Clinical Radiological and Pathological considerations of Epiphysitis and Apophysitis

A prospective longitudinal study of 157 patients between the ages of five and 16 years, high-performance athletes, who were treated with epiphyseal and / or apophyseal injuries due to chronic stress in our service, was carried out in the period between January 1, 2000 and December 31, 2020, at the Mártires del 9 de Abril University Hospital in Sagua La Grande, Villa Clara province, Cuba. Of these patients, 102 are male, the most frequent ages of the affected children are between 13 and 14 years, pain and poor sports performance were the predominant symptoms, 67.7% (n = 106) were in radiological stage II and 70.9% (n = 7) in pathological anatomical stage II, which is closely related, but not the clinical stages.

Abdominal Computed Tomography Imaging Findings in Hospitalized COVID-19 Patients: A Year-Long Experience and Associations Revealed by Explainable Artificial Intelligence

The aim of this retrospective study is to assess any association between abdominal CT findings and the radiological stage of COVID-19 pneumonia, pulmonary embolism and patient outcomes. We included 158 adult hospitalized COVID-19 patients between 1 March 2020 and 1 March 2021 who underwent 206 abdominal CTs. Two radiologists reviewed all CT images. Pathological findings were classified as acute or not. A subset of patients with inflammatory pathology in ACE2 organs (bowel, biliary tract, pancreas, urinary system) was identified. The radiological stage of COVID pneumonia, pulmonary embolism, overall days of hospitalization, ICU admission and outcome were registered. Univariate statistical analysis coupled with explainable artificial intelligence (AI) techniques were used to discover associations between variables. The most frequent acute findings were bowel abnormalities (n = 58), abdominal fluid (n = 42), hematomas (n = 28) and acute urologic conditions (n = 8). According to univariate statistical analysis, pneumonia stage > 2 was significantly associated with increased frequency of hematomas, active bleeding and fluid-filled colon. The presence of at least one hepatobiliary finding was associated with all the COVID-19 stages > 0. Free abdominal fluid, acute pathologies in ACE2 organs and fluid-filled colon were associated with ICU admission; free fluid also presented poor patient outcomes. Hematomas and active bleeding with at least a progressive stage of COVID pneumonia. The explainable AI techniques find no strong relationship between variables.

POS0498 RELATIONSHIP BETWEEN IMPAIRED MELATONIN SECRETION AND DURATION, RADIOLOGICAL STAGE AND PHYSICAL ACTIVITY OF RHEUMATOID ARTHRITIS

Background:There is a close relationship between the development of severe autoimmune diseases and disorders of the neuroendocrine immune regulation of the body [1]. The role of melatonin as the main mediator of neuroendocrinoimmune interactions in rheumatoid arthritis (RA) remains poorly understood [2].Objectives:The aim of the study was to determine the daily serum melatonin profile of RA patients with different duration of the disease, radiological stage and physical activity.Methods:The daily serum melatonin profile of patients with active RA (n=105, mean age 49.8±12.6 years, 75.5% of women) was compared with that of healthy subjects from the general population (n=30). In addition, we investigated daily serum melatonin secretion in relation to duration of the disease, radiological progression and physical activity (HAQ). Patients were divided into 4 groups depending on the RA duration (mean 8.4±6.6 years): 1st group - up to 2 years (n=12), 2nd group - 2-5 years (n=37), 3rd group - 6-10 years (n=26), 4th group - more than 10 years (n=30). Depending on the radiological progression, patients were divided into stages: 1st stage (n=16), 2nd stage (n=64), 3d stage (n=25). Melatonin serum levels was determined by the enzyme immunoassay at 8 and 20 o`clock. For statistical analysis were used the Man - Whitney test and the Spearman rank correlation method.Results:The melatonin serum levels in RA patients were in 2 and 3 times higher in the morning and evening time than those of healthy individuals in the control group (p=0.001). We noticed significant correlations between melatonin level and disease duration (rS =-0.5, p <0.01). Significant differences in melatonin levels were revealed in RA patients in 1st and 3rd groups (p=0.049), in 1st and 4th groups (p = 0.012), in 2nd and 3rd groups (p=0.001), in 2nd and 4th groups (p=0.001). Also we determined significant differences in melatonin levels between 1st and 2nd radiological stages (p =0,001) of RA patients. However, melatonin levels were not related to physical activity (HAQ).Conclusion:We found a close relationship between serum melatonin levels, duration of the disease and radiological progression in RA patients. The most significant changes in melatonin metabolism occur in patients with the duration of the disease up to 5 years and with lower radiological stages. Our data indicate the important role of neurotransmitter in the pathogenesis of RA, especially at the initial stage of the disease.References:[1]Sternberg EM. Neuroendocrine regulation of autoimmune/inflammatory disease. J Endocrinol. 2001 Jun;169(3):429-35. doi: 10.1677/joe.0.1690429. PMID: 11375112.[2]Mańka S, Majewska E. Immunoregulatory action of melatonin. The mechanism of action and the effect on inflammatory cells. Postepy Hig Med Dosw (Online). 2016 Oct 4;70(0):1059-1067. doi: 10.5604/17322693.1221001. PMID: 27708210.Disclosure of Interests:None declared

