Spontaneous Course Research Articles

Unusual and unexpected positive spontaneous courses of chronic drug-resistant epilepsies in adults

Unusual and unexpected positive spontaneous courses of chronic drug-resistant epilepsies in adults

Angular and torsional malalignments of the paediatric knee joint

Abnormal angular and torsional alignment of the lower extremities during growth are acommon reason for consultation of apaediatrician or orthopaedist. There is often uncertainty about the pathological value of these abnormalities and the need for treatment, even among specialists. In the course of physiological growth and development processes, the axial and torsional alignment of the legs sometimes change considerably and in characteristic patterns. The ability to assess whether abnormal angular or torsional alignments of the lower limb in the course of growth should still be regarded as normal or already as pathological, depending on age and gender, is essential for the treating physician and requires precise knowledge of the physiological development processes and the tolerable limits in all three spatial dimensions. After careful explanation to the frequently concerned parents, arestrictive approach with observation of the spontaneous course of correction on the basis of regular clinical check-ups makes sense in the majority of cases. Pathological deviations from the physiological conditions are rare overall, can be idiopathic or of secondary origin and should be further clarified diagnostically using imaging procedures. As conservative measures are ineffective, pronounced angular and/or torsional deformities of the legs requiring treatment can only be corrected by surgical intervention, even in children and adolescents. The surgical treatment modalities available are varied and differ in terms of their invasiveness and complication profile, depending on the localization, type and severity of the deformity, as well as the age and possible concomitant diseases of the affected child or adolescent.

Carbonization of golden shower pods to high surface area biochar for decontamination of cationic dyes and regeneration study by gamma radiations

Detoxification of water resources is the need of the hour and a number of environment friendly materials are proposed by scientist to deal with water pollution issues. The present study deals with preparation and characterization of porous activated carbon from golden shower pods, a waste ligno-cellulosic biomass, for the removal of dye contaminants from aqueous solution. The synthesized material, golden shower biochar (GSBC) was characterized using various analytical techniques to confirm the presence of active sites. The BET analysis of GSBC revealed high surface area of 1120 m2/g with total pore volume of 1.099 cm3/g and average pore radius 19.618 Å. Operational parameters were optimized using batch studies by taking GSBC dose of 50 mg which showed complete removal of target dyes with an initial dye concentration of 200 mg/L with just 60 min interaction time; based on these results, a fixed bed column of GSBC was designed and column studies were performed. Adsorption isotherm studies were carried out using Langmuir and Freundlich models, of which Langmuir model was found to be best-fit with maximum adsorption capacities of 208.86 mg/g, 284.35 mg/g and 327.56 mg/g for Crystal violet, Brilliant green and Methylene blue dyes respectively. Analysis of kinetics and thermodynamics revealed that the best-fit model was pseudo second-order with spontaneous reaction course and exothermic nature. Regeneration was carried out using gamma irradiation of dye loaded GSBC, followed by leaching in alcohol. It was observed that a 30 KGy dose was just sufficient to completely degrade the dye on the adsorbent surface. GSBC has shown immense potential for eradication of dyes from water effluents and it is easily recovered with negligible loss in efficacy.

A HOPE IN THE MANAGEMENT OF CERVICAL MYELOPATHY THROUGH PANCHAKARMA

Cervical myelopathy involves spinal cord compression at the cervical level of the spinal column, resulting in spasticity, hyperreflexia, pathologic reflexes, digit/hand clumsiness, and gait disturbance1 . The spontaneous course of myelopathy is characterised either by long periods of stable disability followed by episodes of deterioration or a linear progressive course. The presentation of cervical myelopathy varies by the severity of the spinal cord compression as well as its location. Without treatment, patients may progress toward significant paralysis and loss of function. Any space-occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy. Cervical myelopathy is predominantly due to pressure on the anterior spinal cord with ischemia as a result of deformation of the cord by anterior herniated discs, spondylitis bone spurs, an ossified posterior longitudinal ligament or spinal stenosis. In Ayurveda, it can be correlated with kaphavruta vyana vata as both signs and symptoms are similar. Objectives--By consideringg cervical myelopathy as Kaphavritta vyana vata, the present study has attempted to evaluate the efficiency of Ayurvedic formulation in the conservative management of cervical myelopathy. Method-A case of cervical myelopathy, Initially the patient was treated with Dashamoola kaya seka followed by Shastika Shalipinda sweda, followed by Madhutailika basti2 and Anuvasana basti with Murchita tila taila as per Kala Basti schedule, followed by Shamana aushadhi. Result-Patient was observed for symptomatic improvement based on the questionnaire over graded signs & symptoms, also observed for clinical examination before & after treatment. Conclusion: The study has shown that conservative management of cervical myelopathy can be managed effectively through the Ayurvedic principle and improve quality of life.

