Results Of Immunological Tests Research Articles

Direct Immunofluorescence in Oral Lichen Planus and Related Lesions: Sensitivity, Specificity, and Diagnostic Accuracy in a Single Diagnostic Center in Poland

Objectives: Our study aimed to establish the basic reliability parameters of direct immunofluorescence test results in patients with oral lichen planus. Methods: We conducted an evaluation of individual antibody classes in the DIF and ELISA (BP180 antigen), comparing these results with the classical histopathological (HP) examination in a group of patients treated within the standard healthcare in our clinic. Results: Among 66 participants with oral changes indicative of LP, only 50% received histopathological confirmation of the LP diagnosis. Among those with a DIF profile entirely typical for LP (C3+, F+), 57.1% had a positive HP result. Fibrinogen deposits were identified in 42.4% and 36.4% of individuals with positive HP results for F1 and F2, respectively; 78.8% of patients with negative HP and 57.6% with positive HP exhibited no fibrinogen deposits. Simultaneous positivity for F1 and F2 occurred in all cases where F1 was positive. HP confirmed positive DIF for C3 in 50% of cases. Fibrinogen deposits demonstrated the highest diagnostic accuracy (61%). Sensitivity and specificity for fibrinogen deposits were 36% and 42% for F1 and 79% and 82% for F2. The positive predictive values were 67% for F1 and 67% for F2, while the negative predictive values were 58% for F1 and 56% for F2. Overall diagnostic accuracy was reported at 61% for F1 and 59% for F2. Conclusions: Our data indicate the complementarity of HP and immunological test results and the necessity of using both methods together in cases of doubt.

Physiological and biochemical assessment of a new three-breed carp cross

The article presents data about the physiological and biochemical assessment of a new three-breed carp cross. The basis for the creation of the cross was the theory of heterosis and the high combinational ability of both parent forms. The effect of heterosis was noted for a number of zootechnical indicators: body weight, head index, number of stamens on the anterior gill arch. The results of a comparative analysis of biochemical parameters such as alanine aminotransferase activity, glucose and total protein content are presented, which allowed us to conclude about the physiological state of the new three-breed cross, about the balance of its carbohydrate metabolism and high rates of protein metabolism, low level of hepatocyte destruction, high immune status and cellular immunity. The new cross is characterized by intensive metabolism of a greater proportion of mature neutrophils and a high level of cellular immunity according to the cytochemical coefficient of lysosomal cationic protein. When obtaining a new three-breed cross, the method of reciprocal hybridization of different carp breeds was used and the choice of an acceptable option with a pronounced effect of heterosis in terms of productivity and vitality was used. The article presents the results of immunological, hematological and biochemical blood tests of the new cross. Also, the article demonstrates the results of studies of the phagocytic activity of neutrophils and determines the content of non-enzymatic cationic protein in them. According to the results of the biochemical assessment, the new three-breed cross showed a high combination of its parent forms with the expected level of the heterosis effect.

The Value of Nailfold Capillaroscopy in the Classification and Differential Diagnosis of Raynaud's Phenomenon in Rheumatology.

Among instrumental techniques, nailfold capillaroscopy plays a leading role in the assessment of Raynaud's phenomenon (RP) patients because it is the only method that provides opportunities for morphological assessment of capillaroscopic findings in the nailfold area, with proven diagnostic and prognostic significance in rheumatology. The discussion about updating the classification of RP in rheumatology is interesting given the current understanding of capillaroscopic findings in rheumatic diseases and improvements in immunological diagnostics. The presence of dilation of the "true" capillary diameters in primary RP could be observed. There are some cases of primary RP where the capillaroscopic pattern is completely normal and there are no dilated capillaries present, which could be related to the duration and severity of the symptoms. It is possible that longer duration and greater severity are associated with the appearance of capillary dilations, but more research is needed to confirm it. Rarely, pathological capillaroscpic features of microangiopathy could be observed in RP patients in whom clinical, laboratory and immunological findings are compatible with the diagnosis "primary RP". These cases should be defined as "suspected secondary RP" and require closer follow-up for the assessment of symptom evolution. Abnormal "scleroderma" type capillaroscopic pattern has been established as a new classification criterion for systemic sclerosis (SSc) in 2013. Similar changes ("scleroderma-like" pattern) could be observed in other rheumatic diseases, i.e., undifferentiated connective tissue disease (UCTD), systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, including without evidence of overlap with scleroderma. The appearance of such microvascular abnormalities at disease presentation is less well studied in diseases different from SSc. However, "scleroderma-like" microangiopathy has also been reported as an initial sign in some systemic rheumatic diseases, such as UCTD and systemic lupus erythematosus. Thus, interpretation of capillaroscopic findings is performed in overall context, including clinical findings and laboratory and immunological test results.

