Asymptomatic Adults Research Articles

Impact on Hearing Among SARS COV-2 Infected Adults and Children Born to Gestational COVID-19 Infected Mothers: A Prospective Case Control Study.

SARS COV 2 infection affects primarily the respiratory system and various organs in humans is responsible for higher mortality secondary to cytokine storm during the COVID-19 pandemic. It affects the internal auditory system is responsible for Sensory neural hearing loss in adults as well as children born to COVID-19 infected mothers. This study was aimed to detect the pattern of hearing loss in COVID-19 infected adults and pattern of hearing loss in children born to gestational COVID-19 infected mothers. Fifty asymptomatic RT-PCR COVID-19 infected adults and age, sex matched healthy controls were evaluated for audiological profile using Pure Tone Audiometry (PTA). Children born to COVID-19 infected mothers were tested using Transient product otoacoustic emissions and click-evoked auditory brainstem responses (ABRs) compared with children born to non-COVID mothers. PTA auditory profile of COVID-19 infected adults on day 7 had 30% (16 out of 50) significant high frequency sensory neural hearing impairment for 4000Hz (p value 0.003), 6000Hz (p value 0.001), 8000Hz (p value 0.001). Repeat PTA testing on day 30 showed normal hearing. Whereas in children, 40% (n = 20) born to COVID-19 infected mothers had OAE as "Refer". BERA (ABRs) testing of that OAE "Refer" children revealed 30% (n = 6) hearing impairment. COVID-19 infection cause transient type of high frequency sensory neural hearing loss in adults. Whereas in children born to COVID-19 infected mothers there is risk of developing permanent, progressive or long-standing transient type of sensory neural hearing loss.

Fully automated quantitative stress perfusion cardiac MRI to assess myocardial perfusion in adult patients with convalescent Kawasaki disease and coronary aneurysms: an age and sex-matched analysis

Abstract Introduction Coronary aneurysms are a well-documented complication of childhood Kawasaki disease. They may persist into adulthood predisposing to impaired myocardial blood flow, symptoms, and adverse cardiovascular events. Preliminary reports suggest that Kawasaki disease may also be associated with coronary microvascular dysfunction. The effect of coronary involvement from Kawasaki disease on myocardial perfusion in convalescent asymptomatic adults has not been studied using fully automated inline quantitative perfusion MRI (CMR). Purpose To assess the effect of coronary artery abnormalities on quantitative myocardial perfusion in adult patients with convalescent Kawasaki disease compared to an age and sex-matched control cohort. Methods Retrospective single centre cohort analysis of adult patients with convalescent Kawasaki disease who have undergone fully automated inline quantitative myocardial stress perfusion CMR. All patients had coronary involvement during their acute childhood illness. An age and sex-matched group (n=14) with normal CMRs was selected for comparison. Rest MBF was corrected for heart rate by dividing by the scan heart rate and multiplying by the mean resting heart rate among all subjects. A per-vessel analysis was performed using a linear mixed effects model with pairwise comparisons to assess the effect of coronary abnormalities (normal, aneurysmal with or without thrombosis, revascularised) on myocardial perfusion reserve (MPR). Results 28 patients were included (14 Kawasaki; 14 controls). All patients in the Kawasaki cohort had assessment of coronary anatomy either by CT (93%) or invasive (7%) coronary angiography. A total of 84 vessels were analysed. Mean age and sex were well matched (Kawasaki: 27±6.2 years; 13 males : 1 female vs. controls: 27±6.4 years; 13 males : 1 female). In patients with Kawasaki disease, thrombosed aneurysmal arteries were associated with a significantly impaired MPR compared to normal (mean Δ: -0.817; P=0.003) and aneurysmal (mean Δ: -0.957; P<0.001) arteries. MPR in aneurysmal and revascularised arteries were not significantly different from normal arteries in patients with Kawasaki disease. There was no significant difference in MPR between normal coronary arteries in patients with Kawasaki compared to controls. Conclusions Thrombosis in coronary aneurysms was associated with a significant impairment of myocardial perfusion in adult patients with convalescent Kawasaki disease. There was no significant reduction in perfusion in territories supplied by normal or aneurysmal arteries which does not support coronary microvascular dysfunction in these patients. Further studies are needed to confirm these preliminary findings.