Click phenomenon in acquired Jaensch-Brown syndrome and trigger finger/thumb: the Notta syndrome

The click phenomenon occurs when an acquired mechanical restriction of the elevation in adduction of the eye or of the extension of the finger/thumb, is forcefully overcome. The common cause is anodule either of the superior oblique tendon posterior to the trochlea in the case of aJaensch-Brown syndrome or of the digital flexor tendon anterior to the A1 annular pulley in the case of atrigger finger. Both locations share similar anatomical conditions for the development of the nodule and the pathomechanism of the click. From these identical findings in the eye and the hand in small children it can be assumed that the results from the studies of the hand in newborns and infants with atrigger thumb/finger are also applicable to the situation of the eye. 1.This motility disorder is not congenital. This is most likely due to an incomplete development at the time of birth of the sliding factors needed for afree passage of the tendon through the trochlea and the A1 annular pulley. 2.Adistinction must be made between stages 0-3: stage0 = no more restriction of the motility and no click phenomenon; stage1 = forced active extension/elevation possible; stage2 = only passive extension/elevation, each with aclick phenomenon; stage3 = no extension/elevation possible and no click phenomenon. 3.In most cases in early childhood there is aspontaneous complete recovery (75% after 6-7years). In the eye this spontaneous course can only limitedly be shortened with motility exercises in combination with segmental occlusion. The click phenomenon is asymptom of stages1 and2 of an acquired mechanical restriction of the elevation in adduction of the eye or the extension of the finger/thumb. It should not be called asyndrome.

Lamellar macular holes-In the center of vitreomacular interface diseases : Pathophysiology, spontaneous courses and treatment concepts

A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.

Epiretinal membrane: diagnostics, indications and surgical treatment

An epiretinal membrane (ERM) is afrequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. Adistinction is made between an idiopathic form caused by age-related changes of the vitreous body and asecondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays amajor role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or areduction of metamorphopsia can be achieved, with anumber of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.

ДВА СПОСОБА МОДЕЛИРОВАНИЯ РИСКА ПРОГРЕССИРУЮЩЕГО АТЕРОСКЛЕРОЗА

Background. Relevance Progressive atherosclerosis has attracted researchers for the last decade due to the fact that it is associated with unfavorable clinical outcomes. Application of modern methods of mathematical modeling will allow to identify patients with such extreme risk of cardiovascular events and optimize their management. Purpose of the study. To develop a mathematical model of the risk of progressive atherosclerosis using the free cross-platform visual programming system Orange and to compare it with the method of nonlinear regression model of logistic type implemented in C++ programming language. Materials and Methods. Female and male patients diagnosed with coronary heart disease (CHD) were included in the study, 100 of them had signs of progressive course of atherosclerosis, 102 - its spontaneous course. Risk models were built using the free cross-platform visual programming system Orange, SPSS 22.0 package, and C++ console. Results and conclusion. The author's proposed approaches to assess the risk of progressive atherosclerosis using regression analysis and machine learning have good prognostic accuracy; both methods are recommended by the authors for application in practice.

Merkel Cell Carcinoma: Integrating Epidemiology, Immunology, and Therapeutic Updates.

Merkel cell carcinoma (MCC) is a rare skin cancer characterized by neuroendocrine differentiation. Its carcinogenesis is based either on the integration of the Merkel cell polyomavirus or on ultraviolet (UV) mutagenesis, both of which lead to high immunogenicity either through the expression of viral proteins or neoantigens. Despite this immunogenicity resulting from viral or UV-associated carcinogenesis, it exhibits highly aggressive behavior. However, owing to the rarity of MCC and the lack of epidemiologic registries with detailed clinical data, there is some uncertainty regarding the spontaneous course of the disease. Historically, advanced MCC patients were treated with conventional cytotoxic chemotherapy yielding a median response duration of only 3 months. Starting in 2017, four programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) immune checkpoint inhibitors-avelumab, pembrolizumab, nivolumab (utilized in both neoadjuvant and adjuvant settings), and retifanlimab-have demonstrated efficacy in treating patients with disseminated MCC on the basis of prospective clinical trials. However, generating clinical evidence for rare cancers, such as MCC, is challenging owing to difficulties in conducting large-scale trials, resulting in small sample sizes and therefore lacking statistical power. Thus, to comprehensively understand the available clinical evidence on various immunotherapy approaches for MCC, we also delve into the epidemiology and immune biology of this cancer. Nevertheless, while randomized studies directly comparing immune checkpoint inhibitors and chemotherapy in MCC are lacking, immunotherapy shows response rates comparable to those previously reported with chemotherapy but with more enduring responses. Notably, adjuvant nivolumab has proven superiority to the standard-of-care therapy (observation) in the adjuvant setting.

