Spectrum Of Disease In Patients Research Articles

A Cross-Sectional Study for the Spectrum of Clinical Diagnosis in Patients Presenting With Macrocytosis.

Objective The objectives of this study were to determine the frequency of the clinical spectrum of diseases in patients with macrocytosis and to summarize the diagnostic evaluation of patients found to have macrocytosis on laboratory testing. Background This was a cross-sectional study that took place at the Department of Medicine in Combined Military Hospital, Rawalpindi, Pakistan, from January to June 2023. Methodology One hundred and five patients with macrocytosis with mean corpuscular volume (MCV) values > 100 fL (80 to 100 fL) were inducted as per inclusion and exclusion criteria. Informed consent was obtained from all patients. Complete blood counts (CBC), peripheral blood film, serum vitamin B12 levels, serum folate levels, renal function tests (RFTs), liver function tests (LFTs), and thyroid function tests (TFTs) were performed during the assessment. Results The commonest cause of macrocytosis was vitamin B12 deficiency followed by folate deficiency, combined vitamin B12 and folate deficiency, and other causes were also found in a few cases. Conclusion Serum vitamin B12 and folate deficiency are the most common preventable causes of macrocytosis.

Neurological complications of COVID-19 and SARS-CoV-2 vaccination: an update

The respiratory infectious disease COVID-19, which emerged in 2019, has affected the world population over a brief period. In 2020, the disease was declared a pandemic by the World Health Organization. Although most COVID-19 patients primarily develop respiratory symptoms, neurological symptoms have been observed. Neurological symptoms are usually mild and non-specific. However, some patients could experience life-threatening neurological symptoms. With the increase in the incidence of COVID-19, the disease spectrum of patients with central and peripheral nervous system involvement has expanded significantly compared to the previous period. Lack of awareness has caused delays in diagnosis and treatment; therefore, updating the disease spectrum of neurological complications of COVID-19 is necessary. After COVID-19 claimed millions of lives, researchers found that some vaccines may induce autoimmune inflammatory responses in the nervous system via molecular mimicry, leading to SARS-CoV-2 vaccine-related neurological deficits. These neurological complications are often ignored by clinicians, delaying diagnosis and treatment; it is essential to study cases of vaccine-associated neurological complications. Therefore, we summarize the neurological complications of COVID-19 and nervous system adverse reactions caused by SARS-CoV-2 vaccines to help clinicians and public health service personnel understand these rare complications. Avoiding delays in diagnosis and treatment would ensure the safety of COVID-19 patients and SARS-CoV-2 vaccine recipients.

Acid sphingomyelinase deficiency: The clinical spectrum of 2 patients who carry the Q294K mutation and diagnostic challenges

Acid sphingomyelinase deficiency (ASMD) is caused by pathogenic variants in the SMPD1 gene. This chronic, progressive, and potentially fatal condition requires prompt specialist care. The diagnosis of ASMD can be delayed or missed if patients that harbor the Q294K mutation undergo enzyme activity assessments that employ synthetic fluorometric substrates. Two case studies are presented, which illustrate the spectrum of disease in patients with a compound heterozygous Q294K pathogenic variant and the impact of false normal ASM activity results.