Infrequent patterns in cerebrospinal fluid isofocusing test: Clinical significance and contribution of IgG index and Reiber diagram to their interpretation

Cerebrospinal fluid (CSF) isoelectrofocusing (IEF) is considered as the gold standard for detecting an intrathecal synthesis of IgG, which is a hallmark of multiple sclerosis (MS). This corresponds to the presence of CSF-restricted IgG oligoclonal bands (OCB) (typically type 2 pattern). Moreover, this technique can also detect a systemic immune reaction with passive transfer of IgG (type 3 and 4 patterns) for which the clinical relevance is less understood. The aim of our study was to determine the frequency and disease associations of IEF type 3 and 4 patterns and to investigate the potential usefulness of including quantitative data (IgG index and Reiber Diagram) in interpreting such IEF profiles.Among 544 patients who underwent CSF IEF (Hydragel CSF isofocusing kit, Sebia®, France) in our Laboratory during a six-year-period, those who presented type 3 or 4 patterns were selected. Clinical data and results of other immunological tests were analyzed for 27 patients followed in the Neurological Department.Frequencies of type 3 and type 4 patterns were relatively low (2.3 % and 3.4 % respectively). Among patients with type 3 pattern included in our study (n = 10), 5 were diagnosed with MS. For the 5 other patients, the diagnosis was a clinically isolated syndrome (CIS) (2 cases), a probable auto-immune encephalitis (2 cases) and a possible genetic neurodegenerative disease (1 case). MS patients had an IgG index >0.7 and fell into area 4 of Reiber diagram while non-MS patients had an IgG index <0.7 and fell into area 1, except the last case. Regarding type 4 pattern (n = 17), the diagnoses were as follows: MS (3), CIS (4), Neuromyelitis optica spectrum disorders with positive anti-AQP4 antibodies (3) and anti-NMDAR autoimmune encephalitis (1). The remaining cases had central nervous system impairment related to vascular, metabolic or tumoral etiologies (3) or peripheral nervous system impairment (3). In this group (type 4 pattern), IgG index was <0.7 in 15/17 cases. Interpretation using Reiber diagram showed an abnormal blood-brain barrier for 8/17 patients.Type 3 and 4 IEF patterns are infrequently observed in routine neurology practice. It is important for the diagnostic laboratory professional as well as for the neurologist to understand their clinical relevance. Our findings highlight the contribution of quantitative evaluation of CSF (IgG index, Reiber diagram) for the interpretation of such situations. Despite the small size of our study population, our results emphasize the importance of reporting the exact type of IEF pattern and not only the positivity or not of OCB.

Seasonal Testing, Results, and Effect of the Pandemic on Coxsackievirus Serum Studies.

Coxsackieviruses (CVs) are common causes of infections and can be life-threatening. Unfortunately, rigorous studies guiding the clinician in interpreting CV serum antibody titer testing is lacking. To explore the epidemiology of circulating CVs and the serological test utility in aiding diagnosis of CV infections in our community, we obtained results of CV immunologic diagnostic tests between 2018 and 2022 from a regional healthcare database. For CV type A, rare individuals had positive CF (complement fixation) tests whereas all 16 individuals with IFA testing showed at least one positive serotype. For CV type B CF testing, 52.2% of 222 patients had at least one serotype positive, with B5 being most common and also the most common with higher titers (14.8% with ≥1:32). We found a significant reduction in seropositivity rate during the pandemic in 2020 compared to 2018, which continued through 2022 (OR: 0.2, 95% CI: 0.08-0.49, p-value < 0.001). During the pandemic, the seasonal pattern of positive tests varied from the pre-pandemic pattern. Testing for CVs was increased after the first year of the pandemic. Overall, the variability by month and seasonal change in our data support that CF testing can be used to identify recent CVB infection.

