Routine Clinical Evaluation Research Articles

A Clinically Applicable 24-Protein Model for Classifying Risk Subgroups in Pancreatic Ductal Adenocarcinomas using Multiple Reaction Monitoring-Mass Spectrometry

Pancreatic ductal adenocarcinoma (PDAC) subtypes have been identified using various methodologies. However, it is a challenge to develop classification system applicable to routine clinical evaluation. We aimed to identify risk subgroups based on molecular features and develop a classification model that was more suited for clinical applications. We collected whole dissected specimens from 225 patients who underwent surgery at Seoul National University Hospital, between October 2009 and February 2018, in Korea. Target proteins with potential relevance to tumor progression or prognosis were quantified with robust quality controls. We used hierarchical clustering analysis to identify risk subgroups. A random forest classification model was developed to predict the identified risk subgroups, and the model was validated using transcriptomic datasets from external cohorts (N = 700), with survival analysis. We identified 24 protein features that could classify the four risk subgroups associated with patient outcomes: Stable; Exocrine-like; Activated; and Extracellular matrix (ECM)-Remodeling. The "Stable" risk subgroup was characterized by proteins that were associated with differentiation and tumor suppressors. "Exocrine-like" tumors highly expressed pancreatic enzymes. Two high-risk subgroups, "Activated" and "ECM-Remodeling," were enriched in such terms as cell cycle, angiogenesis, immuno-competence, tumor invasion-metastasis, and metabolic reprogramming. The classification model that included these features made prognoses with relative accuracy and precision in multiple cohorts. We proposed PDAC risk subgroups and developed a classification model that may potentially be useful for routine clinical implementations, at the individual level. This clinical system may improve the accuracy of risk prediction and treatment guidelines.

Renal Dysplasia in a Free-Living Giant Anteater Cub (Myrmecophaga tridactyla) - Ultrasonographic and Tomographic Aspects

Background: Renal dysplasia is a congenital disorder that occurs during differentiation of the renal parenchyma or as a consequence of a functional and/or structural obstruction of the lower urinary tract. In wild animals, this pathology has been reported in cynomolgus monkeys (Macaca fascicularis), golden hamsters (Mesocricetus auratus) and African elephants (Loxodanta africana). However, there are no reports of the disease in the giant anteater (Myrmecophaga tridactyla). Thus, this paper describes a case of renal dysplasia in a free-living giant anteater cub, which was sent to the wild animal clinic of the Federal University of Mato Grosso (UFMT) in Cuiabá, MT, Brazil. Case: The rescued animal had a good body condition score and clinical parameters within the normal range for the species. After a routine clinical evaluation, the anteater cub was subjected to radiography and ultrasound tests. Blood tests, serum tests for hepatic and renal profiles, urinalysis, urinary protein creatinine ratio, and chest X-rays did not reveal significant changes. However, the abdominal ultrasound examination revealed a volumetric loss of about 1.17 cm in length in the left kidney, and a renal length to aortic artery diameter ratio of approximately 2.8. This kidney showed irregular contours, loss of corticomedullary demarcation, with preserved echogenicity and cortical echotexture. The right kidney showed the standard size of the species, with a length of approximately 3.08 cm. In view of the suspicion of renal dysplasia, a contrast-enhanced CT scan was performed in order to assess the dynamics of uptake and excretion of the contrast medium in the affected kidney and in the ipsilateral collecting system. An examination of the tomographic images indicated that the volume of the left kidney was reduced, isodense in relation to the right kidney, with discrete and homogeneous uptake in all phases after administration of the contrast medium, no occurrence of nephrogram and pyelogram phases, or any detection of contrast in the corresponding ureter.Discussion: Giant anteaters (Myrmecophaga tridactyla) are animals classified as a species vulnerable to extinction. Today, most research involving this species focuses on its ecology, behavior, diet, morphology and parasitology, but little is known about the imaging aspects of the species or about congenital changes such as renal dysplasia. Although the definitive diagnosis of this pathology depends on a histopathological examination, the same diagnosis can be made with a wide margin of safety by assessing the epidemiological aspects and the dynamics of renal uptake of the contrast medium through computed tomography. In this analysis, both vascularization and renal filtration capacity can be assessed. Thus, based on CT imaging, it was concluded that this was a case of renal dysplasia, since the left kidney showed a discrete homogeneous uptake stable in both the arterial and venous phases, without producing any accumulation of contrast medium in the pelvic region or the collecting system, proving to be completely nonfunctional. These findings differ from cases of renal hypoplasia, which, although they reduce renal volume, do not cause structural changes in the renal parenchyma or disturbances in the filtration dynamics of contrast media. They also differ from cases of acquired chronic nephropathy, since, albeit associated with reduced renal volume and changes in renal filtration dynamics, they produce different parenchymal ultrasound changes that usually occur in elderly animals and generally produce bilateral lesions.

