scholarly journals Digital analysis of hormonal immunostaining in pituitary adenomas classified according to WHO 2017 criteria and correlation with preoperative laboratory findings

2020 ◽  
Vol 48 (6) ◽  
pp. E12
Author(s):  
João Vitor Gerdulli Tamanini ◽  
Mateus Dal Fabbro ◽  
Leandro Luiz Lopes de Freitas ◽  
José Vassallo ◽  
Luciano de Souza Queiroz ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Serum Insulin ◽  
Laboratory Data ◽  
Pituitary Tumors ◽  
Tissue Expression ◽  
Primary Antibody ◽  
Cushing Disease ◽  
Laboratory Findings ◽  
Serum Gh ◽  
Serum Acth

OBJECTIVEThe authors sought to evaluate clinical and laboratory data from pituitary adenoma (PA) patients with functioning PA (associated with acromegaly [n = 10] or Cushing disease [n = 10]) or nonfunctioning PA (NFPA; n = 10) that were classified according to 2017 WHO criteria (based on the expression of the transcription factors pituitary-specific positive transcription factor 1 [Pit-1], a transcription factor member of the T-box family [Tpit], and steroidogenic factor 1 [SF-1]) and to assess the immunostaining results for growth hormone (GH) and adrenocorticotropic hormone (ACTH) in the corresponding tumors.METHODSClinical and laboratory data were collected retrospectively. The percentage of tumoral cells positive for Pit-1, Tpit, or SF-1 was assessed and ImageJ software was used to evaluate immunopositivity in PAs with 2 different antibodies against GH (primary antibody 1 [AbGH-1] and primary antibody 2 [AbGH-2]) and 2 different antibodies against ACTH (primary antibody 1 [AbACTH-1] and primary antibody 2 [AbACTH-2]).RESULTSCells with positive Pit-1 staining were more frequently observed in lesions from patients with acromegaly (acromegaly group) than in lesions from patients with Cushing disease (Cushing group; p < 0.001) and those from patients with NFPA (NFPA group; p < 0.001). The percentage of Tpit-positive cells was higher in the Cushing group than in the acromegaly (p < 0.001) and NFPA (p < 0.001) groups. No difference was detected regarding SF-1 frequency among all groups (p = 0.855). In acromegalic individuals, GH immunostaining levels varied depending on the antibody employed, and only one of the antibodies (AbGH-2) yielded higher values in comparison with the values for NFPA patients (p < 0.001). For all of the antibodies employed, no significant correlations were detected between GH tissue expression and the laboratory data (serum GH vs AbGH-1, p = 0.933; serum GH vs AbGH-2, p = 0.853; serum insulin-like growth factor–1 [IGF-1] vs AbGH-1, p = 0.407; serum IGF-1 vs AbGH-2, p = 0.881). In the Cushing group data, both antibodies showed similar ACTH tissue expression, which was higher than that obtained in the NFPA group (p < 0.001). There were no significant associations between ACTH immunohistochemical findings and ACTH serum levels (serum ACTH vs AbACTH-1, p = 0.651; serum ACTH vs AbACTH-2, p = 0.987). However, ACTH immunostaining evaluated with AbACTH-1 showed a significant correlation with 24-hour urinary cortisol (24-hour cortisol vs AbACTH-1, p = 0.047; 24-hour cortisol vs AbACTH-2, p = 0.071).CONCLUSIONSImmunostaining for Pit-1 and Tpit accurately identified lesions associated with acromegaly and Cushing disease, respectively. Conversely, SF-1 did not differentiate NFPA from lesions of the other two groups. Regarding hormonal tissue detection, results of the current investigation indicate that different antibodies may lead not only to divergent immunohistochemical results but also to lack of correlation with laboratory findings. Finally, PA classification based on transcription factor expression (Pit-1, Tpit, and SF-1), as proposed by the 2017 WHO classification of pituitary tumors, may avoid the limitations of PA classification based solely on digital immunohistochemical detection of hormones.

scholarly journals Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy

2020 ◽  
Vol 58 (7) ◽  
pp. 1100-1105 ◽  
Author(s):  
Graziella Bonetti ◽  
Filippo Manelli ◽  
Andrea Patroni ◽  
Alessandra Bettinardi ◽  
Gianluca Borrelli ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Troponin I ◽  
Laboratory Data ◽  
High Sensitivity ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Serum Glucose ◽  
Hospital Death ◽  
Laboratory Findings

AbstractBackgroundComprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity.MethodsThe final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge).ResultsCompared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death.ConclusionsThe most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.

