Specific Etiology Research Articles

Incidence, risk factors, and therapeutic management of equine colic in Lamongan, Indonesia.

Colic is among the common health issues in equine health management. Gastrointestinal (GI) disorders are the most frequent causes of colic, but dysfunction of other organs and systems inside the abdominal cavity may also contribute. Therefore, it is crucial to identify risk factors for colic of specific etiologies. This study aimed to examine the incidence, risk factors, and best therapeutic management practices for horses with colic. A cohort of 256 horses living in Lamongan, East Java, Indonesia, was randomly recruited based on reports of colic symptoms by owners. Diagnosis and treatment were then conducted with the help of owners. Symptom profiles, risk factors, and therapeutic management strategies were analyzed by Chi-square tests. Of 256 horses enrolled, 217 (84%) were diagnosed with colic, of which 172 (79.3%) were cases of spasmodic colic, 33 (15.2%) of impaction colic, and 12 (5.5%) of intestinal obstruction/displacement. Male sex (χ2 = 16.27; p < 0.001), wheat bran feeding (χ2 = 15.49; p < 0.001), concentrate feed intake >5 kg/day (χ2 = 24.95; p < 0.001), no regular anthelmintic drug treatment (χ2 = 67.24; p < 0.001), GI parasite infection (χ2 = 65.11; p < 0.001), recurrent colic (χ2 = 91.09; p < 0.001), poor body condition score (χ2 = 71.81; p < 0.001), limited daily water access (χ2 = 127.92; p < 0.001), and indications of dental disease (χ2 = 9.03; p < 0.001) were identified as risk factors. The most effective therapies were gastric intubation (χ2 = 153.54; p < 0.001), Vitamin B complex injection (χ2 = 32.09; p < 0.001), fluid therapy (χ2 = 42.59; p < 0.001), and non-steroidal anti-inflammatory drug injection (NSAID). Colic is highly prevalent among horses in Lamongan, East Java, Indonesia. Proper diet, workload management, regular access to clean drinking water, and dental care can reduce colic risk. Recommended therapies include NSAID injection without other analgesics or spasmolytics, fluid therapy, Vitamin B complex, and gastric intubation.

Circulatory shock in adults in emergency department.

Circulatory shock is a common condition that carries high morbidity and mortality. This review aims to update the critical steps in managing common types of shock in adult patients admitted to medical emergency and intensive care units. A literature review was performed by searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: ("shock" OR "circulatory shock" OR "septic shock" OR "cardiogenic shock") AND ("management" OR "treatment" OR "resuscitation"). The review emphasizes prompt shock identification with tissue hypoperfusion, knowledge of the underlying pathophysiological mechanism, initial fluid resuscitation with balanced crystalloids, norepinephrine as the preferred vasopressor in septic and profound cardiogenic shock, and tailored intervention addressing specific etiologies. Point-of-care ultrasound may help evaluate an undifferentiated shock and determine fluid responsiveness. The approach to septic shock is improving; however, confirmatory studies are required for many existing (e.g., amount of initial fluids and steroids) and emerging (e.g., angiotensin II) therapies. Knowledge gaps and wide variations persist in managing cardiogenic shock that needs urgent addressing to improve outcomes.

Gut Microbiota and Critical Metabolites: Potential Target in Preventing Gestational Diabetes Mellitus?

Gestational diabetes mellitus (GDM) is an intractable issue that negatively impacts the quality of pregnancy. The incidence of GDM is on the rise, becoming a major health burden for both mothers and children. However, the specific etiology and pathophysiology of GDM remain unknown. Recently, the importance of gut microbiota and related metabolic molecules has gained prominence. Studies have indicated that women with GDM have significantly distinct gut microbiota and gut metabolites than healthy pregnant women. Given that the metabolic pathways of gut flora and related metabolites have a substantial impact on inflammation, insulin signaling, glucose, and lipid metabolism, and so on, gut microbiota or its metabolites, such as short-chain fatty acids, may play a significant role in both pathogenesis and progression of GDM. Whereas the role of intestinal flora during pregnancy is still in its infancy, this review aims to summarize the effects and mechanisms of gut microbiota and related metabolic molecules involved in GDM, thus providing potential intervention targets.