THE PATTERN OF SILVER-RUSSELL SYNDROME: OWN OBSERVATION

Silver-Russell syndrome (SRS) –is an orphan disease characterized by intrauterine and postnatal growth retardation. Children have special phenotypes, difficulties in feeding, the threat of insulin resistance, hypoglycemia, and accelerated sexual development. Aim: Increasing the effectiveness of SRS diagnosis based on the study of the features of the clinical and genetic course. Material and Methods: Clinical examination, blood tests, biochemistry, genetic tests, polymer chain reactions, and ultrasound examination have been carried out. Results: The child, 5 years old, was born from 2nd full-term pregnancy at 37 weeks, 2nd cesarean delivery with a body weight of 1900 g, height of 46 cm, head circumference of 30 cm, and chest circumference of 27 cm. Apgar scored 6/7 points. Neonatal adaptation disorders, intrauterine development, symmetrical shape, risk of hemolytic disease of the newborn according to the Rhesus factor (total bilirubin 190.0 μmol/l). The child had a special phenotype: asymmetry of the body with a relative increase in head circumference, a small triangular face with a protruding forehead, a narrow chin, a small jaw, and curvature of the 5th finger. From birth, insufficient body weight gain was observed (60 g per week, 400 g from birth in 6 weeks), which was explained by physiological vomiting and lactase deficiency (homozygous carrier of genotype C/C during PCR analysis). Body weight at the age of 1 year 5.200 g, height 63 cm, at the age of 5 years body weight 10.2 kg, height 91 cm. The child had heightened intellectual and psychological development. For the sake of differential diagnosis, a study was conducted for the presence of Gaucher’s disease (the result was negative). The results of immunologic tests: IgA 0.77 g/l, tTgIgA&lt; 2.0 units/ml, and tTgIgG 0.05 denied the presence of celiac disease. Clinical diagnosis was established according to the Netchine-Harbison scoring system (NH-CSS), which consists of 6 clinical criteria of NH-CSS. Gene sequencing revealed changes in the variant of uncertain significance SLK25A15, the genetic significance of which is unknown, which did not allow to confirm the diagnosis. Invitae Chromoso-mal Microarray Analysis of genome research on microdeletions (duplications) revealed, with a normal female genomic profile, uniparental dysfunction with two areas of homozygosity ROH&gt;5Mb (GRCh370) in chromosome 20: 20q13-p12.3(1-6690101; 6.69Mb and 20q13.32- q13.33(57394420- 63025520); 5.63 Mb. This change is characterized as a SRS variant, which created the basis for the diagnosis. Therefore, the child has a genetically confirmed diagnosis of SRS and congenital lactose intolerance. Somatotropic hormone (Omnitrop) was prescribed at a dose of 0.6 mg/day continuously. Conclusions: 1. The child’s SRS diagnosis was established on the basis of phenotype data, slow weight gain and growth, genetic research data, and the exclusion of the possibility of other conditions with the impaired physical development of the child. 2. The child needs a multidisciplinary approach to observation and treatment by a pediatrician or family doctor, endocrinologist, geneticist, nutritionist, surgeon, and gynecologist.

ТУБЕРКУЛЕЗ ОРГАНОВ ДЫХАНИЯ У ПОДРОСТКОВ ПОД «МАСКОЙ» ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ: КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

Absence of pathognomonic signs of tuberculosis (TB) of the respiratory system and the diversity of its clinical manifestations reduce the alertness of primary health care (PHC) physicians to this problem, which in its turn leads to belated TB diagnosis. Most often initial diagnosis is “community-acquired pneumonia” at the onset of the disease. An algorithm for interdisciplinary interaction between pediatricians and TB specialists in cases of suspected TB of the respiratory system is proposed. The reasons for untimely detection of TB and diagnostic errors in PHC units are presented using the clinical cases. Absence of suspicion of TB in the presence of its predictors (contact with a TB patient, results of skin immunological tests); development of pulmonary disease outside the season of viral infections in patients who are not included in the risk group according to their frequency and in patients from socially problematic living conditions; incorrect interpretation of the clinical and radiological picture and the course of the disease at its onset are the main reasons for late diagnosis. Conclusion: identifying TB in children and adolescents when seeking medical help is the final part of the diagnostic journey of patients, since opportunities to diagnose the disease at earlier stages of its development were missed. The results of the presented observations indicate the need for interdisciplinary interaction between pediatric physicians and TB specialists for timely diagnosis of TB.

