Baseline Clinical Examination Research Articles

Prognostic indicators of vector electrocardiography in patients with chronic heart failure with reduced left ventricular ejection fraction

Relevance. Computed vector electrocardiography (VECG) is a method of visualization of the total electrical vector of the heart in 3‑dimensional space based on 12 leads and a known computational procedure. VECG may be an additional method to assess the severity and prognosis of patients with chronic heart failure (CHF).Objective. To determine VECG parameters associated with unfavorable prognosis in patients with CHF with reduced ejection fraction (CHFpEF).Materials and methods. VECGs of 100 patients with CHFpEF were analyzed. All patients underwent baseline clinical examination, echocardiography and natriuretic peptide (NT-proBNP) determination. Patients with both ischemic (55 patients, of whom 10 died) and non-ischemic (45 patients, of whom 6 died) etiologies were included. During follow-up for 24 months, fatal outcomes were recorded. The correlation of ECG and NT-proBNP parameters with patients’ prognosis was evaluated.Results. A total of 16 patients died in the study. According to VECG data the surviving patients had lower spatial QRS-T angle in comparison with the deceased ones (p=0,025). There was a trend towards lower planarity index in the group of deceased patients (p=0.09). ROC-analysis was carried out, according to the results of which with sensitivity 76,5% and specificity 62,7% the cut-off value of 156º of QRS-T spatial angle was obtained, exceeding which the probability of lethal outcome will increase (p=0,002). There was a correlation between lethal outcome in patients with a QRS-T angle value greater than 156º and NT-proBNP level (p=0.017). The threshold value of unfavorable prognosis for NT-proBNP was 927.1 pg/ml.Conclusion. The VECG method is available and promising in the diagnosis and monitoring of patients with CHFpEF. The most informative parameters of ECG for detection of suspicion of CHFpEF are spatial QRS-T angle and planarity index. The results obtained in this study allow us to speak about the prognostic value of the QRS-T angle for patients with CHFpEF.

All-cause and cause-specific mortality in US adults with periodontal diseases: A prospective cohort study.

This prospective cohort study investigated the association between periodontal diseases (PDs) and all-cause and cause-specific mortality. We utilized adult participants recruited from six National Health and Nutrition Examination Survey cycles (1999-2014) and linked mortality data from the National Death Index up to December 2019. Baseline clinical periodontal examinations were performed by trained and calibrated examiners. All-cause and cause-specific mortality was modelled through multivariable Cox proportional hazards and Fine-Gray models to account for competing risks. All models were adjusted for demographic and lifestyle variables, clinical measurements and comorbidities. Overall, 15,030 participants were included, with a median length of follow-up of 9 years. Risk of all-cause mortality was 22% greater in people with PD than the control group (adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12-1.31). Risks of mortality by cardiovascular diseases (CVD), respiratory disease and diabetes were highest in participants with severe PD (CVD-sub-distribution HR [SHR]: 1.38, 95% CI: 1.16-1.64; respiratory-SHR: 1.62, 95% CI: 1.07-2.45; diabetes-SHR: 1.68, 95% CI: 1.12-2.53). Severe PD is associated with all-cause and cause-specific mortality among US adults after multivariable adjustment.

Sleep duration in midlife and old age and risk of mortality over a 48-year follow-up: The Helsinki businessmen study (HBS) cohort

ObjectivesBoth short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies. Study designThis is a cohort study of 2504 men born between 1919 and 1934. In 1974–1975 (mean age 48), participants underwent baseline clinical examinations and sleep duration assessments. A follow-up examination took place 35 years later, in 2010 (mean age 82). Main outcome measureAll-cause mortality data from baseline and from old age were collected through to December 31, 2022. ResultsAt baseline, short sleep duration (≤6 h per night), normal sleep duration (>6 and ≤ 8 h), and long sleep duration (>8 h) was reported by 266, 2019 and 219 men, respectively. Men with short sleep duration had higher levels of smoking, alcohol consumption, body mass index, and poorer self-rated health than those with normal sleep duration. During the 48-year follow-up, 2287 men died. The unadjusted hazard ratio for mortality was 1.20 (95 % confidence interval [CI] 1.05–1.37) for short compared with normal sleep duration, but this association vanished after adjustments (1.01, 95 % CI 0.87–1.17). In old age, the corresponding hazard ratios were 1.41 (1.16–1.72) and 1.19 (0.94–1.51) for short sleep duration and 1.33 (1.09–1.63) and 1.31 (1.02–1.67) for long sleep duration. ConclusionsIn a comprehensive lifespan follow-up, the modestly increased mortality among men with short sleep duration in midlife was attributed to unhealthy lifestyle factors. In old age both long and short sleep duration seemed to be associated with modestly increased mortality.ClinicalTrials.gov identifier for the HBS: NCT02526082

Gastroesophageal reflux disease symptoms and risk of atrial fibrillation in a population-based cohort study (the HUNT study).

