bluuebunny/crossref_metadata_2025 huggingface dataset:
Separation-free super-resolution from compressed measurements is possible: an orthonormal atomic norm minimization approach
Authors: Yi Jirong , Dasgupta Soura , Cai Jian-Feng , Jacob Mathews , Gao Jingchao , Cho Myung , Xu Weiyu
Published: August 2023

We consider the problem of recovering the superposition of $R$ distinct complex exponential functions from compressed non-uniform time-domain samples. Total variation (TV) minimization or atomic norm minimization was proposed in the literature to recover the $R$ frequencies or the missing data. However, it is known that in order for TV minimization and atomic norm minimization to recover the missing data or the frequencies, the underlying $R$ frequencies are required to be well separated, even when the measurements are noiseless. This paper shows that the Hankel matrix recovery approach can super-resolve the $R$ complex exponentials and their frequencies from compressed non-uniform measurements, regardless of how close their frequencies are to each other. We propose a new concept of orthonormal atomic norm minimization (OANM), and demonstrate that the success of Hankel matrix recovery in separation-free super-resolution comes from the fact that the nuclear norm of a Hankel matrix is an orthonormal atomic norm. More specifically, we show that, in traditional atomic norm minimization, the underlying parameter values must be well separated to achieve successful signal recovery, if the atoms are changing continuously with respect to the continuously valued parameter. In contrast, for the OANM, it is possible the OANM is successful even though the original atoms can be arbitrarily close. As a byproduct of this research, we provide one matrix-theoretic inequality of nuclear norm, and give its proof using the theory of compressed sensing.
Comparisons of blood alcohol concentrations between initial testing and reanalysis from unopened tubes preserved with 0.25% NaF following refrigerated storage up to 3.93 years
Authors: Olds Maria L
Published: August 2023

Few studies support the usage of <1% nominal sodium fluoride (NaF) to preserve ethanol in antemortem blood. Of these studies, several are limited by short study durations of 90 days or less, and there is limited research of authentic samples preserved with <1% NaF. In this retrospective analysis, data from initial and reanalysis testing of blood alcohol concentration (BAC) in antemortem blood collected in 6 mL gray-top tubes (providing 0.25% nominal NaF) has been compiled, to evaluate changes in ethanol concentration that occurred after periods of refrigerated storage. The time between initial and reanalysis was determined by court request(s), and ranged 0.30–3.93 years. In each case, a previously unopened tube was selected for reanalysis testing. Comparable BAC values were found from initial testing, with BACs ranging from 0.025 to 0.394 g/100 mL, and reanalysis testing, with BACs ranging from 0.021 to 0.393 g/100 mL. Ethanol changes ranged from −0.013 g/100 mL (decrease) to 0.008 g/100 mL (increase). BAC reanalysis values that increased (n = 6) were within the uncertainty of measurement (UM) from the initial BAC test, that is, were not statistically or analytically significant. For BAC decreases (n = 29), four test values exceeded the UM of the original test, with BAC losses ranging from 0.004 to 0.011 g/100 mL (relative percent changes 6.5–16.0% loss). The average ethanol change was −0.004 g/100 mL, which is comparable to or less than ethanol losses from studies using 1% NaF preservative of varying temperature and storage duration.
E06 Does GGT level correlate with activity parameters in enthesitis-related arthritis?
Authors: Ben Ayed Hiba , Ferjani Hanene , Nessib Dorra Ben , Rabhi Emna , Kaffel Dhia , Maatallah Kaouther , Hamdi Wafa
Published: August 2023

Introduction

Enthesitis-related arthritis (ERA) is one of the main subgroups of juvenile idiopathic arthritis. As in the adult population, monitoring of patients with ERA is based on clinical and laboratory evaluation. Some studies showed a correlation between Gamma-glutamyl transferase (GGT) levels and rheumatoid arthritis disease activity markers. Thus, we aimed to evaluate the correlation between GGT levels and ERA activity parameters.

Methods

This is a cross-sectional monocentric study including patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria for ERA. We collected the demographic and clinical data. We assessed the ERA activity using clinical parameters including Patient Global Assessment (PGA), Visual Analogue Scale (VAS), Morning stiffness (MS), tender joint count (TJC), swollen joint count (SJC), active enthesitis count (AEC), clinical sacroiliitis, back mobility, and ocular involvement. We collected biological parameters such as the C-reactive protein (CRP) and the Erythrocyte sedimentation rate (ESR).

We calculated the Juvenile spondyloarthritis disease activity (JSpADA). GGT level was measured on the same day. The correlation was evaluated using Spearman’s rho coefficient (r). r-value <0.3 was considered poor; between 0.3 and 0.39, moderate; between 0.4 and 0.69, strong; and >0.7 very strong.

Results

Thirty patients with a mean age of 15.1 ± 4.1 years, and a ratio-sex of 2.75 were included. The mean disease duration was 4.3 ± 3.2 years. The mean PGA and the mean VAS were 6.2 ± 7.1 and 8.9 ± 2.9 respectively. Mean TJC, mean SJC, and mean AEC were 1.53 ± 2.8, 0.18 ± 0.47, and 1.2 ± 1.6 respectively. Clinical sacroiliitis was found in eight patients, limited back mobility in six, and uveitis in three patients. The mean CRP and ESR were 15.1 ± 22.7 mg/l and 23.8 ± 21.2 mm, respectively. The mean JSpADA was 2.6 ± 1.7. Mean GGT was 14.3 ± 6.6 mg/l. A strong correlation was noted between the GGT level and both CRP (r = 0.504, P = 0.05) and ESR (r = 0.601, P = 0.01). However, no correlation was noted between GGT level and PGA (r = 0.107, P = 0.6), VAS (r = 0.03, P = 0.9), SJC (r = -0.17, P = 0.368), nor JSpADA (r = 0.323, P = 0.87).