POS1094 SYNOVITIS IS FACTOR OF OSTEOARTHRITIS KNEE PROGRESSION IN PATIENTS WITH LESS THAN 5 YEARS OF DISEASE DURATION

Background:There are many studies about investigation of risk factors (RF) of knee osteoarthritis (OA) radiologic progression. Especially, in patients with small disease duration. At the moment, there are ambivalent of results of previous studies, lead to uncertain role of synovitis.Objectives:The aim of study is to investigate relationship between knee OA synovitis and progression risk in patients with small disease duration during a follow-up period of 5 years.Methods:Eligible patients had knee OA based on ACR criteria with x-ray confirmation; baseline (BL) disease duration less than 5 years. Patients were evaluated at BL and at 5-year follow-up, using the questionnaires, clinical examination, knee joints pain by visual analog scale (VAS), musculoskeletal ultrasound and X-ray. Unadjusted p-values are presented.Results:Among 52 adults with knee OA (mean age ± standard deviation, 59.11 ± 8.95 years; 100% female) had the proportion of patients at BL 42.3% (n=22), 46.2 % (n=24), 11.5% (n=6) by disease stage 1,2 and 3, respectively. Patients were categorized into 2 groups by progression during 5 years from BL based on changes of radiological stage. After 5-years follow-up period the progression of knee OA was established in 14 patients (1 group) and in 38 patients (2 group) the progression by radiological stage was absent. BL patients’ characteristics were similar across 1st and 2nd groups: mean age 58.29±7.68 vs 56.05±8.74, р>0.05; disease duration 3.43±1.34 vs 3.47±1.33, р>0.05. Individuals with knee OA progression had worse knee joints pain during walking (60.36±18.33 vs 48.71±17.81, р=0.043), higher body mass index (BMI) (34.45±4.60 vs 28.92±4.92 kg/m2, р=0.001), higher frequency of knee synovitis by clinical examination (42.9% vs 10.5%, RR=4.07; 95%Cl (1,3-12,3), р=0.01) and by musculoskeletal ultrasound (57.1% vs 18.4%, RR=3.1; 95%CI (1.38-6.96), р=0.009). At 5-years follow-up knee pain was significantly greater for 1st group (69.64±18,49 vs 55.76±12.76, р = 0.003), higher BMI (35.74±5.83 vs 30.64±4.64, р = 0.002), also higher frequency of knee synovitis by clinical examination (57.1% vs 10.5%, RR = 5.4 (95%Cl 1.9-15.2), р=0.001) and by musculoskeletal ultrasound (50% vs 13.2%, RR=3.8 (95%Cl 1.4-10.0), р=0.009). Spearman correlation coefficients between radiologic stage and OA progression factors were indicated: between radiologic stage and knee pain during walking (r = 0.34, p<0.05), BMI (r = 0.46, p<0.01), knee synovitis by musculoskeletal ultrasound (r = 0.41, p<0.01). Multivariate (discriminant) analysis was determined that synovitis is a significant predictor of radiographic progression (p < 0.05).Conclusion:The proportion of patients with knee synovitis by clinical examination and musculoskeletal ultrasound data increased by 5-year follow-up from BL. Synovitis is a significant predictor of radiographic progression of knee OA in patients with small disease duration.Disclosure of Interests:None declared.Figure 1.

