The value of clinical characteristics and breast imaging studies in predicting a histopathologic diagnosis of cancer or high-risk lesion in patients with spontaneous nipple discharge

Background:Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and syndrome(SS) are common rheumatic diseases with high incidence. Patients with those rheumatic diseases are at high risk of tuberculosis (TB) infection. However, manifestations can be atypical and easily confused with those of rheumatic disease itself. For those patients, diagnosis is usually much more difficult and further make treatment delayed. Sometimes it may lead to mistreatment. Therefore, it is important to recognize the clinical characteristics of those patients.Objectives:To explore the clinical characteristics and high risk factors of common systemic rheumatism complicated with tuberculosis infection.Methods:A total of 3,906 cases of RA, SLE, and SS common systemic rheumatism diagnosed in the People’s Hospital of Sichuan Province from January 2007 to January 2017 were collected with carefully exclusion with other infectious diseases and neoplastic disease. One hundred and five patients with TB were included as infection group, including 42 cases of RA, 41 cases of SLE, and 22 cases of SS. In the control group, 84 patients with RA, 82 patients with SLE, and 44 patients with SS were randomly selected from the corresponding rheumatoid non-infected patients hospitalized during the same period.Results:Fever was the most common symptom among 42 cases of RA, 41 cases of SLE, and 22 cases of SS with TB, accounting for 83.3%, 92.7%, and 68.2%, respectively. Cough, weight loss or fatigue was less common. For 41 cases of SLE and 22 cases of SS with TB, the proportion of pulmonary was 46.3%, 59.01%, respectively.In TB infection group, 27 cases of RA, 21 cases of SLE, and 13 cases of SS with TB had two or more chest CT findings, accounting for 59%, 57%, 62%, respectively. Lesions located in the posterior or posterior segment which TB usually affected were 9 cases(33.3%),9cases(42.9%),6cases(27.2%),respectively.The daily average dose of hormones within 1 year in TB infection group was higher than that in the control group (P<0.05). For SLE patients, lower counts of CD4+TL were found in TB infection group (P<0.05), while no such differences were found in RA and SS group.Conclusion:Patients with RA who have TB infection are mainly pulmonary TB. For SLE and SS patients, the chance of pulmonary tuberculosis and extra-pulmonary tuberculosis is similar.Symptoms of RA, SLE, SS with TB, such as fever, cough, weight loss, fatigue, are similar with the primary disease or other infection. Chest imaging is diversity. It is difficult to diagnose.Daily average dose of hormone within one year may be a common risk factor for RA, SLE and SS patients with TB. Decreased CD4+TL may also be a risk factor for SLE patients with TB.References:[1]Cantini F, Nannini C, Niccoli L, et al. Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics[J]. Mediators of Inflammation, 2017, 2017(6):1-15.[2]Ruangnapa K, Dissaneewate P, Vachvanichsanong P. Tuberculosis in SLE patients: rare diagnosis, risky treatment.[J]. Clinical & Experimental Medicine, 2015, 15(3):429-432.[3]Manuela D F, Bruno L, Martina S, et al. Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections[J]. International Journal of Molecular Sciences, 2017, 18(2):293-315.[4]Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus.Li JC, Fong W, Wijaya L, Leung YY.Int J Rheum Dis. 2017 Oct 2. doi: 10.1111/1756-185X.13195.[5]Handa R, Upadhyaya S, Kapoor S, et al. Tuberculosis and biologics in rheumatology: India – A special situation[J]. International Journal of Rheumatic Diseases, 2017, 51(2):115.Disclosure of Interests:None declared

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What can we learn from offspring studies in bipolar disorder?

BJPsych Advances ◽

10.1192/apt.bp.114.013086 ◽

2016 ◽

Vol 22 (3) ◽

pp. 176-185 ◽

Cited By ~ 4

Author(s):

Josephine Loftus ◽

Bruno Etain ◽

Jan Scott

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Early Intervention ◽

High Risk ◽

Secondary Prevention ◽

Environmental Risk ◽

Clinical Characteristics ◽

Intervention Strategies ◽

Prevention Programmes ◽

Methodological Approaches

SummaryWe offer a contemporary review of studies of the offspring of parents with bipolar disorder and explore the clinical characteristics of these populations. We discuss how different methodological approaches may influence study findings and may explain some of the heterogeneity in the results reported. We also highlight some of the environmental risk factors that may increase the likelihood of transition from an ‘at-risk’ or high-risk state to bipolar disorder. Last, we briefly discuss the implications of study findings for early intervention strategies and comment on such issues as genetic counselling and primary and early secondary prevention programmes.