E53 Anti-OJ synthetase syndrome: a pediatric case report

Abstract Introduction The antisynthetase syndrome (ASS) is a connectivity with variable clinical expression. It is defined by the presence of anti-tRNA synthetase autoantibodies, associated with a clinical phenotype. It is an overlapping myositis associated with the presence of idiopathic inflammatory myopathy autoantibodies. Observation We report the case of an 11-year-old girl with no particular family history. The patient was diagnosed and treated as rheumatic fever 3 years ago and put on extencillin due to arthralgias of large right knee and hip joints with positive antistreptolysin O antibodies and history of repeated angina but without clinical improvement. The polyarthralgias progressed and became bilateral predominantly in the scapular and pelvic girdles associated with intense myalgias of three days before his admission leading to a motor deficit. A biological assessment was requested: creatine phosphokinase (CPK) = 1880UI/l; ASAT = 58UI/l; procalcitonin = 0.15; erythrocytesedimentation rate (ESR) was elevated. The immunological workup showed antibodies specific for myositis; antiRNA synthetase type OJ Positive. Results of immunological tests for other associated autoimmune diseases were (rheumatoid factor, anti-CyclicCitrullinated Peptide antibodies, anti SM and anti-Native DNA) negative. Electromyography showed no abnormalities. A muscle biopsy was not done. Chest CT scan showed no abnormalities. The patient was commenced on corticosteroid therapy at a dose of 1 mg/kg/day for 4–6 weeks then progressive weaning. Conclusion ASS is a complex and heterogeneous autoimmune connective disease. In the presence of extra-pulmonary signs and the positivity of the anti-tRNA synthetase antibody, the diagnosis is confirmed. The management often requires multidisciplinary approach.

Clinical case of tuberculous otitis media in an adolescent with generalised tuberculosis

Since the incidence of tuberculosis (TB) of the middle ear is low, alertness to this condition among physicians is decreased. The absence of specific clinical signs of the disease results in the late diagnosis of tuberculous otitis media, the development of irreversible changes and extracranial or intracranial complications, which leads to patients' disabilities. The clinical example has demonstrated the development of tuberculous otitis media in the patient with chronic nonspecific inflammation in the middle ear and infiltrative pulmonary TB. The absence of pathognomonic signs led to the late diagnosis of tuberculous otitis media and, consequently, the development of bilateral mesotympanitis. Tuberculous etiology of the disease was suspected based on the case history analysis (drug-refractory chronic otitis media and exposure to TB), clinical and laboratory data (the absence of expressed pain syndrome and normal hemogram values along with expressed changes in the middle ear), active long-lasting pulmonary TB, positive immunological skin test results. The diagnosis was verified by microbiological detection of M. tuberculosis in the ear discharge. Complex treatment of the patient resulted in clinical cure of tuberculous otitis media after 18 months; infiltrative TB led to the development of a tuberculoma after 8 months. The late diagnosis of the disease resulted in surgical treatment (bilateral tympanoplasty, resection of two segments of the left lung).

Study about the association between toxoplasma and breast cancer in Najaf During 2020

This study was begin from January to December 2020 , to learn where there breast cancer and toxoplasma infection are related By used immunology test results . 2020, to know the association between Toxoplasma infection and breast cancer .by examine immunological test.32 women who had tumors were the subjects of a study conducted at the Al-Sadder Teaching Hospital in Al-Najaf Al-Ashraf , with breast tumor symptom . the mean age of women from 35-45 years ago . X-ray was done at first and sonar to detected the site of tumor and size . Biopsy was taken and sent to the Al- kafeel histopathological laboratory for making block and stain with hemaxlin and eoxin typical Histological change and ductal cancer show with irregular shape of duct mammary gland ,by use H &amp; E method , serological was applied for toxoplasma appear in Five women is positive test for Toxoplasma AB by used special kit . the rest women consider control group . this study was find significant Toxoplasma associated with breast cancer , the case record at first time in Al-Najaf government.