Does genital herpes symptom history predict herpes simplex virus type 2 antibody positivity?

Sexually transmitted infections (STIs) associated with genital ulcer disease due to herpes simplex virus-2 (HSV-2) are a prominent cause of morbidity and mortality. Serologic screening for HSV-2 is recommended only for individuals with genital herpes symptom history. However, no validated symptom screening tool currently exists. Currently asymptomatic adults presenting for routine care at STI clinics in Lima, Peru completed a survey of prior genital herpes symptoms and received HSV-2 serological testing with the Euroimmun Anti-HSV-2 (gG2) ELISA IgG (Lubeck, Germany). A sub-sample of indeterminate results were sent for Western blot confirmatory testing. We assessed associations between past symptoms and anti-HSV-2 positivity and corrected the HSV-2 prevalence by re-classifying indeterminates per Western Blot results. We enrolled 131 participants between July and October 2022. HSV-2 antibody test results found 21.4% positive, 41.2% indeterminate, and 37.4% negative. Excluding indeterminate results, 36.4% were positive. Of participants with no prior symptoms 31.2% tested positive, compared to 35.7% with one prior symptom, 50.0% with 2, and 50.0% with 3+ prior symptoms. Among the sub-sample of indeterminates, 92.6% were confirmed positive by Western Blot, bringing the total estimated proportion of participants with HSV-2 antibodies to 59.5%. Either based on the original classification of HSV-2 antibody status or after incorporation of confirmatory testing results, there was no significant association between symptom history and HSV-2 antibody positivity. With currently available tests, recommendations to screen individuals based on genital herpes symptom history may not be useful. More discriminatory symptom screening tools or HSV-2 antibody tests with better performance are needed.

Screening for Hypertension in Asymptomatic Individuals in Nepal: An Expert Consensus Statement

Hypertension affects a substantial proportion of the general population in Nepal with prevalence ranging from 20 to 30 percent. Early diagnosis and treatment are essential for undiagnosed hypertension and is possible through hypertension screening. The aim of this paper is to provide unified consensus recommendations for the effective screening of hypertension in Nepal. In two National Advisory expert consensus meetings, a total of 42 experts participated, discussed and voted on the key statements for formulating the consensus. Each key statement was scored on a Likert scale ranging from 1 to 9 and a mean score was calculated. The consensus statement was accepted if the mean score was seven or more with the voting of more than two-thirds of the experts. The main consensus recommendations are the following. First, screening for hypertension should start among adults from 18 years of age. Second, effective screening of hypertension can aid in the early diagnosis, control, and improve the cardiovascular disease outcomes. Third, in asymptomatic adults, re-screening is necessary every 3 to 6 months and every 3 to 5 years for initial blood pressure levels of 130-139/80-89 mmHg and <130/85 mmHg, respectively. Fourth, hypertension screening is cost-effective in a resource-limited setting. The use of consensus recommendations will help in a unified community screening of hypertension among the asymptomatic adult population of Nepal. Screening of hypertension should be promoted by all the stakeholders in healthcare services.

Exercise capacity and risk of incident atrial fibrillation in healthy adults

Background/Aims: Atrial fibrillation (AF) is a common arrhythmia and is associated with cardiovascular morbidity and mortality. It is important to identify and control the modifiable risk factors of AF. We aimed to examine the association of exercise capacity with the risk of incident AF within 3 years in healthy subjects.Methods: We evaluated asymptomatic adults who had undergone more than two consecutive health checkups. We included subjects who exhibited normal sinus rhythm on the first health examination and who developed AF on the second or subsequent health examinations. Subjects who underwent cardiopulmonary exercise testing within 3 years before the diagnosis of AF were examined.Results: The study population in the analyses included 428 cases (mean age 58.4 ± 7.6 yr, male 95.6%). There were significant differences in maximal systolic blood pressure (SBP; case 169.4 ± 24.2 vs. control 173.9 ± 22.3 mmHg), peak VO<sub>2</sub> (29.5 ± 5.4 vs. 30.4 ± 4.8 mL/kg per minute), and maximal metabolic equivalents (METs; 8.5 ± 1.6 vs. 8.7 ± 1.4) between the two groups. In the multivariable logistic models, adjusted odds ratios were 0.99 for maximal SBP (95% confidence interval [CI] 0.98–0.99), 0.97 for peak VO<sub>2</sub> (95% CI 0.95–0.99), and 0.91 for maximal METs (95% CI 0.83–0.98).Conclusions: We demonstrated that poorer exercise capacity was associated with the development of AF in a healthy population. A prospective, systematic trial is necessary to confirm that appropriate exercise training will be beneficial in preventing the development of AF in such patients.