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FRI0223 SUBPHENOTYPES OF ANCA ASSOCIATED VASCULITIS IDENTIFIED BY LATENT CLASS ANALYSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.832 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 694.3-695

Author(s):

K. Wójcik ◽

A. Ćmiel ◽

A. Masiak ◽

Z. Zdrojewski ◽

R. Jeleniewicz ◽

...

Keyword(s):

High Risk ◽

Latent Class Analysis ◽

Relapse Rate ◽

Clinical Characteristics ◽

Latent Class ◽

Middle Age ◽

Organ Involvement ◽

Class Analysis ◽

Fourth Class ◽

Anca Associated Vasculitis

Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus there is an unmet need for phenotype identification especially among patients with granulomatosis with polyangiitis GPA, patients with microscopic polyangiitis MPA group seems to be more uniform. Recently, based on previous clustering analysis and clinical, histopathological, serological and prognostic aspects three subcategories of AAV have been proposed and named as: non-severe AAV, severe PR3-AAV and severe MPO-AAV [1].Objectives:In line with these attempts to subcategorize AAV we decided to use latent class analysis (LCA) on a large multicenter cohort of polish AAV patients from POLVAS [2] registry to identify potential new subphenotypes or confirm already proposed ones.Methods:Latent Class Analysis (LCA) approach was used as a model based clustering method of objects described by dichotomous (e.g., gender; ANCA status – cANCA, pANCA; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves) and polytomous (number of relapses) variables supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever).Results:Results of LCA on our AAV group returned four class model of AAV subphenotypes, confirming existence of the previously proposed by Mahr at al. [1] and revealed fourth – previously not described clinically relevant subphenotype. To this fourth class - belong patients only with GPA, diagnosed at young age, with multiorgan involvement, high relapse rate and relatively high risk of death.Table 1.AAV subcategorization – summary of clinical characteristics and ANCA specificityLCA Class 1LCA Class 2LCA Class 3LCA Class 4No of patients13019410297AAV typeMainly GPAMainly GPAmainly MPAOnly GPAAge at diagnosisMiddle ageMiddle ageOldYoungMale/female ratio1:22:11:11:1Main organ involvementENT, respiratory, eyeRenal, respiratory, ENTRenal, respiratory, skinMultiorgan involvementRelapse rateintermediateintermediatelowhighModified class description (based on ref. [1])Non severe AAVSevere PR3 AAVSevere MPO AAVSevere non-renalPR3 AAVConclusion:Based on multiple clinical and serological variables LCA methodology identified 4-class subphenotypes model of AAV. Fourth-class is a new clinically important subphenotype including exclusively PR3-positive young AAV patients with multiorgan involvement, high risk of relapse and distinct mortality.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9.https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, i in. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:Krzysztof Wójcik: None declared, Adam Ćmiel: None declared, Anna Masiak: None declared, Zbigniew Zdrojewski: None declared, Radoslaw Jeleniewicz: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Iwona Brzosko: None declared, Marek Brzosko: None declared, Piotr Głuszko: None declared, Małgorzata Stasiek: None declared, Małgorzata Wisłowska: None declared, Joanna Kur-Zalewska: None declared, Marta Madej: None declared, Anna Hawrot-Kawecka: None declared, Hanna Storoniak: None declared, Barbara Bułło-Piontecka: None declared, Alicja Dębska-Ślizień: None declared, Eugeniusz Kucharz: None declared, Katarzyna Jakuszko: None declared, Jacek Musiał: None declared

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Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Revista Mexicana de Urología ◽

10.48193/rmu.v80i3.556 ◽

2020 ◽

Vol 80 (3) ◽

pp. 1-10

Author(s):

Pedro Antonio Madero-Morales ◽

Rigoberto Pallares-Méndez ◽

Rodrigo Romero-Mata ◽

Guillermo Vizcarra-Mata ◽

Andrés Guillén-Lozoya

Keyword(s):

Acute Pyelonephritis ◽

Clinical Characteristics ◽

Clinical Course ◽

Case Series ◽

Therapy Response ◽

Time Frame ◽

Clinical Findings ◽

Imaging Features ◽

Imaging Studies ◽

Retrospective Case

Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature. Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course. Design: A descriptive, retrospective case series was conducted. Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed. Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses. Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.

