Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center

Objectives Clinical presentation of pediatric celiac disease (CD) is heterogeneous and ever-evolving. Our aim is to highlight its changes throughout the years. Methods Data about clinical presentation of CD in children diagnosed between 1990 and 2020 at the CD Center of Maggiore Hospital, Bologna, were collected. Patients were stratified into groups based on the date [P1 (1990–2011), P2 (2012–2020)] and age [G1 (< 2 years), G2 (2–5), G3 (6–11), G4 (12–18)] at diagnosis, then investigated by comparing CD clinical presentation in different periods and ages. Results 1081 children were selected. Mean age at diagnosis increases from 5.9 to 6.6 years from P1 to P2. Gastrointestinal Symptoms (GIs) are predominant, with a decline of diarrhea (47%VS30%) and an increase of constipation (4%VS19%) (p < 0.001). Among Extraintestinal symptoms (EIs) a decrease of anemia (76%VS43%, p = 0,001) is observed. Failure to Thrive (FTT) is stable throughout the years (p = 0.03), while screenings show a trend of increment (19%VS23%). GIs’ frequency decline from G1 to G4 (p = 0,001), with reduction of diarrhea (p < 0.001), and rise of recurrent abdominal pain (p = 0,02). EIs are more frequent at older ages, FTT in younger patients. Conclusions Changes in clinical presentation of CD have occurred in the last 30 years. We observe a reduction of severe and classic gastroenterologic symptoms and a rise of atypical ones, together with a growth of serological screenings and higher age at diagnosis. Awareness about CD clinical trends is crucial for a proper approach and early diagnosis.

Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis

Background Psoriasis is a multisystem inflammatory disorder with variable morphology, clinical pattern and multiple comorbidities. Interplay between genetic and environmental factors leading to an aberrant immune response in the skin may contribute to disease development. The assessment for risk factors, signs, and symptoms of potential comorbid diseases is an important component of patient management. The aim of this study is to determine rheumatoid factors (RF) positivity and its levels in psoriasis patients, and describe its relationship with the demographic and clinical characteristics, comorbidities, and disease patterns of psoriasis. Results Rheumatoid factor was positive in psoriatic patients more than control,30% of patients had positive rheumatoid factor while only 10% of control had positive results. Rheumatoid factor level was 63.8 ± 186.7 IU/ml in psoriasis vs. 9.3 ± 12.3 in control. Thirty percent of psoriasis patients have positive rheumatoid factor vs. 10% of control. There was no significant statistical difference between psoriasis patients with or without arthritis as regard rheumatoid factor positivity and titer; rheumatoid factor was positive in 20% in psoriatic patients with arthritis vs. 26% in psoriatic patients without arthritis. In psoriatic patients, the status of rheumatoid factor did not relate to disease severity, onset, course, site of affection, presence of scalp, nail affection, and presence of dactylitis (p value>0.5). Conclusion Psoriasis was associated with higher seropositivity of RF compared to age-matched non-psoriatic healthy controls. Occurrence and level of rheumatoid factor were not associated with severity or clinical pattern of psoriasis.

Clinical Pattern and Causality Assessment of Drug-induced Cutaneous Reactions in a Tertiary Care hospital in India – A Prospective Study

Background: Cutaneous Adverse Drug Reactions (ADRs) are very common and is an important challenge to the physician especially in situations of multiple comorbidities of the patient, polypharmacy and self-administration of over-the-counter medications. Objective: To analyze the clinical pattern and incidence of cutaneous ADRs and perform causality assessment using the WHO-UMC scale and Naranjo’s scale and severity of the reactions were determined by Hartwig scale. Method: This was conducted as a prospective observational study in patients admitted in SRM Medical College, Kattankulathur, Tamil Nadu, India, between November 2016 to August 2018 after obtaining Institutional Ethics Committee clearance, of all adverse drug reactions reported at the hospital. Results: Of the 158 ADRs reported during the time period, 101 were cutaneous ADRs, of which the most common presentation was maculopapular rash (n=42; 41.58%). The most common drug which produced cutaneous adverse reaction were antimicrobials (n=58; 57.42%) followed by NSAIDs (n=35; 34.6%). The causality assessment as per the Naranjo scale yielded 3.96% (4) cases as definite, 81.18 % (82) as probable and 14.85 % (15) as possible whereas the WHO scale yielded 9 (89.10%) certain, 64 (63.36%) probable and 28 (27.72%) possible cases. The severity of the cases determined as per the Hartwig scale yielded 82.17% cases as mild and 17.82 % as moderate. Conclusion: It is important to recognise the ADRs at the right time and exert caution in future use. This can minimise harm to the patient both physically and financially and improve outcome of the treatment.

