Symptomatic Female Patients Research Articles

Microbiological and Antimicrobial Resistance Pattern Among Pregnant Women in The Sultanate of Oman: Comparison Between Symptomatic and Asymptomatic Bacteriuria

Bacteriuria is common in pregnancy and is associated with the risk of neonatal morbidity and mortality. In Oman, no studies have been done to determine the percentage of symptomatic and asymptomatic bacteriuria in pregnant Omani patients. This study investigated the prevalence and incidence of antibiotic resistance patterns of symptomatic and asymptomatic bacteriuria among pregnant Omani women. A total of 230 urine samples were collected from symptomatic and asymptomatic pregnant Omani female patients. Clinical patient information was gathered from the Hospital Information System (HIS). Bacterial pathogens were identified in the urine samples using microscopic examination, cultures, and serological techniques. Antibiotic sensitivity tests were performed on the isolated bacterial pathogensBacteriuria was found in 14 (6.08%) of the 230 urine samples. Among the 14 bacteriuria-positive samples, 6 were symptomatic (2.06%) and 8 were asymptomatic (3.47%). The most common bacteria were Escherichia coli (35.71%) and Streptococcus agalactiae (21.43%). Most of the clinical isolates were completely resistant to ampicillin. Asymptomatic bacteriuria was more common than symptomatic bacteriuria in the pregnant Omani population. The detection of antibiotic-resistant pathogenic bacteria, especially in asymptomatic pregnant Omani women, underscores the importance of implementing strict guidelines for the prevention of this public health issue. This includes advising and encouraging pregnant women to follow strict hygiene protocols to avoid Urinary tract infection (UTI) during pregnancy, as this type of infection may have adverse maternal and fetal outcomes.

Evaluating the Efficacy of Peroneus Longus Tendon as an Autograft for Anterior Cruciate Ligament Reconstruction in Indian Female Patients: A Prospective Cohort Study.

Background Anterior cruciate ligament (ACL) injuries are prevalent, especially among active individuals, and are increasingly observed even in Indian women who are not active in sports. ACL reconstruction (ACLR) is commonly performed using various graft options, but optimal choices for women remain debated. The aim of our study was to examine the use of the peroneus longus tendon as an autograft for ACLR in Indian female patients. Materials and methods A prospective cohort study was carried out on 44 non-athlete female patients who met the inclusion criteria. The study evaluates functional outcomes using the International Knee Documentation Committee (IKDC), Lysholm-Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as knee stability through clinical tests, over a one-year postoperative period. Results The study demonstrates significant improvements in knee function, with substantial increases in IKDC and Lysholm-Tegner scores from preoperative levels (p-value < 0.01), and effective restoration of knee stability, as shown by improved Lachman, Anterior Drawer, and Pivot Shift test results. Moreover, the peroneus longus graft had minimal impact on ankle morbidity, as indicated by consistent AOFAS scores before and after surgery. Conclusion The study highlights the peroneus longus tendon as a viable graft option for ACLR in symptomatic Indian female patients who were not active in sports, offering both mechanical strength and favorable functional outcomes without affecting the ankle strength or the function.

Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus.

To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color- or power-Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) of the lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power-Doppler examination. The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus.

Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot "form" was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. Level II, development of diagnostic criteria based on consecutive patients.

Specific-cytokine associations with outcomes in knee osteoarthritis subgroups: breaking down disease heterogeneity with phenotyping

BackgroundDespite existing extensive literature, a comprehensive and clinically relevant classification system for osteoarthritis (OA) has yet to be established. In this study, we aimed to further characterize four knee OA (KOA) inflammatory phenotypes (KOIP) recently proposed by our group, by identifying the inflammatory factors associated with KOA severity and progression in a phenotype-specific manner.MethodsWe performed an analysis within each of the previously defined four KOIP groups, to assess the association between KOA severity and progression and a panel of 13 cytokines evaluated in the plasma and synovial fluid of our cohort’s patients. The cohort included 168 symptomatic female KOA patients with persistent joint effusion.ResultsOverall, our analyses showed that associations with KOA outcomes were of higher magnitude within the KOIP groups than for the overall patient series (all p-values < 1.30e−16) and that several of the cytokines showed a KOIP-specific behaviour regarding their associations with KOA outcomes.ConclusionOur study adds further evidence supporting KOA as a multifaceted syndrome composed of multiple phenotypes with differing pathophysiological pathways, providing an explanation for inconsistencies between previous studies focussed on the role of cytokines in OA and the lack of translational results to date. Our findings also highlight the potential clinical benefits of accurately phenotyping KOA patients, including improved patient stratification, tailored therapies, and the discovery of novel treatments.