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Multiple Myeloma, Clinical Characteristics, and Increased COVID-19 Risk Using Real-World Data

Blood ◽

10.1182/blood-2021-152056 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3778-3778

Author(s):

Emily I. Liu ◽

Nathan W. Sweeney ◽

Jennifer M. Ahlstrom

Keyword(s):

At Risk ◽

Multiple Myeloma ◽

High Risk ◽

Clinical Characteristics ◽

Medical Condition ◽

Severe Case ◽

High Risk Group ◽

Smoking History ◽

Medical Conditions ◽

Real World Data

Abstract Background: A question that was commonly investigated during the COVID-19 pandemic was which clinical characteristics would make one more susceptible to contracting COVID-19? This was especially a concern for those who were considered "high risk" as they would be more prone to suffering from more severe COVID-19 symptoms and at times even death. In this abstract, we investigated which clinical characteristics of multiple myeloma (MM) cancer patients could make them more prone to contracting COVID-19. We also investigated which of these conditions make patients more at risk for experiencing more severe COVID-19 symptoms (PMID: 32950467, PMID: 32353254). Knowing what medical conditions that would make a patient more at risk for contracting or experiencing a more severe case of COVID-19 has been a concern for many, especially for those who suffer from more severe health conditions such as cancer. Methods: MM patient data and demographics were collected through HealthTree ® Cure Hub for Multiple Myeloma. We analyzed medical conditions including hypertension, heart condition, neuropathy condition, and BMI. We also looked into lung condition, kidney condition, diabetes, stroke, smoking history, drug use history, HIV, and Mediterranean descent but did not include in the figure due to small population sizes. We determined whether a patient had to be hospitalized, admitted to the ICU, needed oxygen therapy, or needed a D-dimer test as a severe COVID-19 case. Multivariable logistic regressions were performed to quantify the risk for contracting COVID-19 for patients with specific medical conditions and which medical conditions made COVID-19 positive patients more at risk for experiencing a more severe case of COVID-19. Results: Out of the 962 patients that were involved in this study, we found that patients who were overweight were 2% more likely to contract COVID-19 than those who were not overweight. Other medical conditions did not increase the risk of contracting COVID-19. Furthermore, there were 35 patients that were involved in investigating how certain medical conditions may affect the severity of COVID-19 symptoms. We found that overweight patients were 12% more likely to suffer from more severe COVID-19 than those not overweight. Patients who suffered from neuropathy conditions were 3% more likely to experience a more severe COVID-19 case than those who do not have that condition. It is important to note that these results were not statistically significant, although are still informative. Conclusion: Our results show that MM patients who are overweight have a greater tendency to not only contract COVID-19 but experience a more severe case of COVID-19. Somewhat surprisingly, we found that patients who experience neuropathy, common among MM patients, had a higher tendency to experience a more severe case of COVID-19. We speculate whether MM patients, a high-risk group due to their immunocompromised state, took extra care to follow safety recommendations and caution to avoid contracting COVID-19. A logical next step would be to compare medical condition interactions to examine whether patients with more than one condition experience additive or synergistic risk, as well as comparing out results to other high-risk groups. These findings, although not statistically significant, may help MM patients identify which of their own medical conditions may put them more at risk for contracting COVID-19 and thus take precautionary measures. Figure 1 Figure 1. Disclosures Ahlstrom: Takeda: Other: Patient Advisory; Pfizer: Other: Patient Advisory; Janssen: Other: Patient Advisory; Bristol Myers Squibb: Other: Patient Advisory.

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