Guided Growth Vs. Tibial Osteotomy in Early Stage of Blount Disease

Background: There are no real comparative study between guided growth and tibial osteotomy in early stage of Blount disease. The aim of this work was to compare the results of patients treated by these two techniques. Method: We had performed a multicenter retrospective, descriptive and analytical study over a period of 05 years. All children admitted for Blount disease without medial proximal tibial epiphysiodesis and treated by one of these techniques were included. Age, sex, existence of tibial torsion, radiological stage based on Catonne's classification were studied. We also evaluated preoperatively, immediately postoperatively, and at latest follow-up tibiofemoral angle, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, and the tibial metaphyso-diaphyseal angle. Results: Seventeen (17) patients for 24 knees were included. The sex ratio was 0.54. All patients had tibial torsion. Fourteen knees (64%) were treated by guided growth at a mean age of 5.5±2.5 (range, 3-9 years). With a mean follow-up of 12 ± 3.5 months (range 6-15month); tibiofemoral, mechanical medial proximal tibial, and tibial metaphyso-diaphyseal angles were significantly corrected with normalization of the mechanical axis in 8 patients (60%). Ten patients (36%) were treated by revisited Rab osteotomy at a mean age of 7.7±4.9 years (range, 4-12 years). At a mean follow-up of 23±15 months (range, 10-48 months), only tibial metaphyso-diaphyseal angle was significantly corrected. The recurrence rate was 60%. Despite perfect correction of tibiofemoral, and mechanical medial proximal tibial angles in immediate postoperative follow-up, they gradually decrease in patients treated by Rab osteotomy, whereas they gradually increased in case of guided growth. Conclusion: Guided growth appears to be the best treatment for early stage of Blount disease. Trial registration: Retrospectively registered

Chest image staging and prevalence of current smoking among hospitalized COVID-19 patients in Turkey

Objective: Novel Coronavirus disease is a new infectious agent of the respiratory tract characterized by a severe acute respiratory syndrome. For this disease, there are limited data with regard to the clinical characteristics of the patients and prognostic factors. Study Design: Retrospective Cohort Setting: Secondary Referral Center Methods: We collected data from 213 patients who were hospitalized into COVID-19 isolation with positive PCR test results. We recorded various patient values, including blood test results. We also noted age, gender, additional diseases, duration of discharge, whether they live or die, whether they smoke, and their radiological staging. Results: In CT imaging with a staging of maximum 4 points and minimum 0 points, the mean value resulted in 1.95. The average radiological stage of the dead patients group was reported as 2.56. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). The number of smokers was 14 (6.5%). Of the 26 patients who died, 3 were smokers and 23 were non-smokers. Conclusion: 14 of the patients in the study were smokers (6.5%). One in four people in Turkey is a smoker, while in COVID-19 isolation service only a 6.5% rate of smoking was observed. That supports the theory that smoking hasn’t negative impact on COVID-19 development. The average radiological stage was reported as 2.56 in the dead patients’s group. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). It seems that an elevated radiological stage is a predictor of death. Keywords: Covid-19, SARS-CoV-2, smoking, computed tomography, predictor factors. Key points: to learn relations between smoking and covid-19, effect of Ct stages on the disease severity, effect of blood analysis on Covid-19, the parameters in deaths of Covid-19, ratio of smoking in Covid-19 inpatients

AB1045 CLINICAL, ANALYTICAL AND RADIOLOGICAL CHARACTERISTICS OF A COHORT OF PATIENTS WITH SARCOIDOSIS.

