Silent Strokes May Be Involved in Neurocognitive Impairment in Children With Sickle Cell Disease

Neurological complications are frequent occurrences in children and adolescents with sickle cell disease (SCD). This research has investigated the prevalence of neurovascular and neurocognitive impairments in 17 patients with SCD from Northern Brazil, with aged 6-16 years. Transcranial Doppler Ultrasound (TDU) examinations were performed on patients employing the STOP protocol as a risk score to predict stroke. Neuropsychological assessments were also performed: the Wechsler Intelligence Scale for Children - 4th Edition (WISC-IV). Fisher's Exact Test was used for statistical analyses (p ≤0.05) of the collected dataset. Frequent headaches were a common clinical finding, occurring in over 75% of the children. There were no alterations in cerebral hemodynamics on TDU for over 70% of the patients. In general, patients had below-average scores on most cognitive domains. There was a tendency for correlation between transcranial Doppler results and the WISC-IV indices of total Intelligence Quotient (p = 0.069) and Processing Speed Index (p = 0.082). Conclusion: Most SCD patients showed impairments on cognitive tests, but there was no statistically significant correlation between the presence of neurovascular damage and worse performance on the tests.

STUDY OF SPLENOMEGALY IN CHILDREN.

Splenomegaly is common clinical finding in pediatric practice. Splenic enlargement occurs when the spleen is increased by cells or tissue components or by vascular engorgement. Various etiologies can cause splenomegaly. The spleen is rarely the primary site of a disease. Splenomegaly is classified according to the length palpable below the costal margin as mild: <3 cm, moderate: 4-7 cm & massive: >7 cm. Severe/massive splenomegaly doesn't commonly occur in first 5 years of age, occurs after 5 years of age. So, clinical examination of every child is important to diagnose splenomegaly at early stages. Only in the age group of 1 to 5 years females predominated as compared to males. In present study there is obvious male predominance as male: female ratio is 1.8:1. This difference could be due to more priority to male child to seeking medical care with such chronic illness.Present study also suggested that severe/massive splenomegaly doesn't commonly occur in first 5 years of age, occurs after 5 years of age. So, clinical examination of every child is important to diagnose splenomegaly at early stages.

684. Diagnostic Yield of Echocardiography in Coagulase Negative Staphylococcus Bacteremia

Background Coagulase negative Staphylococcus (CoNS) bacteremia is a common clinical finding, but is less commonly associated with infective endocarditis (IE). Echocardiography (Echo) is utilized when clinicians suspect the diagnosis of IE. We sought to evaluate the utilization and yield of Echo in patients who had 1 or ≥ 2 (+) blood cultures (BC) for CoNS, and correlate Echo results with a diagnosis of IE. Methods A retrospective review in a tertiary care hospital between 2013-2020. Patients with or without cardiac device, who had either 1 or ≥ 2 BC positive for CoNS and who underwent Echo were included. Modified Duke’s (MDC) criteria was used for the diagnosis of IE. Logistic regression was used to examine the association between BC positivity, device existence and the presence of a vegetation on Echo. Results We included 116 patients, median age 58 (41-70) years, 64 (55%) women. Cardiac device was present in 69 (59%): Automated implantable cardioverter defibrillator in 49 (71%), pacemaker in 11(16%), ventricular assist device in four (6%), intra-aortic balloon pump in five (7%). CoNS isolated from 1 BC in 53(46%) patients and from ≥ 2 in 63(54%) patients. Trans- thoracic Echo (TTE) was performed in 42(36%), trans- esophageal Echo (TEE) in 39 patients (33.6%). Sequential Echo (TEE after TTE) was performed in 34 patients (29%). “Definite” IE was diagnosed in none, “possible” IE in 30 (26%), the diagnosis was “rejected” in 86 (74%). Vegetations were noted on device lead in 13(43%) and on valves in 17(57%). Overall yield in patients classified as “possible” IE (n=30) was similar in patients with device (n=26) to those without a device (n=4) (22% vs. 3%; p=0.149). For patients with 1 BC positive for CONS, the presence of a device was not associated with a positive Echo yield (OR, 95% C.I: 1.8 (0.3, 12.9); p=0.474). Patients who had ≥ 2 BC for CoNS had the same Echo yield with or without a cardiac device (15% vs. 24% p=0.243). Conclusion In our medical center, patients with CoNS bacteremia, no patients had a “definite” diagnosis of IE. Yield of Echo was similar in patients with either one or ≥ 2 positive BC and there was no significant association with the presence of a device. Disclosures All Authors: No reported disclosures