Conclusion

Our results suggest a strong correlation between GGT level and biological ERA activity parameters, unlike clinical parameters and disease activity scores. More studies are needed to confirm these findings.

Ethics

The authors have no conflicts of interest to declare.
E09 Juvenile idiopathic athritis: a desk review of the available standard treatment guidelines in East Africa
Authors: Meleki Elton , Furia Francis F
Published: August 2023

Background

Juvenile Idiopathic Arthritis (JIA) is a common rheumatic disorder in children, with an estimated prevalence of 1 out of every 1000 children worldwide. In Tanzania, a retrospective review of pediatric patients with pediatric rheumatology conditions for seven years, reported JIA as the most prevalent condition. Timely initiation of therapy and availability of appropriate pharmacotherapy halts morbidity and mortality. Treatment guidelines for this condition is a key in guiding appropriate management.

Aim

This review was conducted to determine the availability of treatment guidelines for JIA in East Africa and compare them with the international guidelines.

Methodology

This was a desk review of available treatment guidelines for juvenile idiopathic arthritis in East Africa and as well international guidelines for comparison. The search was done on google, google scholar, Medline, HINARI and PubMed. The international guidelines were obtained from the respective webpages of the academic associations for rheumatology disorders. The search words entered in the data bases included ‘JIA treatment guidelines’, ‘Systemic arthritis treatment guidelines’, and ‘treatment guidelines for pediatric arthritis’. Each of the words was entered in the search engine with the names of the East African countries separately.

Results

There are no available standard guidelines for treatment of juvenile idiopathic arthritis in East Africa. However, available experts contextualize the international guidelines to attend local patients. This happens amidst a region with scarce resources. In a few available studies including ones conducted by A. Migowa et al. and M. Kamau et al. treatment includes use of NSAIDS for pain management, and corticosteroids for treatment bridging until Disease Modifying Anti-Rheumatic Drugs (DMARDS) become effective. Availability of biologics is not consistent in all the hospitals and their access is limited in third world countries (M. Kamau et al.). The reliable Disease Modifying Anti-Rheumatic Drugs of choice remain to be the convectional ones. The international guidelines exist for other regions including Europe (EULAR), America (ACR), and Asia pacific regions (APLAR).

Conclusion

There is a need to develop standard treatment guidelines in our settings in order to guide clinicians to best manage patients with JIA with the available treatment options in our setting.
E14 Is there a correlation between inflammation and cardiovascular risk in juvenile idiopathic arthritis
Authors: Rahmouni Safa , Tbini Houssem , Rekik Sonia , Ben Ammou Ahlem , Zouaoui Khaoula , Boussaid Soumaya , Sahli Hela , Elleuch Mohammed
Published: August 2023

Introduction

Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease and, like any chronic inflammatory rheumatic disease, has an increased risk of cardiovascular disease compared with the general population.

Objectives

In this work, we investigated the relationship between inflammation and cardiovascular risk during JIA.

Methods

This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Clinical and biological parameters were collected. Cardiovascular risk factors (CVRF) were also assessed: family history of cardiovascular event, physical inactivity, smoking, arterial hypertension, diabetes, dyslipidaemia, obesity.

Results

We included 29 patients (17 females and 12 males) with an average age of 35.69 ± 11.72 [18–61] years, an average age of disease onset of 11.10 ± 4.25 [2–16] years and an average diagnostic delay of 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years.

Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm/h. A biological inflammatory syndrome was noted in 65.5% of cases (n = 19).

CVRF were present in 41.4% (n = 12) of cases: family history of cardiovascular event (n = 2 cases), physical inactivity (n = 5 cases), smoking (n = 3 cases), arterial hypertension (n = 4 cases), diabetes (n = 4 cases), dyslipidaemia (n = 4), and BMI ≥ 25 kg/m2 (n = 4).

Our statistical study concluded that CVRF (all types) were more frequent in case of elevated inflammation markers (60% vs 15.4%; P = 0.016). In addition, the presence of biological inflammatory syndrome associated with smoking in our population (20% vs 0%; P = 0.048). In contrast, we found no significant difference when comparing the rest of CVRF according to the elevation of inflammation markers.

Furthermore, we found a correlation between biological inflammation and the presence of CVRF (all type) (r = 0.456; P = 0.015). However, no correlation was found with the CVRF taken separately.

Conclusion

Inflammation is correlated with cardiovascular risk in JIA. Control of inflammation and modifiable CVRF is recommended in this disease.
E15 Immunopositive and immunonegative juvenile idiopathic arthritis: what makes the difference?
Authors: Tbini Houssem , Rahmouni Safa , Rekik Sonia , Ben Ammou Ahlem , Zouaoui Khaoula , Boussaid Soumaya , Sahli Hela , Elleuch Mohammed
Published: August 2023

Background

Juvenile idiopathic arthritis (JIA) is a complex pediatric rheumatic disease of polymorphic expression. The immunological assessment is commonly performed during this disease.