Gastroesophageal reflux disease (GERD) may influence the risk of atrial fibrillation (AF). We investigated the association between symptoms of GERD and AF in the Trøndelag Health Study (HUNT). The study cohort comprised 34,120 adult men and women initially free of AF with information on GERD symptoms. Participants were followed from the baseline clinical examination (1 October 2006 to 30 June 2008) to March 31, 2018. During a median follow-up of 8.9 years, 1,221 cases of AF were diagnosed. When looking at the whole population, participants with much GERD symptoms did not have an increased risk of AF (HR: 1.01; CI: 95%, 0.82 to 1.24) while participants with little GERD symptoms had a 14% lower risk of AF compared those with no GERD symptoms (HR: 0.86; CI: 95%, 0.76 to 0.97). Among younger participants (<40 years of age), the risk of AF had a trend towards increased risk with increasing symptom load of GERD (little GERD symptoms, HR: 3.09; CI: 95%, 0.74 to 12.94 and much GERD symptoms, HR: 5.40; 95% CI: 0.82 to 35.58). Among older participants (≥65 years of age), we saw a slightly reduced risk of AF in participants with little symptoms (HR: 0.84; CI: 0.72 to 0.97) and no association among those with much GERD symptoms (HR: 1.06; 95% CI: 0.82 to 1.36). We did not find support for a clinically important association between symptoms of GERD and AF across all age groups but for some younger people, GERD might play a role in the development of AF. However, our estimates for this age group were very imprecise and larger studies including younger individuals are warranted.

Clinical Manifestations.

Prediction of the course of cognitive function is of central importance in the care of patients with dementia of Alzheimer type (DAT) for individual management, counseling and treatment. Baseline clinical examination and cognitive function testing are decisive in the classification of the dementia type and stage, but their predictive value to foresee the future course of the disease is critical. This project aims to examine the relationship of baseline dementia stage and Alzheimer's disease neuropathological changes (ADNC) at autopsy with cognitive function during the course of the disease. This study is based on longitudinal data from The National Alzheimer's Coordinating Center (NACC)-Uniform and Neuropathology Data Set. Participants were retrospectively included based on the following criteria: Clinical diagnosis of DAT, cognitive function testing by Mini-Mental State Examination (MMSE), and report of ADNC at autopsy (ABC score). Baseline dementia stages were defined by the MMSE score (≥27/20-26/10-19/≤9). Neuropathological diagnosis of Alzheimer's disease was defined by ABC score levels "High" or "Intermediate" (confirmed-ADNC) as opposed to ABC score levels "Low" or "Not" (no-ADNC). Of 44,359 participants, 1,469 met inclusion criteria with 5,649 cognitive data points (i. e., on average 4.6±1.9 MMSE scores/participant). At baseline, 33%/49%/16%/2% of participants were assigned MMSE ranges of ≥27/20-26/10-19/≤9 respectively. The proportion of confirmed-ADNC within the respective groups increased as a function of the baseline MMSE range (76%/90%/95%/96% respectively). Cognitive function changes from baseline to last visit depended on the neuropathological diagnosis (-7 vs. -4 MMSE score points for confirmed-ADNC vs. no-ADNC respectively), but not on MMSE score at baseline (all -7 score points). Participants with a baseline MMSE score ≤9 decreased even less (-3 score points). The present descriptive analysis does not provide evidence for a clear association of cognitive function decline during follow-up and baseline MMSE scores, in contrast to ADNC which predicted faster decline, in patients with DAT. Modelling analyses including covariates will be presented.

