Application of mNGS in the Etiological Diagnosis of Thoracic and Abdominal Infection in Patients With End-Stage Liver Disease

BackgroundDespite the obvious advantages of metagenomic next-generation sequencing (mNGS) in etiological diagnosis of various infectious diseases, there are few reports on etiological diagnosis of suspected thoracic and abdominal infections in patients with end-stage liver disease (ESLD).MethodsSeventy-three ESLD patients were enrolled from January 2019 to May 2021 due to suspected complicated thoracic and abdominal infections with poor response to empirical anti-infective treatment. Pleural effusion and ascites samples of these patients were collected for mNGS detection and conventional pathogen culture. The application value of mNGS in etiological diagnosis of thoracic and abdominal infections in ESLD patients was finally evaluated.ResultsA total of 96 pathogens were detected using mNGS method, including 47 bacteria, 32 viruses, 14 fungi, 2 Mycobacterium tuberculosis, and 1 parasite. The positive rate of mNGS reached 42.5%, which was significantly higher than that of conventional culture method (21.9%) (p = 0.008). Considering neutrophil counts, the overall positive rate of bacteria detection of both methods in Polymorphonuclear Neutrophils (PMN) ≥250/mm3 group was 64.3% and in PMN <250/mm3 group was 23.7%. Compared with the final clinical diagnosis, the agreement rate of mNGS in patients with positive bacteria detection and with suspected positive bacteria detection was 78.6% (11/14) and 44.4% (8/18), respectively. In addition, the agreement rate of mNGS was 66.7% (4/6, respectively) in patients with positive and suspected fungal detection. Interestingly, of the 11 patients with fungal detection, 5 had alcoholic liver disease, accounting for 45.5% of all patients with alcoholic liver disease. We also detected 32 strains of viruses using mNGS, mainly cytomegalovirus (62.5%).ConclusionsThe mNGS method is a useful supplement to conventional culture methods, which performs a higher positive rate, higher sensitivity, and broader pathogen spectrum, especially for rare pathogens and those difficult to culture. For ESLD patients, mNGS has great prospects in early etiological diagnosis of thoracic and abdominal infections. In addition, the cutoff values for the diagnosis of bacterial infection (PMN ≥250/mm3) in the thoracic and abdominal cavities may need to be redefined.

Imaging of Vascular Aphasia

Brain imaging is essential for the diagnosis of acute stroke and vascular aphasia. Magnetic resonance imaging (MRI) is the modality of choice for the etiological diagnosis of aphasia, the assessment of its severity, and the prediction of recovery. Diffusion weighted imaging is used to detect, localize, and quantify the extension of the irreversibly injured brain tissue called ischemic core. Perfusion weighted imaging (from MRI or CT) is useful to assess the extension of hypoperfused but salvageable tissue called penumbra. Functional imaging (positron emission tomography (PET), functional MRI (fMRI)) may help predicting recovery and is useful for the understanding of language networks and individual variability. This chapter is meant to review the state of the art of morphological and functional imaging of vascular aphasia and to illustrate the MRI profiles of different aphasic syndromes.

Idiopathic dilated cardiomyopathy as cor bovinum in infancy: “A foggy road in winter”

Dilated cardiomyopathy, when diagnosed in infancy, poses an array of difficulties from reaching an etiological diagnosis to prognosticating the long-term outcome. Here, we report a case of idiopathic dilated cardiomyopathy in a 6-month-old child who responded well to beta-blocker (Carvedilol) in optimum dosage and revealed favorable cardiac remodeling over 6 months with substantial improvement in ejection fraction (EF) (EF of 22–44%) with significant amelioration of child’s symptoms. Our case has a unique message that while treating idiopathic dilated cardiomyopathy (DCM) in infancy, optimized use of the beta-blockers is most often the only way to clear the foggy road of idiopathic DCM and obtain a favorable outcome.