Determination of aspergillosis of the female genital organs in women with immunodeficiency

Background. Morphological diagnosis of aspergillosis sometimes poses great difficulties due to the fact that molds of the genus Aspergillus are very sensitive to the use of antimicrobial therapy and change under its influence. In this regard, we provide information about aspergillosis of the female genital organs, discovered accidentally during an autopsy. The purpose of the study is to conduct a complex pathomorphological analysis of biopsy, operative and sectional gynecological material of women with secondary immunodeficiency conditions, for early diagnosis of aspergillosis (which is the key to a favorable outcome of the disease), differential diagnosis and detection of invasive forms of aspergillosis. Materials &amp; Methods. We analyzed the autopsies of 4,796 women who died in Odesa region from 2009 to 2022. Autopsies revealed 7 cases of aspergillosis with damage to the female reproductive system. All of them were found in women who had confirmed HIV infection. In 5 cases, women additionally suffered from chronic alcoholism. Results. Based on the results of these cases, it can be stated that the detection of characteristic mycelium in the preparations is a reliable sign of aspergillosis, but their absence does not deny this disease. Aspergillus hyphae change as the process develops: they can be weakly stained, and with dystrophic phenomena and the presence of necrotic fragments of mycelium, it can be almost colorless when using hematoxylin and eosin. While necrosis, tissue detritus is observed in the center of the granuloma, fibrous structures, fungal hyphae are formed perifocally. To confirm the diagnosis, it is important to detect granulomatous productive inflammation, conidial heads, inflammatory infiltration, microabscesses, foci of calcifications. However, against the background of immunodeficiency, it is not always possible to see the "classic morphological picture" of aspergillosis. In addition, detection of characteristic mycelium is possible only in a proportion of patients. Conclusions. When examining the autopsy material of deceased women with immunodeficiency states, attention should be paid to the specific etiology of inflammatory processes of the reproductive system and the nature of the inflammatory process, the presence of Aspergillus hyphae and mycelia. The presence of morphological changes characteristic of aspergillosis allows to conduct a diagnostic search in the right direction. Detection of an invasive form of aspergillosis may indicate the presence of an immunodeficient state. Keywords: aspergillosis, female reproductive system, immunodeficiency state, HIV infection, uterus, mammary gland, drug addiction.

The trends in death of primary liver cancer caused by specific etiologies worldwide: results from the Global Burden of Disease Study 2019 and implications for liver cancer management

BackgroundOver past decades, epidemiological patterns of liver cancer (LC) have changed dramatically. The Global Burden of Disease (GBD) study provides an opportunity for tracking the progress in cancer control with its annual updated reports at national, regional and global level, which can facilitate the health decision-making and the allocation of health resources. Therefore, we aim to estimate the global, regional and national trends of death caused by liver cancer due to specific etiologies and attributable risks from 1990 to 2019.Materials and methodsData was collected from the GBD study 2019. Estimated annual percentage changes (EAPC) were used to quantify the trends of age-standardized death rate (ASDR). We applied a linear regression for the calculation of estimated annual percentage change in ASDR.ResultsFrom 1990 to 2019, the ASDR of liver cancer decreased globally (EAPC = − 2.23, 95% confidence interval [CI]: − 2.61 to − 1.84). Meanwhile, declining trends were observed in both sexes, socio-demographic index (SDI) areas, and geographies, particularly East Asia (EAPC = − 4.98, 95% CI: − 5.73 to − 4.22). The ASDR for each of the four major etiologies fell globally, while liver cancer caused by hepatitis B had the largest drop (EPAC = − 3.46, 95% CI: − 4.01 to − 2.89). China has had dramatic decreases in death rates on a national scale, particularly when it comes to the hepatitis B etiology (EAPC = − 5.17, 95% CI: − 5.96 to − 4.37). However, certain nations, such as Armenia and Uzbekistan, saw a rise in liver cancer mortality. Controlling smoking, alcohol, and drug use contributed to a drop in LC-related mortality in the majority of socio-demographic index areas. Nevertheless, the excessive body mass index (BMI) was portrayed as the underlying cause for LC fatalities.ConclusionFrom 1990 to 2019, there was a worldwide decrease in deaths caused by liver cancer and its underlying causes. However, rising tendencies have been observed in low-resource regions and countries. The trends in drug use- and high BMI-related death from liver cancer and its underlying etiologies were concerning. The findings indicated that efforts should be increased to prevent liver cancer deaths through improved etiology control and risk management.