Prognosis of Patients With Neuropathic Low Back-Related Leg Pain: An Exploratory Study Using Prospective Data From UK Primary Care

This prospective cohort study investigates the prognosis of patients with neuropathic low back-related leg pain consulting in UK primary care. Data from 511 patients were collected using standardised baseline clinical examinations (including magnetic resonance imaging scan findings), self-report questionnaires at baseline, 4 months, 12 months, and 3 years. Cases of possible neuropathic pain (NP) and persistent-NP were identified using either of 2 definitions: 1) clinical diagnosis of sciatica, 2) self-report version of leeds assessment for neurological symptoms and signs (s-LANSS). Mixed-effects models compared pain intensity (highest of mean leg or mean back pain [0–10 Numerical Rating Scale]) over 3-years between persistent-NP versus non-persistent-NP based on 1) clinical diagnosis, 2) s-LANSS. Logistic regression examined associations between potential prognostic factors and persistent-NP at 4 months based on the 2 NP definitions. At 4-months, using both definitions: 1) approximately 4 out of 10 patients had persistent-NP, 2) mean pain intensity was higher for patients with persistent-NP at all follow-up points compared to those without, 3) only pain self-efficacy was significantly associated with persistent-NP (s-LANSS: OR .98, sciatica: .98), but it did not predict cases of persistent-NP in either multivariable model. Based on factors routinely collected from self-report and clinical examination, it was not possible to predict persistent-NP in this population. PerspectiveThis study provides evidence that neuropathic back-related leg pain in patients consulting in primary care is not always persistent. Patients with persistent neuropathic pain had worse outcomes than those without. Neither leg pain intensity, pain self-efficacy nor MRI scan findings predicted cases of persistent neuropathic pain in this patient population.

Utility of trichoscopy in comparison to the standard methods for assessing the disease activity, severity, and therapeutic response in alopecia areata

Objectives: Alopecia areata (AA) is a common autoimmune hair disorder with variable disease activity and severity. Conventionally, hair pull test (HPT) and off late trichoscopy are used to diagnose and monitor disease course in AA. The aim of the study was to evaluate the use of trichoscope in monitoring the disease activity, severity, and therapeutic response in AA. Material and Methods: This was a hospital-based and longitudinal study. Consecutive patients with AA between March 2018 and February 2019 were included in the study. Baseline clinical examination, HPT, and trichoscopy of patients was done at baseline and adequate treatment initiated. Monthly follow-up for next 3 months was done to study response to treatment. Results: Black dots (BDs) (100%) were commonest trichoscopic feature followed by yellow dots (YDs) (93.5%). BDs, broken hairs (BHs), and short vellus hairs (SVH) had significant correlation with disease activity while all trichoscopic markers significantly correlated with disease severity. With each follow-up, mean values for YDs, BDs, and BHs were declining, while SVH was increasing steadily. The abatement of trichoscopic activity markers preceded the disappearance of a positive HPT. Conclusion: The abatement of trichoscopic markers of disease activity in AA preceded a negative HPT, highlighting the role of trichoscopy as a useful tool in monitoring therapeutic response.

The Correlation of Apolipoprotein B with Alterations in Specific Fat Depots Content in Adults.

Body mass index (BMI) and blood biomarkers are not enough to predict cardiovascular disease risk. Apolipoprotein B was identified to be associated with cardiovascular disease (CVD) progression. The Dual-energy X-ray Absorption (DXA) results could be considered as a predictor for cardiovascular disease in a more refined way based on fat distribution. The prediction of CVD risk by simple indicators still cannot meet clinical needs. The association of ApoB with specific fat depot features remains to be explored to better co-predict cardiovascular disease risk. An amount of 5997 adults from National Health and Nutrition Examination Survey (NHANES) were enrolled. Their demographic information, baseline clinical condition, blood examination, and DXA physical examination data were collected. Multivariate regression was used to assess the correlation between ApoB and site-specific fat characteristics through different adjusted models. Smooth curve fittings and threshold analysis were used to discover the turning points with 95% confidence intervals. ApoB is positively correlated with arms percent fat, legs percent fat, trunk percent fat, android percent fat, gynoid percent fat, arm circumference and waist circumference after adjustment with covariates for age, gender, race, hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking status and vigorous work activity. The smooth curve fitting and threshold analysis also showed that depot-specific fat had lower turning points of ApoB in both males and females within the normal reference range of ApoB. Meanwhile, females have a lower increase in ApoB per 1% total percent fat and android percent fat than males before the turning points, while females have a higher growth of ApoB per 1% gynoid percent fat than males. The combined specific fat-depot DXA and ApoB analysis could indicate the risk of CVD in advance of lipid biomarkers or DXA alone.

