Using Ultrasound Guided Needle Biopsy in Combination With GeneXpert MTB/RIF to Diagnose Epididymal Tuberculosis: a Study of 12 Cases

Objective: This study aims to investigate the diagnostic utility of percutaneous ultrasound-guided needle biopsy in combination with GeneXpert MTB/RIF for epididymal tuberculosis.Methods: Between March 2019 to March 2021, specimens obtained from 12 patients with confirmed epididymal tuberculosis by ultrasound guided needle biopsy were sent for pathology and laboratory examination at the Shandong Public Health Clinical Center. The laboratory examination included acid-fast staining, Mycobacterium tuberculosis culture by BACTEC MGIT 960, and the GeneXpert MTB/RIF test. The diagnosis and complications were comprehensively analyzed.Results: Among the 12 cases, seven cases had granulomatous inflammation and necrotic tissue, four cases had chronic inflammatory cells and necrotic tissue, and one case had chronic inflammatory cell infiltration. Furthermore, among the 12 patients, five patients were positive for Mycobacterium tuberculosis culture, two patients were positive for the acid-fast staining, and twelve patients were positive for the GeneXpert MTB/RIF assay. The sensitivity and specificity of the acid-fast staining, Mycobacterium tuberculosis culture and GeneXpert MTB/RIF in the diagnosis of epididymis tuberculosis were 16.67% and 100.00%, 41.67% and 100.00%, and 100.00% and 50.00%, respectively. The diagnostic value analysis of the three detection techniques indicated that the GeneXpert MTB/RIF technique (Kappa=0.63, AUC=0.75) is superior to the Mycobacterium tuberculosis culture (Kappa=0.17, AUC =0.71) and acid-fast staining (Kappa=0.05, AUC=0.58). Conclusion: Ultrasound guided percutaneous biopsy combined with GeneXpert MTB/RIF assay is extremely useful for diagnosing epididymitis tuberculosis and determining rifampin resistance, with superior sensitivity, specificity and AUC value.

Prostate disorders diagnosis and management review with an osteopathic component

Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.

Pregnancy loss after overcoming the sterility with methods of auxiliary reproductive technologies

Miscarriage is a serious problem of pregnancies resulting from overcoming infertility using assisted reproductive technologies (ART). The overall frequency of losses due to miscarriages of various periods and non-developing pregnancies reaches 30-35%. In order to optimize the outcomes of pregnancies resulting from ART, we have developed a special program that includes activities that are carried out at various stages, including at the stage of preparation for ART. In accordance with this program, all women in the period of preparation for the procedure undergo a full clinical and laboratory examination, including the consultation of a therapist, and, if indicated, other specialists (endocrinologist, ophthalmologist, etc.) in order to identify and correct concomitant diseases that can have an unfavorable influence on the course of pregnancy and childbirth.

Comprehensive analysis of the laboratory examination results of patients with an established bronchial asthma diagnosis

Relevance. Bronchial asthma is a serious medical and social problem. To confirm the diagnosis, it is necessary to assess the allergic status, to determine the biological markers of the disease. Of particular relevance is a comprehensive analysis of the results of laboratory examination of patients, including data from hematological, immunological, microbiological studies. Aim. To study some laboratory parameters (hematological, immunological and microbiological), the changes of which are most typical for patients with an established diagnosis of bronchial asthma. Matherials and Methods . A clinical and diagnostic examination of women in the non-production and industrial sectors with an established diagnosis of bronchial asthma, performed during a periodic medical examination, was carried out. Results and Discussion . Laboratory research has shown that hematological parameters are characterized by a reduced content of hemoglobin, erythrocyte indices MCV, MCH, MCHS - markers of hypochromia. The surveyed women had increased indices: eosinophils, immunoglobulin E, allergy index, leukocyte intoxication index. High rates of allergization are found in the production sector in 41,51%, in the non-production sector - in 44,44%, which indicates a serious sensitization of the body. Bacterial contamination in the examined groups is represented by coccal flora, where the most significant microorganisms are Staphylococcus aureus, Staphylococcus spp, Streptococcus pyogenes and Candida albicans. Conclusion . The results of the analysis indicate the need to conduct and study further research on the development of markers of early, prenosological health disorders in the process of screening examination of large groups of the working population.

