Structured Vascular Segment Analysis for Giant Cell Arteritis: A Proposed Scoring System for CT Angiography-Based Diagnosis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality of the new born, especially in developing countries. The major concerns of the clinicians are its non-specific presentation and unavailability of tests with a high predictive value. Therefore, the need is for an infallible test that can be easily performed, quick, simple and cost-effective. Objectives: To assess the reliability of Haematological scoring system in diagnosis of suspected neonatal sepsis at early stage. Materials and Methods: A total of 84 suspected cases of neonatal sepsis were included in this prospective cross-sectional study carried out in Khulna City Medical College Hospital during the period from July 2021 to June 2022. The peripheral blood smears from all 84 patients were analysed using HSS of Rowell et al by pathologists. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis such as total leukocyte count, total polymorphonuclear neutrophil count, elevated immature PMN count, elevated immature: total PMN ratio, Immature: mature PMN ratio >0.3, platelet count <150000/cmm, and pronounced degenerative or toxic changes in PMNs. The HSS score of >5 was interpreted as sepsis, blood culture was done as gold standard for diagnosis of sepsis. Each haematological parameter was assessed for its individual performance and sensitivity, specificity, positive and negative predictive values were calculated. Results: Among the total 84 suspected cases, 20 cases were diagnosed neonatal sepsis, (23.8%), 31 cases had probable infection (36.9%), and 33 cases were normal (39.3%). Elevated immature: total PMN count ratio (>0.2) and Immature: Mature PMN ratio (>0.3) were the most sensitive and specific parameter for sepsis. It was also seen that with increasing score, the likelihood of sepsis also increases. Conclusion: The sensitivities and specificities of the various parameters of HSS were found to be satisfactorily significant in identifying ........

PurposeBone and joint tuberculosis (BJTB) presents a significant challenge in high TB burden countries, leading to serious complications and increased mortality. Early and accurate diagnosis is critical but often difficult due to limited access to deep tissue samples and low bacterial loads in lesion sites. This study proposes and evaluates a scoring system aimed at improving early diagnosis and management of BJTB.Please confirm if the author names are presented accurately and in the correct sequencecheckedMethodsA cross-sectional study was conducted in a public sector hospital in Karachi, Sindh. Patients with clinical suspicion of BJTB, excluding those with severe underlying diseases or HIV infection, were enrolled. The scoring system included major criteria (joint pain, swelling/effusion, restricted range of motion, X-ray findings) and minor criteria (fever, weight loss, joint redness, current pulmonary TB, raised ESR, history or family history of TB). Patients were categorized as highly suspicious (score > 7), suspicious (score 5–7), or less suspicious (score < 5). Treatment was initiated based on these categories, and outcomes were monitored over a 6-month follow-up period.ResultsOf the 78 patients, 37 (47.43%) were classified as highly suspicious, 26 (33.33%) as suspicious, and 15 (19.23%) as less suspicious. Initial anti-tuberculosis treatment (ATT) was effective in 94.59% of highly suspicious cases, 84.61% of suspicious cases, and 60% of less suspicious cases. The scoring system demonstrated a sensitivity of 94.6%, 84.6%, and 73.3%, specificity of 75.0%, 69.2%, and 84.6%, and positive predictive value (PPV) of 87.2%, 84.6%, and 84.6%, and negative predictive value (NPV) of 88.5%, 83.3%, and 74.7% for highly suspicious, suspicious, and less suspicious categories, respectively.ConclusionThe proposed scoring system is a valuable tool for diagnosing BJTB, especially in resource-limited settings. It promotes early identification and treatment, potentially improving patient outcomes. Further studies are needed to validate its widespread applicability.Affiliations: Journal instruction requires a city/country for affiliations; however, this is missing in affiliation [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. Please verify if the provided city/country is correct and amend if necessary.checked

To elucidate epidemiologic and clinical manifestations of Japanese patients with giant cell arteritis (GCA), the first nationwide survey for GCA was conducted in 1998 in Japan. The first questionnaire on GCA for patients treated in 1997 was sent to 10,717 medical departments in Japan. A total of 177 patients were reported. Among the 177 patients, 66 GCA patients with detailed clinical and epidemiologic features on second survey were analyzed. Prevalence in patients 50 years of age and older in 1997 was 1.47 per 100,000 population in Japan. The average age at onset was 71.5 years old. The male:female ratio was 1:1.7. The association with permanent and complete visual loss (6.5%), jaw claudication (15.2%), and polymyalgia rheumatica (PMR) (30.3%) were low in frequency compared with those reported from other countries. All patients were treated with corticosteroids. Only 3 (4.5%) patients were reported as deceased due to other causes. The prevalence of GCA in Japan was revealed to be extremely low compared with other countries. Clinical findings of permanent and complete visual loss, jaw claudication, and PMR were infrequent among Japanese patients with GCA.