Dynamic changes of emergency visits: a retrospective observational study

BackgroundWith more emergency visits, there is increasing pressure to provide emergency medical services globally and locally. This study aimed to investigate the epidemiological characteristics and the disease spectrum of patients presenting in the last three years to the Department of Emergency Medicine of Tianjin Medical University General Hospital, a tertiary hospital in Tianjin, China, to improve the services of the emergency medicine department.MethodsA retrospective study was conducted on all patients in the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59, including variables like medical record number, gender, age, date of admission, principal diagnosis. The data were analyzed by SPSS statistical software; statistical charts were prepared by GraphPad Prism9.0 and SPSS 20.0; statistical tables were made by Microsoft Excel.ResultsA total of 1,314,916 patients presented to the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59. In terms of gender distribution, the male–female ratio was 0.78∶1. As for age distribution, patients aged 60–69 were the most (23.47%), and patients younger than 20 years were the least (2.80%). Concerning monthly data, the number of visits peaked during January and December. The distribution of daily visits showed the feature of three highs and a low. The top three prevalence diseases in the emergency disease spectrum were respiratory, cardiovascular, and digestive diseases. The respiratory system was the most common in patients with infectious diseases (200,912, accounting for 86.97%). Among the patients suffering from infectious diseases, the number of patients with respiratory infections peaked in 2019 (73,530) and was the lowest in 2020 (20,078).ConclusionsFrom 2017 to 2019, the demand for emergency services in Tianjin Medical University General Hospital continued to increase, but it was greatly affected by COVID-19 in 2020. This emergency department is mainly for patients with respiratory system, circulatory system and digestive system diseases, and its treatment time is relatively centralized. The prevention of diseases for people of all ages, especially female patients and the elderly, should be strengthened, and emergency medical resources should be allocated reasonably according to the peak months and crowed periods of patients.

Nailfold capillaroscopy for the early diagnosis of the scleroderma spectrum of diseases in patients without Raynaud's phenomenon.

The utility of nailfold capillaroscopy in the evaluation of patients without Raynaud's phenomenon is unclear. This study aims to compare the utility of nailfold capillaroscopy for the early diagnosis of the scleroderma-spectrum of diseases in patients who present with Raynaud's phenomenon, undifferentiated non-Raynaud's phenomenon features and positive systemic sclerosis-associated antibodies without scleroderma-spectrum of disease features. Eligible patients were divided into three referral criteria groups: (I) Raynaud's phenomenon; (II) Undifferentiated non-Raynaud's phenomenon features and (III) Positive systemic sclerosis-associated autoantibodies without features to suggest scleroderma-spectrum of diseases. This includes systemic sclerosis, mixed connective tissue disease and dermatomyositis. The association between baseline scleroderma pattern on nailfold capillaroscopy (systemic sclerosis-nailfold capillaroscopy) and final diagnosis at follow-up was determined using logistic regression analysis. Test characteristics of nailfold capillaroscopy were compared and stratified by referral groups. Of 95 patients followed-up for a mean of 1.6 years, 28 (29.5%) patients developed scleroderma-spectrum of diseases, 36 (37.9%) patients had suspected/other connective tissue disease and 27 (28.4%) patients had no connective tissue disease. Baseline systemic sclerosis-nailfold capillaroscopy was significantly associated with the development of scleroderma-spectrum of diseases in patients from Group I (odds ratio, 7.1, p = 0.01) and Group II (odds ratio 7.3, p = 0.005). In Group II patients, nailfold capillaroscopy had a sensitivity, specificity, positive and negative predictive values of 71.4%, 76.5%, 55.6% and 86.7%, respectively. Specificity (81.8%) and PPV (69.2%) were the highest in Group I patients. Nailfold capillaroscopy had the highest negative predictive value in Group III (100%), followed by Group II (86.7%) and Group I (78.3%) patients. In addition to evaluating patients with Raynaud's phenomenon, nailfold capillaroscopy was useful in the evaluation and exclusion of scleroderma-spectrum of diseases in patients with undifferentiated non-Raynaud phenomenon features and those with systemic sclerosis-associated antibodies without features to suggest scleroderma-spectrum of diseases.