Objectives

The objective of this work was to evaluate the difference between immunopositive and immunonegative forms of JIA.

Methods

We conducted a retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period (1994 – 2022). We retrieved the immunological results of all patients. The disease was considered immunopositive in case of rheumatoid factor (RF) and/or anti-citrullinated peptide antibody (ACPA) positivity.

Results

We included 29 patients (12 men and 17 women) with a mean age of 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years.

The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2, 8 patients had a normal BMI. Growth delay was noted in 3 cases.

The polyarticular form was the most frequent, observed in 55.2% of cases. At least one extra-articular manifestation was noted in 16 patients: ophthalmologic, skin, cardiac, pulmonary, and renal involvement were found in 6,4,4,3 and 2 cases, respectively. Osteoporosis was noted in 7 cases.

Mean C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 42.74 ± 63.37 [2–218] mg/l and 69.67 ± 36.23 [36–108] mm/h. Bone erosions, hip involvement and atlantoaxial dislocation were noted in 18, 14, and 4 cases, respectively.

Rheumatoid factor, ACPA and anti-nuclear antibodies were observed in 12, 7 and 5 cases respectively. The disease was considered immunopositive in 13 cases.

Our comparative study found that women had more immunopositive forms (84.6% vs 15.4%; P = 0.010). In addition, osteoporosis was less frequent in immunopositive JIA (11.1% vs 88.9%; P = 0.003). Growth delay was only observed in immunopositive JIA (P = 0.012). Furthermore, the age at disease onset was greater in the immunopositive group (12.85 ± 2.94 vs 9.69 ± 4.7 years; P = 0.045).

However, no significant differences were identified when comparing the rest of the JIA characteristics.

Conclusion

Evaluation of the immunological profile is required in JIA. Our study found associations of RF and/or ACPA positivity with age at disease onset, female gender, osteoporosis, and growth delay in JIA.
E17 Juvenile idiopathic arthritis: are girls less lucky?
Authors: Tbini Houssem , Rahmouni Safa , Rekik Sonia , Ammou Ahlem Ben , Zouaoui Khaoula , Boussaid Soumaya , Sahli Hela , Elleuch Mohammed
Published: August 2023

Introduction

Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. ∼3 million children and young adults worldwide have JIA, with higher prevalence rates in girls.

Objectives

Our objective was to assess the relationship between gender and disease characteristics.

Methods

A retrospective study including adults with long-standing JIA according to International League of Associations of Rheumatology (ILAR) criteria over a 28-year period from 1994 to 2022. We collected clinical, biological, and radiological disease characteristics from medical records. These parameters were compared according to gender.

Results

We have included 29 patients (17 women and 12 men). The mean age was 35.69 ± 11.72 [18–61] years. Symptoms began at an average age of 11.10 ± 4.25 [2–16] years and have been evolving since 24.48 ± 12.76 [1–47] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months.

The mean body mass index (BMI) was 21.20 ± 4.88 [14.17–27.55] kg/m2, 8 patients had a normal BMI. Growth delay was noted in 3 cases.

Sixteen patients (55.2%) had a polyarticular form. The presence of rheumatoid factor (RF), ACPA and anti-nuclear antibodies was noted in 12, 7 and 5 cases, respectively.

At least one extra-articular manifestation was noted in 16 patients: ophthalmologic (n = 6), skin (n = 4), cardiac (n = 4), pulmonary (n = 3) and renal (n = 2) involvement. Osteoporosis was noted in 7 cases.

Mean C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and haemoglobin value level 42.74 ± 63.37 [2–218] mg/l, 69.67 ± 36.23 [36–108] mm, and 11.31 ± 2.10 [6.5–15] g/dl. An elevation of inflammation markers was noted in 19 cases. Anaemia was noted in 20 cases.

Bone erosions were noted in 18 cases. Hip and cervical spine involvement were noted in 14 and 4 cases, respectively.

Our comparative study showed that rheumatoid factor positivity was significantly associated with female gender (73.3% vs 16.7%; P = 0.018). No other significant gender differences were identified when comparing the rest of the clinical, biological, and radiological variables.

The correlation study concluded the following correlations of gender with haemoglobin level (r = -0.574; P = 0.001), rheumatoid factor positivity (r = 0.517; P = 0.016) and JIA subform (r = -0.482; P = 0.008).

Conclusion

A relationship of gender to rheumatoid factor positivity, haemoglobin level, and JIA subform was identified in our study. Larger-scale longitudinal studies would better investigate the influence of gender on JIA.
E19 Gamma-glutamyl transpeptidase level is correlated with disease activity in oligoarticular and polyarticular Juvenile idiopathic arthritis
Authors: Dhia Siwar Ben , Ferjani Hanene , Nessib Dorra Ben , Rabhi Emna , Kaffel Dhia , Maatallah Kaouther , Hamdi Wafa
Published: August 2023

Introduction

Gamma-glutamyl transpeptidase (GGT) level was found to be correlated with disease activity indexes in rheumatoid arthritis [1]. This association was not yet investigated in children with oligoarticular and polyarticular Juvenile idiopathic arthritis (JIA).

Objectives

The present study aims to investigate the correlation between GGT level and disease-related parameters in oligoarticular and polyarticular JIA.

Methods

We performed a retrospective study including patients with oligoarticular and polyarticular JIA responding to the 2001 International League of Associations for Rheumatology (ILAR) classification.