Aetiology and outcome in hospitalized cardiac arrest patients.

To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival. Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13). In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

Efficacy of perampanel in pediatric epilepsy with known and presumed genetic etiology.

The efficacy of perampanel (PER) in pediatric epilepsy with specific etiologies has not been well established. Here, we investigated outcome and predictors of PER treatment in a pediatric cohort with known and presumed genetic etiology. We included pediatric patients with potential genetic epilepsy who received PER treatment and underwent whole-exome sequencing (WES) from January 2020 to September 2021. All patients were followed up for >12 months. A total of 124 patients were included. Overall response rates were 51.6% and 49.6% at 6 months and 12 months, respectively. Pathogenic or likely pathogenic variants in 27 multiple genes were detected among 58 patients (46.8%) by WES. On performing multivariate logistic regression analysis, only developmental delay (OR = 0.406, P = 0.042) was a negative predictor of treatment response. However, the seizure onset age, positive WES results, and number of ASMs before PER administration were not significantly. Thirteen carriers with variants in the SCN1A gene showed a better response compared to eight patients with other sodium channels (P = 0.007), and to the other 45 patients with positive WES results (OR = 7.124, 95% CI = 1.306-38.860, P = 0.023). Adverse events were only reported in 23 patients, the most common being emotional problems. PER is safe and efficacious in pediatric patients with known and presumed genetic etiology. The response rate is comparable to that reported in other pediatric populations, and lower among those with developmental delay. A gene-specific response to PER is found along with better efficacy links to pathogenic variants in the SCN1A gene.

#4918 IS THE KIDNEY FAILURE RISK EQUATION VALID IN PREDICTING END STAGE KIDNEY DISEASE IN ADULTS WITH GLOMERULOPATHIES?

Abstract Background and Aims The Kidney Failure Risk Equation (KFRE) is a clinical tool that predicts the 2- and 5- year risk of progression to end stage kidney disease (ESKD) in patients with chronic kidney disease (CKD) stages 3a-5. The equation's accuracy and its predictive performance in subjects with glomerulopathies were not properly evaluated and validated. The current study examined the 4 variable KFRE in subjects with advanced CKD from glomerulopathy etiologies by evaluating discrimination and calibration at 2 and 5 years. Method This retrospective, single-center, cohort study included 558 subjects who were diagnosed by kidney biopsy with primary or secondary glomerulopathies between 1st January 2008 and 31st December 2016 and followed until 31st December 2021 for a mean follow-up time of 85.3 (95%CI 78.9 to 91.8) months. Patients with inadequate biopsy samples, histological findings other than glomerulopathy, those with missing data, and those with eGFR &amp;gt; 60 ml/min/1.73 m2 were excluded. The 4-variable KFRE using eGFR, urinary albumin to creatinine ratio (uACR), age, and sex was calculated using the data from the first visit. The primary outcome of the study was the need for renal replacement therapy (RRT) initiation (dialysis or kidney transplant). The area under the receiver operator characteristic curve (AUC) and calibration plots were used to measure discrimination and calibration of the KFRE in specific glomerulopathy etiologies: IgA nephropathy, diabetic nephropathy, amyloidosis, endocapillary and crescentic glomerulonephritis, lupus nephritis, minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis. Results In this cohort, most of the patients were males (57.7%) and the median age was 53 (95%CI 53 to 57) years. The median eGFR was 30,5 (95%CI 28 to 32,6) ml/min/ 1.73 m2 and the median uACR 1932 (95% CI 1633 to 2200) mg/g. The most common glomerulopathies were IgA nephropathy (21.3%), diabetic nephropathy (13.4%), and membrano-proliferative glomerulonephritis (9.5%). The median 2-year and 5-year KFRE score was 2.2 (95%CI 1.8 to 2.7) % and 18.9 (95%CI 17.8 to 19.7) % respectively. During the first 2 years of follow-up 154 (27.5%) subjects needed RRT and 93 (16.6%) subjects died, while 218 (39%) started RRT and 108 (19.3%) died within 5 years from the kidney biopsy. The 4-variable KFRE provided good discrimination in the whole cohort with an AUC of 0.728 (95% CI 0.686-0.770) for predicting ESRD at 2-years and 0.725 (95% CI 0.686-0.767) at 5 years (Figure 1A). There was also a good to excellent discrimination of 2-years and 5-years KFRE across all glomerulopathy etiologies, with statistically significant p-values (p&amp;lt;0.05), with the exception of diabetic nephropathy and endocapillary GN which had a non-significant AUC (Figure 2). Calibration plots were adequate both overall and across glomerulopathy etiologies; however, the predicted risks for kidney failure were overestimated across CKD etiologies, especially in those with low to moderate risk in the 2-years model. Notably the calibration plot for the 5-years KFRE showed that the predicted risk was near the observed risk across all glomerulopathies (Figure 1B). Conclusion The 4 variable-KFRE seems to be a good predictive tool in patients with glomerulopathies both for 2 and 5-years, except for diabetic nephropathy and endocapillary glomerulonephritis.