Higher arterial stiffness and systolic blood pressure are differentially associated with lower perfusion in subcortical and cortical gray matter regions

AbstractBackgroundHigher arterial stiffness is associated with lower regional cerebral blood flow (CBF) in older adults. Cortical CBF also correlates with higher systolic blood pressure (SBP). We examined relationships of lobar and deep gray matter CBF with both SBP and arterial stiffness.MethodParticipants of the Clinical Core of the Wake Forest Alzheimer’s Disease Research Center completed baseline clinical examination including measures of: arterial stiffness, blood pressure, medication review, APOE genotyping, 3T MRI, detailed cognitive testing, and cognitive adjudication. T1 structural and pseudocontinuous arterial spin labeling (pcASL) MRI were used to quantify gray matter (GM) CBF in AAL atlas regions. GM CBF was quantified into lobar (frontal, temporal, parietal, occipital), subcortical (caudate, putamen, pallidum, and thalamus), Cingulate/Insula, and posterior (cerebellum and vermis) regions. Arterial stiffness was measured twice in the supine position and averaged to quantify carotid‐femoral pulse wave velocity (cfPWV). Associations for cfPWV and systolic blood pressure (SBP) with GM CBF ROIs was examined by multivariable linear regression models adjusted for age, race, gender, education, hypertension medications, and APOE‐e4 carrier status.Result:Among 404 participants (70±8 years; 39 dementia, 139 MCI, 226 normal cognition), higher cfPWV and SBP were differentially associated with regional GM CBF (Fig 1 &amp; 2). Higher cfPWV was associated with lower subcortical GM CBF (p=0.04) (Table 1). Higher SBP was associated with lower GM CBF in frontal (p=0.03), temporal (p=0.02) and occipital lobes (p=0.01) (Table 1).ConclusionDeep subcortical brain structures may be at greater risk of damage from high arterial stiffness because they are perfused by arteries which branch relatively upstream of other branching arteries, as evidenced by lower GM CBF. High SBP may predict vascular damage in cortical regions manifested as lower GM CBF. These differential relationships with deep and cortical perfusion support and extend prior observations in this group relating vascular risk factors to abnormalities in white matter micro‐ and macro‐ structure, lower total CBF, and lower cognitive performance.

Higher arterial stiffness and systolic blood pressure are differentially associated with lower perfusion in subcortical and cortical gray matter regions

AbstractBackgroundHigher arterial stiffness is associated with lower regional cerebral blood flow (CBF) in older adults. Cortical CBF also correlates with higher systolic blood pressure (SBP). We examined relationships of lobar and deep gray matter CBF with both SBP and arterial stiffness.MethodParticipants of the Clinical Core of the Wake Forest Alzheimer’s Disease Research Center completed baseline clinical examination including measures of: arterial stiffness, blood pressure, medication review, APOE genotyping, 3T MRI, detailed cognitive testing, and cognitive adjudication. T1 structural and pseudocontinuous arterial spin labeling (pcASL) MRI were used to quantify gray matter (GM) CBF in AAL atlas regions. GM CBF was quantified into lobar (frontal, temporal, parietal, occipital), subcortical (caudate, putamen, pallidum, and thalamus), Cingulate/Insula, and posterior (cerebellum and vermis) regions. Arterial stiffness was measured twice in the supine position and averaged to quantify carotid‐femoral pulse wave velocity (cfPWV). Associations for cfPWV and systolic blood pressure (SBP) with GM CBF ROIs was examined by multivariable linear regression models adjusted for age, race, gender, education, hypertension medications, and APOE‐e4 carrier status.ResultAmong 404 participants (70±8 years; 39 dementia, 139 MCI, 226 normal cognition), higher cfPWV and SBP were differentially associated with regional GM CBF (Fig 1 &amp; 2). Higher cfPWV was associated with lower subcortical GM CBF (p=0.04) (Table 1). Higher SBP was associated with lower GM CBF in frontal (p=0.03), temporal (p=0.02) and occipital lobes (p=0.01) (Table 1).ConclusionDeep subcortical brain structures may be at greater risk of damage from high arterial stiffness because they are perfused by arteries which branch relatively upstream of other branching arteries, as evidenced by lower GM CBF. High SBP may predict vascular damage in cortical regions manifested as lower GM CBF. These differential relationships with deep and cortical perfusion support and extend prior observations in this group relating vascular risk factors to abnormalities in white matter micro‐ and macro‐ structure, lower total CBF, and lower cognitive performance.

Acute Swallowing Outcomes After Surgical Resection of Oral Cavity and Oropharyngeal Cancers With the Mandibular Lingual Release Approach.