Sociodemographic, disease-related parameters (age of onset, disease duration, patient global assessment (PGA), Pain Visual Analogue Scale (VAS), C-Reactive protein (CRP) level, Erythrocyte Sedimentation Rate (ESR), disease activity assessed using the Juvenile Arthritis Disease Activity Score (JADAS) based on ESR), and GGT level were collected. Continuous variables were expressed with median and Interquartile range (IQR). Spearman correlation was used to assess the association between GGT levels and disease-related data.

Results

Eleven patients were included with a median age of 12 (IQR: 10–15) years and 8 females. Median disease duration was 4 (IQR: 4–7) years and median age of onset was 8 (IQR: 5–10) years. Five patients had oligoarticular JIA, 3 had a polyarticular with positive Rheumatoid Factor (RF) form, 2 had a polyarticular with negative RF form and one had an undifferentiated JIA. Median JADAS was 3.6 (IQR: 0–9). Median ESR, CRP, and GGT levels were 14 (10–19) mm/H, 1.8 (2–6.4) mg/l, and 14 (12–16) IU/l, respectively. A strong positive correlation was found between GGT level and JADAS (r = 0.749, P = 0.008). Level of CRP and ESR were not correlated with GGT level. Besides, patient global assessment and pain VAS were positively correlated with GGT level (r = 0.670, P = 0.049; r = 0.814, P = 0.014, respectively). No correlation was found between GGT level and disease duration and number of tender or swollen joints.

Conclusion

The GGT level was significantly higher in patients with more active disease, higher pain, and global assessment. This suggests that GGT level can be used as a marker of disease activity as in JIA.

References

1 Vergneault H, Vandebeuque E, Codullo V, Allanore Y, Avouac J. Disease Activity Score-28 using γGT permits a dual evaluation of joint activity and cardiovascular risk. J Rheumatol 2020.
E24 Does juvenile onset impact the serum levels of bone-forming biomarkers in adult patients with Spondyloarthritis?
Authors: Maatallah Kaouther
Published: August 2023

Introduction

The Wnt signalling pathway regulates bone metabolism. Dickkopf1 (DKK-1) and Sclerostin are potent inhibitors of this pathway, and their dysfunction would be responsible for bone formation phenomena in patients with spondyloarthritis (SpA). Osteoprotegerin (OPG), a potent inhibitor of osteoclasts, regulated by the Wnt pathway, has also been implicated in this bone ossification phenomenon. We aimed to assess the impact of juvenile-onset on the serum levels of DKK-1, sclerostin, and OPG in adult with spondyloarthritis.

Methods

It was a cross-sectional case control study including patients with SpA (meeting ASAS criteria). Data collected included sociodemographic and disease characteristics. Biomarker assays were performed using an ELISA technique.

Results

Among one hundred and nine included patients, seven patients had a juvenile onset of the disease (six males, one female). The mean age of disease onset was 12.8 ± 4.3 [5–16] years. The mean duration of SpA at inclusion was 15 ± 6 years [4 – 21]. Two (28.6%) patients had an axial form, and five (71.4%) had an axial and peripheral form. Three patients (42.9%) had entheseal involvement. The means of serum levels of DKK-1 and sclerostin in patients with juvenile-onset SpA and healthy controls were (132 ± 81 vs 122 ± 113; P = 0.439) and (27 ± 15 vs 39 ± 49; P = 0.985) respectively.

The analysis did not show significant differences in serum levels of DKK-1 (P = 0.293), sclerostin (P = 0.428), and OPG (P = 0.504) between patients with SpA with juvenile onset and adult SpA.

Conclusion

In our study the juvenile onset of the disease did not correlate with the inhibitors of the Wnt signalling pathway and OPG in patients with SpA.
E43 Multisystem inflammatory syndrome in children: an experience from Batna –Algeria
Authors: Hadef Djohra , Zerguine Halima , Bouderdaben Leila , Bechah Soumia , Kahlane Ibtissam , Benbouzid Nourelhouda , Bensacia Norhane , Brahmi Saida
Published: August 2023

Introduction

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with Covid-19. MIS-C is defined as a clinically serious condition requiring hospitalization with fever, multi-system organ dysfunction, inflammatory biomarkers increase.

Objectives

The aim of this study was to describe the demographic, clinical features, therapeutic aspects, complications, and outcomes of patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in our region.

Methods

A retrospective descriptive study was conducted in the COVID-19 area of the Department of Pediatrics of the university hospital center (CHU Benflis Touhami Batna) over a three-year period from March 2019 to March 2022. Demographic and clinical data were collected.

Results

As at April 01, 2022, a total of 24 patients were hospitalized for MIS-C in our COVID-19 area of the Department of Pediatrics. The mean age was 5 years [3 months to 15 years]; 58% were male. The most common presenting symptoms were fever (88%), rash (60%), conjunctival injection (56%). 45% had gastrointestinal symptoms and 33% had respiratory symptoms. Elevated levels of C-reactive protein, d-dimer, and procalcitonin were found in 80%, 63%, and 50% of the patients, respectively. For treatment, intravenous immunoglobulin was used in 11 (46%), corticosteroids in 18 (75%). All patients were discharged home.

Conclusion

the incidence of MIS-C among children infected with SARS-CoV-2 is unclear as children often present with mild symptoms of Covid-19. This serious disease condition requires more surveillance and study.