AB0646 Predicting Temporal Artery Biopsy Results… Offering Insights Into Temporal Arteritis Diagnosis

Polymyalgia rheumatica

Giant cell arteritis (GCA) is a form a large- to medium-vessel vasculitis that involves the aorta and its branches. Polymyalgia rheumatica (PMR), a syndrome of muscle pain and stiffness in the neck, shoulders, and hips, often occurs with GCA but can occur independently. GCA predominantly affects the second- to fifth-order aortic branches, often in the extracranial arteries of the head. The mean age at diagnosis of GCA is approximately 72. The diagnosis of GCA is made usually by biopsy of the temporal artery. GCA associated with granulomatous inflammation within the blood vessel wall, but granulomatous changes are not always evident early in the disease. Giant cells occur in a slight majority of cases of positive temporal artery biopsies. Estimates of the frequency of giant cells in temporal artery biopsy tissues are on the order of 50–80%. In GCA, clinical symptoms of local vascular inflam-mation and vascular insufficiency are usually accompanied or preceded by a systemic inflammatory process. Visual loss is the most feared complication of GCA. Visual loss may occur through the syndrome of anterior ischemic optic neuropathy, caused by narrowing of the posterior ciliary artery, as well as through other arterial insufficiency syndromes. Glucocorticoids are the cornerstone of treatment for GCA and PMR. PMR occurring in the absence of GCA requires a lower dose of prednisone for disease control.

Background: The objective of the present study was to find out the predictive values of an ultrasound-based scoring system in diagnosis of morbidly adherent placenta (MAP) for high risk group. Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt.Methods: 63 full term pregnant women (≥37 weeks of gestation) with high risk of morbidly adherent placenta underwent elective cesarean section. Placental assessment by 2 D ultrasound based on ultrasound scoring system in morbidly adherent placenta, these data were recorded for further comparison with intraoperative data for degree of placental adherence.Results: Incidence of MAP was 7.93% (4.76% had a focal form and 3.17% had a complete form of accreta). As regarding to scoring system, 82.5 of cases had a low risk (&lt; 5), 9.5% had a moderate risk (6-7) and 7.93% had a high risk (8-12) of development of morbidly adherent placenta with p value &lt;0.0001. The sensitivity, specificity, positive and negative predictive values of the US scoring system for morbidly adherent placenta were (92.3%, 94.1%, 87.453% and 98.2%) respectively.Conclusions: Ultrasound based scoring system had a high predictive value (sensitivity, specificity, positive and negative predictive values) in diagnosis of morbidly adherent placenta for pregnant women have any risk factors for developing MAP.

Giant cell arteritis (GCA) is a severe form of vasculitis in the elderly. The recent discovery of varicella zoster virus (VZV) in the temporal arteries and adjacent skeletal muscle of patients with GCA, and the rationale and strategy for antiviral and corticosteroid treatment for GCA are reviewed. The clinical features of GCA include excruciating headache/head pain, often with scalp tenderness, a nodular temporal arteries and decreased temporal artery pulsations. Jaw claudication, night sweats, fever, malaise, and a history of polymyalgia rheumatica (aching and stiffness of large muscles primarily in the shoulder girdle, upper back, and pelvis without objective signs of weakness) are common. ESR and CRP are usually elevated. Diagnosis is confirmed by temporal artery biopsy which reveals vessel wall damage and inflammation, with multinucleated giant cells and/or epithelioid macrophages. Skip lesions are common. Importantly, temporal artery biopsies are pathologically negative in many clinically suspect cases. This review highlights recent virological findings in temporal arteries from patients with pathologically verified GCA and in temporal arteries from patients who manifest clinical and laboratory features of GCA, but whose temporal artery biopsies (Bx) are pathologically negative for GCA (Bx-negative GCA). Virological analysis revealed that VZV is present in most GCA-positive and GCA-negative temporal artery biopsies, mostly in skip areas that correlate with adjacent GCA pathology. The presence of VZV in Bx-positive and Bx-negative GCA temporal arteries indicates that VZV triggers the immunopathology of GCA. However, the presence of VZV in about 20% of temporal artery biopsies from non-GCA postmortem controls also suggests that VZV alone is not sufficient to produce disease. Treatment trials should be performed to determine if antiviral agents confer additional benefits to corticosteroids in both Bx-positive and Bx-negative GCA patients. These studies should also examine whether oral antiviral agents and corticosteroids are as effective as intravenous acyclovir and corticosteroids. Appropriate dosage and duration of treatment also remain to be determined.