Respiratory function in adult patients with spinal muscular atrophy treated with nusinersen - a monocenter observational study.

Insufficiency of respiratory muscles is the most important reason for mortality in the natural history of SMA. Thus, improvement or stabilization of respiratory function by disease-modifying therapies (DMT) is a very important issue. We examined respiratory function using forced vital capacity (FVC) in 42 adult SMA patients (2 SMA type 1, 15 SMA type 2, 24 SMA type 3, 1 SMA type 4, median age 37 years, range 17-61 years) treated with nusinersen for a median of 22.1 months (range 2.1 to 46.7 months). Change in FVC was assessed using mixed effects linear regression models. Baseline FVC differed significantly between SMA type 1 (4.0, 8.0%), 2 (median 22.0%, IQR 18.0-44.0), 3 (median 81.0%, IQR 67.0-90.8) and, respectively, type 4 (84.0%) patients reflecting the heterogeneity of respiratory impairment based on the SMA type in adulthood (p < 0.0001). FVC remained stable during follow-up (mean -0.047, 95% CI -0.115 to 0.020, p = 0.17); however, subgroup analysis showed an increase in FVC of type 2 patients (mean 0.144, 95% CI 0.086 to 0.202, p < 0.0001) and a decrease in FVC of type 3/4 patients (-0.142, 95% CI -0.239 to -0.044, p = 0.005). The observed improvement in FVC in patients with SMA type 2 can be seen as a therapeutic response differing from the progressive decline typically seen in the spontaneous course. For SMA type 3/4 patients approaching normal spirometry at baseline, FVC may only be of limited use as an outcome parameter due to ceiling effects.

КОНЦЕПТ «РЕВОЛЮЦИЯ» В ЭПОПЕЕ «КРАСНОЕ КОЛЕСО» И ПУБЛИЦИСТИЧЕСКИХ ПРОИЗВЕДЕНИЯХ А.И. СОЛЖЕНИЦЫНА: КУЛЬТУРФИЛОСОФСКИЙ СИНТЕЗ

At present, the issues of studying historical experience, restoring cultural and historical memory, articulating national-specific features and properly comprehending crucial events for the history of Russia are of particular importance. One of the universal and relevant sources here are literary and artistic works written by outstanding and recognized authors. A significant phenomenon in this regard is the revolution and its comprehensive study. Consideration of the concept of "revolution" in the epic "Red Wheel" and the journalistic works of A.I. Solzhenitsyn through cultural and philosophical synthesis is the purpose of this work. The methodological basis of the study was made up of both general scientific and interdisciplinary methods. During the work on the article, the author mainly turned to the cultural philosophical synthesis. According to the results of the study, the author comes to the conclusion that the concept of "revolution" is presented ambivalently in the epic "Red Wheel" (as a positive and negative event). As a positive event, the revolution is presented as a phenomenon of rare spiritual beauty, a continuous celebration of hearts, a musical and attractive event. At the same time, the revolution symbolizes the truth, the renunciation of arbitrariness, concretizes the truth, and also heals the people's soul. The revolution as a negative event is depicted in the narrative as robbery, chaos, cruelty, stupidity, a bloody explosion, characterized by a spontaneous and uncontrollable course. In the space of publicistic works, A. I. Solzhenitsyn also comprehensively comprehended the phenomenon of revolutions, dividing them into moral and physical. The writer considered moral revolutions an unexplored saving phenomenon, the only possible way of radical transformation, a symbol of evolution. Physical revolutions, on the contrary, undermine the historical process, as they are unnatural, pathogenic in nature, sow chaos, bring to life base instincts, the decline of morals, the disintegration of the family, universal hatred. Such revolutions are often born under the guise of denial of culture, morality and religion.

