ghana 2015\u20132019

BackgroundThe quality of malaria test results is crucial for optimal patient treatment and care. The Ghana Health Service is successfully shifting from presumptive clinical diagnosis and treatment of malaria to the Test, Treat and Track (T3) initiative. In line with the initiative, the National Malaria Control Programme (NMCP) set out to improve the capacity of medical laboratory professionals in Ghana through a five-day Malaria Diagnostic Refresher Training (MDRT) to build competencies and skills in malaria diagnosis, especially in the three components of microscopy: parasite detection, species identification and parasite quantification. This study evaluates the impact of the training on malaria microscopy.MethodsThe training which was based on the World Health Organization basic malaria microscopy training guide employed presentations and practical approaches to malaria diagnosis. A total number of 765 medical laboratory professionals from various health facilities across the country were trained every other year from 2015 to 2019 and were included in this evaluation. Evaluation of this training was done using pre-test and post-test microscopy scores. The Negative Binomial fixed effect model was used in determining the overall effect of the training in improving the competencies of the participants on malaria microscopy.ResultsThe ability of the medical laboratory professionals to correctly detect malaria parasites increased significantly from a median score of 64% prior to the training to 87% after the training (p < 0.001). The competencies of the medical laboratory scientists to correctly identify malaria parasite species and quantify the number of malaria parasites increased significantly from a median score of 17% and 20% pre-test to 78% and 50% post-test, respectively (p < 0.001). The results showed that participants’ competency level and skill to perform malaria microscopy (species identification, parasite quantification and detection of malaria parasites) increased by approximately two folds after the training compared to the no-training scenario (adjusted rate ratio = 2.07, 95% CI 2.01–2.13, p < 0.001).ConclusionThe MDRT programme significantly improved participants’ performance of malaria microscopy over a short period of time.