An Unsupervised Machine Learning Clustering and Prediction of Differential Clinical Phenotypes of COVID-19 Patients Based on Blood Tests—A Hong Kong Population Study

BackgroundTo better understand the different clinical phenotypes across the disease spectrum in patients with COVID-19 using an unsupervised machine learning clustering approach.Materials and MethodsA population-based retrospective study was conducted utilizing demographics, clinical characteristics, comorbidities, and clinical outcomes of 7,606 COVID-19–positive patients on admission to public hospitals in Hong Kong in the year 2020. An unsupervised machine learning clustering was used to explore this large cohort.ResultsFour clusters of differing clinical phenotypes based on data at initial admission was derived in which 86.6% of the deceased cases were aggregated in one of the clusters without prior knowledge of their clinical outcomes. Other distinctive clinical characteristics of this cluster were old age and high concurrent comorbidities as well as laboratory characteristics of lower hemoglobin/hematocrit levels, higher neutrophil, C-reactive protein, lactate dehydrogenase, and creatinine levels. The clinical patterns captured by the cluster analysis was validated on other temporally distinct cohorts in 2021. The phenotypes aligned with existing literature.ConclusionThe study demonstrated the usefulness of unsupervised machine learning techniques with the potential to uncover latent clinical phenotypes. It could serve as a more robust classification for patient triaging and patient-tailored treatment strategies.

The Spectrum of Acute Cerebrovascular Disease in Patients with COVID-19.

(1) Background: COVID-19 infection is responsible for the ongoing pandemic and acute cerebrovascular disease (CVD) has been observed in COVID-19 patients. (2) Methods: We conducted a retrospective, observational study of hospitalized adult patients admitted to our hospital with SARS-CoV-2 and acute cerebrovascular disease. All clinical data were reviewed including epidemiology, clinical features, laboratory data, neuroradiological findings, hospital management and course from 32 patients hospitalized for COVID-19 management with acute cerebrovascular disease. (3) Results: Acute CVD with COVID-19 was associated with higher NIH stroke scale on discharge compared to non-COVID-19 CVDs. Seizures complicated the hospital course in 16% of COVID-19 patients with CVD. The majority of the acute CVDs were ischemic (81%) in nature followed by hemorrhagic (22%). Acute CVD with COVID-19 resulted in average hospital stays greater than twice that of the control group (13 days in COVID-19, 5 days in control). Acute CVD with COVID-19 patients had worse clinical outcomes with 31% patient deaths and 6% discharged to hospice. In the control group, 6% of patients died. (4) Conclusions: Acute CVD associated with COVID-19 tends to be more complicated with unique and adverse clinical phenotype, longer hospital admissions, and worse clinical outcomes.

Quantifying the progression of non-alcoholic fatty liver disease in human biomimetic liver microphysiology systems with fluorescent protein biosensors.

Metabolic syndrome is a complex disease that involves multiple organ systems including a critical role for the liver. Non-alcoholic fatty liver disease (NAFLD) is a key component of the metabolic syndrome and fatty liver is linked to a range of metabolic dysfunctions that occur in approximately 25% of the population. A panel of experts recently agreed that the acronym, NAFLD, did not properly characterize this heterogeneous disease given the associated metabolic abnormalities such as type 2 diabetes mellitus (T2D), obesity, and hypertension. Therefore, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as the new term to cover the heterogeneity identified in the NAFLD patient population. Although many rodent models of NAFLD/NASH have been developed, they do not recapitulate the full disease spectrum in patients. Therefore, a platform has evolved initially focused on human biomimetic liver microphysiology systems that integrates fluorescent protein biosensors along with other key metrics, the microphysiology systems database, and quantitative systems pharmacology. Quantitative systems pharmacology is being applied to investigate the mechanisms of NAFLD/MAFLD progression to select molecular targets for fluorescent protein biosensors, to integrate computational and experimental methods to predict drugs for repurposing, and to facilitate novel drug development. Fluorescent protein biosensors are critical components of the platform since they enable monitoring of the pathophysiology of disease progression by defining and quantifying the temporal and spatial dynamics of protein functions in the biosensor cells, and serve as minimally invasive biomarkers of the physiological state of the microphysiology system experimental disease models. Here, we summarize the progress in developing human microphysiology system disease models of NAFLD/MAFLD from several laboratories, developing fluorescent protein biosensors to monitor and to measure NAFLD/MAFLD disease progression and implementation of quantitative systems pharmacology with the goal of repurposing drugs and guiding the creation of novel therapeutics.