National experience with adenosine deaminase deficiency related SCID in Polish children.

Deficiency of adenosine deaminase (ADA) manifests as severe combined immunodeficiency (SCID), caused by accumulation of toxic purine degradation by-products. Untreated patients develop immune and non-immune symptoms with fatal clinical course. According to ESID and EBMT recommendations enzyme replacement therapy (ERT) should be implemented as soon as possible to stabilize the patient's general condition, normalize transaminases, treat pulmonary proteinosis, bone dysplasia, and protect from neurological damage. Hematopoietic stem cell transplantation (HSCT) from a matched related donor (MRD) is a treatment of choice. In absence of such donor, gene therapy (GT) should be considered. HSCT from a matched unrelated donor (MUD) and haploidentical hematopoietic stem cell transplantation (hHSCT) are associated with worse prognosis. We retrospectively evaluated the clinical course and results of biochemical, immunological and genetic tests of 7 patients diagnosed in Poland with ADA deficiency since 2010 to 2022. All patients demonstrated lymphopenia affecting of T, B and NK cells. Diagnosis was made on the basis of ADA activity in red blood cells and/or genetic testing. Patients manifested with various non-immunological symptoms including: lung proteinosis, skeletal dysplasia, liver dysfunction, atypical hemolytic-uremic syndrome, and psychomotor development disorders. Five patients underwent successful HSCT: 3 patients from matched unrelated donor, 2 from matched sibling donor, and 1 haploidentical from a parental donor. In 4 patients HSCT was preceded by enzyme therapy (lasting from 2 to 5 months). One patient with multiple organ failure died shortly after admission, before the diagnosis was confirmed. None of the patients had undergone gene therapy. It is important to diagnose ADA SCID as early as possible, before irreversible multi-organ failure occurs. In Poland HSCT are performed according to international immunological societies recommendations, while ERT and GT are less accessible. Implementation of Newborn Screening (NBS) for SCID in Poland could enable recognition of SCID, including ADA-SCID.

ИЗУЧЕНИЕ ЦИТОКИНОВОГО ПРОФИЛЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК 5-Й СТАДИИ И ТУБЕРКУЛЕЗОМ

In the recent years detection and diagnosis of TB has widely involved such immunological tests as the recombinant tuberculosis allergen (RTA) skin test (Diaskintest®) and interferon gamma release assay (IGRA) tests. However, numerous defects of cellular and humoral immunity in patients with stage 5 chronic kidney disease (CKD) lower sensitivity of the above tests for TB detection (42% and 47% respectively). The altered immune response in stage 5 CKD patients dictates the need for search for other biomarkers of TB infection for this specific category of patients. The review analyzes literature data for the recent 30 years related to scientific research into cytokine profiling in stage 5 CKD patients with TB infection as a specific comorbid group. We have compared data on immunological studies of TB patients without uremia, including quantitative evaluation of innate immunity cytokines (some interleukins, tumor necrosis factor α) and enzyme immunoassay, analysis of cytokine gene expression using real-time polymerase chain reaction. The data on immune defects in CKD patients on renal replacement therapy (hemodialysis) are represented. The data on elevated concentrations of inflammation markers in dialysis patients and the information about the correlation between dialysis duration and cytokine concentrations are provided. False negative results of immunological tests for TB in CKD patients are partially explained. The current tendencies in search for TB infection biomarkers in CKD patients, including those on renal replacement therapy, are shown, as well asthe tendencies in search for TB activity markers and responses to TB treatment. Despite the controversial data, we believe that our study of immune responses of stage 5 CKD patients can provide the basis for the development of new tools for detection and diagnosis of TB infection in this immunocompromised group. The study of cytokine production in stage 5 CKD patients provides opportunities for the development of new diagnostic tests and/or markers of TB infection activity in this specific group of patients.