Clinical Decision Support Systems in Hospitalized Older Patients: An Exploratory Analysis in a Real-Life Clinical Setting.

Inappropriate prescribing is associated with negative patient outcomes. In hospitalized patients, the use of Clinical Decision Support Systems (CDSSs) may reduce inappropriate prescribing and thereby improve patient-related outcomes. However, recently published large clinical trials (OPERAM and SENATOR) have shown negative results on the use of CDSSs and patient outcomes and strikingly low acceptance of recommendations. The purpose of the present study was to investigate the use of a CDSS in a real-life clinical setting of hospitalized older patients. As such, we report on the real-life pattern of this in-hospital implemented CDSS, including (i) whether generated alerts were resolved; (ii) whether a recorded action by the pharmacist led to an improved number of resolved alerts; and (iii) the natural course of generated alerts, in particular of those in the non-intervention group; as these data are largely lacking in current studies. Hospitalized patients, aged 60 years and older, admitted to Zuyderland Medical Centre, the Netherlands, in 2018 were included. The evaluation of the CDSS was investigated using a database used for standard care. Alongside demographic and clinical data, we also collected the total numbers of CDSS alerts, the number of alerts 'handled' by the pharmacist, those that resulted in an action by the pharmacist, and finally the outcome of the alerts at day 1 and day 3 after the alert was generated. A total of 3574 unique hospitalized patients, mean age 76.7 (SD 8.3) years and 53% female, were included. From these patients, 8073 alerts were generated, of which 7907 (97.9% of total) were handled by the pharmacist (day 1). In 51.6% of the alerts handled by the pharmacist, an action was initiated, resulting in 36.1% of the alerts resolved after day 1, compared with 27.3% if the pharmacist did not perform an action (p<0.001). On day 3, in 52.6% of the alerts an action by the pharmacist was initiated, resulting in 62.4% resolved alerts, compared with 48.0% when no action was performed (p<0.001). In the category renal function, the percentages differed significantly between an action versus no action of the pharmacist at day 1 and at day 3 (16.6% vs 10.6%, p<0.001 [day 1]; 29.8% vs 19.4%, p<0.001 [day 3]). This study demonstrates the pattern and natural course of clinical alerts of an in-hospital implemented CDSS in a real-life clinical setting of hospitalized older patients. Besides the already known beneficial effect of actions by pharmacists, we have also shown that many alerts become resolved without any specific intervention. As such, our study provides an important insight into the spontaneous course of resolved alerts, since these data are currently lacking in the literature.

COMPLEX FORMATION OF GOLD (I) WITH 2-METHYLIMIDAZOLE

The complex formation process of Au (I) with 2-methylimidazole was studied by potentiometric titration. When 2-methylimidazole is added to the [AuCl2]-/Au system, the potential gradually decreases without any jumps. The nonlinearity of the dependence of E on –lg[2MI] indicates the stepwise nature of the complex formation between [AuCl2]- and 2-methylimidazole. The general and thermodynamic stability constants of the complexes were determined in the temperature range of 278-318 K (at T=298 K, lgβ0[AuСl(Н2МИ)]+=13.84±0.03; lgβ10[Au2МИCl]=5.38±0.05; lgβ20[Au(2МИ)2]+=10.60±0.03). The reliability of the determination of the constants is proved by the satisfactory agreement between the experimentally found values of the potentials (Eex.) with theoretical ones (Etheor.). As the temperature increases, the stability of the complexes increases. A change in the ionic strength of the solution has little effect on the stability of the complexes. Comparison of the process of complexation of gold (I) and gold (III) with 2-methylimidazole shows that the stability of the complexes of trivalent gold is superior to similar complexes of gold (I). The thermodynamic functions of the complex formation reaction were calculated by the temperature coefficient method. In this case, the value of ΔrН0 was determined from the tangent of the slope of the direct dependence lgβ0=f(1/T), and the value of ΔrS0 was determined from the segment cut off by this straight line on the y-axis. The change in the isobaric-isothermal potential was calculated by the equation ΔrG0= ΔrН0-TΔrS0. The substitution of chloride ions for a 2MI molecule is accompanied by a positive change in ΔН, which has a negative contribution to the spontaneous course of reactions. For the [AuCl2]- - 2MI system, the number of particles participating in the reaction remains unchanged and the positive change in ΔS is most likely due to the release of water molecules from the hydration shell of the initial substances and reaction products.

Button Battery Ingestions cause the Majority of Severe Complications.