Histopathological spectrum of diseases in patients undergoing thyroid surgery in a teaching hospital in south India

Histopathological spectrum of diseases in patients undergoing thyroid surgery in a teaching hospital in south India

Frequency of Pulmonary Tuberculosis on high resolution computed tomography in clinically suspected patients visiting Radiology Department Mayo Hospital, Lahore.

High resolution computed tomography scan, in modern years, is more effective than standard computed tomography scan and conventional chest radiography in localization of diseases in the lobule of lung and in the appraisal of pulmonary parenchymal diseases because of high-resolution power and minimal partial volume effect. Objectives: To identify pulmonary tuberculosis in clinically suspected patients by high resolution computed tomography scan of chest. Study Design: Cross Sectional Descriptive study. Setting: Department of Radiology, Mayo Hospital, Lahore. Period: 15th February 2018 to 15th November 2018. Material & Methods: After taking consent, fifty patients, fulfilling inclusion and exclusion criteria, were selected by convenient sampling in this cross sectional descriptive study. Demographic details, clinical history and High resolution tomographic scan findings were documented. Data analysis was performed on Microsoft excel and statistical package for social sciences (SPSS v21) and reported by descriptive statistics. Results: Out of 50 patients, pulmonary tuberculosis was diagnosed in 44(88%) patients, acute on chronic tuberculosis in 2(4%), healed tuberculosis in 2(4%), interstitial lung disease in 1(2%) & post tubercular sequela in 1(2%) patient. Majority were males (n=29, 58%) and most patients belonged to fifth decade of life (n=19, 38%). Overall mean age of patients was 45.14±12.16 years and mostly belonged to lower socioeconomic status (n=38, 76%). Most common symptom and High resolution computed tomography finding were low grade fever in 45(95%) & consolidation in 39(78%) patients, respectively. Conclusion: High resolution computed tomography scan is valuable in diagnosis of pulmonary tuberculosis & its related spectrum of diseases in patients having clinical suspicion of pulmonary tuberculosis.

JAAD Game Changers*: Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: A Danish nationwide population-based cohort study

Capsule Summary:•Active cancers and inflammation increase the risk for venous thromboembolism. It is unknown whether this applies to mycosis fungoides and parapsoriasis.•Patients with mycosis fungoides and parapsoriasis have increased risk for venous thromboembolism.•These findings should increase awareness of comorbidities as part of the disease spectrum in patients with mycosis fungoides and parapsoriasis.How did this article change the practice of dermatology?This changes our counseling for patients and the importance of discussing the risk of clots in patients with mycosis fungoides and parapsoriasis, possibly reducing other modifiable risk factors for venous thromboembolism. Risk is highest in the first 5 years after diagnosis, and this should be part of standard counseling at diagnosis of either entity.1

Changes in protein function underlie the disease spectrum in patients with CHIP mutations

Monogenetic disorders that cause cerebellar ataxia are characterized by defects in gait and atrophy of the cerebellum; however, patients often suffer from a spectrum of disease, complicating treatment options. Spinocerebellar ataxia autosomal recessive 16 (SCAR16) is caused by coding mutations in STUB1, a gene that encodes the multifunctional enzyme CHIP (C terminus of HSC70-interacting protein). The disease spectrum of SCAR16 includes a varying age of disease onset, cognitive dysfunction, increased tendon reflex, and hypogonadism. Although SCAR16 mutations span the multiple functional domains of CHIP, it is unclear whether the location of the mutation and the change in the biochemical properties of CHIP contributes to the clinical spectrum of SCAR16. In this study, we examined relationships between the clinical phenotypes of SCAR16 patients and the changes in biophysical, biochemical, and functional properties of the corresponding mutated protein. We found that the severity of ataxia did not correlate with age of onset; however, cognitive dysfunction, increased tendon reflex, and ancestry were able to predict 54% of the variation in ataxia severity. We further identified domain-specific relationships between biochemical changes in CHIP and clinical phenotypes and specific biochemical activities that associate selectively with either increased tendon reflex or cognitive dysfunction, suggesting that specific changes to CHIP–HSC70 dynamics contribute to the clinical spectrum of SCAR16. Finally, linear models of SCAR16 as a function of the biochemical properties of CHIP support the concept that further inhibiting mutant CHIP activity lessens disease severity and may be useful in the design of patient-specific targeted approaches to treat SCAR16.