The Keller Funnel, Capsular Contracture, and Conflict of Interest: A Review.

The Keller funnel (Allergan; AbbVie Inc, North Chicago, IL) is commonly used to insert breast implants as part of a "no touch" protocol. Many plastic surgeons believe that this device reduces the risk of capsular contracture. This review was undertaken to evaluate the evidence regarding any reduction in capsular contracture rate, other possible benefits, safety and to investigate financial conflict of interest. A PubMed electronic literature search was conducted to identify studies comparing capsular contracture rates with and without the Keller funnel. The Open Payments database was accessed for information regarding corporate payments to plastic surgeons. Two retrospective historical case-control studies, published in 2016 and 2018, were identified. Both studies had important confounders, including implant type and placement, which are known to affect capsular contracture rates. Major financial conflicts of interest were present. Most authors did not disclose these conflicts, which totaled more than $1 million and were usually categorized as gifts from Allergan, which purchased the Keller funnel in 2017. Financial conflict of interest, along with publication bias, creates a bias toward publication of positive findings. No reliable evidence supports a "no touch" technique, which is a misnomer because manual handling of implants is unavoidable, even when using a funnel. Recent microbiological studies do not support a specific bacterial etiology for capsular contracture. No evidence supports contamination by the surgeon touching the implant. Among other proposed benefits, such as reduced operating time, less contamination, a shorter incision, and less implant trauma, only a slightly shorter incision (1 cm) is supported by the evidence. The cost is $150 per funnel. No reliable evidence supports the use of a Keller funnel to reduce the risk of capsular contracture. Both supportive studies contain confounding variables, limited follow-up time, and no plausible scientific basis for efficacy. Institutional review board approval of studies on human subjects is not optional. Financial conflicts of interest are extraordinary in their magnitude and potential for creating undue influence. Greater transparency and honest disclosures are needed.

PEDS9: Bleeding in Pediatric Patients on Extracorporeal Membrane Oxygenation-Use of Procoagulant Factors

Background: Bleeding complications remain common in extracorporeal membrane oxygenation (ECMO) and can be associated with adverse outcomes. Effect of excessive shear stress on vasculature may increase bleeding risk associated with preferential loss of high molecular weight von Willebrand factor (high molecular weight (vWF) multimers; acquired vW syndrome, AVWS) and may also be associated with platelet dysfunction. Some pediatric patients may have a pre-existing increased risk of shear-related abnormalities which may further increase bleeding risk on ECMO. We aimed to review bleeding events requiring intervention in a pediatric ECMO cohort. Methods: Retrospective review of pediatric ECMO patients who underwent treatment of bleeding beyond simple transfusion in conjunction with ECMO anticoagulation consultation (EAC) between June 2020 and December 2022 was conducted. Results: Fifty patients required ECMO for 53 runs (52 VA, 2 VV, 1 VAV). Median weight was 4.3 kg (2.4-131 kg). Mean duration of ECMO was 11 days (2-97). 60% (30/50) of patients had congenital heart disease (CHD), and within these 30 patients, 27% of them had bleeding requiring procedural intervention. Ten patients with bleeding were screened for AVWS guided by EAC with 100% meeting criteria for AVWS. Platelet transfusions were administered as first line bleeding therapy with thrombocytopenia or platelet dysfunction and plasma or prothrombin complex concentrate (PCCC) in volume-sensitive patients for coagulopathy. With ongoing bleeding despite transfusion, antihemophilic factor/vWF complex (Humate P) was administered to 4 patients guided by EAC (figure 1). Of these 4 patients, 75% had CHD and 100% had valve abnormalities with 50% having new mechanical valves placed within 1 month prior to ECMO. Initial Humate P dose was given on mean day 14, with mean number of 8 doses. No circuit or mechanical valve thrombosis occurred. Platelet counts and function improved with a decrease in platelet transfusions and clinical bleeding in all patients following Humate P. Conclusion: Bleeding remains a common complication but is often multifactorial and may be difficult to determine specific etiologies. AVWS and thrombocytopenia commonly occur during pediatric ECMO. However, not all patients have clinical bleeding, such that additional risk factors may contribute to increased bleeding risk in these patients. Given impact of recurrent transfusions due to bleeding on morbidity and mortality, as well as cost consideration and potential thrombosis risk of vWF or PCCC supplementation, development of an expert-guided (EAC) algorithm for screening and treatment criteria for such agents appears to be safe, cost-effective and may be associated with decreased bleeding and transfusions. Further research into etiologies and consequences of ECMO-induced bleeding as well as treatment is needed.Figure 1. Algorithm for Assessment of Persistent Bleeding and Consideration of Humate P Administration (pilot).