Foreign body ingestion in children is a clinically important reason for presentation to the emergency department. The individual outcome ranges from benign spontaneous courses to severe complications. Fatal outcomes occur rarely and complications are related to patient's age as well as type and location of the foreign body. The aim of our present study was to evaluate the outcome of children and adolescents with foreign body ingestion with a focus on complications, which mainly occurred after button battery ingestion. We reviewed medical records of patients between 0 and 18 years of age who had presented to the paediatric emergency department of our hospital with suspected foreign body ingestion between January 2011 and March 2021 (123 months). Clinical, imaging, and endoscopic data as well as treatment modalities were analysed. In the ten10 year period under review, a total of 1,162 children and adolescents (6 months - 18 years) presented to our emergency room with suspected foreign body ingestion. Among those, 398 ingestions (34%) could be verified radiologically and/or endoscopically, while in the remaining 764 cases (66%) the suspicion could not be confirmed. The majority of patients with verified ingestion (n=324; 81%) presented with ingestion of a metallic foreign body. We observed 55 cases with verified ingestion of a button battery. Five of these cases had severe complications, with a near-fatal course in two patients who developed an oesophageal-tracheal fistula. In contrast to all other ingestions of foreign bodies in children, button battery ingestions lead to mucosal damage and severe complications in a significant number of children.

Myocarditis and inflammatory bowel diseases: A single-center experience and a systematic literature review

BackgroundMyocarditis and inflammatory bowel diseases (IBD) are rare conditions, but may coexist. Myocarditis in IBD may be infective, immune-mediated, or due to mesalamine toxicity. A gap of knowledge exists on the clinical features of patients that present myocarditis in association with IBD, especially for endomyocardial biopsy-proven cases. Our aims are: 1) to describe the clinical characteristics of patients with an associated diagnosis of myocarditis and IBD in a single-center hospital, 2) to perform a systematic review of the literature of analogous cases. MethodsWe retrospectively analyzed data of patients followed up at the outpatient Cardio-immunology and Gastroenterology Clinic of Padua University Hospital, to identify those with an associated diagnosis of myocarditis and IBD. In addition, a systematic review of the literature was conducted. We performed a qualitative analysis of the overall study population. ResultsThe study included 104 patients (21 from our single center cohort, 83 from the literature review). Myocarditis in IBD more frequently affects young (median age 31 years) males (72%), predominantly with infarct-like presentation (58%), within an acute phase of the IBD (67%) and with an overall benign clinical course (87%). Nevertheless, a not negligible quote of patients may present giant cell myocarditis, deserve immunosuppression and have a chronic, or even fatal course. Histological evidence of mesalamine hypersensitivity is scarce and its incidence may be overestimated. ConclusionsOur study shows that myocarditis in association with IBD, if correctly managed, may have a spontaneous benign course, but predictors of worse prognosis must be promptly recognized.

ГОДИЧНЫЕ ИСХОДЫ У БОЛЬНЫХ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА С ПРОГРЕССИРУЮЩИМ АТЕРОСКЛЕРОЗОМ

Вackground. Progressive atherosclerosis syndrome, in contrast to spontaneous one, is accompanied by a more severe course and frequent complications. Therefore, it is crucial to define the risk stratification criteria and treatment of such patients. Purpose of the study to study one-year outcomes in patients with coronary heart disease with progressive atherosclerosis. Patient Characterization and Research Methods. The study included 202 patients with confirmed diagnosis of CHD: 147 men and 55 women. The mean age of the patients was (53,3 ± 7,16) years. The main group (100 patients) included those who had two (or more) additional cardiovascular events from the following in the two years before the study: MI or unstable angina pectoris, emergency artery stenting, stroke, peripheral artery thrombosis, critical ischemia or lower limb amputation, and the comparison group included 102 patients with CHD without such events. After 12 months from the time of inclusion, end points were evaluated. Statistical Analysis Methods. Microsoft Office Excel 2019 program was used. Results. The work revealed that patients with progressive atherosclerosis have worse long-term (one-year) prognosis in comparison with its spontaneous course; a significant influence on unfavorable outcomes is exerted by: Angina of any EF without surgical treatment - OR 4.125 (1.213; 14.027), multivessel coronary artery disease - OR 3.929, CI (1.156-13.350), C-reactive protein level 5 mg/L or higher - OR 18.667, CI (4.684-74.393).

