Results Of Clinical Examination Research Articles

Evaluation of the Blunt Pancreatic Injury, a Long-Term Tertiary Care Center Study: An Original Research.

Pancreatic trauma is uncommon and challenging to diagnose. Contrarily, severe injuries to the kidney, spleen, and liver are frequent and typically easy to detect with imaging methods. Pancreas injuries can cause a significant amount of morbidity and mortality. Reviewing the institution's experience with this rather infrequent injury was the goal of this study. The patients' records were collected from the data records at the tertiary care center for patients who had pancreatic damage and were followed up for a year. The American Association for the Surgery of Trauma pancreatic damage grade scores were assigned to each patient using the radiologic and surgical findings. Clinical examination and CT results were predominantly used to make the diagnosis in patients who underwent non-operative treatment. The data are presented as descriptive statistics. Only 2.2% of the total cases that presented to the trauma center were finalized as pancreatic injuries. Trauma to the abdomen was seen in nearly half the cases brought. Most of the subjects in pancreatic injuries were in grade 3. Mortality was noted maximum for the grade 3 and 4 cases. While high-grade pancreatic injury almost always requires an operational intervention, low-grade pancreatic injury with an intact main pancreatic duct may be effectively handled non-operatively. When possible, distal pancreatectomy with spleen preservation is the ideal procedure for distal pancreatic trans-action. A patient who is hemodynamically stable with complex pancreaticoduodenal damage, which is related to a high death rate, should undergo Whipple resection.

Clinical Features and Histopathologic Examination of Lentiginosis Profusa in a Dog

An 5-year-old Yorkshire Terrier dog was presented due to a gradually developing hyperpigmented spot at the ventral abdomen, around lips, interdigital space and paws. The skin lesions appeared 2 years ago and gradually increased the numbers. The skin condition was generally dry on presentation, and several hyperpigmented macules and patches were detected. Except for the hyperpigmented skin lesions, other physical examinations and dermatological examination results were non-remarkable. Based on the history and clinical examination results, the genetic dermatological disease, lentigo was highly suspected. Skin biopsy and histopathologic examination were performed to rule out other pigmentary skin disease including tumor. The histopathologic examination revealed epidermal hyperplasia, melanocytic hyperplasia and hyperkeratosis. The dermatologic signs and histopathologic results were compatible with lentiginosis profusa. Canine lentiginosis profusa predominantly occurs in mature dogs and is generally considered a benign condition. While it is primarily a cosmetic concern, it is essential to distinguish it from other hyperpigmentation-related diseases.

Acute Appendicitis: How Often is Appendectomy Negative?

Introduction. At present, medical practice lacks a unifi ed approach to the choice of therapeutic tactics for acute catarrhal appendicitis and therefore lacks understanding of negative appendectomy. Aim. To study the incidence of negative appendectomy in acute appendicitis. Materials and methods. The methodology involved a retrospective analysis of the results of 1590 appendectomies performed from 2003 to 2005 and a prospective non-randomized study of 1112 patientsfor the period from 2018 to 2019. During the first observation period, the examination included physical and laboratory examinations, and in the second period, Alvaro scoring, ultrasound scan, and videolaparoscopy. Results and discussion. In the first period, catarrhal forms of appendicitis were reported in 7.82 % of cases, while in the second period — in 3.04 %. The diagnoses were confi rmed pathohistologically in all cases. Conclusion. No cases of performing negative appendectomy were reported, based on the results of clinical, endoscopic and pathomorphological examinations. However, the ambiguous interpretation of acute catarrhal appendicitis in the national clinical practice guidelines for acute appendicitis does not allow for unambiguous conclusions from the study.