Анализ современного состояния проблемы фузариоза колоса и зерна пшеницы в Российской Федерации

Abstract. The aim of the article was to study and summarize the information about modern aspects of fusarium ear and grain of wheat, strategically important crop in the Russian Federation. Scientific novelty. As a result of analysis of scientific literature data on fusarial ear blight, the following main factors (features) were identify that develop ideas about this branch of knowledge: the biology of pathogens, their ecological plasticity; the difficulty of visual identification of phytopathogenic micromycetes of the Fusarium genus; specific etiology and harmfulness of the disease; insufficient effectiveness of measures to protect crop. Methods. In the process of research, by using analytical and statistical methods, the collection, analysis and generalization of information on biological properties, intrapopulation variability, the ability to produce mycotoxins dangerous for humans and animals, and other properties of phytopathogens of the Fusarium genus were carried out. Results. The information about significant factors causing the spoiling of an agricultural crop was systematized, and the urgency of the problem of fusarium ear and grain of wheat in the Russian Federation was shown. From the analysis of the data obtained, it follows that to control the destructive disease of wheat, it is necessary to study in depth the characteristics of the pathogen, and carry out a set of protective measures with timely identification of the phytopathogen. The presence of unresolved issues causes the continuation of research on the development of genetic methods of fusarium pathogen indication, assessment of the species composition of fungi and methods of forecasting their epiphytotic distribution; fungicide preparations using modern achievements of biotechnology, including nanotechnology and chemical synthesis; instrumental base for monitoring wheat crops for seeding with fusarium pathogens.

Revised algorithmic approach to differentiate between non-specific and specific etiologies of chronic terminal Ileitis.

/Aims-Chronic isolated terminal ileitis(TI) may be seen in Crohn's disease(CD) and Intestinal tuberculosis(ITB) in addition to other etiologies that may be managed symptomatically. We developed a revised algorithm to distinguish patients with a specific etiology from a non specific etiology. Patients with chronic isolated TI following-up from 2007 to 2022 were retrospectively reviewed. A specific(ITB or CD) diagnosis was made based on standardized criteria and other relevant data was collected. Using this cohort, validation of a previously suggested algorithm was conducted. Further, based on the results of a univariate analysis, a multivariate analysis with bootstrap validation was used to develop a revised algorithm. We included 153 patients(mean age-36.9+14.6 years, males-70%, median duration-1.5 years, range:0-56 years) with chronic isolated TI of whom 109(71.2%) received a specific diagnosis(CD-69, ITB-40). On multivariate regression and validation statistics with a combination of clinical, laboratory, radiological and colonoscopic findings, an optimism corrected c-statistic of 0.975 and 0.958 was obtained with and without histopathological findings respectively. Revised algorithm, based on these, showed a sensitivity, specificity, positive and negative predictive value, and overall accuracy of 98.2%(95%CI:93.5 - 99.8), 75.0%(95%CI:59.7 - 86.8), 90.7%(95%CI:85.4 - 94.2), 94.3%(95%CI:80.5 - 98.5) and 91.5%(95%CI:85.9 - 95.4), respectively. This was more sensitive and specific than the previous algorithm(accuracy 83.9%, sensitivity 95.5%, and specificity 54.6%). We developed a revised algorithm and a multi-modality approach to stratify patients with chronic isolated TI into specific and non-specific etiologies with an excellent diagnostic accuracy which could potentially avoid missed diagnosis and unnecessary side effects of treatment.

