Untreated Cases Research Articles

Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series.

Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%-15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20days) and a delay to diagnosis and treatment (mean 54days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.

Real-world evidence of treatment patterns and survival of metastatic gastric cancer patients in Germany

BackgroundPatients with metastatic gastric cancer (mGC) have poor prognosis. This real-world study aimed to describe treatment regimens and survival of mGC patients.MethodsA retrospective analysis was conducted using anonymized German claims data (AOK PLUS) covering a period from 2010 to 2021. The study population included newly diagnosed mGC cases identified from 2011 to 2020. The index date was defined as the first diagnosis of metastasis on or after gastric cancer diagnosis. Therapy regimens were identified based on inpatient and outpatient data, and subsequently stratified by line of treatment. Survival analyses were conducted using the Kaplan–Meier method.ResultsThe cohort consisted of 5,278 mGC incident cases (mean age: 72.7 years; male: 61.9%). Nearly half of the incident cases received mGC-related treatment (49.8%). Treated patients were more often male, younger, and had fewer comorbidities compared to untreated patients. Of the 2,629 mGC patients who started the first line of treatment (1LOT), 32.8% switched to 2LOT, and 10.2% reached 3LOT. Longer survival time was observed among disease-specific treated cases compared with untreated cases (median real-world overall survival (rwOS): 12.7 months [95%CI 12.1 – 13.3 months] vs. 3.7 months [95%CI 3.4 – 4.0 months]).ConclusionSystemic therapy was not received in almost half of the mGC patients. In those patients, a very short median rwOS was observed. Treatment patterns were generally in line with the guideline recommendations, however, therapy switching rates and poor prognosis indicate high unmet needs also in the treated population.

Trematode Granuloma: Journey of the Worm from the River Bed to the Agar Plate

Abstract Trematode granuloma has been reported as one of the common causes of infectious uveitis in paediatric age group in recent times in Tamil Nadu. These granulomas occur after exposure to the trematode-infested water resources. Studies from South India have established the cause of granuloma as trematode by histopathological and molecular diagnostics. The smaller granulomas responded to topical and oral steroids while larger lesions needed surgical excision. Untreated cases develop retro corneal membrane, cataract, glaucoma and even phthisis in the long run. Early identification and prompt treatment are needed to prevent visual morbidity in these children.

Cariprazine efficacy in a 40-year untreated case of a woman with predominantly negative symptoms of psychosis: A case report

IntroductionSeveral studies have demonstrated the unfavorable and neurotoxic effects of untreated psychosis (UP) on the brain. An estimated 10 to 12 cc of brain tissue could be potentially damaged due to neuroinflammation and oxidative stress when a first episode of psychosis goes untreated. Other studies have found a correlation between the duration of untreated psychosis (DUP) and treatment resistance or nonresponse. Evidence-based schizophrenia treatment mainly relies upon the use of first and second-generation antipsychotics, without solid evidence that the former is superior to the latter regarding the treatment of negative symptoms. Both groups, however, can come with a risk of side effects. Cariprazine, a third-generation antipsychotic, represents a safe and effective treatment, targeting both the positive and negative symptoms of schizophrenia.ObjectivesTo report a clinical case of a woman with an extreme DUP with predominantly negative symptoms of schizophrenia and highlight the favorable outcome cariprazine monotherapy had on her global functioning.Methods We report a clinical case of a 58-year-old woman with a history of a 40-year UP successfully treated with 4,5mg of cariprazine. The woman was brought involuntarily for psychiatric assessment at the emergency department with a clinical image of catatonic stupor and predominantly negative symptoms of psychosis. Her total PANSS score at admission was 129. The negative subscale score was 49. She was initially treated with 3mg cariprazine and 10mg olanzapine and was gradually left on 4,5mg cariprazine monotherapy with an adjunctive 30mg mirtazapine.ResultsThe patient was dismissed after 47 days of hospitalization. Cariprazine was effective in targeting both the cognitive and affective symptoms of long-standing UP. In the long-term, cariprazine also improved remnant delusional ideas of somatic and persecutory types, enhancing the patient’s social life, ensuring her support network, and assisting her integration into the community. The patient did not report any side effects, and her blood test results were within the normal range.Conclusions Not all cases of schizophrenia are dramatic at presentation - some can have a chronic and insidious course predominated by negative symptoms. UP can lead to disastrous consequences for the patient’s biopsychosocial well-being, leading to future treatment resistance and disability. Although such cases of untreated psychosis seem to be from the past, we should be conscious of their existence and treat them with a patient-personalized and symptom-centered approach. Cariprazine was successful and effective in treating this patient with a remarkable course of UP.Disclosure of InterestNone Declared