RETROSPECTIVE ANALYSIS OF MEDICAL CHARTS OF PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME

Background. Antiphospholipid attracts the attention of clinicians in various fields of medicine. This pathology is characterized by a triad of clinical and laboratory signs: recurrent venous or arterial thrombosis with localization in any part of the bloodstream, obstetric pathology in the form of primary premature pregnancy and intrauterine death of the fetus with hematological disorders (thrombocytopenia, hemolytic anemia).
 Aim: to conduct a retrospective analysis of medical records of patients with antiphospholipid syndrome.
 Materials and methods. A retrospective analysis of outpatient/inpatient medical records of 54 patients with the main diagnosis: antiphospholipid syndrome between 2016 and 2021, who were examined and treated in the rheumatology department of the Multidisciplinary Medical Center of Odesa National Medical University, was conducted. The diagnosis of antiphospholipid syndrome was established according to the recommendations of EULAR (2019), Order of the Ministry of Health of Ukraine dated October 8, 2007 No. 626 "Clinical protocol for providing medical care to patients with Antiphospholipid Syndrome" and Order of the Ministry of Health of Ukraine No. 22 dated January 20, 2015. "Clinical protocol for providing medical care to patients with immune diseases."
 Results. In the general group of patients, the duration of this pathology at the time of the study ranged from 1 to 10 years. It was established that the number of appeals in connection with exacerbation of antiphospholipid syndrome depended on age and had probable differences. It was also noted that the total number of concomitant pathologies was correlated with the number of appeals regarding exacerbation of antiphospholipid syndrome. It was revealed that arthralgia and polyarthritis were most often detected in male patients aged 20-44 against the background of antiphospholipid syndrome, and skin manifestations in men aged 45-59. In women of the age group of 20-44 years, on the background of the diagnosed antiphospholipid syndrome, skin manifestations in the form of reticular liver, arthralgia and polyarthritis, as well as cardiovascular disorders, were most often noted. In women aged 45-59, arthralgia and polyarthritis and disorders of the cardiovascular system.
 Using the method of collecting anamnestic data and the results of clinical laboratory examination, in accordance with current medical care protocols and diagnostic criteria for antiphospholipid syndrome, a retrospective analysis confirms the fact that antiphospholipid syndrome occurs 5 times more often in women than in men.

RISK FACTORS FOR UNFAVORABLE PROGNOSIS AND PROGRESSION OF CHRONIC HEART FAILURE IN COVID-19 PNEUMONIA

Introduction. Patients with chronic heart failure are vulnerable to coronavirus disease (COVID-19).
 Objectives. To investigate risk factors for unfavorable prognosis and progression of heart failure in hospitalized patients with chronic heart failure and COVID-19 pneumonia.
 Methods. A retrospective analysis of the medical records of 555 hospitalized patients diagnosed with COVID-19 was conducted. Subsequently, the data of 90 patients with chronic heart failure (CHF) and COVID-19 pneumonia from January – February 2021 were collected at Lviv Clinical Hospital of Emergency Medical Care. The following indices were evaluated: anthropometric and demographic data, complications, treatment results, results of clinical, laboratory, and instrumental examinations, and dynamic NT-proBNP.
 Results. CHF is recorded in 42.9% of hospitalized patients with COVID-19 and is accompanied by lower values of blood oxygen level (p=0.0474), hemoglobin (p=0.0090), prothrombin time (p=0.0196), prothrombin index (p=0.0196) and higher indicators of glucose (p=0.0032), creatinine (p=0.00001), interleukin-6 (p=0.0041). CHF decompensation is associated with lower values of body temperature (p=0.0047) and blood oxygen saturation (p=0.0076), while hemoglobin level (p=0.0026), higher creatinine values (p=0.0034), interleukin-6 (p=0.0300), aspartate aminotransferase (p=0.0035), troponin I (p=0.0061); are associated with the development of myocardial infarction (p=0.0014), acute arrhythmias (p=0.0011), hypertensive crisis (p=0.0096) and increased mortality (OR=5.72; 95). % CI: 1.84, 17.81; p=0.0026).
 Conclusions. CHF is common and often fatal in patients with COVID-19, especially in decompensated CHF. Low blood oxygen saturation, myocardial infarction, arrhythmia, hypertensive crisis, increased cardio cytolysis markers and pro-inflammatory cytokines preceding adverse cardiovascular risk factors contribute to CHF decompensation in patients with COVID-19.

Diclofenac sodium and Allopurinol induced Stevens Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs

One of the life-threatening multi-organ emergency conditions is Stevens-Johnson Syndrome (SJS). Although this is a rare disease and manifests as drug reactions, this condition can cause death.We present a case of a 63-year-old male with Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs.The patient was undergoing outpatient TB treatment at the end of the first month. The patient comes to the emergency department of the hospital because of shortness of breath, fever, blistered skin, nasal and oral mucosa, cracks and wounds, visible pus, red eyes accompanied by erythematous rash all over the body after previously taking diclofenac sodium and allopurinol given by the doctor because felt joint pain all over body and uric acid increased. On physical examination of the lungs, crackles and wheezing were heard in both lung fields. The chest radiograph shows infiltrates in both lung fields. Laboratory results showed leukocytosis and the results of other blood laboratory tests were still within normal limits. Patient diagnosed Stevens-Johnson Syndrome based on clinical, laboratory, and radiology examination results. The patient was given treatments using nasal canule oxygen of 5 litres/minute, intravenous fluid dehydration D5% : NaCl 0.9%, ceftriaxone injection, gentamicin injection, dexamethasone injection, cetirizine ranitidine injection, compresses with 0.9% NaCl liquid, 2.5% hydrocortisone ointment. The patient was treated in the Intensive Care Unit for 8 days. The patient had no history of previous drug allergies. In this case, the likelihood of Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs, needs to be a concerned, as well as the importance of evaluation and strict follow-up to prevent Stevens Johnson Syndrome disease.

Can the salivary urea and stimulated saliva concentration be a marker of periodontal diseases in opioid users? A case-control study

Introduction& Aim: Microbial plaque is the primary cause of periodontal diseases, and smoking and opioid addiction can accelerate microbial plaque formation and disease progression. Adequate saliva flow and salivary urea concentration are important parameters for a healthy periodontium. In this study, the relationship between Periodontal Diseases and the History of opioid addiction was investigated by measuring the Salivary Urea and Stimulated Saliva Concentration. Materials & methodsThis case-control study was conducted on 240 patients (120 cases and 120 controls) in 2021 referred to addiction treatment centers and the dental clinic in Iran, Birjand. The control and case groups were matched in terms of age. Demographic, base data, and clinical examination results were collected by a checklist. Data were analyzed using SPSS 19 and one-way ANOVA and chi-square tests. P-value <0.05 was considered as the significance level. ResultsPeriodontitis severity was significantly higher in the case group than in the control group (P-value = 0/000). Salivary urea concentration significantly increased in both case and control groups with an increase in periodontitis severity (P-value = 0/003 in the case group and P-value = 0/000 in the control group), but there was no significant relationship between the stimulated saliva flow rate and the severity of periodontitis in these two groups (P-value>0.05). ConclusionFollowing the use of opioids, the flow of saliva decreases, and with the exacerbation of the periodontal disease, the concentration of urea in saliva increases. Therefore, it seems that the analysis of saliva parameters, including urea concentration, can be useful for the diagnosis of periodontal disease, and saliva urea concentration is not directly related to opioid use.

Early neonatal sepsis caused by &lt;i&gt;Haemophilus influenzae&lt;/i&gt;

Neonatal sepsis still remains a serious problem of modern health care, being one of the main causes of neonatal and infant mortality, as well as disability in surviving children. Due to the high risk of adverse outcomes, the problem of early neonatal sepsis (ENS), especially in preterm infants, attracts special attention. At the same time, if in the previous decades the main causative agents of ENS were Escherichia coli and Streptococcus group B, then in recent years it has been noted that while maintaining the leading value in the etiological structure of Escherichia coli, the frequency of detection of Haemophilus influenzae began to increase. The article contains a review of modern publications on the role of Haemophilus influenzae in the formation of perinatal losses, as well as the significance of this pathogen in the development of neonatal sepsis. The article also presents a clinical case report of ENS caused by Haemophilus influenzae. Particular attention is paid to the issues of timely diagnosis of ENS, which is possible only with a comprehensive analysis of the results of clinical and laboratory-instrumental examination.

Clinical features of Kawasaki disease complicated by macrophage activation syndrome: an analysis of 27 cases