P370 INCIDENCE AND MAIN CLINICAL CHARACTERISTICS OF MYOCARDITIS IN PIACENZA PROVINCE IN THE LAST FIVE YEARS

Abstract Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of etiologies, myocardial involvement and clinical presentations ranging from chest pain to extreme conditions such as cardiogenic shock or death. The variability in presentation reflects the variability in histological disease severity, etiology, and disease stage at presentation. The diagnosis may be suspected by clinical and noninvasive features and is confirmed by endomyocardial biopsy by established histologic, immunologic, and immunohistochemical criteria. CMR imaging is a valid diagnostic support which can detect important myocarditis features from evidence of inflammatory hyperemia and edema to myocardial scar. Due to its clinical presentation and the absence of a safe sensitive non–invasive diagnostic tool, the frequency of this condition and its specific etiology is often difficult to identify, and because of this, the cause is frequently unknown. Anyway among the infectious etiologies, viruses are the presumed to be the most frequent pathogens. We analyzed the main clinical features of patients who were hospitalized for myocarditis in our province in the past five years. Since 2018, 53 patients received a diagnosis of myocarditis. Mean age was 38, 40 (75%) of them were males. The vast majority of patients underwent CMR as a part of diagnostic work–up and we found lateral wall as the most frequently involved. Almost half of the patients showed oedema as a sign of acute inflammation and 35% had more than one segment affected. Mean ejection fraction was 60%. 22 of them were discharged as having as “idiopathic”, 18 had a viral cause (of which 2 were clearly COVID–related) with gastroenteritis being the most common clinical presentation. Of note, only one case was associated with COVID–19 vaccination. Figure 1 shows different distribution of the cases per year. Of note, we did not observe an increased incidence in the last 3 years and mean age was similar in the years analysed possibly reflecting a limited effect of COVID and COVID–vaccination related incidence in our population.

Identifying specific myelopathy etiologies in the evaluation of suspected myelitis: A retrospective analysis

BackgroundMyelopathies require prompt etiologic diagnosis. We aimed to identify a specific myelopathy diagnosis in cases of suspected myelitis to highlight clinicoradiologic differences. MethodsIn this retrospective, single-centre cohort of subjects with suspected myelitis referred to London Multiple Sclerosis (MS) Clinic between 2006 and 2021, we identified those with MS and reviewed the remaining charts for etiologic diagnosis based on clinical, serologic, and imaging details. ResultsOf 333 included subjects, 318/333 (95.5%) received an etiologic diagnosis. Most (274/333, 82%) had MS or clinically isolated syndrome. Spinal cord infarction (n = 10) was the commonest non-inflammatory myelitis mimic characterized by hyperacute decline (n = 10/10, 100%), antecedent claudication (n = 2/10, 20%), axial owl/snake eye (n = 7/9, 77%) and sagittal pencillike (n = 8/9, 89%) MRI patterns, vertebral artery occlusion/stenosis (n = 4/10, 40%), and concurrent acute cerebral infarct (n = 3/9, 33%). Longitudinal lesions were frequent in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) (n = 7/7, 100%) and myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD) (n = 6/7, 86%), accompanied by bright spotty (n = 5/7, 71%) and central-grey-restricted (n = 4/7, 57%) T2-lesions on axial sequences, respectively. Leptomeningeal (n = 4/4, 100%), dorsal subpial (n = 4/4, 100%) enhancement, and positive body PET/CT (n = 4/4, 100%) aided the diagnosis of sarcoidosis. Spondylotic myelopathies had chronic sensorimotor presentations (n = 4/6, 67%) with relative bladder sparing (n = 5/6, 83%), localizable to sites of disc herniation (n = 6/6, 100%). Metabolic myelopathies showed dorsal column or inverted ‘V' sign (n = 2/3, 67%) MRI T2-abnormality with B12 deficiency. ConclusionsAlthough no single feature reliably confirms or refutes a specific myelopathy diagnosis, this study highlights patterns that narrow the differential diagnosis of myelitis and facilitate early recognition of mimics.