scholarly journals Desquamation in Kawasaki Disease

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 317
Author(s):  
Ling-Sai Chang ◽  
Ken-Pen Weng ◽  
Jia-Huei Yan ◽  
Wan-Shan Lo ◽  
Mindy Ming-Huey Guo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Laboratory Data ◽  
Ivig Treatment ◽  
Low Grade ◽  
High Grade ◽  
Laboratory Findings ◽  
Coronary Artery Abnormalities ◽  
Cell Counts ◽  
Hands And Feet

(1) Background: Desquamation is a common characteristic of Kawasaki disease (KD). In this study, we analyzed patients’ varying desquamation levels in their hands or feet, in correlation with clinical presentation, to assess the relationship. (2) Methods: We retrospectively reviewed children with KD. We analyzed their age, laboratory data before intravenous immunoglobulin (IVIG) treatment and coronary artery abnormalities (CAA) based on the desquamation level of their hands and feet. We classified the desquamation level from 0 to 3 and defined high-grade desquamation as grade 2 and 3. (3) Results: We enrolled a total 112 patients in the study. We found the hands’ high-grade desquamation was positively associated with age and segmented neutrophil percentage (p = 0.047 and 0.029, respectively) but negatively associated with lymphocyte and monocyte percentage (p = 0.03 and 0.006, respectively). Meanwhile, the feet’s high-grade desquamation was positively associated with total white blood cell counts (p = 0.033). Furthermore, we found that high-grade hand desquamation had less probability of CAA formation compared with that of a low grade (7.1% vs. 40.8%, p = 0.016). (4) Conclusions: This report is the first to demonstrate that the desquamation level of hands or feet in KD is associated with different coronary artery abnormalities and laboratory findings.

scholarly journals Across-tissue expression and evolution of genes controlled by the Aire transcription factor

Genomics ◽  
2006 ◽  
Vol 88 (4) ◽  
pp. 462-467 ◽  
Author(s):  
Austin L. Hughes ◽  
Robert Friedman
Keyword(s):  
Transcription Factor ◽  
Tissue Expression

Visual and quantitative assessment of COVID-19 pneumonia on chest CT: The relationship with disease severity and clinical findings

2021 ◽  
Vol 17 ◽  
Author(s):  
Furkan Kaya ◽  
Petek Şarlak Konya ◽  
Emin Demirel ◽  
Neşe Demirtürk ◽  
Semiha Orhan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Disease Severity ◽  
Pearson Correlation ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Laboratory Findings ◽  
Pneumonia Severity ◽  
High Attenuation ◽  
The Relationship

Background: Lungs are the primary organ of involvement of COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. Aim: We aimed to evaluate the visual and quantitative pneumonia severity on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. Methods: We retrospectively evaluated adult COVID-19 patients who underwent chest CT, clinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between variables. The Pearson correlation test analyzed the correlation between variables. The diagnostic performance of the variables was assessed using receiver operating characteristic (ROC) analysis was used. Results: The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with disease severity (p<0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r=730,p<0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. Conclusion: The VSQS and QCT scores can help manage the COVID-19 and predict the duration of hospitalization.

scholarly journals Aggressive pituitary lesion with a remarkably high Ki-67

2014 ◽  
Vol 58 (6) ◽  
pp. 656-660 ◽  
Author(s):  
Pedro Marques ◽  
Manuela Mafra ◽  
Carlos Calado ◽  
Anabela Martins ◽  
Joaquim Monteiro ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Severe Disease ◽  
Laboratory Data ◽  
Pituitary Tumors ◽  
Sudden Onset ◽  
World Health ◽  
Treatment Modalities ◽  
Pituitary Neoplasms ◽  
Ki 67

The uncommon aggressive pituitary tumors are named carcinomas when metastases are detected, either in the central nervous system and/or systemically. Some cases are associated with hormonal overproduction, but most are diagnosed because of local symptoms. These neoplasias are generally refractory to current treatments. A 51 year-old woman presented sudden onset of headache, left arm paresis and left facial hypoesthesia. Computed tomography scan and magnetic resonance imaging revealed a pituitary tumor invading the left sphenoidal and cavernous sinuses. Laboratory data excluded hormonal hypersecretion. The patient underwent transsphenoidal surgery and histological findings showed a neoplasia with Ki-67 estimated at 75%. Medical imaging excluded both a primary occult tumor and central nervous system or systemic dissemination. Three weeks postoperatively, neurological condition worsened, with new onset of ataxia, bilateral ptosis, ophthalmoplegia and an increase in the size of the lesion, leading to surgical intervention by craniotomy, followed by only a few sessions of radiotherapy, because of severe disease progression. Patient died nearly 2 months after the initial manifestations. This case illustrates the aggressiveness of some pituitary lesions, the limited efficacy of current treatment modalities such as surgery or radiotherapy and the pitfalls of the current pituitary tumors classification. To our knowledge, this case corresponds to one of the most aggressive pituitary neoplasms reported so far, with a very high Ki-67 index (75%) and short survival (2 months). Ki-67 index could be of prognostic value in pituitary tumors. Pituitary tumors World Health Organization (WHO) classification could be revisited.