Understanding painful versus non-painful dental pain in female and male patients: A transcriptomic analysis of human biopsies.

Dental pain from apical periodontitis is an infection induced-orofacial pain condition that presents with diversity in pain phenotypes among patients. While 60% of patients with a full-blown disease present with the hallmark symptom of mechanical allodynia, nearly 40% of patients experience no pain. Furthermore, a sexual dichotomy exists, with females exhibiting lower mechanical thresholds under basal and diseased states. Finally, the prevalence of post-treatment pain refractory to commonly used analgesics ranges from 7-19% (∼2 million patients), which warrants a thorough investigation of the cellular changes occurring in different patient cohorts. We, therefore, conducted a transcriptomic assessment of periapical biopsies (peripheral diseased tissue) from patients with persistent apical periodontitis. Surgical biopsies from symptomatic male (SM), asymptomatic male (AM), symptomatic female (SF), and asymptomatic female (AF) patients were collected and processed for bulk RNA sequencing. Using strict selection criteria, our study found several unique differentially regulated genes (DEGs) between symptomatic and asymptomatic patients, as well as novel candidate genes between sexes within the same pain group. Specifically, we found the role of cells of the innate and adaptive immune system in mediating nociception in symptomatic patients and the role of genes involved in tissue homeostasis in potentially inhibiting nociception in asymptomatic patients. Furthermore, sex-related differences appear to be tightly regulated by macrophage activity, its secretome, and/or migration. Collectively, we present, for the first time, a comprehensive assessment of peripherally diseased human tissue after a microbial insult and shed important insights into the regulation of the trigeminal system in female and male patients.

Predicting the Outcome of a Pregnancy of Unknown Location: What Can the Endometrial Stripe Thickness Reveal?

Objective: To investigate the role of the uterine endometrial thickness and sonographic pattern as potential predictors for a pregnancy with an unknown location (PUL) and its possible outcomes. Materials and Methods: A convenient sample of 330 symptomatic extra preposition female patients were enrolled in this study with a diagnosis of PUL. The clinical variables of endometrial stripe thickness and endometrial sonographic pattern were determined with transvaginal sonography. These sonographic examinations (it seems that examination in this context is a countable noun) were conducted during the first 24 hours of referral, and their predictive values for PUL outcomes (normal intrauterine pregnancy (IUP), ectopic pregnancy (EP), and pregnancy loss) were assessed after clinical follow-up sessions provided a definite outcome. The statistical significance was set a priori at a P value &lt; .05. Results: The mean initial endometrial stripe thickness among participants, with a normal IUP, was more than those patients with an abnormal pregnancy outcome ( P &lt; .05). The optimum cut-off value for predicting a an EP, compared to a normal IUP was 11 mm and had a sensitivity of 73.3% and specificity of 39% ( P &lt; .001). These results also demonstrated no statistically significant relationship between the PUL outcome and the categories of endometrial sonographic pattern ( P = .15). Conclusion: In this large cohort of patients, the endometrial stripe thickness of more than 11 mm, among those who were symptomatic and deemed as PUL, had the potential to predict ectopic pregnancy as an unlikely diagnosis.

Evaluation of molecular testing for Mycoplasma genitalium for symptomatic women.

Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STI) with a capacity to rapidly develop antibiotic resistance. The aim of this work was to carry out an evaluation and descriptive analysis of routine molecular testing of M. genitalium in symptomatic women at the Rotunda Hospital, Dublin January 2018-December 2019. 1972 specimens were tested from1291 individual symptomatic female patients > 18years old. The median age was 29 (range 18-71). There were 10 confirmed positive specimens (0.77%); median patient age 26 (range 18-34); seven were obstetrics/gynaecology patients and three were attendees at a sexual assault treatment unit (SATU). The prevalence of positive cases in the ≥ 18 ≤ 30-year-old age group (n = 683) was six times that of the ≥ 30year-old age group (n = 608) at 1.3% versus 0.2%. Patient symptoms included: discharge in five (50%); pelvic pain on examination in five (50%); abdominal pain in two (20%); pelvic bleeding in two (20%); dyspareunia in two (20%) patients. Co-infections were present in three patients (30%). Macrolide resistance was detected in two positives (28.6%). This initial pilot study prompts the following recommendations which require further study and consideration: 1. promotion of M. genitalium status to notifiable disease; 2 widespread screening of female population not warranted; 3. M. genitalium testing for women symptomatic for STIs; 4. antibiotic resistance testing of all positive cases. 5. Further research into other potential risk groups.

Symptomatic Female Patients Have Higher Postoperative Complication Following Transcarotid Artery Revascularization (TCAR)

Disparities between male and female patients undergoing vascular surgery have been widely reported, particularly among endovascular procedures. It is hypothesized that this is due to differences in vessel diameter, but disparities in health care access may also contribute. Evidence surrounding the effects of sex on outcomes after carotid stenting has been conflicting, and few investigations have been specific to Transcarotid artery revascularization (TCAR). The purpose of this study is to compare in-hospital outcomes between male and female patients after TCAR.

Higher Long-term Mortality With Carotid Artery Stenting in Asymptomatic Male Compared to Female Patients in the Southeastern Vascular Study Group

Retrospective review of the Southeastern Vascular Study Group between January 2011 and December 2018 Of 8303 carotid endarterectomies (CEAs) and 1876 carotid artery stenting (CAS) procedures, slightly more than half of patients were asymptomatic in each group. Symptomatic patients had significantly higher rates of in-hospital neurologic events, myocardial infarction, and death after CEA and of neurologic events after CAS than asymptomatic patients. There was no difference in mortality among symptomatic and asymptomatic male and female patients at 3 years after CEA, but asymptomatic men had significantly higher 3-year mortality than women after CAS. Long-term mortality risk in asymptomatic men should be considered before offering CAS.

Higher Long-Term Mortality with Carotid Artery Stenting in Asymptomatic Male Compared with Female Patients in the Southeastern Vascular Study Group

To review the sex differences among symptomatic and asymptomatic patients treated with carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the Southeastern Vascular Study Group (SEVSG), a regional quality group of the Vascular Quality Initiative (VQI). All cases reported by the SEVSG members of symptomatic and asymptomatic patients were included in this retrospective review of CEA and CAS. Primary end point was 3-year survival difference between male and female patients. Secondary end points included in-hospital myocardial infarction (MI), transient ischemic attack (TIA)/stroke, and mortality differences between symptomatic and asymptomatic male and female patients. Cox proportional hazard regression was used to assess 3-year survival differences. There were 8,303 CEA and 1,876 CAS procedures performed in 29 centers from January 2011 to December 2018. From those, 4,650 (56.0%) and 938 (50.1%) were asymptomatic CEA and CAS, respectively. There were 2,760 (59.4%) male patients in the asymptomatic CEA and 597 (63.9%) in the asymptomatic CAS groups. After CEA, the rates of in-hospital MI (P=0.034), TIA/stroke (P<0.001), and death (P<0.001) were significantly higher in symptomatic patients. MIs were more frequent in females with asymptomatic disease (P=0.041). After CAS, the rate of TIA/stroke was higher in symptomatic patients (P=0.030). There were no differences according to sex in the CAS group. On follow-up, asymptomatic male patients treated with CAS had a higher 3-year all-cause mortality compared with their female counterparts (7.0% vs. 1.8%; P=0.015). On multivariable Cox regression analysis, male sex (HR=2.63 [95% CI=1.058-6.536]; P=0.038) and lower hemoglobin levels (HR=0.72 [95% CI=0.597-0.857]; P<0.001) were predictors of death in asymptomatic male patients treated with CAS. In our SEVSG region, postoperative MIs, TIA/stroke, and deaths were higher in symptomatic CEA patients. MIs were more frequent in asymptomatic CEA females. Postoperative TIA/stroke was more frequent in symptomatic CAS patients. After CAS, asymptomatic male patients had higher 3-year all-cause mortality than female patients. On multivariable Cox regression analysis, male sex and lower hemoglobin levels were predictors of death in these asymptomatic male patients treated with CAS. Long-term mortality risk in asymptomatic males should be considered before offering CAS. Further national VQI analysis of our asymptomatic and symptomatic male and female patients treated with CEA and CAS would be warranted.