Inter-segment coordination amplitude and variability during gait in patients with knee osteoarthritis and asymptomatic adults

BackgroundInter-segment coordination examines the timing and coupling of multiple body segments and provides a complex understanding of how the neuromuscular system controls the body. Research is required to examine if inter-segment coordination during gait differs between individuals with different knee osteoarthritis (OA) severities and asymptomatic adults. Research questionDo inter-segment coordination amplitude and between-trial variability during gait differ between individuals with varying levels of knee OA severity and asymptomatic adults? MethodsThis observational, cross-sectional study included participants with mild/moderate knee OA (n = 38), severe knee OA (n = 24), and asymptomatic adults (n = 51). Participants ambulated overground at self-selected speeds. Data were collected with an eight-camera motion capture system and two force plates. Continuous relative phase (CRP) was used to quantify sagittal plane inter-segment coordination amplitude and between-trial variability for the thigh-shank and shank-foot pairs. Hierarchical linear models examined if CRP variables were related to the group (asymptomatic, mild/moderate OA, severe OA) after accounting for gait speed and gait phase. ResultsThigh-shank CRP amplitude was significantly associated with group variables. The severe OA group had lower CRP amplitudes than both asymptomatic (b=8.57, 95 % confidence interval=2.75–14.38) and mild/moderate OA (b=5.69, 95 % confidence interval=−0.25 to 11.62) groups. Thigh-shank CRP variability was also associated with group. The severe OA group had lower CRP variability than the asymptomatic group (b=0.45, 95 % confidence interval=0.12–0.78); there were no differences between severe and mild/moderate OA groups (p > 0.050). There were no significant associations between any of the shank-foot CRP measures and the groups. SignificanceLower thigh-shank CRP amplitude and variability in individuals with severe knee OA represents a more rigid motor system. These individuals could be attempting to stabilize their knee in response to a loss of passive stability or in response to pain. They might have difficulty adapting their gait to perturbations.

Longitudinal follow-up of incidental renal calculi on computed tomography.

Measuring small kidney stones on CT is a time-consuming task often neglected. Volumetric assessment provides a better measure of size than linear dimensions. Our objective is to analyze the growth rate and prognosis of incidental kidney stones in asymptomatic patients on CT. This retrospective study included 4266 scans from 2030 asymptomatic patients who underwent two or more nonenhanced CT scans for colorectal screening between 2004 and 2016. The DL software identified and measured the volume, location, and attenuation of 883 stones. The corresponding scans were manually evaluated, and patients without follow-up were excluded. At each follow-up, the stones were categorized as new, growing, persistent, or resolved. Stone size (volume and diameter), attenuation, and location were correlated with the outcome and growth rates of the stones. The stone cohort comprised 407 scans from 189 (M: 124, F: 65, median age: 55.4years) patients. The median number of stones per scan was 1 (IQR: [1, 2]). The median stone volume was 17.1mm3 (IQR: [7.4, 43.6]) and the median peak attenuation was 308 HU (IQR: [204, 532]. The 189 initial scans contained 291stones; 91 (31.3%) resolved, 142 (48.8%) grew, and 58 (19.9) remained persistent at the first follow-up. At the second follow-up (for 27 patients with 2 follow-ups), 14/44 (31.8%) stones had resolved, 19/44 (43.2%) grew and 11/44 (25%) were persistent. The median growth rate of growing stones was 3.3mm3/year, IQR: [1.4,7.4]. Size and attenuation had a moderate correlation (Spearman rho 0.53, P < .001 for volume, and 0.50 P < .001 for peak attenuation) with the growth rate. Growing and persistent stones had significantly greater maximum axial diameter (2.7 vs 2.3mm, P =.047) and peak attenuation (300 vs 258 HU, P =.031) CONCLUSION: We report a 12.7% prevalence of incidental kidney stones in asymptomatic adults, of which about half grew during follow-up with a median growth rate of about 3.3mm3/year.