Peripheral polyneuropathy from electrodiagnostic tests: a 10-year etiology and neurophysiology overview

ABSTRACT Background: Polyneuropathies are characterized by a symmetrical impairment of the peripheral nervous system, resulting in sensory, motor and/or autonomic deficits. Due to the heterogeneity of causes, an etiological diagnosis for polyneuropathy is challenging. Objective: The aim of this study was to determine the main causes of polyneuropathy confirmed by electrodiagnostic (EDX) tests in a tertiary service and its neurophysiological aspects. Methods: This observational cross-sectional study from a neuromuscular disorders center included individuals whose electrodiagnostic tests performed between 2008 and 2017 confirmed a diagnosis of polyneuropathy. Through analysis of medical records, polyneuropathies were classified according to etiology and neurophysiological aspect. Results: Of the 380 included patients, 59.5% were male, with a median age of 43 years. The main etiologies were: inflammatory (23.7%), hereditary (18.9%), idiopathic (13.7%), multifactorial (11.1%), and diabetes (10.8%). The main electrophysiological patterns were axonal sensorimotor polyneuropathy (36.1%) and “demyelinating and axonal” sensorimotor polyneuropathy (27.9%). Axonal patterns showed greater etiological heterogeneity, with a predominance of idiopathic and multifactorial polyneuropathy, while demyelinating and “demyelinating and axonal” polyneuropathies had a significantly fewer etiologies, with a predominance of hereditary and inflammatory polyneuropathies. Conclusion: The main causes of polyneuropathy confirmed by EDX test in this study were those that presented a severe, atypical and/or rapidly progressing pattern. Other causes were hereditary and those that defy clinical reasoning, such as multiple risk factors; some polyneuropathies did not have a specific etiology. EDX tests are useful for etiological diagnosis of rare polyneuropathies, because neurophysiological patterns are correlated with specific etiologies.

Assessment and classification of chronic pruritis and its relation to systemic diseases

Although pruritis might not be a serious condition with significant healthcare impacts, it is usually associated with an unpleasant sensation that leads to scratching the skin. It has been demonstrated that the severity of the condition is significantly variable and ranges between disabling and mild conditions. Chronic pruritis has been defined as the presence of daily itching for >6 months. In the present literature review, we have discussed the different approaches that have been previously indicated to assess and evaluate chronic pruritis, and the classification of the condition its relation to the different systemic diseases. The classification of chronic pruritis can be done using a clinical or an etiological diagnosis. The clinical diagnosis is usually based a primary skin condition, while the etiological diagnosis is based on the presence of different diseases that may be systematic, neurological, or psychiatric disorders. Accordingly, conducting a thorough examination is essential to establish a proper diagnosis before adequately managing the affected patients. Furthermore, the treatment of the underlying etiology should also be adequately considered for adequate management and enhanced prognosis.

Chauffard-Still syndrome (clinical case)

The article presents a clinical case of Chauffard-Still syndrome. It is shown that for the correct etiological diagnosis of iridocyclitis in Still's syndrome, careful collection of anamnesis, the connection of the articular syndrome with uveitis and characteristic ophthalmological changes in the form of ribbon-like dystrophy of the cornea are important. Key words: Chaufard-Still syndrome, uveitis, corneal ribbon dystrophy.

Additional Thrombocytopenia after Cardiac Surgery with Extracorporeal Circulation: A Case Report

Thrombocytopenia occurs almost systematically in cardiac surgery under extracorporeal circulation (ECC). Its usual causes are multiple and recognized, but sometimes uncommon mechanisms are added, posing the problem of etiological diagnosis and the dilemma of optimal adequate management. The etiological diagnosis of thrombocytopenia after extracorporeal circulation requires a careful analysis of the chronology of the thrombocytopenia and also of the clinical and biological context. The authors report the observation of a case of additional thrombocytopenia after cardiovascular surgery under extracorporeal circulation, detailing the diagnostic modalities and describing the different usual clinical and biological characteristics of platelet changes induced by extracorporeal circulation.