Management and Therapeutic Strategies for Spinal Muscular Atrophy

Spinal muscular atrophy is an autosomal recessive neuromuscular disorder characterized by progressive muscle weakness and atrophy. It is one of the most common single-gene disorders with an incidence rate of approximately 1 in 10,000 live births. The clinical manifestations are progressive hypotonia and muscle weakness due to the degeneration of alpha neurons in the anterior horn cells of the spinal cord and motor nuclei in the lower brain stem. Depending on the severity of the symptoms, SMA has five subtypes. Supportive measures can be offered for respiratory, gastrointestinal, and musculoskeletal complications. Carrier testing for all couples is recommended and this can be done by Multiplex Ligation-dependent Probe Amplification (MLPA). Prenatal diagnosis can be offered to carrier couples. Therapies must be given within the newborn period for maximum benefit and before the loss of motor neurons. It is achieved by identifying the SMA babies through Newborn screening. Several new FDA-approved drugs can reduce the progression of symptoms in SMA. However, they cannot offer a definite cure. Clinical follow-up and Neurological assessment demonstrate that SMA children can attain developmental milestones after receiving treatment, which is never normally attained in untreated cases. In utero SMA treatment with Zolgensma would enhance the survival rate and favorable neurological outcomes in the future. Base editing and Gene editing with CRISPR-Cas technologies to target the mutations and restore functional and stable SMN protein levels are the future hopes for a permanent cure of SMA.

Urinary schistosomiasis among female secondary school students in Ndokwa East Local Government Area in Delta State, Nigeria: Knowledge, risk factors and prevalence

x`Undiagnosed and untreated cases of urinary schistosomiasis in females usually lead to severe gynaecological complications, collectively known as Female Genital Schistosomiasis. Periodic assessment of schistosomiasis in vulnerable endemic communities will prevent late diagnosis and treatment. This study was conducted to determine the prevalence, knowledge, and risk factors of urinary schistosomiasis among female secondary school students in Ndokwa East Local Government Area, Delta State, Nigeria. A Cross-sectional research design and multi-stage sampling technique were used to select 401 female secondary school students in the Ndokwa East Local Government Area. Participants’ urine samples were obtained and examined for Schistosoma haematobium eggs. A questionnaire was administered to collect information on the knowledge of schistosomiasis and exposure to known schistosomiasis risk factors from each participant. Urinary schistosomiasis was not detected in any of the analysed samples. Most students were uneducated (8% had good knowledge) regarding the infection. The absence of egg- patent prevalence in the samples may be due to mass administration of praziquantel to control the disease in the LGA. Knowledge about the disease was low. None of the independent variables was a significant predictor of knowledge about urinary schistosomiasis.

Paroxysmal nocturnal hemoglobinuria–related thrombosis in the era of novel therapies: a 2043-patient-year analysis

AbstractThrombophilia is one of the principal features of paroxysmal nocturnal hemoglobinuria (PNH) and constitutes the main cause of disease morbidity/mortality. Anticomplement treatment has revolutionized the natural history of PNH, with control of the hemolytic process and abolition of thrombotic events (TEs). However, no guidelines exist for the management of thromboembolic complications in this setting, with type and duration of anticoagulation depending on individual practices. Besides, a scarcity of data is present on the efficacy of direct oral anticoagulants (DOACs). Herein, we accrued a large real-world cohort of patients with PNH from 4 US centers to explore features, predictors of TE, and anticoagulation strategies. Among 267 patients followed up for a total of 2043 patient-years, 56 (21%) developed TEs. These occurred at disease onset in 43% of cases, involving more frequently the venous system, typically as Budd-Chiari syndrome. Rate of TEs was halved in patients receiving complement inhibitors (21 vs 40 TEs per 1000 patient-years in untreated cases, with a 2-year cumulative incidence of thrombosis of 3.9% vs 18.3%, respectively), and varied according to PNH granulocytes and erythrocytes clone size, type, disease activity parameters, as well as number (≥2 mutations, or less) and variant allelic frequency of PIGA mutations. Anticoagulation with warfarin (39%), DOACs (37%), and low-molecular weight heparin (16%) was administered for a median of 29 months (interquartile range [IQR], 9-61.8). No thrombotic recurrence was observed in 19 patients treated with DOACs at a median observation of 17.1 months (IQR, 8.9-45) whereas 14 cases discontinued anticoagulation without TE recurrence at a median time of 51.4 months (IQR, 29.9-86.8).