To investigate the clinical manifestations and laboratory examination results of children with Kawasaki disease complicated by macrophage activation syndrome (KD-MAS), and to provide a basis for identifying early warning indicators for the early diagnosis and treatment of KD-MAS. A retrospective study was performed on 27 children with KD-MAS (KD-MAS group) and 110 children with KD (KD group) who were admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2014 to January 2022. Clinical and laboratory data were compared between the two groups. The receiver operating characteristic (ROC) curve was used to investigate the value of laboratory markers with statistical significance in the diagnosis of KD-MAS. Compared with the KD group, the KD-MAS group had significantly higher incidence rates of hepatomegaly, splenomegaly, incomplete KD, no response to intravenous immunoglobulin, coronary artery damage, multiple organ damage, and KD recurrence, as well as a significantly longer length of hospital stay (P<0.05). Compared with the KD group, the KD-MAS group had significantly lower levels of white blood cell count, absolute neutrophil count, hemoglobin, platelet count (PLT), erythrocyte sedimentation rate, serum albumin, serum sodium, prealbumin, and fibrinogen (FIB), a significantly lower incidence rate of non-exudative conjunctiva, and significantly higher levels of C-reactive protein, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase (LDH), and serum ferritin (SF) (P<0.05). The ROC curve analysis showed that SF, PLT, FIB, and LDH had high value in the diagnosis of KD-MAS, with areas under the curve (AUC) of 0.989, 0.966, 0.932, and 0.897, respectively (P<0.001), and optimal cut-off values of 349.95 μg/L, 159×109/L, 3.85 g/L, and 403.50 U/L, respectively. The combination of SF, PLT, FIB, and LDH had a larger AUC than PLT, FIB, and LDH alone in the diagnosis of KD-MAS (P<0.05), but there was no significant difference in the AUC between the combination of SF, PLT, FIB, and LDH and SF alone (P>0.05). KD-MAS should be considered when children with KD have hepatosplenomegaly, no response to intravenous immunoglobulin, coronary artery damage, and KD recurrence during treatment. SF, PLT, FIB, and LDH are of high value in the diagnosis of KD-MAS, especially SF is of great significance in the diagnosis of KD-MAS.

Experience of personalized management of patients with breast cancer associated with pregnancy

The clinical case of a patient with pregnancy-associated breast cancer observed in Sverdlovsk Regional Oncological Dispensary was analyzed. The information obtained from the electronic map of obstetric database and the medical history of oncological dispensary regarding the results of clinical examination as well as the data of instrumental and laboratory research were used. The tactics of managing this patient was discussed at the Regional Obstetric and Interdisciplinary Consultation with the participation of oncologists; a compromise concept was chosen, which implies surgical treatment of malignant neoplasms followed by chemotherapy during pregnancy and early delivery at the term when a child is viable 34 weeks of pregnancy. At present, preference is given to personalized tactics of pregnancy management and treatment of pregnancy-associated breast cancer using an interdisciplinary approach with the participation of medical specialists: obstetrician-gynecologist, oncologist-surgeon, oncologist-chemotherapist, radiotherapist, anesthesiologist-resuscitator, neonatologist, pathologist. The described clinical case demonstrates successful implementation of this approach, as evidenced by the favourable outcome of childbirth as well as the absence of recurrence and progression of the tumor process in dynamics.

The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: implications for future educational designs

BackgroundPandemic disruptions to medical education worldwide resulted in rapid adaptations to clinical skills learning. These adaptations included moving most teaching to the online environment, decreasing the accepted “hands-on” methods of teaching and learning. While studies have shown significant impacts on student confidence in skills acquisition, there is a paucity of assessment outcome studies which would contribute a valuable perspective on whether measurable deficits were incurred. Here, a preclinical (Year 2) cohort was investigated for clinical skills learning impacts that could influence their transition to hospital-based placements.MethodsA sequential mixed methods approach was used on the Year 2 Medicine cohort, including: focus group discussions with thematic analysis; a survey derived from the themes observed; and a cohort comparison of the clinical skills examination results of the disrupted Year 2 cohort, compared to pre-pandemic cohorts.ResultsStudents reported experiencing benefits and disadvantages of the shift to online learning, including a decrease in confidence in their skills acquisition. End of year summative clinical assessments showed non-inferior outcomes when compared to previous cohorts for the majority of clinical skills. However, for procedural skills (venepuncture) the disrupted cohort had significantly lower scores compared to a pre-pandemic cohort.ConclusionsRapid innovation during the COVID-19 pandemic provided the opportunity to compare online asynchronous hybrid clinical skills learning with the usual practice of face-to-face synchronous experiential learning. In this study, students’ reported perceptions and assessment performance data indicate that careful selection of skills suitable for online teaching, supported by timetabled “hands-on” sessions and ample practice opportunities, is likely to provide non-inferior outcomes for clinical skills learning in students about to transition to clinical placements. The findings can be used to inform clinical skills curriculum designs that incorporate the virtual environment, and assist with future-proofing skills teaching in the case of further catastrophic disruptions.