Background:Sarcoidosis is a systemic disease whose etiology is unknown. It is characterized by the formation of granulomas in any tissue of the organism. Ganglionic, pulmonary and cutaneus involvement is the most prevalent.Objectives:Describe clinical characteristics of a cohort of patients with sarcoidosis diagnosed.Define the association between the ACE’s number at diagnosis, radiological lung stage, treatment and course of disease.Evaluate if the extrapulmonary involvement is related to the course of the disease.Methods:Descriptive retrospective study of patients with S diagnosis treated in our Hospital in 2019. Data were obtained by reviewing medical records. Chi-square tests and parametric tests have been used to establish the differences described in the objectives.Results:102 patients diagnosed with sarcoidosis have been included, (51% females) with an average age of 56±11 years. Suspected diagnosis at the onset of disease was S in 70.6% of patients, followed by suspected lymphoma (20.6%). The average time for the definitive diagnosis of S was 9.5 months. 70.6% of the patients had elevated ACE titles at the beginning. Regarding the clinical manifestations, 18.6% of the patients presented fever at the beginning and 66.7% extrathoracic clinical manifestations. 72.5% have lymph node adenopathies, and in 91% there is thoracic involvement (the most frequent pulmonary stage is stage II). A biopsy was performed in 84.3% of the patients, the lung biopsy being the most performed (52.3%). 88.2% of patients received corticosteroid treatment at the onset of the disease (currently under treatment with corticosteroids 37.3%). 50% of patients are treated with immunosuppressants, Methotrexate was the most used. 5 patients are treated with biological therapy (AntiTNF).Regarding the course of the disease, 51% of the patients have a chronic course, 45.1% are in remission and 3.9% have suffered a relapse of the disease. In this study, no significant relationship was found between the ACE values at the onset of the disease, the pulmonary stage and the course of the disease.According to our data, patients presenting with extrathoracic clinical manifestations need more frequently corticosteroid treatment (p = 0.017) and immunosuppressive treatment (p = 0.001) with respect to patients who do not have an extrathoracic clinic. In addition, patients with an extrathoracic clinic present more frequently a chronic course of the disease than those who do not (p = 0.019).Conclusion:The results described in this study are similar to those found in the literature. The differences found can be explained because patients presenting with extrathoracic clinical manifestations have a more complicated management and need more treatment than those with only pulmonary involvement, even patients with radiological stage I do not usually need treatment, only surveillance.Disclosure of Interests:None declared

Special peculiarities of clinical course of osteoarthrosis of knee joints depending on 6-hydroxymelatonin-sulfate urinary excretion profile

The study objective was to define the special features of the clinical course of knee joint osteoarthrosis depending on 6-sulfatoxymelatonin urinaryexcretion profile.Materials and methods.We surveyed 141 patients with radiological Stage II-III osteoarthrosis (OA) of the knee joints (18 female subjects). Diagnosis of OA was established on the basis of ACR criteria (1991) and EULAR (2010) recommendations. We determined the AO clinical indexes (Lequesne, WOMAC, KOOS), HAQ functional index, sleep quality and psycho-emotional state indicators. ELISA was used to assess 6-sulfatoxymelatonin urinary excretion profile.Results. It was established that 66% of patients with OA of knee joints had a reduced 6-sulfatoxymelatonin urinary excretion compared to this of practically healthy individuals. AO patients with low 6-SMT urinary excretion profiles had higher incidence of severe insomnia and depressive disorders. Reduction in 6-SMT excretion was associated with a moderate increase in pain syndrome and deterioration of physical functions by Lequesne, WOMAC, KOOS, and HAQ indexes.Conclusion.The reducedmelatonin production in ОА patients is a factor of more severe clinical course of the disease due to deterioration of the psycho-emotional state, the development of pain syndrome, and functional disorders.