Disclosure statement: None declared.
E46 Viruses reactivating each other’s!
Authors: Guedri R , Glai M , Jelassi A , Fitouri Z , Becher S Ben
Published: August 2023

Introduction

COVID-19 is known to cause an immunocompromised state. This condition was associated with reactivation of quiescent viruses.

Objectives

Describe a case of HHV-6 reactivation in a patient diagnosed with MIS-C syndrome.

Methods

The diagnosis of MIS-C syndrome associated to SARS-CoV-2 was done by following the criteria established by the World Health Organization (WHO). The reactivation of HHV6 was confirmed by positivity of RT-PCR in blood and presence of IgG in serology.

Results

A four years old girl, with no medical history who presented to emergency room with high fever associated with conjunctival injection, cheilitis, cervical adenopathy and rash since four days. She developed a generalized tonic-clonic seizure then a vasoplegic shock two days later. Thus, she was admitted in ICU. Clinical examination on admission showed polypnea, a low blood oxygen level, tachycardia, a low blood pressure (28/15mmhg), a hepatomegaly, a maculopapular rash in pelvic region and a bilateral eyelid swelling. Biology showed lymphopenia (660 109/l), hepatic cytolysis, low prothrombin test (19%), an acute renal failure, a biological inflammatory syndrome with an elevated C-reactive protein (274 mg/l), an elevated ferritin, increased d-dimers (1µg/ml) and fibrinogen level which suggest activation of the coagulation cascade with a prothrombotic state and elevated lactatemia (6.4 mmol/l). The chest X-ray was normal. She had a low ejection fraction (39%) showed on echocardiogram. A rapid SARS-CoV-2 test was negative but serology was positive. Since MIS-C syndrome was not known to give severe hepatitis, other diagnoses was proposed. RT-PCR in serum associated to RT-PCR in cutaneous lesion’s biopsy was positive for HHV6. The hepatitis A serology was negative. She has an anterior immunity to varicella-zoster (VZV). She was intubated. She received vasoactive medications, intravenous immunoglobulin (IVIG) and steroids. Course was marked by hemolytic anaemia, which was associated to immunoglobulin (IVIG). Our patient become rapidly afebrile. Vital signs and laboratory parameters of inflammation, CRP, lymphopenia, markers of cardiac injury, transaminases and renal function parameters all normalized. On day 28 of hospital stay, she was discharged with full dose of steroids and low dose of aspirin.

Conclusion

HHV6 reactivation needs a state of immunosuppression and was reported with acquired immunodeficiency syndrome (AIDS) and a variety of lymphoproliferative disorders. It leads to fever, cutaneous eruption as well as more serious complication such as hepatitis, which is the case with our patient.

Ethics

No conflicts of interest.
E49 Behçet's disease associated with Warkany syndrome: a case report
Authors: Hadef Djohra , Zerguine Halima , Behamma Hayette , Benbouzid Nourhane , Rougui Mohamed Fateh
Published: August 2023

Background

Behçet's disease is a rare chronic, relapsing, multisystem vasculitis characterized by mucocutaneous lesions, articular, ocular, vascular, and central nervous system manifestations, of which pediatric forms may be syndromic. Warkany syndrome is a rare genetic anomaly defined by trisomy 8, characterized clinically by facial dysmorphia, mild intellectual disability, and skeletal anomalies.

Aim

We report the case of a 9-year-old boy diagnosed with Behçet's disease and whose examination revealed an associated Warkany syndrome.

Observation

the boy was from a non-consanguineous marriage, correctly vaccinated, with a history of congenital dislocation of the hip operated at the age of 3 years and obstruction of the lacrimal duct operated at the age of 6 years, who presented with chronic bilateral synechial pan uveitis, recurrent oral aphthosis (>3 times a year), multiple dysostosis with chronic diffuse arthralgias: hip, knees, shoulders. The clinical examination reveals a facial dysmorphia (elongated skull, high and prominent forehead, hypertelorism, sunken eyes, wide nose with anteverted nostrils, micrognathia with eversion of the lower lip, large ears with a thick rim), organomegaly (hepatosplenomegaly, large kidneys), a moderate intellectual deficit and deep palmar and plantar folds Auditory evoked potential finds bilateral deafness. Inflammatory workup was positive, HLAb51 typing was positive. MPS enzyme assay is normal. Genetic study: not done due to lack of means.

Conclusion

Behçet's disease in children can be associated with other genetic syndromes, it remains to be seen if it is a simple fortuitous association.
E64 Clinical, radiological, and etiological profile of hip pain in children
Authors: Taboubi F , Lassoued Ferjani H , Ben Nessib D , Belhaj W , Kaffel D , Maatallah K , Hamdi W
Published: August 2023

Background

Hip pain is a frequent complaint in the pediatric population, in orthopedics, and in rheumatology. In children, the clinical features of hip pain vary widely according to age. This clinical variability represents a diagnosis challenge for clinicians. This study aimed to identify the clinical, paraclinical, and etiological spectrum of hip pain in children.

Methods

A retrospective, descriptive study was conducted between January 2017 and December 2020. We included children aged under 16 years who were hospitalized in the rheumatology and/or pediatric orthopedics department at Mohamed Kassab orthopedics institute for non-traumatic hip pathology. Clinical, biological, and radiological data were collected from recorded medical files. Missed anamnestic data were collected from parents by telephone call.