Transcriptional Expression of the ompA, cpaf, tarp, and tox Genes of Chlamydia trachomatis Clinical Isolates at Different Stages of the Developmental Cycle.

The transcriptional gene expression patterns of Chlamydia trachomatis have mainly been studied using reference strains propagated in cultured cells. Here, using five low-passage-number C. trachomatis clinical isolates that originated from asymptomatic or symptomatic female patients, the in vitro expression of the ompA, cpaf, tarp, and tox genes was studied with reverse transcriptase real-time PCR during the chlamydial developmental cycle. We observed dissimilarities in the gene expression patterns between the low-passage-number clinical isolates and the reference strains. The expression of ompA and the peak of the tox expression were observed earlier in the reference strains than in most of the clinical isolates. The expression of cpaf was high in the reference strains compared with the clinical isolates at the mid-phase (6–24 hours post infection) of the developmental cycle. All of the strains had a rather similar tarp expression profile. Four out of five clinical isolates exhibited slower growth kinetics compared with the reference strains. The use of low-passage-number C. trachomatis clinical isolates instead of reference strains in the studies might better reflect the situation in human infection.

Use of a Novel Probiotic Formulation to Alleviate Lactose Intolerance Symptoms-a Pilot Study.

Lactose intolerance is a common condition caused by lactase deficiency and may result in symptoms of lactose malabsorption (bloating, flatulence, abdominal discomfort, and change in bowel habits). As current data is limited, the aim of our study was to assess the efficacy of probiotics with a β-galactosidase activity on symptoms of lactose malabsorption and on the lactose hydrogen breath test (LHBT). The study group comprised eight symptomatic female patients with a positive LHBT. Patients were treated for 6months with a probiotic formula with β-galactosidase activity (Bio-25, Ambrosia-SupHerb, Israel). All patients completed a demographic questionnaire as well as a diary for the assessment of symptom severity and frequency at entry, every 8weeks, and at the end of the treatment period. Measurements of hydrogen (H2) levels (parts per million, ppm) at each of these time points were also performed. End points were a decrease of 50% in symptom severity or frequency, and the normalization (decrease below cutoff point of 20ppm) of the breath test. Mean age and mean body mass index (BMI) were 36.4 ± 18.6years and 23.2kg/m2, respectively. Compared to baseline scores, the frequency of most symptoms, and the severity of bloating and flatulence, improved after treatment. Normalization of LHBT was obtained in only two patients (25%). In this pilot study, Bio-25, a unique formulation of probiotics with β-galactosidase activity, demonstrated symptom resolution in most patients with lactose malabsorption. A larger randomized trial is warranted to confirm these preliminary findings.

Trans-catheter ovarian vein coiling in management of symptomatic females having chronic pelvic congestion

Abstract Objectives To assess the technical success and short term clinical efficacy of trans-catheter ovarian vein coiling in the treatment of symptomatic pelvic congestion syndrome in women. Methods This study included 10 female patients having pelvic venous congestion treated by coiling and were followed up for 3 months between February 2016 and April 2017 at Ain Shams University hospital, Cairo, Egypt. Symptomatology of pelvic congestion syndrome that was documented either by transvaginal Doppler and/or by MRI with no response to conservative treatment. Results Symptoms successfully disappeared in 8 patients out of 10. Partial relief of symptoms in one patient that was then disappeared after another session. Only one patient showed no improvement. Conclusion Our study demonstrates high efficacy of ovarian vein coiling as a new technique in the treatment of symptomatic female patients with pelvic congestion syndrome.