Training of Machine Learning Models for Recurrence Prediction in Patients with Respiratory Pathologies

Information extracted from electronic health records (EHRs) is used for predictive tasks and clinical pattern recognition. Machine learning techniques also allow the extraction of knowledge from EHR. This study is a continuation of previous work in which EHRs were exploited to make predictions about patients with respiratory diseases. In this study, we will try to predict the recurrence of patients with respiratory diseases using four different machine learning algorithms.

Inpatient Diagnosis and Management of Neuromuscular Disorders

Although many neuromuscular conditions are evaluated on an outpatient basis owing to their chronic or progressive nature, more urgent evaluation and management is often required for the inpatient presenting with acute to subacute focal or generalized numbness or weakness. This review focuses on clinical pattern recognition and basic anatomic localization principles to aid in the identification of common, as well as some less frequently encountered, neuromuscular disorders in hospitalized patients. The characteristic clinical and diagnostic features, associated complications, and recommended treatments of key neuromuscular conditions with acute and subacute manifestations are discussed. These conditions can be life-threatening in some cases, such as in Guillain–Barré syndrome, owing to associated oropharyngeal weakness, respiratory failure, or marked dysautonomia. Prompt recognition of the clinical and pathologic features is therefore necessary to reduce associated morbidity and mortality.

Environmental toxic factors and clinical pattern of Parkinson’s disease

Background: Parkinson’s disease (PD) – the most common neuro-degenerative movement disorder – is considered a result of a multifactorial pathogenic process modulated by cumulative and interactive effects of genes and exposures. An environmental exposure could enhance or create dopaminergic neurons vulnerability and increase PD risk. The purpose of the study was to find if excessive exposure to toxic environmental factors may influence clinical pattern of PD. Material and methods: The study was conducted on 111 patients diagnosed with PD, study group being defined as PD exposed to toxins (33 patients), control group including PD patients without toxin exposure (78 patients). General epidemiological data and clinical data were recorded. Results: Toxin exposure was found in 33 patients (29.73%), more of them – men and rural residents. Toxin exposed PD patients had an insignificantly younger age. The most common disease phenotype in the study group was the akinetic-rigid phenotype (64.7%, p = 0.040), bradykinesia being the most common sign at the disease onset (57.6%, p = 0.008). Levodopa equivalent daily dose also was higher in the study group (659.02 ± 232.46, p = 0.042). Conclusions: Excessive exposure to toxic environmental factors may influence the clinical pattern of PD. In this study the akinetic-rigid type was the predominant disease phenotype associated with toxin exposure. Doses needed for treatment were higher in PD patients exposed to toxins, as an indicator of a more severe motor impairment in this group

Dermatophytosis in a Suburban Hospital-A Study on Distribution and Clinical Types According to Age and Sex

Aim and Objectives: Dermatophytosis is a fungal infection of the outermost layer of skin and its appendages such as hair, nails and scalp. The present study was undertaken with a view to find out the clinical pattern of dermatophytic infections in our hospital. Materials and Methods: A total of 100 patients were included in the study. History was taken, general and physical examination was done. Multiple sites were involved in some cases, but were categorised prioritising the most predominant site involved. Patient was diagnosed and classified based on clinical types, age and sex. Results and Conclusion: A total of 100 patients were enrolled in the study in which 56 males and 44 females were affected. The most commonly affected age group was 19 to 59 years (63%). The most common clinical type of infection was T. cruris affecting 41% of the study population.

The Difficulties of Diagnosing Tumor of the Ewing’s Family of Sarcomas in an Emergency Hospital (Clinical Observation)

The author presents his own clinical case demonstrating the long stage and difficulties in diagnosing a rare tumor of the Ewing’s Family of Sarcomas in a young patient, due to the peculiarity of the course of the disease, manifested by a non-pathognomonic clinical pattern.