Results

We included 81 children. Male predominance was noted (48 boys and 33 girls). The mean age was 9.9 ± 4.4 years with extremes from 1.3–16 years. Limping was the presenting feature in 84.4% of children, followed by pain (76.5%) and refusal to bear weight (12.3%). The mean time of onset to presentation was 8.8 ± 21.3 months. The mean diagnosis delay was 3.5 ± 15.3 months with extremes from 0 to 10 years. Fifty-four (66.7%) children visited their physician at least once before diagnosis. In clinical examination, fever was found in 12 children, and local inflammatory signs in 2 children. Leg length discrepancy was noted in 13 children, hip joint pain in 47 children, and restricted hip movement in 58 children. Elevation of erythrocyte sedimentation rate was noted in (23/28) of children and elevation of C reactive protein in (14/33) of children. An elevated leucocyte count was present in (10/79) patients. Radiographs showed anomalies in 76.5% of cases and Ultrasonography in 90.9% of cases. The final diagnoses of our sample were: slipped capital femoral epiphysis (37%), juvenile idiopathic arthritis (18.5%), hip dysplasia (14.8%), septic arthritis (12.3%), transient synovitis (8.6%) and tumors (4.9%). The chirurgical approach was conducted in 71.6% of patients. Most children (72.5%) had benign outcomes.

Conclusion

The diagnosis of pediatric hip pain should always follow a standard algorithm. This starts with taking a detailed history from the patient, if possible, and parents and conducting a thorough clinical examination; imaging and/or blood tests may follow if necessary.

Ethics

The authors declare that they have no conflict of interest.
E68 Kawasaki Disease before and during COVID-19
Authors: Guedri R , Jelassi A , Meriem Glai , Hrizi H , Essaddam L , Fitouri Z , Ben Becher S
Published: August 2023

Introduction

Kawasaki disease is a febrile systemic vasculitis of children, which is suspected to be triggered by respiratory viral infections. We further note, with the outbreak of COVID 19, an increase in incidence with a change in the profile of Kawasaki disease.

Objective

To describe the epidemiological, clinical and evolutionary characteristics of children managed for Kawasaki or Kawasaki-Like syndrome before and during the Covid pandemic19.

Materials and Methods

This is a retrospective, descriptive study conducted in the PUC department of the Béchir Hamza children's hospital in Tunis, over a period of 05 years from 1 January 2017–31 December 2021.

Results

We collected 30 cases of patients hospitalized with Kawasaki disease, between January 2017 and December 2021: 11 cases with Kawasaki syndrome before COVID-19; and 19 cases with Kawasaki syndrome after COVID-19. The mean age of diagnosis was 42 months before the pandemic vs 81 months after the pandemic. The sex ratio was 0.5 before the pandemic vs 0.7 after the pandemic. Viral disease was reported in 0 cases before the pandemic vs 4 cases with confirmed COVID contacts after the pandemic. Fever was the main symptom in both periods, with a mean maximum temperature of 39.7°C before the pandemic vs 39.5°C after the pandemic. The delay of fever from diagnosis was 7.8 days before the pandemic vs 5 days after the pandemic. Cheilitis was reported in 10 cases before the pandemic vs 16 case after the pandemic. Palmoplantarerythema was reported in 1 case before the pandemic vs 7 cases after the pandemic. Scaling was found in 8 cases before the pandemic vs 2 cases after the pandemic. The rash was reported in 9 cases mainly purpuric before the pandemic vs 17 cases after the pandemic, maculopapular. Abdominal involvement was found in 2 cases before the pandemic vs 14 cases after the pandemic. Clinical cardiac involvement was found in 2 cases before the pandemic vs 3 cases after the pandemic. The TTE was pathological in 2 cases before the pandemic, with coronary aneurysm vs 7 cases after the pandemic, with heart failure. All cases received immunoglobulin with a mean time to apyrexia of 26 h before the pandemic vs 25 h after the pandemic. The mean time to hospitalization was 8 days before the pandemic vs 7.3 days after the pandemic. No deaths occurred.

Conclusion

The change in the profile and incidence of Kawasaki disease following the emergence of COVID-19 must be taken into account in order to manage an influx of patients with severe Kawasaki disease.
Management of postpartum perineal wound complications
Authors: Saad Jaber , Painter Caitlyn
Published: August 2023

Purpose of review

Perineal wound complications occur in up to 25% of postpartum patients. Wound complications are most common after obstetric anal sphincter injuries (OASIS) but can occur after any laceration. It is imperative that any provider caring for postpartum patients understand the best evidence-based practices to recognize and manage these complications. We present a review of the available literature on the management of postpartum perineal wound complications.

Recent findings

There is a paucity of new publications on the management of postpartum perineal wound complications, despite an increased emphasis on postpartum recovery in women's health. The role of topical estrogen in healing of perineal wounds was investigated in a pilot study, demonstrating that granulation tissue does express estrogen receptors, and the use of estrogen increases cell proliferation. Progression of perineal wound healing by secondary intention was evaluated in an observational study. Wound healing was delayed in 30% of women, with the initial wound area, perimeter, bacterial colonization, and OASIS being associated with delayed healing.