Combination Therapy with Rituximab, Tofacitinib and Pirfenidone in a Patient with Rapid Progressive Interstitial Lung Disease (RP-ILD) Due to MDA5 Antibody-Associated Dermatomyositis: A Case Report

Anti-melanoma differentiation-associated protein 5 (MDA5)-positive rapidly progressive interstitial lung disease (RP-ILD) is associated with poor prognosis, and the most effective therapeutic intervention has not been established. Herein we report a case of a 45-year-old female patient who presented with myalgia, Gottron’s papules with ulceration, and dyspnea on exertion which became aggravated within weeks. Laboratory examination and electromyography confirmed myopathy changes, and a survey of myositis-specific antibodies was strongly positive for anti-MDA5 antibody. High-resolution chest tomography suggested organizing pneumonia with rapidly progressive changes within the first month after diagnosis of the disease. Anti-MDA5-associated dermatomyositis with RP-ILD was diagnosed. Following combination therapy with rituximab, tofacitinib and pirfenidone, clinical symptoms, including cutaneous manifestation, respiratory conditions and radiographic changes, showed significant and sustainable improvement. To our knowledge, this is the first reported case of anti-MDA5-associated dermatomyositis with RP-ILD successfully treated with the combination of rituximab, tofacitinib, and pirfenidone.

Herbicide Intoxication: Still A Threat in Developing Countries

The critically ill patient has severe respiratory, cardiovascular or neurological disorder often in combination. The critically ill patient needs intensive care unit (ICU) admission and strict monitoring. Intoxication commonly experienced in a critically ill patient in ICU and can complicate management. In developing countries, poisoning of herbicide still common and used for suicide attempts. Herbicides such as paraquat and glyphosate are often used because of their availability. Paraquat and glyphosate have high mortality rate primarily as a suicide attempt agent in developing countries. The primary target for paraquat toxicity is in the lung and can cause lung fibrosis. Severe glyphosate intoxication can cause dehydration, hypotension, pneumonitis, oliguria, loss of consciousness, liver dysfunction, acidosis, hyperkalemia and dysrhythmia. Diagnosis for herbicide intoxication needs a history of herbicide ingestion, physical examination and laboratory examination. Stabilisation and supportive therapy is the only choice, and there is still no specific treatment for herbicide intoxication. The intoxication of herbicide particular critically ill patient because there is still no such specific treatment for these.

Vitamin D metabolite and calcium phosphorus metabolism in in patients with primary hyperparathyroidism on the background of bolus therapy with colecalciferol

BACKGROUND: Vitamin D (25-hydroxyvitamin D [25(ОН)D]) deficiency (<20 ng/mL) and insufficiency (20–29 ng/mL) are common in primary hyperparathyroidism (PHPT), but data regarding the vitamin D metabolism in this population is limited.AIM: The aim of this study is to estimate the vitamin D metabolites and their relationship with the main parameters of phosphorus-calcium metabolism in patients with PHPT at baseline and on the background of a single dose of cholecalciferol 150,000 IU.MATERIALS AND METHODS: A single-center interventional, dynamic, prospective, comparative study has been carried out. The study included 54 participants, divided into two groups: the 1st group included 27 patients with confirmed PHPT, the 2nd control group (n = 27), matched on gender (p = 0.062). The study included 4 visits; the baseline laboratory examination and a bolus dose of cholecalciferol were performed at the visit 1, the subsequent visits included a dynamic laboratory examination.RESULTS: Vitamin D deficiency (<20 ng/ml) was detected in 69% of patients with PHPT. In the PHPT group (before cholecalciferol therapy), there was a direct association of 1.25(OH)2 D3 with albumin-corrected and ionized calcium, as well as between the 25(OH)D3 /24.25(OH)2 D3 ratio with PTH and magnesium. After taking of cholecalciferol, the levels of 1.25(OH)2 D3 and 25(OH)D3 /24.25(OH)2 D3 were significantly increased, and the levels of 25(OH)D3 /1.25(OH)2 D3 were significantly declined at all visits among patients with PHPT. The common 25(OH)D level was comparable to the control group, however the levels of 1,25(OH)2 D3 in patients with PHPT were 55% higher at baseline, and after taking of cholecalciferol 150,000 IU. They remained increased by 3–7 days by an additional 23–36%, significantly higher than those in the control group: 44%, 74% and 65%, at visits 2, 3 and 4, respectively (p<0.05). The taking of 150,000 IU cholecalciferol in the PHPT group did not lead to a significant increase in hypercalcemia and hypercalciuria, which indicates the safety of this dose in patients with mild hypercalcemia (albumin corrected calcium <3 mmol/l). None of the study participants experienced any side effects.CONCLUSION: The completely comprehensive assessment of vitamin D metabolites was carried out for the first time in patients with PHPT before and after using a bolus dose of cholecalciferol. The results confirmed the differences of vitamin D metabolism in chronic excessive secretion of PTH compared to control group, which is new data in the pathogenesis of the disease, and can be used to develop optimal regimens for cholecalciferol taking in this population.