Predicting thoracic kyphosis morphology and the thoracolumbar inflection point determined by individual lumbar lordosis in asymptomatic adults.

The aims of this study were to explore the correlations between thoracic kyphosis (TK) and lumbar lordosis (LL) parameters and to build corresponding linear regressions to predict TK morphology and the thoracolumbar inflection point (IP) determined by individual LL parameters in asymptomatic adults. A total of 280 adult healthy volunteers were recruited, and full-spine X-rays were performed for each subject in a standing posture. The following sagittal parameters were measured: cumulative TK, LL, proximal LL (PLL), the apices of TK (TKA) and LL (LLA), the IP and the distance from the plumb line of the thoracic apex (TAPL) and the lumbar apex (LAPL) to the gravity line. The correlations between TK and LL parameters were analyzed, and the corresponding linear regressions were conducted. Extensive variations existed in TK alignment, including angular and morphological parameters. In addition, there were statistical correlations of all cumulative TK angles with LL (r values from - 0.173 to - 0.708) and PLL (r values from - 0.206 to - 0.803), TKA and IP with LLA (rs = 0.359 and 0.582, respectively) and TAPL with LAPL (rs = 0.335). The common predictive formulas employed in ASD surgery could include T10-L1 = - 3.6-0.2*LL (R2 = 0.201), T4-L1 = 3.4-0.5*LL (R2 = 0.457), TKA = - 10.3 + 1.1*LLA (R2 = 0.180) and IP = - 12.7 + 1.6*LLA (R2 = 0.330). There were intimate associations between TK and LL parameters in asymptomatic adults. Moreover, predictive models for thoracic alignment, particularly cumulative TK, based on LL parameters were proposed, which could better delineate anatomical relationships, guide thoracic construction during adult spinal deformity surgery and may help preventing proximal junctional failure.

Impact of hepatitis B virus infection on the risk of gallbladder polyps: a cohort study.

We aimed to determine whether hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains an important risk factor for gallbladder polyps (GBPs) in the current context of reduced prevalence of these infections. The cohort included 392,913 asymptomatic adults who underwent abdominal ultrasonography (US). The prevalence of GBP sized ≥ 5 mm, ≥ 10 mm, and overall (< 5, 5-9 and ≥ 10 mm) was 2.9%, 0.1%, and 12.8%, respectively. The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and hepatitis C antibody (anti-HCV) positivity was 3.2%, 26.7%, and 0.1%, respectively. The GBP risk was significantly increased in HBsAg-positive individuals, with an adjusted odds ratio of 1.66 (95% confidence interval, 1.49-1.85) for GBP ≥ 5 mm, 2.39 (1.53-3.75) for GBP ≥ 10 mm, and 1.49 (1.41-1.59) for overall, whereas there was no significant association between anti-HCV positivity and GBP risk. The GBP risk did not increase significantly in individuals who tested negative for HBsAg but positive for HBcAb. The presence of HBsAg may be an independent risk factor for GBP development in the current context of a indecreasing prevalence of HBsAg positivity. A more comprehensive evaluation of GBP during abdominal US surveillance of HBsAg-positive individuals may be necessary.

Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults

Objective With our aging population, an increasing number of older adults with hearing loss have cognitive decline. Hearing care practitioners have an important role in supporting healthy aging and should be knowledgeable about cognitive decline and associated management strategies to maximize successful hearing intervention. Methods A review of current research and expert opinion. Results This article outlines the association between hearing loss and cognitive decline/dementia, hypothesized mechanisms underlying this, and considers current research into the effects of hearing intervention on cognitive decline. Cognition into old age, cognitive impairment, dementia, and how to recognize cognitive decline that is not part of normal aging are described. Screening of older asymptomatic adults for cognitive decline and practical suggestions for the delivery of person-centered hearing care are discussed. Holistic management goals, personhood, and person-centered care in hearing care management are considered for older adults with normal cognitive aging through to dementia. A case study illustrates important skills and potential management methods. Prevention strategies for managing hearing and cognitive health and function through to older age, and strategies to maximize successful hearing aid use are provided. Conclusion This article provides evidence-based recommendations for hearing care professionals supporting older clients to maximize well-being through the cognitive trajectory.

