scholarly journals 1166. Reverse Syphilis Screening and Adherence to The Congenital Syphilis Guidelines: Institutional Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S674-S675
Author(s):  
Brandon Chatani ◽  
Aida Chaparro ◽  
Patricia Alvarez ◽  
Kristopher Arheart ◽  
Ivan Gonzalez ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Congenital Syphilis ◽  
American Academy Of Pediatrics ◽  
Institutional Experience ◽  
Group A ◽  
Syphilis Screening ◽  
Maternal Syphilis ◽  
Group B ◽  
Work Up ◽  
Positive Results

Abstract Background This study is analysis the consequences of the reverse syphilis screening on the management of newborns exposed to maternal syphilis, and pediatric physicians’ adherence to the existing guidelines. Methods We conducted a 5-year retrospective review of the maternal population and their newborns diagnosed with syphilis. Women with positive results (TT+/NTT+) and discordant (TT+/NTT-/TT+) and their newborns were included in the analysis. Results Per American Academy of Pediatrics (AAP), the 202 newborns were divided in two groups: proved or highly probable and possible congenital syphilis (Group A, n=102) and less likely and unlikely congenital syphilis (Group B, n=100). Except for the RPR, none of the other laboratory tests showed higher odds for predicting congenital syphilis. The RPR titers above 1:16 were only identified among newborns belonging to the Group A (5%); 32 patients (31%) in the Group A and 19 (9%) in the Group B had an RPR titer equal to or below 1:8. An RPR titer equal to or above 1:4 was almost three times more likely to be identified in patients from Group A (OR 2.91; CI 1.51- 5.59, p< 0.05). The newborns with non-reactive RPRs represented 64% of the patients in the Group A and 47% of them were born to mother with non-reactive RPR also (mothers with discordant results). Among the Group B, 82% of the neonates had a non-reactive RPR and 54% were delivered to mother with non-reactive RPRs. Babies in Group B had additional work-up performed 69% (n=37) of the time; 15% of these babies were treated with intramuscular penicillin which does not follow established AAP guidelines. Statistical analysis of the laboratory tests used for the congenital syphilis work-up Result table comparing the two groups of newborns Conclusion The reverse syphilis screening and non-adherence to the guidelines led to additional screening to half of the newborns in both groups. This study highlights the need for a comprehensive maternal history at the time of delivery that is effectively communicated between the providers. This might lead to greater congruence with the established AAP guidelines. Disclosures All Authors: No reported disclosures

scholarly journals POS1229 ANTI-MDA5 AND ANTISYNTHETASE ANTIBODIES SCREENING IN SEVERE SARS-COV-2 PNEUMONIA. BE AWARE OF FALSE POSITIVE RESULTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 898.1-898
Author(s):  
A. Gil-Vila ◽  
J. Perurena-Prieto ◽  
C. Nolla-Fontana ◽  
O. Orozco-Galvez ◽  
M. Miarons-Font ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Immune Response ◽  
Severe Acute Respiratory Syndrome ◽  
Chest Ct ◽  
Antisynthetase Syndrome ◽  
Antisynthetase Antibodies ◽  
Group A ◽  
Group B ◽  
Positive Results ◽  
Glass Pattern

Background:Several reports have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may trigger a vigorous immune response that could lead to the appearance of various autoantibodies such as antinuclear antibodies, antiphospholipid antibodies or anti-neutrophil cytoplasmic antibodies, among others. Moreover, the pulmonary involvement in SARS-CoV-2 may resemble that of patients with anti-MDA5 positive syndrome or acute form of antisynthetase syndrome.Objectives:Our aim was to analyse the presence of anti-MDA5 and other myositis-specific autoantibodies such as the antisynthetase antibodies in patients diagnosed with severe acute respiratory syndrome caused by SARS-CoV-2.Methods:Retrospective observational study performed in a tertiary care center. We included 28 patients admitted to the intensive care unit with severe acute respiratory syndrome, 14 at the onset of the disease (group A) and 14 after 30 days of being treated in an intensive care unit (group B). Chest CT was performed at the admission. We analyzed the presence of anti-MDA5 and antisynthetase antibodies by immunoblot (Euroimmune®) and in those who were positive we performed a confirmatory test by immunoprecipitation.Results:All chest CT showed bilateral ground glass pattern. Three out of 14 patients of group A (12 males, 86%, mean ± SD age 67.1 ± 12.2) were positive for antisynthetase antibodies (2 anti-PL7, 1 anti-Jo1), and 6 out of 14 patients of the group B (6 males, 48%, mean ± SD age 68.7 ± 8.1) were positive to antisynthetase antibodies (2 anti-PL7, 2 anti-PL-12, 1 anti-EJ, 1 anti-OJ+PL7). Immunoblots also show positivity for other myositis-specific or associated antibodies, such as anti-TIF1g, anti-PM75, anti-SAE and anti-SRP. All of these results found by immunoblotting were negative by immunoprecipitation. None of the 28 patients were positive for anti-MDA5 antibodies.Conclusion:Severe SARS-CoV-2 pneumonia is characterized by ground glass pattern in chest CT, as it is found in anti-MDA5 or antisynthetase syndrome. The positivity of several myositis related autoantibodies showed in immunoblot appears to be more related to the vigorous immune response producing polyclonal immunoglobulins than triggering a real myositis-associated interstitial lung disease. Clinicians must be aware about these false positive results in patients with severe COVID-19 acute respiratory syndrome.References:[1]Xu Q. MDA5 should be detected in severe COVID-19 patients. Med Hypotheses. 2020; 143:109890.[2]Giannini M, Ohana M, Nespola B, Zanframundo G, Geny B, Meyer A. Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care? Eur Respir J. 2020; 56:2001618.[3]Vlachoyiannopoulos PG, Magira E, Alexopoulos H, Jahaj E, Theophilopoulou K, Kotanidou A, Tzioufas AG. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis. 2020 Dec;79(12):1661-1663Disclosure of Interests:None declared