First results of maintenance of register in electronic form in pediatric patients with hypertrophic cardiomyopathy

Background. The problem of managing children with hypertrophic cardiomyopathy (HCM) remains relevant due to the high risk of sudden cardiac death (SCD). Registers of patients with HCM contribute to a better understanding of the course of the disease and its outcomes.Objective. To study the structure of CMP with a hypertrophic phenotype, as well as to identify clinical, molecular and genetic features of the course of HCM and outcome in children based on anamnestic, clinical and instrumental data from an electronic database.Design and method/ Currently, the database includes complete information on 80 children from 0 to 18 years of age inclusive with a hypertrophic phenotype of CMP. The study was performed on the basis of the Department of Pediatric Cardiology and Medical Rehabilitation of the V.A. Almazov” of the Ministry of Health of Russia. The database contains the history of the disease and family history, the results of clinical and laboratory-instrumental examination, the results of molecular genetic research. The register is dynamically updated.Results. The mean age of onset of HCM was 1.75 [0.02; 10.00] years. There were more boys than girls — 54 (67.5 %). The main complaints were decreased exercise tolerance in 35 (43.8 %) children and shortness of breath in 30 (37.5%) children. All children had signs of heart failure (HF): 53 (66.3 %) had signs of functional class 2 HF, 26 (32.5 %) — functional class 1 and 1 (1.2 %) — functional class 3. Ventricular arrhythmias were recorded in 23 (29 %) children, unstable ventricular tachycardia in 2 (2.5 %) children. Myocardial fibrosis of the left ventricle according to the results of MRI of the heart was found in 60.7 %. A lethal outcome was registered in 5 % (n = 4) of cases on average at 241 ± 117 days of life. All the deceased had phenocopies of HCM.Conclusion. Maintaining an electronic database of patients with HCM will allow a better understanding of the influence of factors, including genetic ones, on the course, outcomes, and prognosis of the disease in the pediatric population.

One case of congenital myopathy caused by new mutation of RYR1 gene and literature review

ObjectiveTo report a case of congenital myopathy caused by RYR1 gene complex heterozygous mutation and analyze the pathogenicity of the mutation. Method The clinical manifestation, laboratory examination, imaging findings, muscle pathology and gene test results of a child with congenital myopathy were analyzed retrospectively. Combined with literature review, it is analyzed and discussed. Result The child, female, was admitted to hospital because of “dyspnea for 22 min after asphyxia resuscitation”. The main manifestations are low muscle tension, the original reflex cannot be drawn out, the trunk and proximal muscles are weak, and the tendon reflex is not drawn out. The pathological signs were negative. The electrolyte of blood liver and kidney function, blood thyroid and blood ammonia were not abnormal, and creatine kinase increased temporarily. Electromyography suggests myogenic damage. Whole exome sequencing showed that there was a new compound heterozygous variation in RYR1 gene c.14427_ 14429del/c.14138C＞T.Western blot showed that the expression of RYR1 protein in patients was significantly lower than that in normal controls. Conclusion The compound heterozygous variation of RYR1 gene c.14427 was reported for the first time in China_ 14429del/c.14138c > t is the pathogenic gene of the child. The new discovery of RYR1 gene spectrum was revealed, which expanded the RYR1 gene spectrum.

Analysis of surgical treatment of appendix neuroendocrine neoplasms—17 years of single-center experience

Background/aimThis study investigated the clinicopathological characteristics and treatment of appendix neuroendocrine neoplasms in appendectomy specimens of our center.Materials and methodsThe clinicopathological data, including age, sex, preoperative clinical manifestation, surgical method, and histopathological examination results of 11 patients with appendix neuroendocrine neoplasms confirmed by surgery and pathology between November 2005 and January 2023, were retrospectively analyzed.ResultsIn the histopathological examination of 7277 appendectomy specimens, 11 cases (0.2%) had appendix neuroendocrine neoplasms. Among the 11 patients, 8(72.7%) were males, and 3(27.3%) were females, with an average age of 48.1 years. All patients underwent emergency surgery. A total of 9 patients underwent open appendectomy, including 1 patient who underwent second-stage simple right hemicolectomy after an appendectomy, and two who underwent laparoscopic appendectomy. All 11 patients were followed up for a period of 1 to 17 years. All patients survived without any indication of tumor recurrence.ConclusionAppendiceal neuroendocrine neoplasms are low-grade malignant tumors originating from neuroendocrine cells. They are rarely seen in clinical practice and are often treated based on acute and chronic appendicitis symptoms. These tumors are challenging to diagnose before surgery due to the lack of specificity in clinical manifestations and auxiliary examinations. The diagnosis generally depends on postoperative pathology and immunohistochemistry. Despite the diagnostic challenges, these tumors have a favorable prognosis.

