Concurrent tau pathologies in frontotemporal lobar degeneration with TDP-43 pathology

Aims: Accumulating evidence suggests that patients with frontotemporal lobar degeneration (FTLD) can have pathologic accumulation of multiple proteins, including tau and TDP-43. This study aimed to determine the frequency and characteristics of concurrent tau pathology in FTLD with TDP-43 pathology (FTLD-TDP). Methods: The study included 146 autopsy-confirmed cases of FTLD-TDP and 55 cases of FTLD-TDP with motor neuron disease (FTLD-MND). Sections from the basal forebrain were screened for tau pathology with phospho-tau immunohistochemistry. For cases with tau pathology on the screening section, additional brain sections were studied to establish a diagnosis. Genetic analysis of C9ORF72, GRN, and MAPT was performed on select cases. Results: Among 201 cases, we found 72 cases (36%) with primary age-related tauopathy (PART), 85 (42%) with aging-related tau astrogliopathy (ARTAG), 45 (22%) with argyrophilic grain disease (AGD), and 2 cases (1%) with corticobasal degeneration (CBD). Patients with ARTAG or AGD were significantly older than those without these comorbidities. One of the patients with FTLD-TDP and CBD had C9ORF72 mutation and relatively mild tau pathology, consistent with incidental CBD. Conclusion: The coexistence of TDP-43 and tau pathologies was relatively common, particularly PART and ARTAG. Although rare, individual patients with FTLD can have multiple concurrent proteinopathies. The absence of TDP-43-positive astrocytic plaques may suggest that CBD and FTLD-TDP were independent disease processes in the two patients with both tau and TDP-43 pathologies. It remains to be determined if mixed cases represent a unique disease process or two concurrent disease processes in an individual.

Shoulder Involvement in Daily Practice – Ultrasonographic Approach

Shoulder involvement is one of the most frequent findings in rheumatology and many of the rheumatic diseases can determine inflammatory lesions, as well as degenerative ones. Due to the non-specificity of clinical symptoms, imaging methods are emerging into the daily practice in order to establish an accurate diagnosis. Objectives. The aim of the study was to determine the presence of different pathologic changes in patients with shoulder pain, depending on the concurrent disease and associated risk factors. Material and methods. We included in our retrospective study 40 consecutive patients that presented with shoulder pain, during the past 6 months, in the Department of Rheumatology. All those patients underwent ultrasound evaluation according to EULAR Guidelines for musculoskeletal Ultrasound in Rheumatology. Results. Rotator cuff lesions, which most commonly underlie non traumatic pain in adults, were detected with frequencies similar to the ones described by the literature. It seems that comorbidities, as the presence of diabetes, may influence tendon degeneration or rupture. Conclusions. Although it included a relatively low number of subjects, our paper reveals data similar to the ones previously published and underlines the necessity of applying an algorithm for managing shoulder pathology, that should mandatory include ultrasonography examination, in order to obtain an accurate diagnosis and individualize each patient's therapeutic approach and improve their life quality.

Analysis of the care complexity in the surgical area: Persiceto’s score

Introduction: In Italy a new way of thinking about hospitals is emerging. It involves the articulation of care and resources according to the intensity and the complexity of care; patients acquire a central role and are no longer grouped by medical disciplines but by high, medium or low care complexity. Purpose of this study is to test a tool that detects care complexity in the areas of intervention, calculating and analyzing the care complexity of surgical patients in their first day after surgery. Methods: adoption of the Swot method to specify the Persiceto's Score tool, adapted to the Alexandrian context. The Persiceto tool consists of scores obtained from three elements: type of surgery, state of health/concurrent disease condition, autonomy level of the patient in various activities. Results: In an evaluation period of about 60 days the Persiceto tools completed on the first day after surgery were 80. The state of health and concurrent disease condition of the 80 patients was constituted by 43 with moderate systemic disease, 22 with severe systemic disease, 13 in good health and 2 in threatening health conditions. The level of care dependency that emerged from the IDA assessment of the 80 patients was 56 with low care dependency, 23 with average and 1 with high care dependency. Conclusions: This study has shown that a simple, effective and replicable tool can be useful during the reorganization of care intensity during post-surgery to obtain a precise classifications of care complexity.