To investigate the incidence, nature, severity, and recovery of early dysphagia in patients following surgical resection of oral and/or oropharyngeal squamous cell carcinoma with a mandibular lingual release approach (MLRA). Retrospective cohort study. Tertiary head and neck cancer center. Inclusion of patients' after surgical resection of oral cavity and/or oropharyngeal squamous cell carcinoma via an MLRA between 2012 and 2017. Data collection included acute medical care, enteral feeding, and swallowing outcomes derived from clinical swallow examination and videofluoroscopic swallowing study assessments at baseline, after surgery, and prior to discharge. Twenty-eight patients were eligible for participation (23 males; mean age, 63 years). Baseline clinical swallow examination findings revealed that 32% (n = 9) were tolerating normal diet and fluids preoperatively (Functional Oral Intake Scale [FOIS] = 7). Following surgery, the majority (n = 21, 75%) experienced severe dysphagia (FOIS ≤4), of which 15 were nil by mouth. Twelve patients received a postoperative videofluoroscopic swallowing study, with silent aspiration observed in 9 cases. At discharge, 12 (43%) patients had persistent severe functional dysphagia (FOIS ≤4) with ongoing enteral feeding requirements, of which 7 were nil by mouth. Eleven (39%) were managing diets of modified fluid/diet consistencies (FOIS = 5), and 5 (18%) had mild dysphagia (FOIS ≥6) at discharge. None were able to manage a normal diet. The average length of hospital stay was 27.9 days. Early dysphagia post-MLRA is a common and often severe complication of surgery. Patients require extended hospital admission with prolonged enteral feeding, which may persist postdischarge. This cohort requires early intervention by speech-language pathology services to aid swallow rehabilitation.

Examining the Gradient of All-Cause Mortality Risk in Women across the Cardiorespiratory Fitness Continuum.

Although cardiorespiratory fitness (CRF) is inversely associated with all-cause mortality in women, less is known regarding the gradient of mortality risk in women, particularly at the lower end of the CRF continuum. A total of 17,901 healthy women (mean age, 45.9 yr) completed a baseline clinical examination, including a maximal treadmill exercise test at the Cooper Clinic in Dallas, TX, between 1971 and 2016. Participants were placed into CRF quintiles based on age and treadmill time. After a mean follow-up period of 17.9 yr, 1198 all-cause deaths occurred. More favorable cardiometabolic risk factors, smoking status, and physical activity levels were observed across ordered CRF quintiles ( P < 0.001 for all). Adjusted all-cause mortality hazard ratios with 95% confidence intervals were 1.71 (1.40-2.09), 1.55 (1.29-1.87), 1.25 (1.03-1.51), 1.16 (0.97-1.38), and 1.0 (referent), respectively, across CRF quintiles ( P trend ≤ 0.001). When utilizing CRF as a continuous variable in a spline analysis and using 4.5 METs as the referent, we estimate a 10% reduction in mortality risk per 1-MET increment in CRF ( P < 0.001) until a threshold of approximately 11 METs. Mortality risk was approximately 50% lower at the 11-MET threshold when compared with the referent. No further significant reduction in mortality risk was observed beyond the 11-MET threshold. In addition, age-adjusted hemodynamic variables including resting and maximal double product, heart rate reserve, double-product reserve, and 1-min recovery heart rate were more favorable across CRF quintiles ( P < 0.001 for all). Beginning at a referent value of 4.5 METs, a significant decreasing gradient of all-cause mortality exists across the CRF continuum, until a threshold of approximately 11 METs is reached. Although all women should be encouraged to work toward meeting public health guidelines for physical activity, it is especially important to target those at the low end of the CRF continuum.

Relationship between lifestyle factors and hypertension: a cross-sectional analysis from the Gubbio study

Background Hypertension (HTN) is a well-established and a major risk factor for cardiovascular disease. Lifestyle behaviours for its prevention and control are recommended within worldwide guidelines. Their relationship with HTN need more investigations. Aim We aimed to investigate the associations between lifestyle, anthropometric and biological measurements and BP in the Gubbio residential study. Methods Cross-sectional analyses were performed using data from Gubbio study. Information concerning lifestyle factors were collected using self-reported questionnaire and were further completed with a baseline clinical examination and blood exams. Three BP measurements were performed following a standard protocol. Age-adjusted and multivariable logistic regressions were used to examine the relationships between lifestyle parameters and HTN separately for each sex. We used heterogeneity test to observe sex differences. Results There were 3,183 persons included (48% men, 43 ± 17 years old). Mean systolic BP (SBP) was 119 ± 16 mmHg and 10.6% were hypertensives. Age [OR: 129.70 (95%CI: 18.57–905.79) in women and OR: 8.37 (95%CI: 4.01–17.48) (p < 0.0001) in men] and BMI [OR: 2.14 (95%CI: 1.32–3.46) (p = 0.006) in women and OR: 1.81 (95%CI: 1.05–3.12), p = 0.03 in men], were positively associated with SBP in both sexes. Serum uric acid [OR: 3.86 (95%CI: 2.03–7.26), p = 0.04] was positively associated with HTN in women while fasting blood glucose [OR: 3.04 (95%CI: 1.55–5.97), p < 0.001] were associated to HTN only in men. Discussion In addition to age, BMI is associated with HTN in both sexes while sex differences were observed in the associations between serum uric acid, fasting blood glucose and HTN.