PREVALENCE OF LATENT TUBERCULOSIS INFECTION AMONG MEDICAL WORKERS

The analysis of the results of immunological tests (skin test with tuberculosis recombinant allergen in standard dilution, hereinafter referred to as the test with ATP) and laboratory immunological test IGRA, delivered in 2019-2022 to employees of medical organizations of the Moscow Department of Health, working in four administrative districts of Moscow (Central, Western, South-Western, Troitsk and Novomoskovsk, next – CAD, WAD, SWAD/T&amp;NAD). Among the average annual number of employees over 5 years – 43,452 people, with medical examination and exclusion of tuberculosis, the prevalence of persons with latent tuberculosis infection (LTI) was 2.6, 6.1 and 1.8%, in the CAD, WAD and SWAD/T&amp;NAD, respectively, or 3.4% in general to these districts. At the same time, the average annual frequency of detection of cases of LTI («first detected LTI») was 0.6, 1.3 and 0.6% in these districts, respectively, and 0.75% in all districts as a whole. 95.4% of the employees were assigned a course of preventive therapy (PT), 45.8% of which the course was started. Among the latter, 85.0% successfully completed the course, 14.1% – the course was interrupted by the patient, and 0.9% – canceled by the doctor due to adverse events. The main PT regimen used (78.4%) included 3 months of taking a combination of isoniazid and pyrazinamide (INN: isoniazid 150 mg + pyrazinamide 500 mg), which showed a low proportion of adverse events – 3.1%. The identification of workers of medical organizations of LTI allows to determine a group high risk for tuberculosis and to allocate a group of persons for preventive therapy

Human Neurocysticercosis: An Overview.

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that account for the pleomorphism of this disease. Seizures/epilepsy are the most common clinical manifestation, but other patients present with headache, focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of NCC is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. However, neuroimaging studies are fundamental for diagnosis because immunological test and clinical manifestations only provide circumstantial evidence of NCC. The introduction of cysticidal drugs changed the prognosis of most NCC patients. These drugs have been shown to reduce the burden of infection and to improve the clinical course of the disease in many patients. Efforts should be directed to eradicate the disease through the implementation of control programs against all the steps in the life cycle of T. solium, including carriers of the adult tapeworm, infected pigs, and eggs in the environment.

Foot Drop In A Performing Arts Dance Girl

HISTORY: A 12-year-old performing arts dance girl with history of cerebral cavernous malformations (CCM) presents with pain in left leg and suddenly foot drop. She is involved in a strict strength and conditioning program and her mom referred symptoms began two days after a dance session. PHYSICAL EXAMINATION: examination revealed stepagge gait with an ample sustentation base, left ankle with no active range of motion with stiffness at passive range of motion, strength of tibialis anterior muscle 0/5 in Lovett scale, extensor digitorum longus and extensor hallucis longus muscle 3/5 in Lovett scale. Pain with the manipulation of proximal tibiofibular joint, positive Tinel test and muscle atrophy in calf zone, no abnormal reflexes, no overlying erythema or skin changes were noted. Neurodynamic testing for peroneal nerve reproduced tingle and pain. DIFFERENTIAL DIAGNOSIS:1. Vasculitis 2. Peroneal stress fracture 3. L5 radiculopathy TEST AND RESULTS: laboratory and immunological test results were normal. Brain MRI showed the CCM and knee MRI showed increased intensity and thickness of common peroneal nerve and edema of the tibialis anterior, peroneous longus and extensor digitorum longus suggestive of edema. FINAL WORKING DIAGNOSIS: traction peroneal neuropathy TREATMENT AND OUTCOMES: 1. Splint immobilization at night. 2. Physical therapy with progressive neurodynamic peroneal nerve glide exercises and manual therapy in ankle joint.3. Proprioception exercises. 4. Range of motion and ankle strengthening exercises started 2 weeks post injury. 5. Return to sports 4 months post injury with total resolution of symptomatology.