Osteopetrosis presenting as Leukoerythroblastosis in 4 month old patient: A case report

Osteopetrosis, is also known as marble bone disease or the Albers Schonberg disease. It is an extremely rare inherited disease. The disease results due to defective resorption of bone by the osteoclasts. This causes bone mass to increase accompanied by decreased hematopoietic tissue, causing extramedullary hematopoiesis. The clinical and radiological assessment plays an important role in diagnosis of infantile osteopetrosis. Clinical symptoms range from asymptomatic adults to life threatening condition in infants. We report a 4-month-old female patient with infantile osteopetrosis presenting with leukoerythroblastic blood picture and hepatosplenomegaly. This case highlights the importance of hematological findings, radiographic and genetic analysis for diagnosis of osteopetrosis.

A Nationwide Study of GATA2 Deficiency in Italy Reveals Novel Symptoms and Genotype-phenotype Association.

GATA2 deficiency is a rare disorder encompassing a broadly variable phenotype and its clinical picture is continuously evolving. Since it was first described in 2011, up to 500 patients have been reported. Here, we describe a cohort of 31 Italian patients (26 families) with molecular diagnosis of GATA2 deficiency. Patients were recruited contacting all the Italian Association of Pediatric Hematology and Oncology (AIEOP) centers, the Hematology Department in their institution and Italian societies involved in the field of vascular anomalies, otorhinolaryngology, dermatology, infectious and respiratory diseases. Median age at the time of first manifestation, molecular diagnosis and last follow-up visit was 12.5 (age-range, 2-52years), 18 (age-range, 7-64years) and 22years (age-range, 3-64), respectively. Infections (39%), hematological malignancies (23%) and undefined cytopenia (16%) were the most frequent symptoms at the onset of the disease. The majority of patients (55%) underwent hematopoietic stem cell transplantation. During the follow-up rarer manifestations emerged. The clinical penetrance was highly variable, with the coexistence of severely affected pediatric patients and asymptomatic adults in the same pedigree. Two individuals remained asymptomatic at the last follow-up visit. Our study highlights new (pilonidal cyst/sacrococcygeal fistula, cholangiocarcinoma and gastric adenocarcinoma) phenotypes and show that lymphedema may be associated with null/regulatory mutations. Countrywide studies providing long prospective follow-up are essential to unveil the exact burden of rarer manifestations and the natural history in GATA2 deficiency.

Efficacy and safety of ivermectin for the treatment of Plasmodium falciparum infections in asymptomatic male and female Gabonese adults – a pilot randomized, double-blind, placebo-controlled single-centre phase Ib/IIa clinical trial

Ivermectin's mosquitocidal effect and invitro activity against Plasmodium falciparum asexual stages are known. Its invivo blood-schizonticidal efficacy is unknown. Ivermectin's tolerability and efficacy against P.falciparum infections in Gabonese adults were assessed. The study consisted of a multiple dose stage and a randomized, double-blind, placebo-controlled stage. Adults with asymptomatic P.falciparum parasitaemia (200-5000 parasites/μl) were enrolled. First, three groups of five participants received 200μg/kg ivermectin once daily for one, two, and three days, respectively, and then 34 participants were randomized to 300μg/kg ivermectin or placebo once daily for 3 days. Primary efficacy outcome was time to 90% parasite reduction. Primary safety outcomes were drug-related serious and severe adverse events (Trial registration: PACTR201908520097051). Between June 2019 and October 2020, 49 participants were enrolled. Out of the 34 randomized participants, 29 (85%) completed the trial as per protocol. No severe or serious adverse events were observed. The median time to 90% parasite reduction was 24.1 vs. 32.0h in the ivermectin and placebo groups, respectively (HR 1.38 [95% CI 0.64 to 2.97]). Ivermectin was well tolerated in doses up to 300μg/kg once daily for three days and asymptomatic P.falciparum asexual parasitaemia was reduced similarly with this dose of ivermectin compared to placebo. Further studies are needed to evaluate plasmodicidal effect of ivermectin at higher doses and in larger samples. This study was funded by the Centre de Recherches Médicales de Lambaréné and the Centre for Tropical Medicine of the Bernhard Nocht Institute for Tropical Medicine.