Evaluate the Distribution of Heavy Elements that Dissolved in Ground Water Using IDW in AL-Wafa City, Al-Ramadi,Iraq

Groundwater can be assessed by studying water wells. This study was conducted in Al-Wafa District, Anbar Governorate, Iraq. The water samples were collected from 24 different wells in the study area, in January 2021. A laboratory examination of the samples was conducted. Geographical information systems technique was relied on to determine the values of polluting elements in the wells. The chemical elements that were measured were [cadmium, lead, cobalt and chromium]. The output of this research were planned to be spatial maps that show the distribution of the elements with respect to their concentrations. The results show a variation in the heavy elements concentrations at the studied area groundwater. The samples show different values of concentrations; for Cadmium (0.218-1.624) ppm, Lead (0.217-1.157) ppm, Cobalt (0.014-0156) ppm, and for Chromium (0.045-0263) ppm. The distribution of the materials concentrations differs for each element which is refer to the sources of pollution are not relate to industry, but it could be relate to fertilization.

Possibilities of predicting lesions of the hepatobiliary system in children with community-acquired pneumonia

Annotation. The prognostic criteria of complications of community-acquired pneumonia and the possibility of developing disorders of the hepatobiliary system (HBS) depending on the concentration in the serum of the secretory leukocyte protease inhibitor (SLPI) were studied. The data of clinical and laboratory examination of 338 children with community-acquired pneumonia aged from one to three years were analyzed. Statistical processing of the results was performed using the system “IBM SPSS Statistica” 12 using parametric and non-parametric methods. It was found that in young children with pneumonia in the serum increases the concentration of SLPI, the level of which depends on the course and severity of pneumonia. It has been shown that the development of lobar pneumonia is significantly higher in patients from the SLPI cohort IV quartile (OR – 1.986, 95% CI – 1.864-2.356), compared with children from the cohort SLPI II and III quartile (OR – 0.476, 95% CI – 0.405- 0.559, OR – 0.494, 95% CI – 10.423-0.576, respectively). At the same time, at the values of SLPI at the level of III-IV quartile (OR – 1.923, 95% CI – 1.457-1.866) there is the development of community-acquired pneumonia. It was found that the development of pathological processes in the organs of HBS is associated with increased levels of SLPI. Thus, patients with polysegmental pneumonia and SLPI III/IV quartile (OR – 2.190, 95% CI – 1.810-2,754) are twice as likely to develop pathology of the hepatobiliary system than children with SLPI I/II quartile (OR – 1.153, 95% CI – 1.071-1.527). The established fact indicates the involvement of SLPI in the pathogenesis not only of pneumonia, but also in disorders of HBS.

Clinical Features and Laboratory Examination to Identify Severe Patients with COVID-19: A Systematic Review and Meta-Analysis

Background. With the COVID-19 epidemic breakout in China, up to 25% of diagnosed cases are considered to be severe. To effectively predict the progression of COVID-19 via patients’ clinical features at an early stage, the prevalence of these clinical factors and their relationships with severe illness were assessed. Methods. In this study, electronic databases (PubMed, Embase, Web of Science, and Chinese database) were searched to obtain relevant studies, including information on severe patients. Publication bias analysis, sensitivity analysis, prevalence, sensitivity, specificity, likelihood ratio, diagnosis odds ratio calculation, and visualization graphics were achieved through software Review Manager 5.3, Stata 15, Meta-DiSc 1.4, and R. Results. Data of 3.547 patients from 24 studies were included in this study. The results revealed that patients with chronic respiratory system diseases (pooled positive likelihood 6.07, 95% CI: 3.12-11.82), chronic renal disease (4.79, 2.04-11.25), cardiovascular disease (3.45, 2.19-5.44), and symptoms of the onset of chest tightness (3.8, 1.44-10.05), shortness of breath (3.18, 2.24-4.51), and diarrhea (2.04, 1.38-3.04) exhibited increased probability of progressing to severe illness. C-reactive protein, ratio of neutrophils to lymphocytes, and erythrocyte sedimentation rate increased a lot in severe patients compared to nonsevere. Yet, it was found that clinical features including fever, cough, and headache, as well as some comorbidities, have little warning value. Conclusions. The clinical features and laboratory examination could be used to estimate the process of infection in COVID-19 patients. The findings contribute to the more efficient prediction of serious illness for patients with COVID-19 to reduce mortality.