A preliminary study on the characteristics of ERCP population and disease trends in Zhejiang Province

Objective To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography (ERCP) . Methods Data of 20 170 patients, who underwent ERCP in the First People′s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment, patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases (including calculus, benign stenosis, malignant stenosis, and other causes) and pancreatic diseases (including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes) group; and according to the age, they were divided into the younger age (0-18 years old) , young and middle age (19-65 years old) , old age (66-85 years old) , and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. Results Among the 20 170 patients, there were 10 260 males and 9 910 females, with age of 62.65±17.11 years. The proportion of the younger age group and the advanced age group was 1.04% (24/2 308) , 1.69% (127/7 520) , 2.39% (247/10 342) , and 2.95% (68/2 308) , 4.19% (315/7 520) , 6.15% (636/10 342) , respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0.017) . A total 20 032 patients had a clear postoperative diagnosis, including 15 618 (77.97%) of biliary diseases and 4 414 (22.03%) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63.2%, 9 863/15 618) , and its proportion increased from 59.9% (1 191/1 987) in 2004-2008 to 64.5% (5 118/7 939) in 2014-2018 (P=0.000) . Acute pancreatitis accounted for the majority of pancreatic diseases (67.4%, 1 973/4 414) , and its proportion increased from 52.4% (162/309) in 2004-2008 to 69.9% (1 636/2 340) in 2014-2018 (P=0.000) . The top 3 diseases in the younger group and the advanced age group were acute pancreatitis (32.58%, 129/396) , biliary stones (25.25%, 100/396) , chronic pancreatitis (22.22%, 88/396) , and biliary stones (56.46%, 568/1 006) , malignant biliary stenosis (12.52%, 126/1 006) , benign biliary stricture (10.34%, 104/1 006) , respectively. Conclusion The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively. Key words: Cholangiopancreatography, endoscopic retrograde; Population surveilance; Trend

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdomen.

Introduction: Acute Abdomen is the most common presenting complaints about 20% of all emergency department, due to its varied etiology it poses significant diagnostic challenges for emergency surgeons. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation.&#x0D; Objective: To identify the spectrum of diseases in patients of non-traumatic leading to Acute abdomen, presenting in a surgical unit.&#x0D; Methodology: During Jan 2012 to Dec 2014, this retrospective study conducted at Surgical Department of Muhammad Medical College, all patients presenting with non-traumatic acute abdominal pain were included in this study. Gynecological and urological causes were excluded. The patient diagnosis and management were recorded from the case files and OT registers.&#x0D; Results: During the period, a total of 216 patients presented with non-traumatic acute abdomen; of which there were 145 (67.12%) males and 71 (32.87%) females, with a male to female ratio of 2:1. The highest incidence of acute abdomen 72 (33.33%) was found in patients of 22-32 years age group followed by under 21 years age group i.e. 51 (23.61%) and 33-42 years age group 43 (19.90%). There were 31 (14.35%) cases in 43-52 years and 19 (8.79%) cases in 53-70 years.&#x0D; The most common cause of acute abdomen was acute appendicitis 105 (48.61%) admissions. These patients were mostly young males in twenties. Intestinal obstruction was second cause 45 (20.83%) cases and this affected more commonly the middle-aged persons. Two hundred and seven (95.83 %) patients were treated successfully and discharged home while 5 (2.31 %) left against medical advice, while 4 expired giving a mortality of (1.85) % in patients with gut perforation&#x0D; Conclusion: The most common cause of acute abdomen is acute appendicitis affecting young population mostly. Another common cause is intestinal obstruction and gut perforation. Acute cholecystitis commonly affects the middle aged, post-menopausal women. Hepatic abscess and Pancreatitis are rare cause of acute abdomen in this area.&#x0D; Key Words: Acute abdomen. Non-traumatic Acute appendicitis, Intestinal obstruction.