Recurrent Hemoptysis Post Re-Embolization in a 49 Year-Old Male with Post Tuberculosis Lung Disease (PTLD) and Bronchiectasis

Introduction: Hemoptysis is a symptom of lung disease, could be caused by lung infections, structural disorders of the lung, malignancy or disorders from outside of the lung. One of the pulmonary intervention for hemoptysis is embolization with a success rate > 70%, but the recurrence rate reaches 10-55%. The prognosis is poor depending on the amount of bleeding (untreated cases can have a mortality risk of over 50%), etiology and presence of recurrences.
 Case Illustration: A 49-year-old Male came to the policlinic with recurrent hemoptysis for a year. Non-smoker. History of Lung Tuberculosis (TB), completed treatment 15 years ago. Imaging result showed widening of the right subcostal artery, right posterior intercostal artery, bronchiectasis, active lung tuberculosis and left pulmonary emphysema. First embolization was done during Anti-Tuberculosis Drug (ATD) treatment for 6 months. Symptom of hemoptysis reappeared, then second embolization and fiber optic bronchoscopy (FOB) was performed. From the evaluation, he was diagnosed with infected bronchiectasis and PTLD, therefore given antibiotic medications for 2 weeks.
 Discussion: Embolization had been done twice in this case, no significant result. Based on literature, recurrent hemoptysis can still occur with a percentage about 10-55% after embolization and in this case, it might be caused by previous lung structural disorder and lung infections (Lung TB and Infected bronchiectasis).
 Conclusion: Although embolization has a success rate of > 70% for hemoptysis treatment, recurrence can still occur and highly dependent on the cause itself and patient's previous lung condition.
 Keywords: Hemoptysis, Embolization, Bronchiectasis, FOB, Lung TB, PTLD, ATD

The amelioration effect of antidiabetic agents on cytokine expression in patients with type 2 diabetes mellitus

Inflammation is a condition that is closely linked to diabetes mellitus type 2 (T2DM), short for T2DM several different antidiabetic medications have been produced to regulate hyperglycemia, with indications that these therapies may have anti-inflammatory effects along with their glucose-lowering efficacy. Thus, this research was planned to explore the impact of antidiabetic agents on the cytokine expression levels —interleukin (IL)-1β, IL-6, IL-17, and IL-37 when patients have T2DM.In this study, 168 eligible subject matter was split into two groups: 50 healthy individuals and 118 cases with T2DM, who were classified into two subgroups: 30 untreated patients and 88 patients treated with metformin-based therapy.The outcome exhibited a significant increase within HbA1c% and proinflammatory cytokines (i.e., IL-1β, IL- 6, and IL-17), whereas IL-37 decreased considerably in untreated cases with T2DM compared to those in subjects who are healthy. Furthermore, the results showed increased levels Regarding waist size, body mass index and assessment using that homeostasis model, cholesterol, triglycerides, low-density lipoprotein levels, and heart danger elements in untreated cases with T2DM in comparison with hygienic subjects. Notably, treated patients with T2DM revealed an ameliorative impact on HbA1c, IL-6, IL-17, IL-37, IL-1β levels and lipid profile compared with untreated patients with T2DM.Antidiabetic agents may have a beneficial activity on the inflammatory status by reducing blood glucose levels, hyperlipidemia, and proinflammatory cytokines. The anti-inflammatory activity of IL-37 can apply a potentially effective therapeutic goal in treating T2DM and its complications.