scholarly journals Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data

2021 ◽  
Vol 27 ◽  
Author(s):  
L. M. Mikhaleva ◽  
A. L. Cherniaev ◽  
M. V. Samsonova ◽  
O. V. Zayratyants ◽  
L. V. Kakturskiy ◽  
...  
Keyword(s):  
Diffuse Alveolar Damage ◽  
Laboratory Data ◽  
Post Mortem ◽  
Lethal Outcome ◽  
Laboratory Findings ◽  
Intravascular Thrombosis ◽  
Preventative Measures ◽  
Post Mortem Findings ◽  
Insight Into ◽  
Full Body

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies.Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings.Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present.Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

scholarly journals Critically Ill vs. Non-Critically Ill Patients With COVID-19 Pneumonia: Clinical Features, Laboratory Findings, and Prediction

2021 ◽  
Vol 11 ◽  
Author(s):  
Wandong Hong ◽  
Qin Chen ◽  
Songzan Qian ◽  
Zarrin Basharat ◽  
Vincent Zimmer ◽  
...  
Keyword(s):  
Critical Illness ◽  
Disease Severity ◽  
Critically Ill ◽  
Clinical Features ◽  
Critically Ill Patients ◽  
Interleukin 6 ◽  
Discharge Rate ◽  
Laboratory Data ◽  
Laboratory Findings ◽  
Laboratory Parameters

ObjectivesThe objective of this study was to investigate the clinical features and laboratory findings of patients with and without critical COVID-19 pneumonia and identify predictors for the critical form of the disease.MethodsDemographic, clinical, and laboratory data of 63 COVID-19 pneumonia patients were retrospectively reviewed. Laboratory parameters were also collected within 3–5 days, 7–9 days, and 11–14 days of hospitalization. Outcomes were followed up until March 12, 2020.ResultsTwenty-two patients developed critically ill pneumonia; one of them died. Upon admission, older patients with critical illness were more likely to report cough and dyspnoea with higher respiration rates and had a greater possibility of abnormal laboratory parameters than patients without critical illness. When compared with the non-critically ill patients, patients with serious illness had a lower discharge rate and longer hospital stays, with a trend towards higher mortality. The interleukin-6 level in patients upon hospital admission was important in predicting disease severity and was associated with the length of hospitalization.ConclusionsMany differences in clinical features and laboratory findings were observed between patients exhibiting non-critically ill and critically ill COVID-19 pneumonia. Non-critically ill COVID-19 pneumonia also needs aggressive treatments. Interleukin-6 was a superior predictor of disease severity.

Clinical and Epidemiological Features of Acute Zika Virus Infections in León, Nicaragua

2021 ◽  
Author(s):  
Natalie M. Bowman ◽  
Filemón Bucardo ◽  
Matthew H. Collins ◽  
Yaoska Reyes ◽  
Edwing Centeno Cuadra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sore Throat ◽  
Zika Virus ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Maculopapular Rash ◽  
Laboratory Diagnosis ◽  
Zikv Infection ◽  
Serological Tests ◽  
Laboratory Findings

The American Zika virus (ZIKV) epidemic has highlighted the need to gain a better understanding of this emerging virus. The goal of this study was to describe the clinical symptoms, laboratory findings, and risk factors for symptomatic ZIKV infection in an area with ongoing transmission of other arboviral infections. We recruited patients at least 2 years of age seeking care at public health centers in León, Nicaragua, between January 2016 and August 2017, for fever, maculopapular rash, and/or nonsuppurative conjunctivitis with a duration of less than 1 week. A laboratory diagnosis of ZIKV was established using a combination of molecular and serological tests. Clinical and laboratory findings and potential risk factors were compared between participants with and without acute ZIKV infection. Fifty-eight (26%) of the 225 participants included in the analysis were found to have acute ZIKV infection. Pregnancy and reports of previous arboviral infection were associated with a higher risk of ZIKV infection. Rash, conjunctivitis, sore throat, and lower absolute neutrophil counts were associated with acute ZIKV infection. The clinical characteristics and risk factors identified were consistent with those identified by previous studies; however, we found sore throat to be a feature of ZIKV infection. We also found that neutrophil counts were lower in ZIKV-infected subjects. These clinical symptoms and laboratory data may help clinicians suspect ZIKV infection during future outbreaks.