Risk of progression to overt hypothyroidism in Indian patients with subclinical hypothyroidism: a prospective observational study

Background: Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group.Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody was predictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

Foreign Body Ingestion and Management in Children.

The aim of the study is to evaluate of the children who came to our hospital with the complaint of foreign body (FB) ingestion and were treated. A retrospective evaluation was made of the records of children who presented at our institution between January 2014 and August 2021 with the complaint of FB ingestion. Evaluation was made of 297 children, comprising 121 female children (40.7%) with a mean age of 61.1 ± 50.3 months (range, 4-202 months). The ingested FB most frequently was coins (n = 88, 29.6%). The most common complaint on presentation was vomiting in 47 cases (15.8%). Endoscopy was applied to 75 cases (25.3%), and most common FB was removed from the upper esophagus in 31 cases (41.3%). The most frequently removed FB was coins at the rate of 40%. Of the 211 cases left to a spontaneous course, 117 were in the intestines, 22 in the stomach, and in 72 cases localization could not be determined on conventional radiography as the FB was not opaque. In 7 cases with a bolus of food caught in the esophagus, 3 had corrosive esophagus stricture (1 case with colon transposition), 2 had operated esophagus atresia, 1 had eosinophilic esophagitis, and 1 had congenital esophagus stricture. Although there can be serious outcomes, there is spontaneous expulsion in most cases. However, a significant proportion requires a timely endoscopic procedure. Attention must be paid to underlying diseases when FBs, such as a food bolus, are in the esophagus.

P 62 Does Photosensitivity matter? Clinical relevance

Photosensitivity is a phenomenon which is defined more precisely by intermittent photic stimulation that elicits a photoparoxysmal response (PPR). Data about the prognosis of people with PPR are scarce. Pure PPR mostly appears in later childhood and adolescence, has a female preponderance and disappears in many people during the third decade. However, whether or not it disappears is mainly dependent whether or not it is associated with an underlying disease with a benign spontaneous course like Rolandic epilepsy, a good therapy prognosis like juvenile myoclonic epilepsy (which is the epilepsy syndrome with the highest proportion of PPR) or a bad prognosis like progressive myoclonic epilepsies. If PPR persists in epilepsy patients stimulus avoidance and suppression is an appropriate additional approach beyond antiepileptic drug treatment. A typical case is reported. Keywords photosensitivity photoparoxysmal response prognosis

The Spontaneous Course of Human Herpesvirus 6 DNA-Associated Myocarditis and the Effect of Immunosuppressive Intervention.

Introduction: This study investigated the spontaneous clinical course of patients with endomyocardial biopsy (EMB)-proven lymphocytic myocarditis and cardiac human herpesvirus 6 (HHV6) DNA presence, and the effectiveness of steroid-based intervention in HHV6-positive patients. Results: 756 heart failure (HF) patients underwent an EMB procedure to determine the underlying cause of unexplained HF. Low levels of HHV6 DNA, detectable by nested PCR only, were found in 10.4% of the cases (n = 79) of which 62% (n = 49) showed myocardial inflammation. The spontaneous course of patients with EMB-proven HHV6 DNA-associated lymphocytic myocarditis (n = 26) showed significant improvements in the left ventricular ejection fraction (LVEF) and clinical symptoms, respectively, in 15/26 (60%) patients, 3–12 months after disease onset. EMB mRNA expression of components of the NLRP3 inflammasome pathway and protein analysis of cardiac remodeling markers, analyzed by real-time PCR and MALDI mass spectrometry, respectively, did not differ between HHV6-positive and -negative patients. In another cohort of patients with ongoing symptoms related to lymphocytic myocarditis associated with cardiac levels of HHV6-DNA copy numbers <500 copies/µg cardiac DNA, quantified by real-time PCR, the efficacy and safety of steroid-based immunosuppression for six months was investigated. Steroid-based immunosuppression improved the LVEF (≥5%) in 8/10 patients and reduced cardiac inflammation in 7/10 patients, without an increase in cardiac HHV6 DNA levels in follow-up EMBs. Conclusion: Low HHV6 DNA levels are frequently detected in the myocardium, independent of inflammation. In patients with lymphocytic myocarditis with low levels of HHV6 DNA, the spontaneous clinical improvement is nearby 60%. In selected symptomatic patients with cardiac HHV6 DNA copy numbers less than 500 copies/µg cardiac DNA and without signs of an active systemic HHV6 infection, steroid-based therapy was found to be effective and safe. This finding needs to be further confirmed in large, randomized trials.