COVID-19 and the Gastrointestinal Tract

Since it was discovered at the end of 2019; the pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a serious public health threat worldwide, with over 175 million confirmed cases reported globally. Even when COVID-19 was initially considered a respiratory disease, it was actually known to be multisystemic, with gastrointestinal involvement a common clinical finding. Furthermore, COVID-19 may affect patients with gastrointestinal comorbidities, being the clinical intersectionality of utmost interest for gastroenterologists; critical care physicians and all the healthcare team taking care of COVID-19 patients. The present article presents a brief review of the reported gastrointestinal manifestations of COVID-19 disease in both previously healthy individuals and in patients with gastrointestinal comorbidities.

The Investigation of Canine Distemper Virus in Different Diagnosis Materials of Dogs using Molecular and Pathological Methods, Northeastern Turkey

Background: Canine distemper virus (CDV) is highly contagious disease that affects dogs despite several control measures. This study was aimed at investigating the presence of CDV nucleic acid in different clinical and tissue materials, from naturally infected dogs, by reverse transcriptase-polymerase chain reaction (RT-PCR) and to molecularly characterize distemper strains according to the partial Nucleoprotein (NP) gene sequence. Furthermore, tissue samples under went histopathological examination for distemper infection. Methods: A total of 202 different diagnosis materials were collected from dogs (n=60) in the Kars region in northeastern Turkey. The samples were tested for CDV using RT-PCR with primers designed for the CDV NP gene. Samples determined as positive for CDV (n=7) were sequenced. Tissue samples underwent histopathological examination. Result: Most of the cases were in animals aged 0-6 months. The most common clinical finding was severe respiratory system infection. This finding was accompanied by gastrointestinal and nervous system infections. CDV nucleic acid was detected in 112 of 202 materials by RT-PCR. According to RT-PCR results, positivity rates of 88.2% (30/34), 72.2% (13/18), 60% (3/5), 55.5% (10/18), 55.5% (10/18), 51.6% (16/31), 45.5% (5/11), 37.8% (14/37) and 36.7% (11/30) were detected in nasal swab, lung, footpad, kidney, spleen, rectal swab, cerebrospinal fluids (CSF), leuokocyte and cerebellum samples, respectively. Viral nucleic acids were detected at higher rates in nasal swabs. The phylogenetic assessment of the amplicon sequences revealed a 97.7%-100% similarity among the Turkish CDV strains, which are independent from vaccine strains, were found to be more closely related to the European lineage. Intranuclear and intracytoplasmic inclusion bodies were detected by histopathology. This is the first study to investigate CDV in naturally infected dogs from northeastern Turkey and to provide novel and updated epidemiological information.

The Role of Confocal Endomicroscopy in the Diagnosis and Management of Pancreatic Cysts

Pancreatic cystic lesions are an increasingly common clinical finding. Current diagnostic techniques cannot reliably differentiate patients with high-risk lesions requiring surgical resection from those that can be safely surveyed or discharged. As a result, some patients may undergo unnecessary surgery with associated morbidity while others enter long-term surveillance with associated healthcare costs. Needle-based confocal laser endomicroscopy enables real time microscopic examination of the epithelial lining of a cyst wall at the time of a standard endoscopic ultrasound examination. The procedure is associated with low rates of adverse events, especially when the probe is loaded into the fine-needle aspiration needle before the procedure and examination times are limited. Needle-based confocal laser endomicroscopy has consistently been shown to have better diagnostic accuracy than cytology, which is often paucicellular and non-diagnostic in pancreatic cystic lesions. Studies have shown that diagnostic accuracy in needle-based confocal laser endomicroscopy is 84–95% in mucinous lesions and 39–99% in serous lesions. However, this technology is expensive and its place in diagnostic algorithms remains uncertain. Despite this, health economic analyses in certain health systems have been favourable, largely because of its potential to be able to discharge patients with benign lesions, such as serous cystic neoplasms, from long-term surveillance. Widespread adoption of this technology is unlikely but it has the potential to have an important role in indeterminate pancreatic cystic lesions.