Prediction of coronary artery lesions in children with Kawasaki syndrome based on machine learning

ObjectiveKawasaki syndrome (KS) is an acute vasculitis that affects children < 5 years of age and leads to coronary artery lesions (CAL) in about 20-25% of untreated cases. Machine learning (ML) is a branch of artificial intelligence (AI) that integrates complex data sets on a large scale and uses huge data to predict future events. The purpose of the present study was to use ML to present the model for early risk assessment of CAL in children with KS by different algorithms.MethodsA total of 158 children were enrolled from Women and Children’s Hospital, Qingdao University, and divided into 70–30% as the training sets and the test sets for modeling and validation studies. There are several classifiers are constructed for models including the random forest (RF), the logistic regression (LR), and the eXtreme Gradient Boosting (XGBoost). Data preprocessing is analyzed before applying the classifiers to modeling. To avoid the problem of overfitting, the 5-fold cross validation method was used throughout all the data.ResultsThe area under the curve (AUC) of the RF model was 0.925 according to the validation of the test set. The average accuracy was 0.930 (95% CI, 0.905 to 0.956). The AUC of the LG model was 0.888 and the average accuracy was 0.893 (95% CI, 0,837 to 0.950). The AUC of the XGBoost model was 0.879 and the average accuracy was 0.935 (95% CI, 0.891 to 0.980).ConclusionThe RF algorithm was used in the present study to construct a prediction model for CAL effectively, with an accuracy of 0.930 and AUC of 0.925. The novel model established by ML may help guide clinicians in the initial decision to make a more aggressive initial anti-inflammatory therapy. Due to the limitations of external validation and regional population characteristics, additional research is required to initiate a further application in the clinic.

Clinical characteristics and outcome of genitourinary tuberculosis in Balochistan: An observational study.

Objective: To make aware that the healthcare professionals should diagnose GUTB as early as possible to avoid the grave side effects of untreated cases as it can lead to the gross structural abnormalities in the Genito urinary system. Study Design: Single Center Observational study. Setting: Tertiary Care Medicine Unit in Baluchistan, in BMCH Teaching Hospital. Period: 1st January 2012 to 31st Dec 2022. Material &amp; Methods: Total 118 patients were enrolled in the research and patients were taken a detailed history, they went through physical examination, then they went they underwent through different diagnostic modalities as per the availability in indications. The diagnosed cases were treated and the follow up was done the mean duration for the follow up was around two years. Results: All individuals received interventions primarily involving anti-tuberculosis medications. Three patients had bilateral fallopian tubes obstruction who went under laparoscopy and later on 1 couple opted for IVF, for infertility. Anti-TB drug therapy resulted in severe adverse reactions in 8 individuals. Among them, two female patients experienced the formation of a thimble bladder accompanied by incapacitating storage symptoms. Additionally, at the time of diagnosis, 4 patients exhibited impaired renal functions, which, fortunately, remained unaltered following the completion of the prescribed treatment. None of our patients went into ESRD, and no death during study was reported due to GUTB. Conclusion: It was concluded in our study that Genito urinary tuberculosis being the second commonest type of extrapulmonary tuberculosis is also common in Baluchistan and it needs to be treated and diagnosed and treated as soon as possible, we also suggest that if the expert diagnostic modalities for the diagnosis of GUTB are not available even the clinical suspicion can be used to diagnose the case and start the treatment.

Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases.

Perivascular spaces (PVSs) are spaces in brain parenchyma filled with interstitial fluid surrounding small cerebral vessels. Massive enlargements of PVSs are referred to as "giant tumefactive perivascular spaces" (GTPVSs), which can be classified into three types depending on their localization. These lesions are rare, predominantly asymptomatic, and often initially misinterpreted as cystic tumor formations. However, there are several reported cases in which GTPVSs have induced neurological symptoms because of their size, mass effect, and location, ultimately leading to obstructive hydrocephalus necessitating neurosurgical intervention. Presented here are three diverse clinical presentations of GTPVS. Here, the authors observed an asymptomatic case of type 1 GTPVS and two symptomatic cases of type 3 GTPVS, one causing local mass effect and the other hydrocephalus. GTPVSs are mostly asymptomatic lesions. Patients without symptoms should be closely monitored, and biopsy is discouraged. Hydrocephalus resulting from GTPVS necessitates surgical intervention. In these cases, third ventriculostomy, shunt implantation, or direct cyst fenestration are surgical options. For patients presenting with symptoms from localized mass effect, a thorough evaluation for potential neurosurgical intervention is imperative. Follow-up in type 3 GTPVS is recommended, particularly in untreated cases. Given the infrequency of GTPVS, definitive guidelines for neurosurgical treatment and subsequent follow-up remain elusive.