scholarly journals A COMPARISON BETWEEN SYNTHETIC AND BIOSYNTHETIC MESHES IN THE SURGICAL TREATMENT OF SEVERE GENITAL PROLAPSE: RESULTS AND COMPLICATIONS

2010 ◽  
Vol 23 (3) ◽  
pp. 21
Author(s):  
S. Dati ◽  
V. De Lellis ◽  
P. Palermo ◽  
G. Carta
Keyword(s):  
Genital Prolapse ◽  
Pelvic Organ ◽  
Wilcoxon Test ◽  
Type I ◽  
Replacement Surgery ◽  
Group A ◽  
Group B ◽  
Work Up

The effectiveness, tolerability and complications of two surgical procedures using prosthetic materials with different physical and structural properties were assessed with a full Urogynecology work-up, through a retrospective study of 158 patients with severe genital prolapse (POP-Q staging III-IV) selected from November 2006 to April 2009. Eighty-six patients underwent fascial replacement surgery with ProliftTM System with a dual transobturator access in the anterior district and a transperineal posterior access with a synthetic polypropylene type I mesh (Group A). Seventy-two patients who underwent pelvic organ prolapse surgery with Avaulta/Avaulta PlusTM System with a dual transobturator access in the anterior district and a dual transperineal posterior access with a biosynthetic polypropylene type I mesh coated with a film of hydrophilic porcine collagen were placed in Group B. There were no intra and postoperative complications. Results of mean 20.8 month follow-up showed an effective anatomical cure rate of 89.5% in group A and 86.1% in group B and a low percentage of erosive complications, 8.1% and 5.6% respectively. Validated questionnaires for prolapse, the UDI 6 s.f., the IIQ7 s.f. and the PISQ-12 all showed a statistically significant improvement of quality of life in patients undergoing the two procedures (Wilcoxon test: P<0.001).

scholarly journals A concise infertility work-up results in fewer pregnancies

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
J A M Hamilton ◽  
J W van der Steeg ◽  
C J C M Hamilton ◽  
J P de Bruin
Keyword(s):  
Success Rate ◽  
Pregnancy Rate ◽  
Semen Analysis ◽  
Prognostic Score ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Group A ◽  
Group B ◽  
Work Up

Abstract STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

scholarly journals A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Kirti Hooda ◽  
Manu Goyal ◽  
Asir John Samuel
Keyword(s):  
Manual Therapy ◽  
Plantar Fasciitis ◽  
Term Care ◽  
Hip Abductor ◽  
Group A ◽  
Foot Function ◽  
Conventional Physiotherapy ◽  
Group B ◽  
Positive Results

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%-15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE:  To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group Pretest-Posttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. “Foot function index,” “Podia scan,” “Navicular drop test” will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. That will be the first study to compare the effect of hip abductors strengthening and manual therapy. 

scholarly journals Clinical implication of right-sided augmentation pressure in patients with pulmonary hypertension

2019 ◽  
Vol 9 (1) ◽  
pp. 204589401983335
Author(s):  
Dae-Won Sohn ◽  
Jun-Bean Park ◽  
Seung-Pyo Lee ◽  
Hyung-Kwan Kim ◽  
Yong-Jin Kim
Keyword(s):  
Pulmonary Hypertension ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pressure Waveform ◽  
Female Ratio ◽  
Augmentation Pressure ◽  
Group A ◽  
Group B ◽  
Work Up