Clinical and radiological profile of cavernous sinus syndrome: a study from eastern part of India

BackgroundCavernous sinus syndrome (CSS) consists of a variable combination of involvement of the 3rd-to-6th cranial nerves. The etiologies vary across studies, and it has a significant impact on the outcome. This study was done to delineate the etiology, clinico-radiological profile and outcome of CSS. In this prospective study, patients were recruited consecutively over 2 years, and were followed up for at least 6 months. MRI of the brain and orbit with contrast was done, and other relevant investigations were performed to arrive at a specific etiology. Tolosa-Hunt Syndrome (THS) was defined in accordance with the second edition of the International Classification of Headache Disorders (ICHD-II).ResultsOf the 92 patients studied, THS was the predominant diagnosis, followed by Tuberculosis, fungal infection, aneurysm, neoplastic and Sjögren’s syndrome. Cranial nerves commonly involved were 3rd, 4th, 6th and 5th. The optic nerve was affected in 54.3% of patients. The non-THS patients showed the greater occurrence of proptosis, complete ophthalmoplegia, involvement of optic nerve and cranial nerves 7th–10th. Nasal blockage was present in fungal infection. MRI revealed more frequent involvement of orbit in non-THS cases. Bony erosions, ICA narrowing, intracranial extension and involvement of paranasal sinus were seen in fungal infection and neoplasm. THS patients improved with corticosteroid therapy, although, there was recurrence in 8 patients.ConclusionsTHS and tuberculosis were the most common cause of CSS. Clinical and radiological features were useful in distinguishing among the etiologies. Most of the patients responded to treatment, although, recurrence was seen in THS.

Pulmonary Histopathologic Findings in Pediatric Patients After Hematopoietic Stem Cell Transplantation: An Autopsy Study.

Pathologic characterization of pulmonary complications following hematopoietic stem cell transplantation (HSCT) is limited. We describe lung findings in pediatric patients who died following HSCT and attempt to identify potential clinical associations. Pathology databases at Texas Children's Hospital and the Children's Hospital of Philadelphia were queried (2013-2018 CHOP and 2017-2018 TCH). Electronic medical records and slides were reviewed. Among 29 patients, 19 received HSCT for hematologic malignancy, 8 for non-malignant hematologic disorders, and 2 for metastatic solid tumors. Twenty-five patients (86%) showed 1 or more patterns of acute and organizing lung injury. Sixty-two percent had microvascular sclerosis, with venous involvement noted in most cases and not correlating with clinical history of pulmonary hypertension, clinical transplant-associated thrombotic microangiopathy, irradiation, or graft-versus-host disease. Features suggestive of graft-versus-host-disease were uncommon: 6 patients had lymphocytic bronchiolitis, and only 2 patients had evidence of bronchiolitis obliterans (both clinically unexpected), both with a mismatched unrelated donor transplant. Acute and subacute alveolar injury (diffuse alveolar damage or organizing pneumonia) is common in pediatric patients who died following HSCT and is difficult to assign to a specific etiology. Microvascular sclerosis was frequent and did not correlate with a single distinct clinical feature.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

PO-03-125 VENTRICULAR PREEXCITATION AND PEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: ETIOLOGY AND ACCESSORY PATHWAY CHARACTERISTICS

The etiology of pediatric hypertrophic cardiomyopathy (HCM) is varied. Ventricular preexcitation (VPe) is well recognized, yet little is known regarding the specific etiology, and accessory pathways (AP) characteristics. Define the etiology of HCM in patients with VPe and the characteristics of the responsible APs. Retrospective cohort study of patients <21 years of age with HCM/VPe from 2000-22. The etiology was defined as sarcomeric/non-sarcomeric (isolated HCM), storage disorder, metabolic disease, or genetic syndrome. AP were designated as atrioventricular (AV) or fasciculoventricular fibers (FVF) using standard invasive EP study criteria when available. AV APs were defined as high risk if any of the following were <250 ms: shortest preexcited RR interval in AF, shortest paced preexcited cycle length, or APERP. ECG characteristics were compared in patients with VPe exclusively secondary to an FVF to those with anteroseptal AP-mediated VPe. From a total of 345 patients with HCM, 28 (8%) had VPe and proportion with VPe varied significantly between etiologic groups: isolated HCM 10/220 (5%), storage 8/17 (47%), metabolic 5/19 (26%), genetic syndrome 5/89 (6%), p < 0.001. Six (21%) had clinical AF (1 with SPPRI <250 ms, 4 with storage disease). Invasive EP study was performed in 22, identifying 39 APs (23 AV AP, 16 FVF; fig 1). VPe resulted exclusively from an FVF in 8 (36%) patients. Multiple AV APs were seen in 8 (36%) and AV AP plus FVF in 10 (45%). Five (23%) patients had AV APs with high-risk conduction properties (≥1 in each etiologic group). Ablation was acutely successful in 13/14 patients with recurrence in 3. The only complication was a single case of heart block after ablation of a high-risk midseptal AP. Patients with storage disease had larger QRS amplitudes (median 42.3 v. 23.0 mm, p < 0.01). The delta wave amplitude did not discriminate between anteroseptal AP and FVF (median 4.3 v. 4.1 mm, p = 0.92). VPe and high risk or multiple AP may be associated with any etiology of childhood HCM. This is most common in storage disorders associated with high QRS amplitudes and clinical AF, with important implications for prognosis and management.

