Chest radiography in children aged 2–59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis

Background Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes. Methods When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes. Results Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was “other infiltrates only” in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was “primary endpoint pneumonia”(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58). Conclusions In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with “primary endpoint pneumonia” was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs. Trial registration ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov (NCT02760420, NCT02678195, and NCT02960919, respectively).

Analysis Disability Indicators Due to Malignant Neoplasms in Kyrgyzstan

In the structure of the first recognized by persons with disabilities, persons with disabilities take a leading position due to malignancies. In the implementation of measures for the prevention and rehabilitation of persons with disabilities, it is necessary to carry out a disability analysis with a view to taking measures to reduce it. In the Kyrgyz Republic as a whole, there is a downward trend in dynamics by year, with the exception of 2015 and 2018. The most dysfunctional situation has developed in the Issyk-Kul region, where the largest frequency of primary recognized persons with disabilities is annually noted, and in 2018 and 2020 in the Talas region. In the Issyk-Kul region, despite highly intensive indicators, in comparison with other regions, the dynamics showed a decrease in the frequency of primary recognized persons with disabilities in 2015 by −11.7%, in 2016 by −3.3%, in 2019 by −9.6%, in 2020 by −17.8% with zero growth in 2014 and 2017. The increase was only in 2018 by +6.8%. In the frequency of persons with disabilities due to neoplasms under medical supervision in health organizations, a multi-directional trend was revealed, which is characterized by an increase in all years, with the exception of 2017 and 2020. The highest level of persons with disabilities in all years by region of the republic was observed in the Issyk-Kul region. By year, there was an upward trend in the level of the indicator, with the exception of 2020. The analysis made it possible to identify regions with an unfavorable situation. These include Issyk-Kul, Talas, Osh, Chui, Naryn regions. The precarious situation dictates the need for effective prevention of primary disability due to socially significant pathology leading to disability.

Assessment Screening of Chest Pain in Primary Setting: A Review

Chest pain can be caused by a variety of illnesses, ranging from benign and self-limiting to significant or life-threatening. Before a doctor examines more benign reasons, a workup must focus on ruling out significant pathology. The words "dull," "deep," "pressure," and "squeezing" are commonly used to describe visceral discomfort. Visceral pain generally has a diffuse distribution pattern, making it difficult for the patient to pinpoint a precise location. chest discomfort accounts for 1.5 percent of all consultations in primary care. The age group 45 to 64 years has the highest prevalence of chest pain consultations. Patients with suspected Acute coronary syndrome (ACS) should be diagnosed and treated as soon as feasible. While most patients are sent to the hospital, an electrocardiogram (ECG) is the sole examination necessary in primary care. In this review we will be looking at chest pain incident in primary care, and also we’ll be making overview to the etiology and diagnosis of the disease.

Evaluation of Computed Tomography Scan of Brain in Pediatric Patients

Objective: To determine the effectiveness of computed tomography in pediatric patients referred to radiology department for computed tomography scan brain Study Design: Cross sectional study Place and Duration of Study: Radiology Department, Sandmen Provincial Hospital Quetta form 1st January 2018 to 30th March 2018. Methodology: Sixty pediatric patients included in the study who referred from Pediatric OPD for computed tomography scan of brain. Patients with trauma were excluded while all other patient’s age between 1 month to 4 years were included. Findings were divided with normal and abnormal findings. Results: Twenty five (41.7%) were boys and 35 (58.3%) were girls. Only 25% were negative and 75% were positive and showed significant pathology. Major complaint was fits accompanied with fever and unconsciousness was also one of the reasons. Conclusion: Computed tomography scan is quick and now-a-days with easy access it is an effective diagnostic method in sick children with cases of neurological disease in spite of its radiation exposure child. Key word: Computed tomography (CT), Effectiveness, Children

Age is the only predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia: a prospective investigation of endoscopic findings

Background Dyspepsia is a common cause of physician visits. If and when endoscopy should be performed depend on the regions and the populations. This study aimed to identify the current risk factors predictive of upper gastrointestinal malignancy or peptic ulcer in China with high prevalence of gastric cancer. Methods A questionnaire was conducted among consecutive outpatients undergoing their first esophagogastroduodenoscopy for dyspepsia. Symptoms other than alarm symptoms in this study were defined as uncomplicated dyspepsia. Results 4310 outpatients (mean age 44, median 42, range 14–86) were included in the final analyses. Significant pathology was found in 13.8% (595/4310) patients including peptic ulcer (12.3%) and upper gastrointestinal malignancy (1.5%). Age, male sex and alarm symptoms were significantly associated with malignancy. The age cut-off identified for upper gastrointestinal malignancy was 56 years among patients with uncomplicated dyspepsia, which was similar to the combined cutoff of age and gender. Conclusions Age should be considered as the primary predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia. 56 could probably be the optimal age to identify those lesions in this population. Trial registration: Chictr.org (ChiCTR2000040775).

Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus

Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.

TYPE 2 DIABETES MELLITUS’S DECOMPENSATED FORM: ON THE PROBLEM OF EFFECTIVE PHARMACOTHERAPY IN REAL CLINICAL PRACTICE

The aim of this retrospective study was to analyze the pharmacotherapy regimens of the decompensated form of type 2 diabetes mellitus (DM2) and to evaluate its effectiveness, its compliance with clinical recommendations.Materials and methods: A retrospective analysis of 54 medical cards of patients with decompensated DM2 was conducted. The 1st group (n=24; 44%) included the patients who had a decrease in glycated hemoglobin (HbA1c) by 50% or more in 3 months after hypoglycemic therapy; and the 2nd group (n=30; 56%) – the patients whose HbA1c level decreased by less than 50%.Results. A HbA1c level was 10.4% in the 1st group and 13.2% in the 2nd group (р<0.001). However, the target levels of venous blood plasma glucose and HbA1c were not achieved in any of the patient groups. The total number of the drugs prescribed to the patients ranged from 4 (in 25% (n=6) and 10% (n=3) cases in the 1st and the 2nd groups, respectively) to 8 (in 12.5% (n=3) and 20% (n=6) cases in the 1st and the 2nd, groups, respectively). However, in a number of cases some violations of clinical recommendations were recorded: the prescription to the obese patients of insulin drugs, the administration of sulfonylureas derivatives to patients with a history of cardiovascular diseases of the atherosclerotic origin, but modern hypoglycemic drugs with proven benefits in reducing cardiovascular risks were rarely prescribed.Conclusion. The tactics of pharmacotherapy in the patients with a decompensated form of DM2 does not fully comply with the approved clinical guidelines, which requires the effectiveness of treatment optimization of this medically and socially significant pathology.

TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy

Introduction Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort. Patients and Methods Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC). Results 372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%. NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC. Conclusion NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.

1579 Effect of COVID-19 pandemic on the Suspected Colorectal Cancer Pathway at a District General Hospital

Aim During the initial phase of the COVID-19 pandemic the British Society of Gastroenterology and Joint Advisory Group on GI Endoscopy published guidance to halt all non-emergency endoscopy. As a result, CT was used as the first-line investigation with delayed completion endoscopy. We reviewed the efficacy of this change to determine its influence on future practice. Method All patients referred via the suspected colorectal cancer pathway (SCCP) to our district general hospital from 15/04/20-15/05/20 (during the initial COVID-19 lockdown) were included. Retrospective analysis of patient electronic records, radiology and endoscopy was performed. Results were analysed using χ² statistic. Significant incidental pathology was defined as non-colorectal pathology requiring referral to different speciality or further imaging. Results 115 patients were included for analysis, mean age 68 years. 2/115 (1.7%) were found to have a colorectal malignancy on CT, with no further diagnoses following completion colonoscopy. CT imaging detected significant incidental pathology in 31/115 (27%). Subgroup analysis by presenting complaint showed significant pathology was most likely to be detected in those presenting with weight loss (13/36, 36.1%, p = 0.049) or anaemia (12/31, 38.7% p = 0.084). Conclusions CT is a valuable first-line investigation in SCCP patients. In this cohort, no colorectal malignancies were missed on CT that were later detected on endoscopy and 27% of scans detected significant non-colorectal incidental pathology. Weight loss was found to have a statistically significant correlation with incidental pathology. These findings suggest CT as a possible first-line investigation in patients presenting with weight loss, anaemia or in the event of delayed access to endoscopy.

Saccharin and Sucralose Protect the Glomerular Microvasculature In Vitro against VEGF-Induced Permeability

Diabetic kidney disease (DKD) has become a global health concern, with about 40% of people living with type 1 and type 2 diabetes mellitus developing DKD. Upregulation of vascular endothelial growth factor (VEGF) in the kidney is a significant pathology of DKD associated with increased glomerular vascular permeability. To date, however, current anti-VEGF therapies have demonstrated limited success in treating DKD. Recent studies have shown that artificial sweeteners exhibit anti-VEGF potential. The aim of this study was therefore to assess the effects of aspartame, saccharin, and sucralose on VEGF-induced leak using an in vitro model of the glomerular endothelium. Saccharin and sucralose but not aspartame protected against VEGF-induced permeability. Whilst the sweeteners had no effect on traditional VEGF signalling, GC-MS analysis demonstrated that the sweetener sucralose was not able to enter the glomerular endothelial cell to exert the protective effect. Chemical and molecular inhibition studies demonstrated that sweetener-mediated protection of the glomerular endothelium against VEGF is dependent on the sweet taste receptor, T1R3. These studies demonstrate the potential for sweeteners to exert a protective effect against VEGF-induced increased permeability to maintain a healthy endothelium and protect against vascular leak in the glomerulus in settings of DKD.