X-ray dark-field tomography reveals tooth cracks

Cracked tooth syndrome (CTS) is a common clinical finding for teeth, it affects about 5% of all adults each year. The finding of CTS is favored by several risk factors such as restorations, bruxism, occlusion habits, and age. Treatment options range, depending on the severity, from no treatment at all to tooth extraction. Early diagnosis of CTS is crucial for optimal treatment and symptom reduction. There is no standard procedure for an evidence-based diagnosis up to date. The diagnosis is a challenge by the fact that the symptoms, including pain and sensitivity to temperature stimuli, cannot be clearly linked to the disease. Commonly used visual inspection does not provide in-depth information and is limited by the resolution of human eyes. This can be overcome by magnifying optics or contrast enhancers, but the diagnosis will still strongly rely on the practicians experience. Other methods are symptom reproduction with percussions, thermal pulp tests or bite tests. Dental X-ray radiography, as well as computed tomography, rarely detect cracks as they are limited in resolution. Here, we investigate X-ray dark-field tomography (XDT) for the detection of tooth microcracks. XDT simultaneously detects X-ray small-angle scattering (SAXS) in addition to the attenuation, whereas it is most sensitive to the micrometer regime. Since SAXS originates from gradients in electron density, the signal is sensitive to the sample morphology. Microcracks create manifold interfaces which lead to a strong signal. Therefore, it is possible to detect structural changes originating from subpixel-sized structures without directly resolving them. Together with complementary attenuation information, which visualizes comparatively large cracks, cracks are detected on all length-scales for a whole tooth in a non-destructive way. Hence, this proof-of principle study on three ex-vivo teeth shows the potential of X-ray scattering for evidence-based detection of cracked teeth.

Fifteen-minute consultation: Cardiac murmurs in the Newborn Infant Physical Examination (NIPE)

The finding of a cardiac murmur on the initial newborn examination is common but may be a source of anxiety for practitioners due to worries about missing critical congenital heart defects (CHDs). This article aims to provide an approach to this common finding, in particular, reviewing the evidence base behind features of the history, examination and subsequent non-specialist investigations which may increase the likelihood of CHDs. The aim of this structured approach is to give clinicians confidence in dealing with this common clinical finding, to be able to pick out those infants most at risk of having critical CHDs.

Influence of Diode Laser for the Treatment of Dentin Hypersensitivity on Microleakage of Cervical Restorations

Noncarious cervical lesions (NCCLs) are a common clinical finding often linked with dentin hypersensitivity (DH). Aim. The aim of the study was to evaluate the influence of diode laser for the treatment of DH on microleakage of subsequent NCCL restorations. Materials and Methods. Forty-eight extracted human premolars were collected. All teeth received standardized cervical preparation on both the buccal and palatal surfaces and were randomly divided into three groups ( n = 16 ) according to the restorative material used: nanohybrid composite resin (CR), resin-modified glass ionomer (RMGI), and conventional glass ionomer (GIC). The prepared cavities on the palatal surfaces were treated by diode laser using SIROlaser Blue (Sirona Dental Systems, Bensheim, Germany) prior to restoration, while preparations on the buccal surfaces were directly restored. After thermocycling, the teeth were immersed in methylene blue dye for microleakage evaluation under 40x magnification at both occlusal and cervical margins. The Kruskal-Wallis test followed by the Bonferroni tests was conducted to determine inter- and intragroup differences ( P < 0.05 ). Results. All restorative materials tested showed some degree of microleakage with no statistically significantly different scores with or without the use of laser desensitization prior to restorative treatment. Group CR showed the least microleakage, followed by group RMGI, while group GIC showed the highest. Cervical margins showed greater microleakage than the occlusal margins where the difference was statistically significant in the RMGI group without laser pretreatment ( P = 0.006 ) and in both groups CR ( P = 0.02 ) and RMGI ( P = 0.006 ) with the laser pretreatment. Conclusion. Application of diode laser for the treatment of DH prior to the restoration of teeth with NCCL did not affect the microleakage of all the restorative materials tested. All the materials showed some degree of microleakage, which was higher in gingival margins compared to occlusal margins. The resin composite shows the least microleakage among all the tested materials.

Tinea Capitis in an Immigrant Pediatric Community; A Clinical Signs-Based Treatment Approach

Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations. This study aimed to identify the clinical characteristics and treatment response of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan, for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016-2017. Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the tests in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) of the children, and induced clinical responses. No side effects were reported. In African refugee children with suspected Tinea capitis, a culture, direct examination and empiric treatment with griseofulvin 50 mg/kg/day are recommended to prevent outbreak of an epidemic.