Disorders of the hemostatic system in patients with COVID-19 infection of varying severity

Aim to evaluate the individual characteristics of the hemostatic system and lungs CT-scan data in patients with a new coronavirus infection caused by the COVID-19, depending on the severity of the disease.&#x0D; Material and methods.A comparative analysis included the results of clinical, epidemiological and laboratory examination of 209 COVID-19 patients divided in two groups: in-patients of the Samara State Medical University Clinics with moderate (n=106) and severe (n=103) course of the disease. The diagnosis was verified by enzyme immunoassay (ELISA) and polymerase chain reaction (PCR). The following indicators were analyzed: gender, age, body mass index (BMI), epidemiological history, clinical signs of the disease, severity, degree of lung damage according to the results of computed tomography (CT).&#x0D; Results.There were no significant differences between the groups in terms of gender and age characteristics, as well as epidemiological data of COVID-19 patients. In 91% of patients with severe COVID-19, the clinical manifestations of hemorrhagic syndrome were recorded in the form of ecchymoses at injection sites, and in 75% - in the form of bleeding of various localization. The changes in the hemostatic system in patients with severe COVID-19 were characterized by high levels of platelets, INR, APTT, fibrinogen and a decrease in PI. In patients with severe COVID-19, a positive correlation was established between the level of fibrinogen, INR, APTT, PI and consolidation of lung tissue, as well as between the level of INR, APTT, PI and the presence of lung lesions in the form of "ground-glass" opacities on the CT images.

STATE OF NEUROLOGICAL SYMPTOMS IN NEWBORNS WITH HEMORRHAGIC DISEASE

The aim of the study was to study the significance of risk factors for the formation of hemorrhagic disease of the newborn and the course of the disease to improve the organization of disease prevention.&#x0D; Case histories and results of clinical and anamnestic examinations were studied in 38 newborns with hemorrhagic disease, hospitalized in the neonatology department during the last three years. Diagnosis of the disease was carried out on the basis of a detailed study of the anamnesis and clinical, laboratory and instrumental parameters (platelet count, coagulogram, ultrasound and neurosonography).&#x0D; It was revealed that vitamin K deficiency leads to the development of hemorrhagic disease of the newborn due to the influence of adverse factors from the mother (preeclampsia, medication during pregnancy, operative delivery), and the child (prematurity), which requires enhanced dispensary monitoring of a pregnant woman, early identification of risk factors to a newborn.

Early evaluation of severe immune checkpoint inhibitor-associated myocarditis: a real-world clinical practice.

Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but severe complication for patients treated with immunotherapy. This study aims to explore the predictive significance of patients' clinical features and examination results for the severity of ICI-associated myocarditis. Data from a real-world cohort of 81 cancer patients who developed ICI-associated myocarditis after immunotherapy were retrospectively analyzed. The development of myocarditis of Common Terminology Criteria for Adverse Events (CTCAE) grades 3-5 and/or the major adverse cardiovascular event (MACE) was set as endpoints. Logistic regression was used to evaluate the predictive value of each factor. CTCAE grades 3-5 and MACE developed in 43/81 (53.1%) and 28/81 (34.6%) cases, respectively. The likelihood of CTCAE grades 3-5 and MACE increased with the accumulation of organs affected by the ICI-associated adverse events and initial clinical symptoms. Concurrent systematic therapies during ICI treatment did not raise the risk of myocarditis severity, while prior chemotherapy did. Besides classical serum cardiac markers, a higher neutrophil ratio was also related to poorer cardiac outcomes, whereas higher lymphocyte and monocyte ratios were predictors of favorable cardiac outcomes. The CD4+ T cell ratio and CD4/CD8 ratio were negatively related to CTCAE grades 3-5. Several cardiovascular magnetic resonance parameters were associated with myocarditis severity, whereas the predictive value of echocardiography and electrocardiogram was weak. This study comprehensively evaluated the prognostic value of patients' clinical characteristics and examination results and identified several predictors of severe ICI-associated myocarditis, which will facilitate early detection of severe ICI-associated myocarditis in patients receiving immunotherapy.