A Novel Custom Cycle Ergometer Protocol to Determine V̇O2max: Validation with ACSM’s Cycle Ergometry Metabolic Equation

ABSTRACT Introduction Protocols for determination of maximal oxygen consumption (V̇O2max) on a cycle ergometer should be easily administered while maximizing physiological efficiency and minimizing premature local muscle fatigue for individuals of variable fitness levels. Current protocols typically increase workload by adding resistance to the flywheel; however, increasing pedal rate later in the test, rather than resistance, may provide increased physiological efficiency, yielding a more valid determination of V̇O2max. Purpose The purpose of this study was to design and validate a novel V̇O2max cycle ergometer protocol that can be used for measuring and predicting submaximal oxygen consumption (V̇O2) and V̇O2max during exercise testing in healthy, asymptomatic adults. Methods Subjects (n = 60, 19–60 yr old) performed a V̇O2max test using the new cycle ergometer protocol. Workload increases were based on predetermined incremental target heart rates (ITHR) using heart rate reserve. Stages commenced at a workload of 150 kg·m·min−1 (0.5 kg, 50 rpm) and increased every 2 min by adding 0.5 or 1.0 kg resistance based on ITHR. When an ITHR representing ≥60% heart rate reserve was achieved, workloads increased by 10 rpm for subsequent stages. Pearson’s r was used to examine relationships between predicted (American College of Sports Medicine cycle equation) and measured V̇O2 at workload intensities representing moderate, vigorous, and maximal exercise. Bland–Altman plots were used to display predicted and measured V̇O2 at all exercise intensities and heart rate values at maximal exercise. Results There was a strong and statistically significant correlation between predicted and measured V̇O2 at moderate (r = 0.92, P &lt; 0.001), vigorous (r = 0.94, P &lt; 0.001), and maximal (r = 0.90, P &lt; 0.001) exercise intensities. All subjects reached ≥90% of age-predicted maximum heart rate. Conclusion This novel cycle ergometer protocol was demonstrated to be a viable tool to predict and/or measure submaximal V̇O2 and V̇O2max in a population of healthy, asymptomatic adults.

In-vivo characterization of the lumbar annulus fibrosus in adults with ultrasonography and shear wave elastography.

In vivo characterization of intervertebral disc (IVD) mechanical properties and microstructure could give an insight into the onset and progression of disc pathologies. Ultrasound shearwave elastography provided promising results in children, but feasibility in adult lumbar discs, which are deep in the abdomen, was never proved. The aim of this work was to determine the feasibility and reliability of ultrasound assessment of lumbar IVD in adults. Thirty asymptomatic adults were included (22 to 67 years old). Subjects were lying supine, and the annulus fibrosus of the L3-L4 IVD was imaged by conventional ultrasonography and shearwave elastography. Shear wave speed (SWS) and lamellar thickness were measured. Reliability was determined through repeated measurements acquired by three operators. Average SWS in AF at the L3L4 level was 4.0±0.9m/s, with an inter-operator uncertainty of 8.7%, while lamellar thickness was 255±27µm with an uncertainty of 9.6%. Measurement was not feasible in one out of four subjects with BMI > 24kg/m² (overweight). Ultrasound assessment of annulus fibrosus revealed feasible, within certain limitations, and reproducible. This method gives an insight into disc microstructure and mechanical properties, and it could be applied for the early detection or follow-up of disc pathologies.

Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida.

The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established. Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes. Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%. Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.