Pathological spectrum of glomerular disease in patients with renal insufficiency: a single-center study in Northeastern China

Background: To investigate the pathological spectrum of glomerular disease in patients with renal insufficiency (RI) from 2008 to 2017.Methods and results: We calculated the estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration creatinine (CKD-EPI) equation and defined RI as an eGFR <60 ml/min/1.73 m2. A total of 969 RI patients were included in our study. IgA nephropathy (IgAN) was the most common subtype of primary glomerulonephritis (37.2%). The frequencies of IgAN and non-IgA mesangioproliferative glomerulonephritis decreased from 27.3% and 9.5% during 2008–2012 to 20.7% and 2.6% during 2013–2017, respectively. However, the frequency of membranous nephropathy increased from 6.8% to 16.2%. Lupus nephritis was the most common subtype of secondary glomerulonephritis (32.1%). The frequencies of both ANCA-associated systemic vasculitis and diabetic nephropathy increased from 3.8% to 7.6% and from 4.3% to 7.6%, respectively. The number of elderly patients (≥60 years) in our study increased sharply, from 15.6% in 2008 to 35.0% in 2017. Membranous nephropathy, minimal change disease, membranoproliferative glomerulonephritis, lupus nephritis and renal amyloidosis are more frequently observed in the elderly patients than in nonelderly patients (<60 years) (p < .05). Excluding those with acute kidney injury, IgAN was the leading cause of RI (24.9%), followed by membranous nephropathy (13.3%) and lupus nephritis (12.0%).Conclusions: IgAN and lupus nephritis were the most prevalent primary glomerulonephritis and secondary glomerulonephritis in patients with RI, respectively. The frequencies of membranous nephropathy, ANCA-associated systemic vasculitis and diabetic nephropathy increased significantly. The number of elderly patients with RI increased sharply.

Abstract #258 Spectrum of Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus

Abstract #258 Spectrum of Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus

Distribution and epidemiological characteristics of disease spectrum in patients with pre-hospital care in Hohhot in 2016: a case analysis in 28 325 patients

To analyze the distribution and epidemiological characteristics of patients in pre-hospital emergency in Hohhot. The data of 28 325 pre-hospital emergency patients in 7 first-aid stations in Hohhot from January 1st to December 31st in 2016 were analyzed retrospectively. The gender, age, call time, disease spectrum of patients served as investigation elements, the data were collected into Excel 2010 form, and statistical analysis was carried out. Among 28 325 pre-hospital emergency patients, there were 15 973 male (56.39%) and 12 352 female (43.61%), with the ratio of male to female of 1.29:1. The age of patients were 1 day-108 years, with the majority of patients aged 51-60 years, which accounting for 16.08% (4 554/28 325). The top 6 of diseases were trauma [33.10% (9 376/28 325)], neurological system diseases [16.81% (4 762/28 325)], circulatory system diseases [12.31% (3 486/28 325)], respiratory system diseases [7.62% (2 159/28 325)], digestive system diseases [5.68% (1 609/28 325)], acute poisoning [5.02% (1 422/28 325)]. The peak period of call for help was 09:00-11:00 (12.55%, 3 554/28 325), and 1 small peak occurred at 15:00-17:00 (11.22%, 3 179/28 325). The highest number of patients with pre-hospital care happened in summer (26.22%, 7 428/28 325), followed by autumn (24.94%, 7 065/28 325) and winter (24.83, 7 032/28 325), and the lowest in spring (24.01%, 6 800/28 325). The peak incidence of traumatic patients was in November (11.13%, 1 044/9 376), the most patients with nervous system diseases were found in October (9.97%, 475/4 762), and the most patients with circulatory system diseases were found in July (11.16%, 389/3 486). The first aid patients in Hohhot were mainly suffered from diseases of trauma, nervous system and circulatory system, more men than women, most in 51-60 years old patients, and the summer was the peak season. Therefore, the establishment of trauma center in emergency department, strengthening the health education of high-risk groups and the primary prevention of patients with cardiovascular and cerebrovascular diseases, scientific and effective use of medical resources can improve the success rate of pre-hospital rescue.