Clinical features and genetic analysis of two Chinese ATP1A2 gene variants pedigrees of familial hemiplegic migraine

ObjectiveTo analyze the clinical manifestations and genetic examination results of affected members of two Chinese ATP1A2 gene variants pedigrees, and to summarize their phenotypic and genotypic features. MethodsThe clinical features were recorded in detailed. The cranial magnetic resonance imaging for patients and gene sequencing of two Chinese ATP1A2 gene variant pedigrees were perform. The correlation between the types of variants and the clinical phenotypes of ATP1A2 gene were analyzed. ResultsThese two pedigrees are diagnosed as familial hemiplegic migraine type 2 (FHM2) with ATP1A2 heterozygous missense variants, c.1091C > T (p.T364M) found in pedigree 1 and c.899T > C (p.L300P) in pedigree 2. Multiple phenotypes coexist in both families, and the two probands have severe cranial magnetic resonance imaging manifesting hemiplegic contralateral cortical swelling and diffusion weighted imaging hyperintense signal, which can be fully recovered. ATP1A2 gene variants were seen in FHM2, sporadic hemiplegic migraine and atypical alternating hemiplegia of childhood (AHC) families or sporadic cases, etc. The clinical features of ATP1A2 variant c.1091C > T (p.T364M) are basically similar in Chinese patients and European patients. ConclusionThese two Chinese pedigrees had FHM2 due to ATP1A2 heterozygous missense variation. It would expand the understanding of ATP1A2.

Could the different estrus periods significantly affect body temperature on clinical examination in bitches?

Clinical examination is essential to make a differential diagnosis list, and body temperature measurement is an indispensable part of the clinical examination. Throughout the estrus cycle, body temperature may fluctuate high enough to affect the clinical examination results. Aim of this study, whether there were any differences between the different estrus periods, body parts (rectal, intravaginal and corneal), and methods (contact thermography and infrared thermography) in regard to temperature in bitches. The animal material of this study consisted of 61 healthy, non-pregnant, non-sportive bitches (2.78 ± 0.22 mean years of age; mean weight 23.81 ± 1.61kg) of different breeds. Corneal temperature measurement results were found the least constant and significant differences were observed between different estrus periods except in the anestrus period. Rectal temperature (RT) measurement results were the most constant. However, in ANOVA analysis, significant differences were observed between the different estrus periods, and the difference between the anestrus and diestrus periods was very close to 0.5 °C. Although, in the Bland-Altman plot analysis, the agreement was observed only between rectal and intravaginal temperature (p: 0.572, r2: 0.70), the limits of agreement were not clinically acceptable. In conclusion, neither corneal temperature measurement with infrared technology nor intravaginal temperature measurement should not be an alternative to RT measurement, and RT measurement results should evaluate carefully considering the estrus period.

CLINICO-PATHOLOGICAL PROFILE OF BLADDER CANCER PATIENTS IN A TERTIARY CARE CENTRE.

Introduction: Bladder cancer (BC) is one of the most common urological malignancies.With Industrialisation, increasing exposure to occupational hazards and ever increasing use of tobacco in various forms, more and more of these BCs are being diagnosed nowadays. Objectives of the study: To study the clinical and histo-pathological prole of bladder cancer patients attending a tertiary care centre in Kerala in southern part of india. Materials and methods: A prospective observational study of 90 patients with bladder cancer was conducted in department of Urology at a tertiary care centre over a period of 1 year from Feb 2020 to Feb 2021. Patients presenting to department of urology, undergoing surgery for BC were studied by demographic parameters (age,gender) detailed history, clinical examination, cystoscopy ndings and cytopathology results and results analyzed. Results: A total of 90 patients were evaluated in the study. Highest number was found in patients of 60-80 years age group, with males &gt; females. Most patients presented with haematuria (88.89%), some with pain (18.89%) and irritative voiding complaints (12.22%) and 5.56% were incidental detection. Of all patients, 70% had history of smoking. Transitional Cell Carcinoma (TCC) was most common histology found in 92.22% of study population followed by Adenocarcinoma (4.44%), Squamous cell carcinoma (2.22) and leiomyosarcoma(1.11%). Among TCC, 54.22% had low grade, 33.73% were high grade and rest of them were PUNLUMP. Most of the lesions were unifocal polypoidal growths. High grade cancers were found predominantly in patients with age&gt;60 and history of tobacco smoking. Conclusion: Bladder cancer is predominantly a disease of older men. High index of clinical suspicion, as well as thorough exploration of all possible epidemiological factors will help clinician diagnose bladder malignancies. Awareness among the public should also be emphasized to make them understand the deleterious consequences of exposure to risk factors like smoking.