Acute Appendicitis stands as the leading cause of acute abdominal pain necessitating surgical intervention in the world. The initial clinical assessment of patients suspected of having acute appendicitis remains crucial. The aim is to quickly confirm or rule out the diagnosis to minimize delays, avoid unnecessary surgeries. The aim of our study is to evaluate the predictive value of multiple scoring systems for Diagnosis of acute appendicitis cases with correlation between scores prediction results and surgical interventions results. This a prospective study carried out in Mansoura university hospitals and Mansoura emergency hospital in the period between December 2024 and June 2025. Patients included in the study were admitted at emergency department of General Surgery at Mansoura University Hospital. The study was explained in details to the whole patients sharing in the study and a written informed consent was taken from all the patients. All patient presented with suspected acute appendicitis were subjected to four scores with comparing between them : Alvarado score, Appendicitis Inflammatory Response score (AIR), The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score and AAS (Adult Appendicitis Score). ROC curve analysis demonstrated variable diagnostic performance among the evaluated scoring systems for acute appendicitis. The Adult Appendicitis Score (AAS) showed the highest discriminatory ability with an AUC of 0.988 (p = 0.001), followed by the Appendicitis Inflammatory Response (AIR) score (AUC = 0.920, p = 0.005) and the RIPASA score (AUC = 0.825, p = 0.03). The Alvarado score demonstrated comparatively lower accuracy (AUC = 0.715, p = 0.155). At their respective optimal cutoff points, AAS and AIR achieved high sensitivity and overall accuracy, with AAS demonstrating an apparent specificity of 100%. These findings suggest superior diagnostic performance of AAS and AIR compared with Alvarado and RIPASA in the studied population. Among the evaluated clinical scoring systems, the Adult Appendicitis Score (AAS) and the Appendicitis Inflammatory Response (AIR) score demonstrated the highest diagnostic accuracy for acute appendicitis, with AAS showing the best overall performance. These scoring systems may represent reliable tools for supporting clinical decision-making and improving diagnostic confidence, potentially reducing unnecessary imaging or negative appendectomies. However, further validation in larger, more diverse cohorts is required before firm recommendations can be made.

To investigate clinical and laboratory features of giant cell arteritis (GCA). We included 24 patients (6 men, 18 women; mean age 69.8 years) in this study. GCA was diagnosed based on the American College of Rheumatology 1990 classification criteria. Mean serum C-reactive protein was 9.03 mg/dl. GCA was classified into three types: classic temporal arteritis type (cranial GCA, nine patients); large-vessel type, affecting the aorta and its major branches without temporal arteries (12 patients); generalized type, affecting both temporal arteries and large vessels (three patients). Swelling and tenderness of temporal arteries were recognized in temporal arteritis and generalized arteritis. Ten of these patients also had histopathologic findings of arteritis, including giant cells in biopsy specimens. Examination of HLA-class 1 expression showed that one patient with cranial GCA, three with generalized GCA, and seven with large-vessel GCA were positive for HLA-A24, and four patients with large-vessel GCA were positive for HLA-B39. One patient with cranial GCA, one with generalized GCA, and six with large-vessel GCA were positive for HLA-B52. Nine patients were positive for anti-phospholipid antibodies (seven for anti-cardiolipin antibody immunoglobulin G, seven for anti-cardiolipin β2-glycoprotein-1 antibody, one for lupus anticoagulant). Our study demonstrated that HLA-class 1 expression in GCA resembles that in Takayasu arteritis, suggesting that these two arteritis types share the same genetic background. In contrast, the difference in the prevalence of anti-phospholipid antibodies in GCA and Takayasu arteritis patients shows a difference in the characteristic aspects of these two arteritis types.