Similar to left ventricular and aortic pressure waveforms, augmentation pressure (AugPr) in the right ventricular (RV) pressure waveform is also frequent in patients with pulmonary hypertension (PH). This study sought to evaluate whether the degree of AugPr in RV pressure waveform has prognostic value. Forty-one patients (13 men; mean age = 50.7 ± 16.1 years) with group 1 PH (mean pulmonary artery pressure [mPAP] ≥ 25 mmHg) who underwent cardiac catheterization as part of their work-up were retrospectively enrolled. Patients were divided into three groups. Group A: AugPr/RV systolic pressure < 25%; group B: AugPr/RV systolic pressure ≥ 25%; and group C: no discernible AugPr but showing peaked RV pressure waveform. Ten patients were included in group A (male-to-female ratio 3:7; mean age = 45.9 ± 12.1 years), 12 in group B (4:8, 53.8 ± 14.6 years), and 19 in group C (6:13, 51.8 ± 18.7 years). No differences in mPAP were seen between the three groups. Pulse pressure was significantly higher in group C compared to group A. Eight patients died during the mean follow-up period of 35.9 ± 30.7 months; the incidence of death was significantly higher in group C than in the other groups (one patient in group A and seven patients in group C). AugPr in RV pressure waveform has prognostic value in patients with PH. Therefore, additional attention should be given to the RV pressure waveform in patients with PH undergoing invasive pressure measurements as a part of their work-up.

Elimination of mother-to-child transmission of syphilis: Is it a reality in Nigeria by 2020?

2017 ◽  
Vol 46 (8) ◽  
pp. 794-797 ◽  
Author(s):  
Daniel A. Adeyinka ◽  
Babayemi O. Olakunde ◽  
Chamberline E. Ozigbu ◽  
Emmanuel A. Agogo ◽  
Mercy Morka ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Congenital Syphilis ◽  
Scale Up ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Treatment Coverage ◽  
Syphilis Screening ◽  
Maternal Syphilis ◽  
Mother To Child

Background: Congenital syphilis is a global health problem, yet it has received little attention in recent years. Despite cost-effective syphilis screening and treatment, it continues to contribute hugely to perinatal morbidity and mortality worldwide. Aims: To determine the prevalence and treatment coverage trend for syphilis among pregnant women in the national prevention of mother-to-child transmission programme in Nigeria and to evaluate progress towards the elimination of congenital syphilis in the country. Methods: A retrospective analysis of validated national health sector performance data on pregnant women attending antenatal care at prevention of mother-to-child transmission clinics from 2013 to 2016 in Nigeria. Results: The proportion of new antenatal care attendees who annually received serological testing for syphilis increased from 12.2% in 2013 to 16.3% in 2016 (p-trend<0.0001). Although the prevalence of maternal syphilis decreased from 3.2% in 2013 to 1.4% in 2016 (p-trend<0.0001), the syphilis treatment coverage during pregnancy has decreased from 71.3% in 2013 to 54.9% in 2016 (p-trend<0.0001). Conclusions: Maternal syphilis screening and treatment in Nigeria are inadequate to meet the elimination aspirations. A rapid scale-up of antenatal care syphilis screening and treatment are crucial to averting an epidemic in Nigeria by 2020.

scholarly journals Increased Sensitization to Mold Allergens Measured by Intradermal Skin Testing following Hurricanes

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Diego Saporta ◽  
David Hurst
Keyword(s):  
Health Risk ◽  
Respiratory Symptoms ◽  
Environmental Changes ◽  
Skin Testing ◽  
Test Results ◽  
Chi Square ◽  
Chi Square Test ◽  
Group A ◽  
Group B ◽  
Positive Results

Objective. To report on changes in sensitivity to mold allergens determined by changes in intradermal skin testing reactivity, after exposure to two severe hurricanes. Methods. A random, retrospective allergy charts review divided into 2 groups of 100 patients each: Group A, patients tested between 2003 and 2010 prior to hurricanes, and Group B, patients tested in 2014 and 2015 following hurricanes. Reactivity to eighteen molds was determined by intradermal skin testing. Test results, age, and respiratory symptoms were recorded. Chi-square test determined reactivity/sensitivity differences between groups. Results. Posthurricane patients had 34.6 times more positive results (p<0.0001) at weaker dilutions, all tested molds were found to be more reactive, and 95% had at least one positive test versus only 62% before the hurricanes (p<0.0001); average mold reactivity was 55% versus 16% while 17% of patients reacted to the entire panel versus none before the hurricanes (p<0.0001). The posthurricane population was younger (p<0.001) and included more patients with asthma or lower respiratory symptoms (p<0.05). Conclusion. Reactivity and sensitization to mold allergens increased compared to patients before the hurricanes. This supports climatologists’ hypothesis that environmental changes resulting from hurricanes can be a health risk as reflected in increased allergic sensitivities and symptoms and has significant implications for physicians treating patients from affected areas.