AN IN VIVO STUDY OF INTRAVITREAL RANIBIZUMAB FOLLOWING SUBRETINAL INOCULATION OF RB CELLS IN RABBITS EYES.

This study aimed to determine the effects of a single intravitreal ranibizumab injection in rabbits induced with retinoblastoma (RB). RB was induced in six New Zealand white rabbits by subretinal injection of a cultured WERI-RBb-1 cell line into the right eye. After six weeks, Group A (n = 3) was given intravitreal ranibizumab injection (0.3mg in 0.03ml) and Group B (n = 3) was the control. Baseline and serial clinical examinations were performed on days 1, 3, 6, 12, 15, 18 and 21. The right eyes were enucleated for both groups on day 21 for histopathological examination. The rabbits in both groups developed intraocular lesions which was detectable clinically at one-week post-tumor inoculation. The tumor grew slowly without spontaneous regression. After the animals in Group A were given an intravitreal ranibizumab injection, regression of the tumor was detected clinically, while the tumor in Group B continued to grow slowly. Histopathological findings confirmed the presence of a tumor that closely resembled features of poorly differentiated human RB cells. At the end of 21 days, the size of the tumor was larger in Group B in comparison to Group A. However, the treated group also developed a focal area of retinal hyperplasia. There was no significant side effect of ranibizumab injection except temporary high intraocular pressure immediately post-injection, which was relieved after paracentesis. Intravitreal ranibizumab is a potential treatment for RB. It is an effective therapy with a tolerable safety profile in this animal experimental study.

Abstract 27: Neuropathy in primary hypothyroidism and response to thyroxine replacement

Background: Entrapment neuropathy and sensorimotor polyneuropathy has been described as a manifestation of hypothyroidism in many studies. Only few studies are available in Indian population to know the extent of neuropathies in hypothyroid patient and effect of thyroxine replacement on these abnormalities.Aims and Objectives: To study the extent and pattern of peripheral nerve involvement in hypothyroid (subclinical and overt) patients and the response to optimal thyroid hormone replacement in them.Methods: Consecutive patients with primary hypothyroidism were clinically and electrophysiologically evaluated for peripheral nerve dysfunction at baseline and after achieving euthyroid status.Results: A total of 61 patients, were studied (Mean age 39.2 yrs, Range 19 - 55 yrs, Mean TSH 22.32 ±15.6 IU/ml). Baseline clinical examination was abnormal in 13 (21.3%) and electrophysiology was abnormal in 21 (34.4%). Among these, 6 (29%) had demyelination, 8 (38%) axonal neuropathy and 07 (33%) entrapment neuropathy. After optimal thyroxine replacement, 14 (67%) showed complete recovery. While 8 (72.7%) out of 11 with sensory axonal neuropathy showed significant improvement, all 04 patients with motor neuropathy showed significant improvement. One patient with demyelinating neuropathy did not show any improvement. Out of 7 patients with CTS, 5 (71.4%) showed improvement after thyroxine replacementConclusion: Subclinical peripheral nerve involvement is frequent in primary hypothyroidism and most cases responds well to optimum thyroxine replacement.

Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial

ObjectiveTeledentistry conveniently delivers dental care when in-person visits are restricted, such as during the COVID-19 pandemic. This study aimed to assess Saudi Arabian patients’ accuracy, perceptions, knowledge, attitudes, and challenges regarding teledentistry used for diagnosis during the COVID-19 pandemic, as well as its accuracy, versus traditional dental visits. MethodsA single-blind, parallel-group randomised controlled trial design was used. The 70 participants were randomised equally into study and control groups. While the control group waited, the study group received teledentistry diagnoses which were compared with baseline clinical examinations retrieved from the UQU dental hospital, Makkah, KSA. After the intervention was completed, all participants answered a questionnaire. ResultsThere were no significant differences between the groups in knowledge or attitudes regarding teledentistry. However, study group participants had more favourable experiences with teledentistry. They reported good accuracy with diagnosis and recording of their chief complaints (74.3%), number of missing teeth (74.3%), number of filled teeth (71.4%), and oral hygiene status (65.7%). Additionally, moderate accuracy was reported on recording of health complaints (51.4%) and number of decayed teeth (40.?%). The number of decayed teeth and the decayed, missing, and filled teeth (DMF) index scores reported using teledentistry were significantly (p < 0.05) higher than reported in the baseline examinations. ConclusionTeledentistry is widely accepted by patients and can be efficient for preliminary examinations, particularly during pandemic lockdowns or in more frequently occurring situations such as severe weather conditions, but subsequent clinical examination is necessary for maximally accurate diagnoses.

Statin use and MRI subchondral bone marrow lesion worsening in generalized osteoarthritis: longitudinal analysis from Osteoarthritis Initiative data.

To determine the association between statin therapy and knee MRI-detected subchondral bone marrow lesion (BML) longitudinal worsening in patients with Heberden's nodes (HNs) as the hallmark of generalized osteoarthritis (OA) phenotype. All participants gave informed consent, and IRB approved HIPAA-compliant protocol. We assessed the worsening in BML volume and number of affected subregions in the Osteoarthritis Initiative (OAI) participants with HNs at baseline clinical examination (HN+), using the semi-quantitative MRI Osteoarthritis Knee Scores at baseline and 24months. Participants were classified according to baseline BML involvement as "no/minimal" (≤ 2/14 knee subregions affected and maximum BML score ≤ 1) or "moderate/severe." Statin users and non-users were selected using 1:1 propensity-score (PS) matching for OA and cardiovascular disease (CVD)-related potential confounding variables. We assessed the association between statin use and increasing BML score and affected subregions using adjusted mixed-effect regression models. The PS-matched HN+ participants (63% female, aged 63.5 ± 8.5-year-old) with no/minimal and moderate/severe BML cohorts consisted of 332 (166:166, statin users: non-users) and 380 (190:190) knees, respectively. In the HN+ participants with no/minimal BML, statin use was associated with lower odds of both BML score worsening (odds ratio, 95% confidence interval: 0.62, 0.39-0.98) and increased number of affected subregions (0.54, 0.33-0.88). There was no such association in HN- participants or those HN+ participants with baseline moderate/severe BML. In patients with CVD indications for statin therapy and generalized OA phenotype (HN+), statin use may be protective against the OA-related subchondral bone damage only in the subgroup of participants with no/minimal baseline BML. • Statin use may reduce the risk of subchondral bone damage in specific osteoarthritis patients with a generalized phenotype, minimal subchondral bone damage, and cardiovascular statin indications.

Is There a Link Between Nailfold Videocapillaroscopy and Pulmonary Function Tests in Systemic Sclerosis Patients?: A 24-Month Follow-up Monocentric Study.

The aim of this study was to explore the associations between nailfold videocapillaroscopy (NVC) and pulmonary function tests (PFTs) in systemic sclerosis (SSc) patients. This was a longitudinal study with follow-up of unselected Brazilian SSc patients. Baseline clinical examination, serological workup, high-resolution chest tomography, and NVC were performed. Pulmonary function test was performed at baseline and after 24 months. Pulmonary function test worsening over time was defined as either a ΔFVC decline ≥10% or a ΔFVC decline ≥5% and <9%, combined with a ΔDLCO decline ≥15%, at 24 months. The NVC parameters were quantitatively (capillary density number, dimension, morphology, and hemorrhages) and qualitatively (NVC pattern) evaluated according to the consented standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Seventy-nine patients were included. Fifty-nine were rated to have a scleroderma pattern (6 "early"/16 "active"/37 "late"). The mean FVC and DLCO were 76.8% and 67.2% at baseline and 73.8% and 64.3% at 24 months, respectively. After multivariate analysis, we found that a reduced baseline FVC was associated with reduced capillary density (odds ratio [OR], 11; 95% confidence interval [CI], 1.5-90.7; p = 0.03) and a reduced baseline DLCO associated with the late scleroderma pattern (OR, 6.75; 95% CI, 1.09-42; p = 0.03). No association between worsening of PFT over time and NVC was found. The association between NVC and PFTs might corroborate the link between microangiopathy and interstitial lung disease in patients with SSc. This finding might strengthen the idea of incorporating NVC as a tool to predict progressive interstitial lung disease in these patients in the future.