Advancing the Care of Pancreatic Cancer Patients: Moving Beyond Just Tumour Tissue

Biobanking efforts, to establish and grow the pool of available tissue from which evidence on aetiology, therapeutic susceptibility and prognosis of various diseases, have been underway for decades. This is illustrated nowhere better than in cancer. High incidence cancers such as breast, colorectal and lung have seen massive increases in their requisite formularies that have yielded improved prognoses. These discoveries, on a very fundamental level, were made by scientists who had access to tumour tissue and associated clinical data from patient donors. As the research space for higher incidence malignancies became increasingly crowded, attention has turned towards those malignancies with lower incidence. In the same time span, technology has continued to evolve, allowing the next generation of scientists and clinicians to ask more nuanced questions. Inquiries are no longer limited to the -omics of tumour tissue but also include biomarkers of blood and excretory products, concurrent disease status and composition of the gut microbiome. The impact of these new technologies and the questions now facing researchers in low-incidence cancers will be summarized and discussed. Our experience with pancreatic ductal adenocarcinoma will be used as a model for this review.

The Relevance of Caseous Lymphadenitis as a Cause of Culling in Adult Sheep

Four hundred and ninety-eight culled sheep received at the Ruminant Clinical Service of the Veterinary Faculty of Zaragoza, Spain, were examined in life and after humanitarian sacrifice in order to reach the final diagnosis of the cause of culling and to evaluate the presence of caseous lymphadenitis (CLA) lesions. One hundred and forty-seven of the 498 studied animals (29.52%) showed CLA compatible lesions that were subsequently confirmed by Corynebacterium pseudotuberculosis isolation. One hundred and seven of the 147 CLA affected animals presenting the visceral clinical form of the disease (72.79%), while only 32 animals were affected by the superficial form (21.77%). In addition, eight animals were found to be affected in both the visceral and the superficial presentations (5.44%). Eighty-four of the 147 CLA-affected animals (57.14%) did not show any concurrent disease, considering, in this case, CLA the main cause of culling (84/498: 16.87%). In the superficial presentation, the retropharyngeal lymph node, as a sole lesion, was the most frequently affected (13/32: 40.63%). Further, in the visceral form of the disease, 85.06% of the affected animals had the lesions located in the respiratory system (91/107: 85.06%). CLA was revealed as an important cause of culling in sheep production.

Putative paraneoplastic pemphigus in a dog: clinical and microscopic findings

In this case report, a dog with clinical and histopathological features of paraneoplastic pemphigus is described. A Lhasa apso with severe ulcerative oral and predominant facial skin disease had a thoracic mass histopathologically diagnosed as a thymoma. A concurrent disease-association was suspected. Cytologic examination of the oral lesions provided early clues to the dog’s ulcerative condition.

Recurrent Polychondritis Associated with IgG4 Disease

Relapsing polychondritis (RP) is a rare systemic autoimmune disorder characterized by the episodic and progressive deterioration of cartilage inflammation. Approximately 30% patients with RP have concurrent disease. However, there are three cases reports of RP complicated by immunoglobulin G4-related disease (IgG4-RD). Here we report another case of a 37-year-old female who developed RP approximately 1 years before IgG4-RD diagnosis. The association between IgG4-RD and RP remains unclear.

Clinical Assessment of Gastrointestinal Involvement in Patients with Systemic Sclerosis

Systemic sclerosis (SSc) is an autoimmune connective tissue disease that negatively impacts the function of the skin and internal organs. The gastrointestinal (GI) tract is the most commonly affected internal organ in SSc, though GI complications may also arise indirectly when infections occur in the setting of immunosuppression or concurrent disease processes arise for which patients with SSc are found to be at higher risk. In this review, we provide a systematic approach for the clinical assessment of GI complications in SSc from the oropharynx to the anorectum to guide both general internists and rheumatologists caring for this complex patient population. It is organized so that each component of the luminal GI tract has its own specified section, beginning with a review of a clinical approach to diagnosis, followed by a more detailed discussion of the literature surrounding approaches for an objective GI evaluation. A focused discussion early in the manuscript addressing what is known about pathogenesis, and later about in the manuscript about the assessment for GI bleeding are also included.

Pattern of drug use among the geriatric patients: a prospective, observational and hospital based study

Background: The world’s population continues to grow at an unprecedented rate. With the advances in medical therapeutics have contributed to health gains and increase in life expectancy. So strategies to improve prescribing are essential so as to ensure that the medications available to manage concurrent disease states are prescribed appropriately. This study is undertaken to identify patterns of drug use in treating elderly patients and assessment of polypharmacy among the geriatric age group.Methods: The study was approved by institutional ethics committee of Rangaraya Medical College, Kakinada. The study was conducted as a hospital based study in different departments in Government General Hospital during period from January 2016 to December 2016 at Government General Hospital with a total of 549 patients among outpatient and inpatients.Results: Polypharmacy is unfortunately very common in India and some other countries. In the present study average number of drugs prescribed per patient was 4.66.Conclusions: With ever increasing therapeutic options, escalating proportions of older people worldwide, the prescription pattern among them matters a lot. Also as this group of patients are vulnerable, taking necessary care and reviewing the past drug history will have a major role and increase the betterment of the geriatric age group.