scholarly journals COMPARATIVE STUDY ON THE EFFICACY OF MAITLAND TECHNIQUE (GRADE IV) AND MULLIGAN TECHNIQUE, IN THE TREATMENT OF FROZEN SHOULDER

2013 ◽  
Vol 2 (1) ◽  
pp. 10-14
Author(s):  
Syed Abid Mehdi Kazmi ◽  
Jharna Devi ◽  
Faisal Yamin ◽  
Sunil Kumar
Keyword(s):  
Experimental Study ◽  
Functional Activity ◽  
Frozen Shoulder ◽  
Group Interventions ◽  
Treatment Results ◽  
Treatment Groups ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Positive Results

OBJECTIVES To compare the effectiveness of Maitland technique (Grade IV) and Mulligan technique for the treatment of frozen shoulders. STUDY DESIGN Experimental Study. STUDY SETTINGS & PARTICIPANTS This study has been conducted at Ziauddin Hospital with 50 volunteers who participated in the study that were equally divided into two groups (pre and post treatment groups). Subjects were randomly assigned to each group. INTERVENTIONS Intervention given to Group A was Maitland Technique (Grade IV) and Group B, Mulligan Technique. OUTCOME MEASURES Functional activity of shoulder is measured by using Shoulder Pain and Disability Index (SPADI) score, Pain is measured by VAS Score, and Range of motion, measured by Goniometer both before and after treatment. RESULTS Both the treatments showed positive results but Mulligan technique was found to be more effective. The total SPADI score was 15.48 before and 11.92 after the Mulligan technique and 15.32 before and 13.16 after the Maitland technique. CONCLUSIONS It is evident that Mulligan technique is more effective for the treatment of frozen shoulder compared to Maitland technique.

scholarly journals Comparative study of rise of vitamin D in hypovitaminosis D babies after two different dosage recommendations

2018 ◽  
Vol 6 (1) ◽  
pp. 230
Author(s):  
Bijal Shrivastava ◽  
Rashi Aryan ◽  
Abhinav Tiwari ◽  
Lekha Tiwari ◽  
Nimmkayala Pravallika
Keyword(s):  
Vitamin D ◽  
American Academy ◽  
Vitamin D Deficiency ◽  
Hypovitaminosis D ◽  
Endocrine Society ◽  
American Academy Of Pediatrics ◽  
Vitamin D Levels ◽  
Study Results ◽  
Group A ◽  
Group B

Background: There are currently two different guidelines for treatment of Vitamin D deficiency in infants, one is that of American Academy of Pediatrics and the other being Clinical Practice Guidelines of the Endocrine Society. This study was done to compare the two guidelines for treatment of Vitamin D deficiency in infants.Methods: A hospital based, longitudinal interventional study was conducted for 2 years and 115 babies having vitamin d deficiency (Vitamin D less than or equal to 20ng/dl) were divided into group A and group B. Group A babies were treated as per American Academy of Pediatrics Guidelines whereas Group Cases were treated as per International Endocrine Society guidelines. All babies were followed up after 3-4 months when repeat Vitamin D levels were checked and then compared.Results: In present study, Vitamin D level had increased by 0.6 times in Group A whereas it had increased by 1.3 times in group B and it was significant.Conclusions: Study results were in favour of the guidelines recommended by the International Endocrine Society.

Group B Streptococcal Infections: An Obstetrical Viewpoint

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 148-149
Author(s):  
JOHN W. LARSEN ◽  
SHARON L. DOOLEY
Keyword(s):  
Group A Streptococcus ◽  
Group B Streptococcus ◽  
Perinatal Transmission ◽  
Pediatric Care ◽  
Care Providers ◽  
The Past ◽  
American Academy Of Pediatrics ◽  
Group A ◽  
The 1960S ◽  
Group B

Group B Streptococcus (GBS) was first identified as a cause of puerperal sepsis during the late 1930s. However, concern regarding GBS was diminished in part by the greater pathogenicity of the group A Streptococcus, which was described in the same studies. Clinical research regarding GBS infections resumed during the 1960s. Data regarding the perinatal transmission of GBS have now accumulated to an extent that education of all obstetric and pediatric care providers is imperative. During the past 2 years, committees of both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have considered the issues of perinatal transmission of GBS. Each group had input from the other by a series of meetings and document exchanges.

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