Clinical, Radiological and Laboratory Profile of Covid-19 Patients Admitted to a Dedicated Covid-19 Hospital in Odisha

2021 ◽  
Vol 8 (15) ◽  
pp. 989-993
Author(s):  
Mohan Rao C ◽  
Nipa Singh ◽  
Kinshuk Sarbhai ◽  
Saswat Subhankar ◽  
Sanghamitra Pati ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Ct Images ◽  
The State ◽  
Viral Clearance ◽  
Clinical Profile ◽  
Chronic Obstructive ◽  
Laboratory Findings ◽  
Obstructive Pulmonary Disease ◽  
Reactive Protein ◽  
Set Up

BACKGROUND The Covid-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health challenge being faced by the world currently. International and national responses to combat the Covid-19 pandemic have been very prompt with the setting up of dedicated Covid-19 hospitals. In the state of Odisha, situated in the eastern part of India, Kalinga Institute of Medical Sciences (KIMS), set up the first dedicated Covid hospital of the state. This study intends to chronicle the clinical profile, radiological presentations, laboratory findings, and clinical outcome of patients admitted to the KIMS Covid hospital. METHODS A retrospective analysis of the clinical and laboratory data of patients admitted with Covid-19 diagnosis at the dedicated Covid-19 hospital from 5th April 2020 to 4th June 2020 was done. RESULTS A total number of 272 Covid-19 cases were included in this study. Majority of the patients were males (83.57 %) and most of the patients (79.04 %) were asymptomatic. The mortality rate was 1.9 %. Fever (18.38 %), cough (17.27 %), dyspnoea (16.91 %) and myalgia (14.7 %) were the major symptoms observed. Severity was mild in 78.94 % cases. Delayed viral clearance was seen in 13 % cases. The typical features of novel SARS-CoV-2 infection was seen in 12 - 13 % cases in computed tomography (CT) images of thorax. c-reactive protein (CRP) was raised as a biomarker of inflammation. Of the 5 deaths encountered, 2 had diabetes mellitus, 2 were hypertensive and 1 had chronic obstructive pulmonary disease (COPD). CONCLUSIONS Covid-19 may have a delayed viral clearance beyond two weeks. A discordance between CT images and the clinical condition may also be observed. Diabetes, hypertension, and high blood CRP levels were significantly associated with mortality. KEYWORDS Covid-19, SARS-CoV-2, Clinical Profile, Radiological Findings, Comorbidities, Fatality

scholarly journals 398. Description of a Large Pediatric Lyme Arthritis Cohort in an Endemic Region

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S203-S204
Author(s):  
Ancil J Abney ◽  
Megan Reinhard ◽  
Bazak Sharon
Keyword(s):  
Clinical Setting ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Chronic Arthritis ◽  
Lyme Arthritis ◽  
Steady Increase ◽  
Medical Organization ◽  
Endemic Region ◽  
Laboratory Findings ◽  
High Index Of Suspicion

Abstract Background In endemic areas, Lyme arthritis (LA) is a leading cause of joint swelling. Due to the shared inflammatory nature and common clinical features, acute LA is often misdiagnosed as septic arthritis (SA) while recurrent disease is at times difficult to differentiate from other causes of chronic arthritis. In Minnesota, there has been a steady increase in cases of Lyme disease. This has not been met by a clear guideline and there is no consensus for the management of pediatric arthritis. In this context, we sought to characterize the epidemiology and clinical presentation of a large local cohort. Methods This is a retrospective review of medical charts from children with confirmed LA, presented at a large academic medical organization in the Upper Midwest between January 2011 to December 2017. Demographic, clinical, and laboratory data were collected and analyzed. Results Lyme arthritis was confirmed in 109 children. Acute presentation was more common (67) while the rest (42) had either persistence or reoccurrence of symptoms [Figure 1]. Elevated inflammatory markers and synovial pleocytosis were common, unlike fever and refusal to bear weight which were seen occasionally [Figure 2]. Seasonal distribution and the clinical setting for initial presentation as well as admissions are summarized in Figure 3. The knee was involved in all but 2 patients, both had acute monoarthritis (elbow and hip) [Figure 4]. Conclusion LA causes a spectrum of disease, is seen year round, and across the clinical setting continuum. Acute knee monoarthritis is the most common presentation (54% in our cohort) and is often misdiagnosed as SA leading to unnecessary hospitalizations and aggressive interventions. This occurs more frequently at the ED setting and for children with significant synovial pleocytosis. When evaluating a child with arthritis, laboratory findings are none specific and should be used in caution. Pediatric providers in endemic regions, especially those in primary, hospital, or emergency care must be familiar with the clinical presentation and have a high index of suspicion for LA in order to prevent mismanagement. Disclosures All authors: No reported disclosures.

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