Atorvastatin-induced necrotizing autoimmune myositis: An emerging dominant entity in patients with autoimmune myositis presenting with a pure polymyositis phenotype.

The general aim of this study was to evaluate the disease spectrum in patients presenting with a pure polymyositis (pPM) phenotype. Specific objectives were to characterize clinical features, autoantibodies (aAbs), and membrane attack complex (MAC) in muscle biopsies of patients with treatment-responsive, statin-exposed necrotizing autoimmune myositis (NAM). Patients from the Centre hospitalier de l’Université de Montréal autoimmune myositis (AIM) Cohort with a pPM phenotype, response to immunosuppression, and follow-up ≥3 years were included. Of 17 consecutive patients with pPM, 14 patients had a NAM, of whom 12 were previously exposed to atorvastatin (mean 38.8 months). These 12 patients were therefore suspected of atorvastatin-induced AIM (atorAIM) and selected for study. All had aAbs to 3-hydroxy-3-methylglutaryl coenzyme A reductase, and none had overlap aAbs, aAbs to signal recognition particle, or cancer. Three stages of myopathy were recognized: stage 1 (isolated serum creatine kinase [CK] elevation), stage 2 (CK elevation, normal strength, and abnormal electromyogram [EMG]), and stage 3 (CK elevation, proximal weakness, and abnormal EMG). At diagnosis, 10/12 (83%) patients had stage 3 myopathy (mean CK elevation: 7247 U/L). The presenting mode was stage 1 in 6 patients (50%) (mean CK elevation: 1540 U/L), all of whom progressed to stage 3 (mean delay: 37 months) despite atorvastatin discontinuation. MAC deposition was observed in all muscle biopsies (isolated sarcolemmal deposition on non-necrotic fibers, isolated granular deposition on endomysial capillaries, or mixed pattern). Oral corticosteroids alone failed to normalize CKs and induce remission. Ten patients (83%) received intravenous immune globulin (IVIG) as part of an induction regimen. Of 10 patients with ≥1 year remission on stable maintenance therapy, IVIG was needed in 50%, either with methotrexate (MTX) monotherapy or combination immunosuppression. In the remaining patients, MTX monotherapy or combination therapy maintained remission without IVIG. AtorAIM emerged as the dominant entity in patients with a pPM phenotype and treatment-responsive myopathy. Isolated CK elevation was the mode of presentation of atorAIM. The new onset of isolated CK elevation on atorvastatin and persistent CK elevation on statin discontinuation should raise early suspicion for atorAIM. Statin-induced AIM should be included in the differential diagnosis of asymptomatic hyperCKemia. Three patterns of MAC deposition, while nonpathognomonic, were pathological clues to atorAIM. AtorAIM was uniformly corticosteroid resistant but responsive to IVIG as induction and maintenance therapy.

Swallowing Disorders

Swallowing disorders are a common disease in all ages. The spectrum of diseases in patients with swallowing disorders has significantly changed in the last decades. Often complexe clinical pictures require a multidisciplinary approach including various different professionals. Videofluoroscopy is the method of choice for evaluation of the entire swallowing tract within one investigation. Functional as well as morphological changes can be diagnosed and as a therapeutic study, it helps guide decisions regarding further swallow therapy based on those findings.

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdominal Pain Presenting to General Surgery Department in a Rural Tertiary Care Centre in West Bengal

Spectrum of Diseases in Patients with Non-Traumatic Acute Abdominal Pain Presenting to General Surgery Department in a Rural Tertiary Care Centre in West Bengal