The importance of routine screening for macroprolactin in symptomatic patients with idiopathic hyperprolactinemia

Objective: To evaluate the importance of screening for macroprolactin in symptomatic patients with apparent idiopathic hyperprolactinemia. Methods: During 20 months, the prevalence of macroprolactinemia was evaluated among consecutive symptomatic female patients with apparent idiopathic hyperprolactinemia routinely followed in two neuroendocrinology reference centers from Recife. This prevalence has never been systematically evaluated. Results: A total of 82 patients (mean age, 36.1±7.3 yrs; age range, from 25 to 50) were included; 69 of them (84.1%) had been treated with cabergoline. The screening for macroprolactin was positive in 22 patients (26.8%), 15 of whom (68.2%) misleadingly received longterm treatment with cabergoline. The clinicaland demographic features, as well as baseline prolactin levels, were comparable in patients with true idiopathic hyperprolactinemia and in those with macroprolactinemia. Conclusion: Macroprolactinemia was found in about one quarter of the patients with apparent idiopathic hyperprolactinemia. Our findings highlight the importance of routine screening for macroprolactin in all patients with idiopathic hyperprolactinemia, regardless their clinical features, in order to avoid misdiagnosis and unnecessary treatment with dopamine agonists.

Exercise Electrocardiogram Neither Predicts Nor Excludes Coronary Artery Disease in Women with Low to Intermediate Risk.

The value of exercise electrocardiogram (ExECG) in symptomatic female patients with low to intermediate risk for significant coronary artery disease (CAD) has been under debate for many years, and nondiagnostic or even erroneous test results are frequently encountered. Cardiac-CT may be more appropriate to exclude CAD in women. This study compares the results of ExECGs with those of cardiac-CTs, performed within a time frame of 1 month in an all-comers female chest pain population. Five hundred fifty-one consecutive female patients from a patient registry were included. ExECGs were negative in 324 (59%), positive in 14 (3%), and nondiagnostic in 213 (39%) patients. CAD was revealed by cardiac-CT in 57% of the women with negative ExECG. No signs of CAD were present on cardiac-CT in 64% of the women with a positive ExECG. Cardiac-CT showed presence of CAD in 268/551 (49%) patients, of whom 56/268 (21%) was diagnosed with ≥50% stenosis. The ExECG of the latter group was negative in 26 (46%), inconclusive in 29 (52%), and positive in 1 (2%). Considering ≥50% stenosis at cardiac-CT as the reference, sensitivity, specificity, PPV, and NPV of ExECG for the present population were 3.7%, 95.7%, 7.1%, and 91.7%, respectively. Similar diagnostic performance was calculated when considering ≥70% stenosis at cardiac-CT as the reference. ExECG failed to detect CAD in more than half of this cohort and in almost half of women with >50% stenosis at cardiac-CT. Importantly, no CAD was detected by cardiac-CT in 64% of women with a positive ExECG. ExECG is therefore questionable as a diagnostic strategy in women with low-to-intermediate risk of CAD, although prospective studies are warranted to determine whether replacing ExECG by cardiac-CT provides better prognoses.

Differential involvement of synovial adipokines in pain and physical function in female patients with knee osteoarthritis. A cross-sectional study.

Adipokines have been reported to play a role in the development, progression and severity of knee osteoarthritis but the influence of the different adipokines are not well known. The aim of this study was to evaluate the association between different synovial fluid adipokines with pain and disability knee osteoarthritis patients. Cross-sectional study with systematic inclusion of 115 symptomatic primary knee osteoarthritis female patients with ultrasound-confirmed joint effusion. Age, physical exercise, symptoms duration and different anthropometric measurements were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function scales. Seven adipokines and three inflammatory markers were measured by ELISA in synovial fluid. Partial Correlation Coefficient (PCC) and corresponding 95% confidence interval were used as a measure of association. Leptin, osteopontin and inflammatory factors, especially TNF-alpha, were associated to pain and function. After adjustment for potential confounders including inflammatory factors and all adipokines, an association was found for adiponectin with pain (PCC 0.240 [0.012, 0.444]) and for resistin and visfatin with function (PCC 0.336 [0.117, 0.524] and-0.262 [-0.463,-0.036]). No other adipokines or inflammatory markers were statistically and independently associated. An association between physical exercise and pain and disability remained after adjustment, whereas an attenuation of the influence of anthropometric measurements was observed. Different patterns of association between synovial fluid adipokines were observed regarding pain and disability in knee osteoarthritis patients. Specifically, adiponectin was associated to pain while resistin and visfatin were mainly related to function.