К ВОПРОСУ О ВЫЯВЛЕНИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У ПОДРОСТКОВ ПРИ ПРОВЕДЕНИИ ПЛАНОВОЙ ФЛЮОРОГРАФИИ: ВЗГЛЯД ФТИЗИАТРА

The scheduled, routine fluorography does not allow detecting of the primary small forms of tuberculosis (TB) and the limited prevalence processes without bacterial excretion. The purpose of the study was to evaluate the contribution and the informative content of the scheduled fluorography as a screening method for the early detection of TB in adolescents. Materials and methods: a single-center retrospective cohort study of 142 disease history cases of adolescents admitted for treatment at the Children's and Adolescents Department with the Central Research Institute of Tuberculosis (Moscow, Russia) at the age of 15 to 17 years old, of which 74 (52.1%) were girls, and 68 (47.9%) boys, with respiratory TB. The continuous sample from 2015 to 2020, 34 (24.0%) of which were identified with the scheduled, routine fluorography. The data for inclusion in the study was obtained from medical records submitted upon admission. Results: according to the routine fluorography results, the infiltrative TB of the respiratory organs was diagnosed statistically significantly more often compared to the results of skin immunological tests: in 76.5% and 20.5% of cases, respectively, р˂0.001; the lung tissue decay in 58.8% and 15.4% of cases, respectively, p˂0.001; and the bacterial excretion in 58.8% and 5.1% of cases, respectively, p˂0.001. This indicates a high epidemic risk of patients. Conclusion: the routine fluorography in adolescents does not correspond to the concept of screening for TB infection, the essence of which is the early detection of the disease. From the authors’ point of view, the expediency of fluorography in this age group should be considered primarily as the first - and not the only - stage for diagnostic approach in the acute period of a pulmonary disease.

The Value of Effective Lung Ventilation Area Ratio Based on CT Image Analysis Is a New Index to Predict the Shorter Outcome of Anti-melanoma Differentiation-Associated Protein 5 Positive Dermatomyositis Associated Interstitial Lung Disease: A Single-Center Retrospective Study.

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) positive dermatomyositis (MDA5+DM) patients have poor outcomes due to rapidly progressive interstitial lung disease (ILD). The accurate assessment of lung involvement is an urgent focus of research.Methods: A computer-aided lung interstitial image analysis technology has been developed, and a quantitative indicator named effective lung ventilation area ratio (ELVAR) that calculates the proportion of the area outside the lung interstitium in lung tissue has been established. 55 newly diagnosed MDA5+DM patients and 46 healthy individuals, matched for age and gender, were enrolled in this study. MDA5+DM patients were classified into early death group or early survival group according to their survival state within 3 months after diagnosis. Clinical characteristics, laboratory and immunological test results, lung involvement (including ELVAR value) and treatment were compared between early death group and early survival group to determine an index that can predict prognoses of patients with MDA5+DM.Results: There were significant differences between early death MDA5+DM patients and early survival MDA5+DM patients about 12 indices including age of onset, CRP, ferritin, albumin, and pulmonary involvement including severity of type I respiratory failure at diagnosis, P/F ratio, oxygen supplementation, values of ELVAR, FVC, and DLCO. The results of ROC analysis and correlation analysis showed the value of ELVAR had good diagnostic value and widely correlation with many clinical characteristics. Univariate analysis and Multivariate analysis showed four factors including age of onset, ferritin, value of ELVAR, and oxygen supplementation >4 L/min significantly value for poor prognosis in MDA5+DM patients. A cutoff value of 0.835 about ELVAR had good predictive power for mortality within 3 months in 54.2% of MDA5+DM patients.Conclusion: The value of ELVAR derived from computed tomography image analysis is a new index that can predict poor outcomes in MDA5+DM patients with rapidly progressive interstitial lung disease.

Investigation of primary immune deficiency after severe bacterial infection in children: A population-based study in western France

BackgroundInfectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitted to a pediatric intensive care unit. We also assessed the frequency and described the typology of diagnosed primary immune deficiency (PID). MethodsWe conducted a retrospective observational epidemiological study in six university hospitals in western France. All children from 1 month to 16 years of age admitted to hospital for bacterial meningitis, purpura fulminans, or meningococcal disease between August 2009 and January 2014 were included. We analyzed the frequency, type, and results of the immunological tests performed on children with meningitis, purpura fulminans, or a meningococcemia episode. ResultsAmong the 143 children included (144 episodes), 84 (59%) and 60 (41%) had bacterial meningitis and purpura fulminans or meningococcemia, respectively: 72 (50%) had immunological tests and 8% had a complete immunological investigation as recommended. Among the 72 children examined for PID, 11 (15%) had at least one anomaly in the immunological test results. Two children had a diagnosis of PID (one with C2 deficit and the other with C8 deficit) and seven other children had possible PID. Thus, the prevalence of a definite or possible diagnosis of PID was 12% among the children examined. ConclusionPID is rarely investigated after COSBI. We raise awareness of the need for immunological investigations after a severe infection requiring PICU admission.