Evidence based practices on timing of follow-up, addressing wound care and analgesia, administrating antibiotics, timing secondary repair, and surgical technique all play a role in optimizing recovery and reducing morbidity in patients with postpartum perineal wound complications.
P2RX7 gene knockout or antagonism reduces angiotensin II-induced hypertension, vascular injury and immune cell activation
Authors: Shokoples Brandon G. , Berillo Olga , Comeau Kevin , Chen Hao Yu , Higaki Akinori , Caillon Antoine , Ferreira Nathanne S. , Engert James C. , Thanassoulis George , Paradis Pierre , Schiffrin Ernesto L.
Published: August 2023

Objective:

Extracellular ATP is elevated in hypertensive mice and humans and may trigger immune activation through the purinergic receptor P2X7 (P2RX7) causing interleukin-1β production and T-cell activation and memory T-cell development. Furthermore, P2RX7 single nucleotide polymorphisms (SNP) are associated with hypertension. We hypothesized that P2RX7 activation contributes to hypertension and cardiovascular injury by promoting immune activation.

Methods:

Male wild-type and P2rx7

–/–
mice were infused or not with angiotensin II (AngII) for 14 days. A second group of AngII-infused wild-type mice were co-infused with the P2RX7 antagonist AZ10606120 or vehicle. BP was monitored by telemetry. Cardiac and mesenteric artery function and remodeling were assessed using ultrasound and pressure myography, respectively. T cells were profiled in thoracic aorta/perivascular adipose tissue by flow cytometry. Associations between SNPs within 50 kb of P2RX7 transcription, and BP or hypertension were modeled in 384 653 UK Biobank participants.

Results:

P2rx7 inactivation attenuated AngII-induced SBP elevation, and mesenteric artery dysfunction and remodeling. This was associated with decreased perivascular infiltration of activated and effector memory T-cell subsets. Surprisingly, P2rx7 knockout exaggerated AngII-induced cardiac dysfunction and remodeling. Treatment with a P2RX7 antagonist reduced BP elevation, preserved mesenteric artery function and reduced activated and effector memory T cell perivascular infiltration without adversely affecting cardiac function and remodeling in AngII-infused mice. Three P2RX7 SNPs were associated with increased odds of DBP elevation.

Conclusion:

P2RX7 may represent a target for attenuating BP elevation and associated vascular damage by decreasing immune activation.
Evaluation of cardiac electromechanics in patients with newly diagnosed hypertension
Authors: Omar Timor , Hamideyin Şerif , Karakayali Muammer , Artaç İnanç , Karabağ Yavuz , Dündar Cihan , Rencüzoğullari İbrahim
Published: August 2023

Objectives:

This study aimed to investigate the relationship between subclinical left ventricular (LV) systolic dysfunction and ECG parameters in newly diagnosed hypertension patients.

Methods:

In this cross-sectional study, adults diagnosed with hypertension based on 24-h ambulatory blood pressure monitor recordings were included. The patients were classified into two groups based on the presence of subclinical LV systolic dysfunction according to LV global longitudinal strain (LVGLS). Findings were compared between the two groups.

Results:

A total of 244 patients (female, 55.7%) were included. Based on LVGLS, 82 (33.6%) patients had subclinical LV systolic dysfunction. The proportion of early repolarization pattern (ERP) on ECG was significantly higher in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [24 (28.6%) vs. 8 (5%), P < 0.001]. PR and corrected QT intervals were also significantly longer in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [median (interquartile range), 148 (132–158) vs. 141 (127–152), P = 0.036 and 443 (427–459) vs. 431 (411–455), P = 0.007, respectively]. According to multivariate regression analysis ERP, early (E) wave velocity/late (A) wave velocity (E/A), and LV mass index were independently associated with subclinical LV systolic dysfunction.

Conclusion:

In newly diagnosed hypertension patients, the ERP on admission ECG could be a sign of subclinical systolic dysfunction.
Coexistence of acute pancreatitis and an obstructing upper ureteral calculus: does a calculus cause pancreatitis? a case report
Authors: Bapir Rawa , Hama Hussein Karokh F. , Baba Hiwa O. , Muhialdeen Aso S. , Tahir Soran H. , Abdalla Berun A. , Mohammed Shvan H. , Salih Abdulwahid M. , kakamad Fahmi H. , Aghaways Ismaeel
Published: August 2023

Introduction and importance:

Acute pancreatitis is an inflammatory disease that can affect both the peripancreatic tissues and distant organs. There are few reports of acute pancreatitis caused by endourological procedures. However, an obstructing ureteral calculus causing acute pancreatitis is very rare.

Case presentation:

A 36-year-old male patient presented with epigastric, and right loin pain with decreased urine output for 3 days. On physical examination, he had central abdominal and right flank tenderness. An abdominal ultrasound showed mild to moderate ascites, a hyperechoic pancreas, a small (26×77 mm) left kidney with increased echogenicity, right renal hypertrophy with moderate hydronephrosis, and a dilated upper ureter due to a 10 mm obstructing stone with a perirenal fluid collection. The diagnosis of acute pancreatitis with an obstructing right upper ureteric stone was established. Under spinal anesthesia, an emergency ureteroscopy with laser fragmentation of the stone was performed, and a JJ stent was inserted. He developed postobstructive diuresis and his renal function was improved with a rapid decline of pancreatic enzymes as well.

Clinical discussion:

Two theories explain the presentation of acute pancreatitis by ureteral obstruction. First, the obstructed severe hydronephrotic kidney compresses the duodenum and head of the pancreas, obstructing the distal part of the common bile duct and triggering the elevation of pancreatic duct pressure, bile reflux, trypsin activation, and pancreatic autodigestion. The second theory states that acute pancreatitis develops when urine is extravasated from an obstructed kidney into the adjacent tissues, irritating the uncinate process of the pancreas.