Estimation of cardiorespiratory fitness using heart rate and step count data

Predicting cardiorespiratory fitness levels can be useful for measuring progress in an exercise program as well as for stratifying cardiovascular risk in asymptomatic adults. This study proposes a model to predict fitness level in terms of maximal oxygen uptake using anthropometric, heart rate, and step count data. The model was trained on a diverse cohort of 3115 healthy subjects (1035 women and 2080 men) aged 42 ± 10.6 years and tested on a cohort of 779 healthy subjects (260 women and 519 men) aged 42 ± 10.18 years. The developed model is capable of making accurate and reliable predictions with the average test set error of 3.946 ml/kg/min. The maximal oxygen uptake labels were obtained using wearable devices (Apple Watch and Garmin) during recorded workout sessions. Additionally, the model was validated on a sample of 10 subjects with maximal oxygen uptake determined directly using a treadmill protocol in a laboratory setting and showed an error of 4.982 ml/kg/min. Unlike most other models, which use accelerometer readings as additional input data, the proposed model relies solely on heart rate and step counts—data readily available on the majority of fitness trackers. The proposed model provides a point estimation and a probabilistic prediction of cardiorespiratory fitness level, thus it can estimate the prediction’s uncertainty and construct confidence intervals.

Clinical Phenotype of Pediatric and Adult Patients With Spinal Muscular Atrophy With Four SMN2 Copies: Are They Really All Stable?

The aim of this study was to provide an overview of the clinical phenotypes associated with 4 SMN2 copies. Clinical phenotypes were analyzed in all the patients with 4 SMN2 copies as part of a nationwide effort including all the Italian pediatric and adult reference centers for spinal muscular atrophy (SMA). The cohort includes 169 patients (102 men and 67 women) with confirmed 4 SMN2 copies (mean age at last follow-up = 36.9 ± 19 years). Six of the 169 patients were presymptomatic, 8 were classified as type II, 145 as type III (38 type IIIA and 107 type IIIB), and 8 as type IV. The remaining 2 patients were asymptomatic adults identified because of a familial case. The cross-sectional functional data showed a reduction of scores with increasing age. Over 35% of the type III and 25% of the type IV lost ambulation (mean age = 26.8 years ± 16.3 SD). The risk of loss of ambulation was significantly associated with SMA type (p < 0.0001), with patients with IIIB and IV less likely to lose ambulation compared to type IIIA. There was an overall gender effect with a smaller number of women and a lower risk for women to lose ambulation. This was significant in the adult (p = 0.009) but not in the pediatric cohort (p = 0.43). Our results expand the existing literature on natural history of 4 SMN2 copies confirming the variability of phenotypes in untreated patients, ranging from type II to type IV and an overall reduction of functional scores with increasing age. ANN NEUROL 2023;94:1126-1135.

A strange case of pleuritic pain in the third trimester of pregnancy.

Pulmonary sequestration is an uncommon congenital malformation of the lung, generally diagnosed in childhood or adolescence, corresponding to dysplastic lung tissue not communicating with the rest of vascular or bronchial lung system but receiving an arterial blood supply from systemic arteries. Currently, surgical resection is usually indicated in order to prevent or treat related symptoms or complications, although controversy exists regarding its use in asymptomatic patients and adults. We present the case of a 32-year-old pregnant woman with acute chest pain and vomiting diagnosed with intralobar sequestration at 32+2 weeks of gestation and treated with pulmonary lobectomy after giving birth by cesarean section at 33+0 weeks of gestation.

Six-minute step test performance in asymptomatic adults

The objectives of this study were i) to measure a six-minute step test (6MST) in asymptomatic adults; ii) to determine the applicability of Arcuri et al.’s reference equation to Indian adults; iii) to develop a prediction equation for Indian adults. 110 adult males and females aged 18-40 years were recruited for this prospective cross-sectional study conducted in India. Participants underwent 6MST. Applicability was assessed by comparing the findings of the 6MST with the values derived from Arcuri et al.’s predicted equations using the Bland-Altman plot. A multiple regression analysis was used to develop the prediction equation. The mean±SD six-minute step count was 159.42±17.60 steps and 150.78±14.39 steps in males and females respectively. The 6MST for males can be determined by males (steps)=204.371-1.521×age(years) and females (steps)=179.567-1.06×age (years). Arcuri et al.’s equation cannot be used to predict 6MST in Indian adults. Region-specific equations are useful to assess the values.