Increased percentage of HLA-DR T cells in untreated juvenile dermatomyositis

This study investigates HLA-DR expression on activated T cells and serum neopterin levels in Juvenile Dermatomyositis (JDM) children pre- and post-treatment. Sixty-nine JDM children (less than 18 years) were included. Elevated HLA-DR+ T cells (>7 %) were observed in 19 % of untreated cases. Post-treatment, mean HLA-DR+ T cells decreased from 5.1 to 2.9 (P < 0.001), and serum neopterin levels declined from 19.3 to 9.1 nmol/L (P < 0.0001). A positive correlation between serum neopterin and HLA-DR T cell percentage was observed (r = 0.39, P = 0.01). Intravenous steroid treatment exhibited a 47.4 % improvement in HLA-DR+ T cells and a 50.5 % reduction in serum neopterin levels, in contrast to 14.8 % and 34.1 % in the oral steroid group. In conclusion, treatment, particularly with IV steroids, significantly improved HLA-DR+ T cells percentage and neopterin levels. A correlation between HLA-DR+ T cells percentage and serum neopterin was noted in untreated JDM patients.

Spontaneous tension pneumothorax: a devastating consequence of pulmonary tuberculosis

Tuberculosis (TB) was the world’s second leading cause of death from a single infectious agent, with mortality reaching 50% in untreated cases. It has been acknowledged as a potential cause of secondary spontaneous pneumothorax. A 57-year-old male presented to emergency department due to shortness of breath since 12 hours before admission. He had a history of chronic cough along with significant weight loss. He was cachexic and fully alert, with normal blood pressure, tachypnea, and slight tachycardia. Decreased breath sounds on the right hemithorax was noted. Chest x-ray revealed right tension pneumothorax and active pulmonary TB. Emergency needle decompression was performed with 14-gauge intravenous catheter. Unfortunately, he died eight hours later following a cardiac arrest. Occurrence of spontaneous tension pneumothorax in TB involves several mechanisms such as pleural porosity, chronic inflammation, and alveolar rupture. Compensatory mechanisms including gradual tachycardia, respiratory rate elevation, along with increasingly negative contralateral intrathoracic pressures could preserve venous return, serving as protective factors against hypotension until the late stages. Late presentation of 12 hours after the first onset might contribute to enormous air leak that could not be effectively managed by needle decompression. Undiagnosed and untreated TB could lead to morbid consequence such as tension pneumothorax, highlighting the importance of TB detection within the community. Clinicians should be aware of variations in the clinical presentation of tension pneumothorax as compensatory mechanisms may hinder the diagnosis at initial presentation. Strategic approaches are imperative to reinforce our commitment to eliminate TB by 2030.

A Narrative Review of the Advances in Screening Methods for Diabetic Retinopathy: Enhancing Early Detection and Vision Preservation.

Diabetes mellitus (DM) is putting a great burden worldwide.This rise in DM cases, both type 1 and 2, significantly impacts public health.India hasgrappled with a diabetes epidemic for several years, leading to many misdiagnosed and untreated diabetes cases. Diabetes remains a significant factor in adult-onset blindness despite improvements in diabetes management.This increases the danger of diabetic retinopathy (DR) with permanent loss of sight for those affected. The screening for DR aims to identify those persons with complications arising from diabetes or DR, which could potentially result in blindness, so that treatment can be started immediately and blindness can be avoided. A comprehensive health system approach is required to ensure that the public sector in India effectively screens for DR. Improving patient outcomes and avoiding visual loss depends significantly on early identification and treatment. This article discusses the actions that should be implemented to establish a national effort for systematic DR screening. It also highlights the importance of screening in DR and its impact on treatment effectiveness. Regular screenings enable the early detection of retinopathy, allowing for timely intervention and treatment. Earlyscreening helps prevent complications associated with DR, such as macular edema or retinal detachment. Screening also assists healthcare providers in planning, optimizing treatment approaches, and monitoring treatment effectiveness. Meanwhile, early interventionis essential for enhancing treatment outcomes, thus enhancingthe chances of preserving vision and preventing further progression of the disease. This helps inimproving the overall management of this sight-threatening complication.