Features of renal tuberculosis and other extrapulmonary tuberculosis localizations, depending on the presence or absence of the diagnosis confirmation in children

Introduction. A persistent trend towards a decrease in the incidence of extrapulmonary tuberculosis is noted both in the Omsk region and throughout the Russian Federation Purpose of the study. To study anamnestic, epidemiological and clinical features of children diagnosed with renal tuberculosis and other extrapulmonary localizations, established by typical clinical and radiological manifestations or proven bacteriologically or histologically. Materials and methods. A retrospective study data was carried out from 125 children aged 0-14 years in the period 2001-2018 with registered as «extrapulmonary tuberculosis» with or without lung involvement. Group 1 consisted of 50 patients with a typical clinical and radiological picture of tuberculosis, group 2 - 75 cases, with a specific extrapulmonary process, verified bacteriologically and/or using molecular genetic methods or histology. The differences between groups were determined using Pearson's χ2 test. Results. The predominance in the structure of confirmed and established extrapulmonary process of renal tuberculosis was established, and children living in urban areas had better accessibility of diagnostic methods for verifying extrapulmonary tuberculosis (62.7%, p < 0.05). A history of concomitant pathology (94.7%, p < 0.05) and the availability of the lesion for bacteriological or histological examination (urine, pus, punctate) increased the likelihood of diagnosis verification. Most of the considered factors for renal tuberculosis in children did not differ significantly. Hyperergic results (up to 24%, p < 0.05) of immunological tests, the presence of complaints of dysuric disorders (21%, p < 0.05) prevailing in groups of children with an established diagnosis of tuberculosis kidneys, only suggest the presence of MBT-infection and do not prove the specific nature of the disease, while systematic preventive work on the examination of the risk group allows timely diagnosis of the disease at an early stage of the disease (up to 26%, p < 0.05). Conclusion. The widespread improvement of material and technical equipment, the introduction of new diagnostic techniques (PCR of urine) into routine practice, training of medical personnel in assessing prevalence issues and early detection of the disease can improve the quality of verification of this nosology.

Common variable immunodeficiency: different faces of the same disease.

IntroductionCommon variable immunodeficiency (CVID) is one of the primary humoral immunodeficiencies. Despite the inborn nature, the first symptoms may appear in both children and adults. It is characterized by hypogammaglobulinaemia, severe infections, autoimmunity, allergies, and a predisposition to cancer. A delay in diagnosis is a significant problem: the time from the first symptoms of the disease to diagnosis and the implementation of proper treatment is usually very long. The consequence can be irreversible complications, which is why it is so important to promote knowledge on this immunodeficiency.AimTo present the clinical and laboratory manifestation of primary immunodeficiencies such as common variable immunodeficiency.Material and methodsThe study presents the clinical and laboratory phenotype of 14 patients diagnosed with CVID, aged 5 to 58 years. A detailed medical history was taken, and clinical symptoms, immunological test results and complications were analysed in each patient. According to the ESID guidelines, in the differential diagnosis process of CVID the secondary hypogammaglobulinaemia was excluded.ResultsThe follow-up period ranged from 39 to 133 months (median: 79 months). The median delay for the entire group was 5 years, which was shorter in children than in adults. In the presented group, the infectious phenotype (pneumonia, sinusitis) was dominant. Autoimmune and allergic diseases, malignant tumours and enteropathies have also been observed.ConclusionsThe diagnostic delay is still too long, especially in adults, which can lead to serious and irreversible complications. Early diagnosis and appropriate treatment with intravenous and subcutaneous immunoglobulins reduces the frequency of infections and their potential complications.