BEDSIDE LAPAROSCOPY AS DIAGNOSTIC TOOL REVIEW OF ABDOMINAL PATHOLOGIES IN CRITICALLY ILL PATIENTS: REVIEW

Introduction: The diagnosis of abdominal pathologies in critically ill patients is often difficult because of inconclusive laboratory tests or imaging results, or the inability to safely transfer a patient to the radiology room. These causes give a delayed diagnosis of abdominal pathology in the intensive care unit (ICU) and increase rate of morbidity and mortality. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Aim: The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Materials and Methods: A literature research was carried out including PubMed, Medline, Embase, Cochrane and Google Scholar databases to identify articles reporting on importance of diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Conclusions: Bedside diagnostic laparoscopy represents a safe and accurate technique for diagnosing intraabdominal pathology in an ICU setting and should be taken into consideration when patient transfer to radiology or the operating room is considered unsafe or when routine radiological examinations are not conclusive enough to reach a definite diagnosis. Keywords: Bedside laparoscopy, critically ill patients, ultrasonography (US), computed tomography (CT) , emergency surgery

Aptamer Selection against Alpha-defensin Human Neutrophil Peptide 1 on an Integrated Microfluidic System for Diagnosis of Periprosthetic Joint Infections

Periprosthetic joint infections (PJI) arising from joint arthroplasty are dreadful, yet difficult to diagnose in subtle cases. Definite diagnosis requires microbiological culture to confirm the causative pathogens. However, up to...

Validation and Application of Skin RT-QuIC to Patients in China with Probable CJD

The definite diagnosis of human sporadic Creutzfeldt–Jakob disease (sCJD) largely depends on postmortem neuropathology and PrPSc detection in the brain. The development of real-time quaking-induced conversion (RT-QuIC) of cerebrospinal fluid (CSF) samples makes it possible for premortem diagnosis for sCJD. To test the diagnostic potential of RT-QuIC of skin specimens for probable sCJD, we collected the paired skin and CSF samples from 51 recruited living patients referred to the Chinese CJD surveillance center, including 34 probable sCJD, 14 non-CJD, and 3 genetic prion disease (gPrD). The samples were subjected to RT-QuIC assays using recombinant hamster PrP protein rHaPrP90-231 as the substrate. Using skin RT-QuIC assay, 91.2% (31/34) probable sCJD patients, and 1 T188K genetic CJD (gCJD) cases showed positive prion-seeding activity, while 85.7% (12/14) non-CJD patients were negative. CSF RT-QuIC positive seeding activity was only observed in 14 probable sCJD patients. Analysis of the reactivity of 38 positive skin RT-QuIC tests revealed that the positive rates in the preparations of 10−2, 10−3 and 10−4 diluted skin samples were 88.6% (39/44), 63.6% (28/44), and 25.0% (11/44), respectively. Eleven probable sCJD patients donated two skin specimens collected at different sites simultaneously. Although 95.5% (21/22) skin RT-QuIC elicited positive reaction, the reactivity varied. Our preliminary data indicate high sensitivity and specificity of skin RT-QuIC in prion detection for Chinese probable sCJD and highlight that skin prion-seeding activity is a reliable biomarker for premortem diagnosis of human prion disease.

Quantitative Imaging Parameters in the Diagnosis of Endometriomas

The classic imaging diagnosis of endometriomas encounters multiple limitations, including the subjective evaluation of medical examinations and a similar imaging appearance with other adnexal lesions, especially the functional hemorrhagic cysts. For this reason, a definite diagnosis of endometriomas can be made only by pathological analysis, which reveals particular features in terms of cellularity and biochemical components of their fluid content. It is theorized that these histopathological features can also be reflected in medical images, altering the pixel intensity and distribution, but these changes are too subtle to be assessed by the naked eye. New quantitative imaging evaluations and emerging computer-aided diagnosis techniques can provide a detailed description of image contents that can be furtherly processed by algorithms, aiming to provide a more accurate and non-invasive diagnosis for this disease.