Osteitis condensans ilii may demonstrate bone marrow edema on sacroiliac joint magnetic resonance imaging.

To reveal whether bone marrow edema (BME) may appear with osteitis condensans ilii (OCI) on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) and to evaluate the characteristics of BME demonstrated with OCI. Altogether 27 symptomatic female OCI patients with both complete clinical records and SIJ-MRI examination data were enrolled for retrospective analysis. SIJ-MRI exams were retrospectively analyzed by two musculoskeletal radiologists. Patients were separated into BME group and non-BME group according to whether there was BME of SIJ demonstrated as high signal intensity on MR short tau inversion recovery sequences beneath the SIJ articular surface. For the BME group the characteristics of BME including distribution pattern and location, depth and signal intensity were assessed. BME could be seen in 48.1% (13/27) OCI patients. Ilium side BME demonstrated with OCI was centered at the ventral-cartilaginous joint part and had a trend of extending to bone marrow beneath the arcuate line in a continuous distribution pattern. There was a trend that OCI patients with BME demonstrated on MRI were younger (P = 0.054, Student's t-test) and with shorter pain duration (P = 0.091, Student's t-test) than OCI patients without BME, but the differences did not reaching statistical significance. More cases endured diagnosis delay in the BME group than the non-BME group (nine cases vs. two cases, P = 0.006, Fisher's exact test). Some OCI may demonstrate BME on SIJ-MRI. Careful observation of the location and distribution pattern of BME may give some help in differentiating OCI from early spondyloarthritis.

P114 Sensitivity and cost-effectiveness of trichomonas vaginalis naat (nucleic acid amplification) assay in symptomatic female patients attending a genitourinary medicine clinic

IntroductionTrichomonas vaginalis is the commonest curable sexually transmitted infection worldwide. Diagnosis is by detecting Trichomonas organisms or its DNA. Sensitivity of microscopy in females is 45–60%. Culture has a higher sensitivity than microscopy but molecular detection offers the highest sensitivity and is considered gold standard. We currently use only microscopy and this may lead to false negatives. This study assesses sensitivity and cost-effectiveness of TV NAAT assay compared with microscopy and acridine orange (AO) staining in symptomatic female patients.MethodsProspective study looking at symptomatic female patients attending sexual health clinic during the period from 05/10/2015 to 17/05/2016.Female patients with one or more of the following symptoms; vulval soreness, itchiness, ulceration or abnormal discharge were included. Wet microscopy was performed and dried slide was sent to the lab for AO staining. TV NAAT was added to the Chlamydia/Gonorrhoea dual testing swab.Results452 patients were included. Age ranged from 14–65 years. 31,18 and 8 patients had positive NAAT, microscopy and AO respectively. Considering NAAT as the gold standard; sensitivity, specificity, PPV and NPV of microscopy and AO was 48%, 100%, 100%, 95% and 28%, 100%, 100%, 94% respectively. 51.6% of the cases would have been missed if only the microscopy was used to diagnose TV.DiscussionOverall prevalence of TV positivity in our study population was 7.52%.Microscopy provided the advantage of rapid result but failed to identify half the positives.TV NAAT testing in carefully selected symptomatic women will be of value to provide better patient care.

Impact of deploying multiple point-of-care tests with a ‘sample first’ approach on a sexual health clinical care pathway. A service evaluation

ObjectivesTo assess clinical service value of STI point-of-care test (POCT) use in a ‘sample first’ clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were:...