Prevalence of Diabetic Retinopathy Among Individuals with Diabetes in Gulf Cooperation Council countries: A Systematic Review and Meta-analysis.

To determine the proportion of diabetic retinopathy (DR) among individuals with diabetes mellitus in the Gulf Cooperation Council (GCC) countries. This study was executed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Online databases including Scopus, Web of Sciences, PubMed, Index Medicus for the eastern Mediterranean region, Medline, and ProQuest, were utilized to retrieve studies on the prevalence of DR in GCC countries that were conducted from 2003 to 2019. Twenty articles were included in the meta-analysis, involving 61 855 patients. The prevalence of DR was 20.5% (95% CI: 20.212-20.850). The highest prevalence rate was observed in Saudi Arabia (69.8%; 95% CI: 64.989-74.216) and the lowest in the UAE (6.0%; 95% CI: 2.780-11.084). There was a significant heterogeneity between the reviewed studies (p < 0.001). The prevalence of DR was high in the GCC countries. Our findings provide crucial information for the public healthcare systems in these countries to actively educate the public and screen at-risk populations for undiagnosed cases of diabetes, detect early stages of retinopathy, and provide required care to minimize the number of untreated cases.

A Case Report on Avascular Necrosis of Right Femoral Head in a 20-years Old Male

Avascular necrosis of the femoral head is a condition which causes cellular destruction of bone material due to interruption of blood supply. Necrosis is caused by inadequate blood supply, resulting in bone tissue destruction with collapsing of that segment. The disease usually occurs in young adults, and femoral head is one of the commonest sites. Avascular necrosis may be traumatic or non-traumatic and causes major musculoskeletal disability. Initially patients remain asymptomatic. In untreated cases the disease progresses and causes joint destruction, requiring surgical intervention and in later stages need total hip replacement. Plain X-ray, isotope bone scan and magnetic resonance imaging (MRI) play important role in making the diagnosis. MRI is highly accurate method for the diagnosis of avascular necrosis of the femoral head.

Intranasal delivery of LaAg vaccine improves immunity of aged mice against visceral Leishmaniasis

There are no approved vaccines yet for human visceral leishmaniasis (VL), the most severe form of the leishmaniasis clinical manifestations that is fatal in over 95 % of untreated cases. It is well-accepted that immunological changes during aging have deleterious impact on the efficacy of vaccines and response to infections. In this work, we compared the response of young and aged mice to intranasal vaccination with killed Leishmania amazonensis promastigote antigens (LaAg) that were then challenged with L. infantum infection, a species that causes visceral leishmaniasis. Intranasal vaccination with LaAg induced a similar reduction in parasitism and hepatosplenomegaly in both young and aged mice compared to their unvaccinated counterparts. Following infection, there was also a less prominent inflammatory profile particularly in the vaccinated aged group, with lower production of TNF-α and nitrite compared to the respective unvaccinated group. Interestingly, the LaAg intranasal vaccination promoted increased production of IFN-γ that was observed in both young- and aged vaccinated groups. Additionally, CD4+ and CD8+T cells from both vaccinated groups presented decreased expression of the inhibitory receptors PD-1 and KLRG1 compared to their unvaccinated controls. Interestingly, a strong positive correlation was observed between the expression of both inhibitory receptors PD-1 and KLRG1 and parasitism, which was more conspicuous in the unvaccinated-aged mice than in the others. Overall, this study helps define new strategies to improve vaccine effectiveness and provides a perspective for prophylactic alternatives against leishmaniasis.

Esophageal cancer in Hispanics: A propensity score matched analysis of the National Cancer Database.