Objectives: Giant cell arteritis (GCA) is a systemic disease with extensive vascular involvement. The aim of this study was to investigate the cumulative incidence of large vessel involvement (LVI) in GCA, the distribution of vessels involved, and predictors for LVI.Method: Patients with biopsy-proven GCA in a defined area in southern Sweden, diagnosed between 1997 and 2010, were identified through the register of the regional Department of Clinical Pathology. A structured review of all medical records and imaging and histopathology reports was performed. Imaging studies for an age- and sex-matched reference cohort were also reviewed.Results: A total of 164 patients with GCA were investigated, of whom 24 (15%) had LVI. LVI manifestations were detected a median of 3.7 [interquartile range (IQR) 0.7–7.5] years after GCA diagnosis. Aortic involvement was found in 16 patients (10%), mainly aneurysms/ectasias of the thoracic aorta. Two patients had aortic dissections. Fourteen patients had tributary involvement. In the reference population, the cumulative incidence of LVI overall was 10.8% and aortic involvement was found in 5.4%. The presence of giant cells in the biopsy was significantly less frequent among GCA patients with LVI (23% vs. 52%; p = 0.01), and a presentation with polymyalgia rheumatica (PMR) was more frequent (44% vs. 20%, p = 0.01).Conclusions: The estimated incidence of LVI, detected by imaging in a clinical setting, was higher among patients with GCA than the reference population. The aorta was the most commonly affected vascular territory. The negative association with giant cells may suggest particular mechanisms in this subset of GCA.

Risk factors for visual loss in giant cell (temporal) arteritis: a prospective study of 174 patients

AB0439 Contribution of anti-ferritin antibodies to the diagnosis of giant cell arteritis

Background: Prompt diagnosis of stroke in resource poor settings without CT/MRI can be done by stroke scoring systems.Allen's score, Siriraj score and Greek score are available scoring systems employed in distinguishing stroke subtypes.This study is done to assess the agreeability between results obtained by using these stroke scoring systems.Aim: To assess the agreeability between available clinical stroke scoring systems in diagnosing stroke subtypes.Materials and methods: This cross sectional study was done in 100 new stroke patients at G. S. L. Medical College, Rajahmundry.Clinical scoring systems were employed in all the patients.Cohen's Kappa value is calculated to find out agreebiality between clinical stroke scoring systems.Results: Cohen's kappa values are 0.862 for Allen's score and Siriraj score; 0.740 for Allen's score and Greek score; 0.664 for Siriraj score and Greek score.Conclusion: Using Allen's score or Siriraj score yields consistent results unlike Greek score which had disparity in agreeing with results of Allen's score and Siriraj score.

Use of a modified clinical grading score improves accuracy in diagnosing acute appendicitis in the pediatric population while decreasing the use of computed tomography (CT). Retrospective medical records review after approval by the institutional review board. We determined the Alvarado score for each patient and correlated it with the pathological findings and imaging studies to evaluate the efficacy of CT and its attendant radiation exposure. Community teaching hospital. Sixty-one patients, aged 3 to 16 years, admitted with suspected acute appendicitis. Sensitivity, specificity, and accuracy of the modified Alvarado scoring system. The standard Alvarado score for acute appendicitis had a sensitivity of 92% and a specificity of 82%, with an accuracy of 92%. In the modified Alvarado scoring system, CT findings were substituted for Alvarado scores in the ranges of 5 or 6, 5 to 7, 5 to 8, and 5 to 9. The modification resulted in the greatest accuracy (98%) in diagnosing appendicitis in patients with scores in the range of 5 to 7. This modification theoretically would have decreased the use of CT by about 27% in this group of retrospectively studied patients. Furthermore, in patients with Alvarado scores of 1 to 4, another diagnosis should be considered; in patients with scores of 5 to 7, CT should be performed; and, in patients with scores of 8 to 10, an appendectomy should be performed promptly without further studies. The modified Alvarado score is useful as an aid in diagnosing acute appendicitis in the pediatric population. This scoring system eliminates unnecessary use of CT and the attendant potential cancer-inducing radiation in the pediatric population.