Mechanism, Pathophysiology and Herbal Management-A Review on Irritable Bowel Syndrome

Background: The global distribution of IBS is surprisingly uniform, affecting men and women of all ages. Its deep-rooted character, symptoms that fluctuate from moderate to extreme, have several detrimental effects on the sufferer's standard of living; consequently, proper treatment of these patients is necessary. The etiology of IBS is unknown. Although several explanations were also proposed, the specific etiology of irritable bowel syndrome remains unknown. Clinical trials using stabilized therapies and new active medications have shown symptom reduction over placebo. Objective: IBS has long been linked to visceral sensitivity and gastrointestinal motor abnormalities. The pathophysiology of IBS appears to be multifaceted. However, several of the following elements are vital in forming IBS. This paper aims to provide a complete, scientific proof assessment of the prognosis, pathogenesis, and therapy choices to assist clinicians in successfully treating their patients. Method: The report's information was compiled by combining numerous review articles and research papers from multiple sources, including Hindawi, Elsevier, NCBI [National Centre for Biotechnology Information], and Research Gate, from 1981 to 2021, using keywords such as IBS, Brain-gut axis, postinfectious IBS, Microbiota, low-grade inflammation, and so on. Conclusion: The acute symptom influences the selection of medical techniques and therapy (IBS with diarrhoea, IBS with constipation, or mixed IBS). Current research demonstrates both pharmaceutical and non-pharmaceutical treatment has a positive impact (in comparison to a placebo) on irritable bowel syndrome (IBS) problems, discomfort relief, and improved health status.

Causes of Dorsal Cutaneous Branch of the Ulnar Nerve Neuropathy Among Patients Undergoing Electrodiagnostic Studies: A Series of 14 Patients.

Isolated neuropathy of the dorsal cutaneous branch of the ulnar nerve (DCBUN) is rare and most cases are secondary to trauma, often iatrogenic.The topography of sensory abnormalities and abnormal electrodiagnostic (EDX) findings are crucial in confirming DCBUN neuropathy. Materials and methods: This is a retrospective study of patients with isolated involvement of the DCBUN from among patients referred for EDX studies for upper extremity symptoms.All patients underwent a focused neurological examination followed by EDX studies.Ultrasound (US) studies were performed in two patients. Results: Of the 14 patients with DCBUN neuropathy, decreased pinprick sensation in the distribution of the DCBUN was noted in 11 (78%) patients.DCBUN sensory nerve action potential (SNAP) was not recordable in 13 (92%) patients.In one patient who had a recordable SNAP, the latency was prolonged, and the amplitude was decreased.Four (28%) patients had incidental EDX abnormalities suggestive of entrapment of the median nerve at the carpal tunnel.The most common cause of DCBUN neuropathy was trauma in 13 (92%) patients, of which eight were iatrogenic.No specific etiology was detected in one patient (7%).Of the two patients who underwent US studies, one had increased cross-sectional area (CSA) at the wrist with prominent fascicles and hyperechoic scar tissue, while the CSA was normal in the other patient. Although rare, DCBUN neuropathy can be readily confirmed by typical clinical features and EDX findings.Surgeons should be aware of the anatomy and clinical features of DCBUN neuropathy and avoid injuring the nerve during surgical procedures at the wrist and forearm.