258 Background: Hispanics are the fastest-growing minority and largest ethnic group accounting for 19.1% of the US population. The American Cancer Society estimated 21,560 new cases of esophageal cancer (EC) in the US in 2023. Hispanics are reported to be at high risks for EC. We sought to interrogate the demographic patterns of esophageal cancer in Hispanics. Additionally, we sought to examine evidence of socioeconomic disparities and differential therapy. Methods: We identified Hispanic vs Non-Hispanic (NH) patients in the National Cancer Database with esophageal cancer between 2005–2018. Variables compared were age, sex, tumor data, surgical intervention, type of treatment, insurance status, income, residence area, and Charlson/Deyo score. Pearson’s Chi-square test was used to compare categorical variables. Groups were statically equated with propensity score-matched analysis (PSM). Survival analysis was estimated by the Kaplan-Meier method and associated log-rank test. Significance was considered at p-value ≤0.05. Results: We identified 66,335 patients with a median age of 63 years (18-90). Hispanics represented 4.2% (2,786) of the entire patient cohort. In this US population we identified significant disparities between Hispanic and NH groups. Differences among Hispanics included higher prevalence of squamous EC (22% vs 19%) p&lt;0.001, higher likelihood of stage IV disease (40.7% vs. 34.8%) p&lt;0.001, younger age p&lt;0.001, higher uninsured status (10.3% vs 3.3%) with income &lt; $40,227 (27.5% vs 16.9%) p&lt;0.001 when compared to NH. However, Hispanics were less likely to have surgical intervention (20.5% vs 27.5%) p&lt;0.001, receive neoadjuvant therapy (61.8% vs 72%) and overall, less likely to receive any type of treatment (30.1% vs 26.1%) when compared to NH p&lt;0.001. Time to treatment was delayed in those Hispanics who were uninsured 37 weeks (22-55) compared to those with private insurance 31 weeks (20-47) p&lt;0.001. Multivariate analysis revealed that any treatment, insurance status, and lower income were all predictors of survival. Treated Hispanics demonstrated no difference in survival then their treated non-Hispanic counterparts (median survival 18.5 vs 18.7 months) with overall 5 year survival at 24% and 25% respectively (p=0.66). Conclusions: Despite lower prevalence, there is a disproportionately higher number of metastatic and untreated cases of esophageal cancer among Hispanics. This disparity may be explained by Hispanics' limited access to medical care exacerbated by their socioeconomic and insurance status. Our findings warrant further clinical and epidemiologic research to reveal other factors impacting these health and health care disparities.

Characteristic Profiling of Soluble Factors in the Cerebrospinal Fluid of Patients With Neurosyphilis.

Soluble inflammatory factors in the cerebrospinal fluid (CSF) of patients with neurosyphilis have been investigated with low-throughput technology. This study aimed to illustrate the characteristics of soluble factor profiles in CSF of patients with neurosyphilis. We measured the concentrations of 45 cytokines, chemokines, and growth factors in CSF from 112 untreated syphilis cases, including latent syphilis (LS), asymptomatic neurosyphilis (ANS), meningeal neurosyphilis (MNS), meningovascular neurosyphilis (MVNS), paralytic dementia (PD), and ocular syphilis (OS). Thirty-three differentially expressed soluble factors (DeSFs) were categorized into 3 clusters. DeSF scores of clusters 1 and 2 (DeSFS1 and DeSFS2) were positively correlated with elevated neopterin and neurofilament light subunit (NF-L) concentration, respectively. DeSF scores of cluster 3 were positively correlated with white blood cells, protein, NF-L, and neopterin. Patients with LS, ANS, and OS exhibited an overall lower abundance of DeSFs. Patients with PD exhibited significantly increased levels of clusters 1 and 3, and the highest total DeSF score, whereas patients with MNS and MVNS showed enhanced levels of cluster 2. Receiver operating characteristic analysis revealed that DeSFS1 effectively discriminated PD, and DeSFS2 discriminated MNS/MVNS with high accuracy. Patients with neurosyphilis at different stages have distinctive patterns of soluble factors in CSF, which are correlated with immune status and neuronal damage.