Causes, frequencies, and predictors of relapse in patients with ulcerative colitis on long-term follow-up in a tertiary care hospital of Northern India

Context: Ulcerative colitis (UC) initially thought to be a disease of developed world is equally common in India. Surprisingly, there are very scant data from India. The study was undertaken to find the frequency of relapse and to determine factors predictor of relapse in Indian population. Subjects and Methods: This study was conducted at a tertiary care center of New Delhi for a period of 1 year. Patients were included if they had a diagnosis of UC based on accepted historical, endoscopic, histological, and/or radiologic criteria. Detailed past/present history, baseline clinical examination, dietary details, and psychological analysis using shortened Depression Anxiety Stress Scale score, biochemical tests, inflammatory markers, endoscopic, and histopathological analysis were done at baseline and regular intervals. The outcome was clinical relapse or continued remission. Results: Out of 86 patients screened, 50 patients were included in the study according to inclusion criteria and were followed up. The frequency of relapse was 32%. Univariate analysis showed higher relapse frequency, frequency of steroid received in past, patients on immunomodulator therapy, presence of acute or chronic inflammatory cells on histology, and disease activity at baseline as predictors of relapse. There was no significant difference between anxiety, stress, and depression relapsers and those who maintained remission. On multivariate analysis, disease activity at baseline was the only independent predictor of relapse. Conclusions: Stringent control of disease activity with mucosal healing should be the aim, as mucosal healing is the only predictor for prolonged remission.

Assessment of the Diagnostic Accuracy of Baseline Clinical Examination and Ultrasonographic Imaging for the Detection of Lymph Node Metastasis in Patients With High-risk Cutaneous Squamous Cell Carcinoma of the Head and Neck

Patients with cutaneous squamous cell carcinoma (SCC) of the head and neck may develop lymph node metastasis; therefore, additional workup of the regional lymph nodes in these patients should be considered. However, there is uncertainty regarding the value of baseline ultrasonographic imaging in addition to clinical examination for the detection of metastasis. To assess the diagnostic accuracy of clinical examination and baseline ultrasonography for the detection of metastasis among patients with high-risk cutaneous SCC of the head and neck and to assess the accuracy of ultrasonography when baseline clinical examination produces negative results. This diagnostic study was conducted among a retrospective cohort of 233 patients with 246 high-risk cutaneous SCC tumors of the head and neck. The study included all patients with high-risk cutaneous SCC of the head and neck who received clinical examination and baseline ultrasonographic imaging of their lymph nodes at the Erasmus Medical Center Cancer Institute, a tertiary referral hospital for patients with skin cancer in Rotterdam, the Netherlands, between January 1, 2015, and December 31, 2017. Data were analyzed from October 13, 2020, to September 29, 2021. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Fine-needle aspiration cytologic biopsy and 6 months of follow-up per patient were used as the reference standards. Among 233 patients (176 men [75.5%]; median age, 79.1 years [IQR, 71.5-83.7 years]; data on race and ethnicity were not collected) with 246 high-risk cutaneous SCC tumors of the head and neck, 20 metastases were cytologically confirmed at baseline, and 2 metastases were detected during 6 months of follow-up, yielding a 9% metastasis rate. The sensitivity of clinical examination was 50% (95% CI, 28%-72%), and the specificity was 96% (95% CI, 93%-98%). The PPV and NPV were 55% (95% CI, 36%-72%) and 95% (95% CI, 93%-97%), respectively. In the total cohort, ultrasonography had a sensitivity of 91% (95% CI, 71%-99%) and a specificity of 78% (95% CI, 72%-83%), with a PPV of 29% (95% CI, 23%-35%) and an NPV of 99% (95% CI, 96%-100%). In the group of patients with negative results at baseline clinical examination, 9 of 11 metastases were detected by ultrasonography, with 82% sensitivity (95% CI, 48%-98%); specificity was 79% (95% CI, 73%-84%), PPV was 17% (95% CI, 12%-23%), and NPV was 99% (95% CI, 96%-100%). In this diagnostic study, among a cohort of patients with high-risk cutaneous SCC of the head and neck, baseline ultrasonography was more sensitive than clinical examination alone for the detection of lymph node metastasis. In the setting of a negative result at baseline clinical examination, ultrasonography had high sensitivity for detecting nodal metastases, but this sensitivity should be evaluated against the high rate of false-positive findings.