Conclusion:

Although mentioning ureteral obstruction as a cause of pancreatitis is scarce, the clinician should be aware that in each case of ureteral obstruction, the emergence of acute pancreatitis is a possible complication.
Assessing the condition of percutaneous coronary intervention services in Africa: challenges and prospects for advancement – a review
Authors: Aderinto Nicholas , Olatunji Deji
Published: August 2023

This study assesses the state of percutaneous coronary intervention (PCI) services in Africa, identifying the challenges and prospects for improvement. The study highlights limited infrastructure, resources, and the healthcare workforce as significant challenges in providing adequate PCI services to the population. However, opportunities for improvement are available through increased investment in healthcare infrastructure, healthcare professional training programs, and telemedicine. Collaboration among governments, healthcare providers, and international organizations is essential to address these challenges and improve access to high-quality PCI services for all Africans. Improving PCI facilities and utilization will not only benefit current and future patients with cardiovascular disease but will also advance healthcare as a whole in Africa.
Pasture shooting and mobile slaughterhouses from a consumer's point of view: alternative slaughter methods and the meat paradox
Authors: Bayer Elisa , Busch Gesa , Spiller Achim , Kühl Sarah
Published: August 2023

Purpose

The purpose of this study is to investigate consumers' attitudes towards alternative slaughter methods (ASMs). ASMs present more animal-friendly and stress-free slaughter practices. However, these practices are not yet widespread due to strict regulations, high labor efforts and costs. Therefore, the market for meat products from ASMs is still small, and less is known about consumers' awareness, assessment and willingness to pay (WTP) for these products.

Design/methodology/approach

This study aims to close the research gap using a standardized and representative online survey among 1,604 German participants. To identify target groups for these kinds of meat products, a factor and cluster analysis was conducted.

Findings

The results show that ASMs are not widely known among consumers. Overall, participants evaluated ASMs positively, but about 1/3 of the participants stated to also have concerns related more to hygiene than to animal welfare issues. The cluster analysis reveals two out of four clusters found that are interested in ASMs. These clusters are characterized by high trust in small butcheries and organic meat consumption.

Originality/value

The slaughtering sector has hardly been examined from an economic point of view in the animal welfare debate so far. This study identifies potential target groups for products originating from ASMs based on possible consumption drivers and barriers. Therewith, products from particular animal welfare friendly slaughter methods can be promoted purposefully to suitable target groups.
A paradoxical perspective on subsidiary autonomy and MNE entrepreneurial initiative support: uncovering the role of organizational complexity and external embeddedness
Authors: Raziq Muhammad Mustafa
Published: August 2023

Purpose

This study examines the relationship between subsidiary autonomy and the MNE subsidiary initiative collaboration (i.e. entrepreneurial initiative resource support, the subsidiary seeks and receives from the MNE). It proposes some underlying mechanisms as external embeddedness, and MNE organizational structures to explain the relationship between subsidiary autonomy and the MNE subsidiary initiative collaboration. The study draws on paradox theory arguing how at both the subsidiary and the parent MNE levels certain paradoxes are handled.

Design/methodology/approach

Survey data are collected in a time-lagged fashion from 429 foreign subsidiaries in New Zealand. Data are analyzed using structural equation modeling.

Findings

Results show that the relationship between subsidiary autonomy and the receipt of MNE resource support for initiatives is positive, and this is more likely the case where the subsidiary is managed under simple structures (i.e. subsidiary reports to corporate headquarters, regional headquarters or mandated units) rather than complex structures (i.e. a matrix or a network). Furthermore, an increase in subsidiary autonomy positively influences MNE initiative resource-seeking, and this is more likely the case where the subsidiary is less embedded externally.

Originality/value

The study is one of the first of studies that has applied paradox theory to MNE–subsidiary relationships regarding autonomy and MNE collaboration on initiatives. The study extends research on MNE–subsidiary collaboration on subsidiary initiatives as existing research is limited on this domain. The study contributes by showing how external embeddedness, and the complexity of organizational structures determine the relationship between subsidiary autonomy and MNE subsidiary initiative collaboration.
Thermodynamical interactions in a micropolar magneto-thermoelastic medium with photothermal effect
Authors: Jatain Sohit , Deswal Sunita , Kalkal Kapil Kumar
Published: August 2023

Purpose

The purpose of this paper is to establish a two-dimensional model of Green–Lindsay theory for micropolar magneto-thermoelastic medium to study the photothermal effect. The model is used to study the coupling between elastic waves and plasma waves generated due to thermal changes in a micropolar elastic medium.

Design/methodology/approach

Normal mode analysis is used to obtain the analytical solutions of the governing equations.

Findings

Effects of magnetic field, micropolarity, photothermal and time are highlighted on various physical fields such as stresses, temperature, displacement and carrier density. The above physical fields also conform to the boundary conditions. It is further observed that all the physical quantities become zero outside some bounded region of space, thus confirming the notion of generalized theory of thermoelasticity.

Originality/value

The values of physical fields are computed numerically using MATLAB software considering material constants for silicon. Furthermore, the effects are depicted graphically and analyzed accordingly. The study is valuable for the analysis of thermoelastic problems involving magnetic field, micropolarity and elastic deformations.