125 Sex differences in myocarditis natural history

Aims The role of sex in determining the profile and the outcomes of patients with myocarditis is widely unexplored. Our study seeks to evaluate the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis. Methods and results We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis (i.e., endomyocardial biopsy or cardiac magnetic resonance proven) of myocarditis. A sub-analysis was performed after division of population according to the main symptom of presentation (i.e., chest pain, ventricular arrhythmias, and heart failure). Clinical and echocardiographic data were evaluated at diagnosis and at last available evaluation (i.e., median of 30 months). The study outcome measure was a composite of all-cause mortality or heart transplantation. We enrolled 312 patients (187; 60% presenting with chest pain; 19; 6% with ventricular arrhythmias; 106; 34% with heart failure). Most of patients (211, 68% of the whole population) were males, consistently in the three modes of presentation. Despite no clinically relevant differences were found at baseline presentation, males presented a larger indexed left ventricular end-diastolic volume (LVEDVi) (62 ± 23 vs. 52 ± 20, P = 0.011 in males vs. females respectively) at follow-up evaluation. At a median follow-up of 62 months, 36 (17%) males vs. females experienced death or heart transplantation (Log-rank P = 0.037). At multivariable Cox analysis, male sex emerged as a predictor of mortality (HR: 2.358; 1.044–5.322; P = 0.039 and left ventricular ejection fraction (LVEF) < 50% (HR: 8.169; 1.226–54.425; P = 0.030)]. Results were consistent in patients presenting with heart failure and chest pain, while arrhythmic group was too small to be reliably interpreted. Conclusions In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favorable long-term prognosis than male, despite a similar clinical profile at baseline.

ROLE OF USG IN PATIENTS WITH ACUTE ABDOMEN

Background: The main goal of imaging in acute abdomen is to narrow down the differential diagnosis and for prompt treatment. Material and methods: This study was done on patient presented with acute abdomen in Department of Radiodiagnosis, SMS Medical College & Associate Group of Hospitals, Jaipur. Scout X-ray done in 100 patients. Scout X –Ray film gives lots of information and very helpful in diagnosing perforation and intestinal obstruction. Results: USG was able to diagnose 94% cases of perforation peritonitis. intes­tinal obstruction was diagnosed only in 73.17% of cases with USG. Conclusion: This study shows that simple X-Ray plays an important role in definite diagnosis of acute abdomen as compare to USG. Keywords: Ultrasound, X- Ray, Acute Abdomen

Placental Polyp : A Rare Case Report

Placental polyp is the retained fragment of placental tissue which presents as a polypoidal or pedunculated mass within the uterus. It is a rare entity and has an incidence of less than 0.25 % of all pregnancies. There are also very few reported cases of the clinical placental polyp. Here,we report a case of 22-year-old P1 woman presenting with vaginal bleeding and something coming down into vagina.Her last pregnancy had occurred one year ago.Laboratory investigation revealed slightly elevated serum b-hCG. Ultrasonography revealed thick endometrium, broad cervix (5.2cm) and a hyperechoic mass within the cervix. Extraction of the placental polyp followed by endometrial curettage were done and tissue sent for histopathology. Definite diagnosis was made by histopathological examination and which was a placental polyp. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 85-88

Monomorphic Epitheliotropic Intestinal T Cell Lymphoma With Lower Gastrointestinal Hemorrhage: A Case Report and Literature Review

Enteropathy-associated T cell lymphoma(EATL) is a kind of malignant lymphoma with strong invasiveness. Due to poor effect of conventional symptomatic treatment, the prognosis is not as good as other T-cell lymphomas. A 63-year-old man was admitted to our hospital due to hematochezia. No definite cause was found by electronic gastroscopy and electronic colonoscopy. After symptomatic treatment, the patient's condition did not show significant remission. However, he refused further examination and was discharged. Two months later, the man was admitted to our hospital again due to hematochezia. The site of the lesion was found by capsule endoscopy and small intestinal endoscopy, and the nature of the lesion was confirmed by immunohistochemistry. The patient received chemotherapy and autologous stem cell transplantation after a definite diagnosis. No recurrence or metastasis has been found in an 18-months follow-up after treatment.

A case of nodular episcleritis mimicking a solitary giant episcleral mass

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.