Cytomegalovirus infection is associated with an increase in aortic stiffness in older men which may be mediated in part by CD4 memory T-cells.

Human Cytomegalovirus (CMV) infection is associated with atherosclerosis, higher cardiovascular disease (CVD) risk, and an increase in memory T-cells (Tmem). T-cells have also been implicated in CVD, independently of CMV infection. To better understand the CMV-associated CVD risk, we examined the association between CMV (IgG) serostatus and central aortic (carotid-to-femoral) pulse wave velocity (cfPWV), an early, independent predictor of CVD. We also investigated if such an association might be reflected by the distribution of Tmem and/or other T-cell subsets.Methods: Healthy older volunteers (60-93 years) underwent routine clinical and laboratory evaluation, including assessment of cfPWV in eligible participants. Flow-cytometry was used to assess proportions of memory T-cells, CD28null T-cells, and CMV-specific T-cells. The following associations were examined; CMV serostatus/cfPWV, CMV serostatus/proportion of Tmem, proportion of Tmem/cfPWV, CD28null T-cells/cfPWV, and CMV-specific T-cells/cfPWV. Linear regression models were used to adjust for age, sex, socioeconomic status, smoking, waist-to-hip ratio, cholesterol, and blood pressure as required.Results: Statistically significant positive associations were found (P-values for the fully adjusted models are given); CMV serostatus/cfPWV in men (P ≤ 0.01) but not in women, CMV serostatus/proportions of CD4 Tmem in men (P ≤ 0.05) but not in women; proportions of CD4 Tmem/cfPWV among CMV seropositive (CMV+) people (P ≤ 0.05) but not CMV seronegative (CMV-) people.Conclusion: CMV infection increases the CVD risk of older men by increasing cfPWV. This may be mediated in part by increased proportions of CD4 Tmem, higher numbers of which are found in CMV+ older people and more so among men than women. Given the high prevalence of CMV worldwide, our findings point to a significant global health issue. Novel strategies to mitigate the increased CVD risk associated with CMV may be required.

Multiple Scale of Complexity for Anorectal Fistulas

Background: Anorectal fistulas are common and difficult to manage. Objective: To create a scale of complexity through the identification, description of medical history, clinical and ultrasonographic findings. To reduce the rate of recurrence and complications in fistulas is the treatment goal. Patient's inherent traits increase the complexity of anorectal fistulas with the risks of incontinence, delayed healing, infections, and requiring difficult surgeries. The aim of this study was to create a scale of complexity through identification, description of medical history, and clinical and ultrasonography (USG) findings. Patients and Methods: Retrospective study of a prospectively maintained database conducted at two Venezuelan hospitals. All patients who underwent anorectal USG examination at our institutions between 2010 and 2017 were investigated and included in the numerical scoring system, which categorizes the risk of fistula into simple, intermediate, and complex. The Chi-square test of the Statistical Program of Social Sciences (SPSS) was used to establish the significance level, P < 0.005. One thousand one hundred and seventy-three patients were evaluated, and perianal fistula was identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate, and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of the fistula may not be obvious in routine thorough clinical evaluation, requiring complementary studies. Using the scale avoids excluding factors that indicate complexity, with a statistically significant difference with the classification based exclusively on tracts. Limitation: The limitation of this study is that it is a retrospective single medical group study.

Diffusion Magnetic Resonance Imaging with Applications to Cardiac Muscle: Short Review

Abstract This review describes in brief recent magnetic resonance imaging (MRI) methods for assessing cardiac structure in healthy and pathologic state using diffusion-weighted (DW) and diffusion tensor imaging (DTI) approaches. A background on the theory and MR pulse sequences employed in DW/DT imaging is given, along with the calculation of diffusion tensor (D), apparent diffusion coefficient (ADC) and fractional anisotropy (FA). Parametric maps derived from DW/DT images can quantify microstructure alterations due to fibrotic collagen deposition, along with associated changes in cardiac muscle anisotropy. Representative examples of ADC and FA parametric maps are shown from ex vivo high-resolution DT images of explanted healthy and scarred hearts obtained from pre-clinical investigations. Furthermore, examples of fiber tractography demonstrating DTI-based 3D (three-dimensional) reconstruction of fiber directions within the heart are illustrated using advanced open-source software. Lastly, future developments and potential translation of DW/DT methods into routine clinical evaluation for cardiac MR imaging protocols are highlighted.

Assessment of metastatic lymph nodes in head and neck squamous cell carcinomas using simultaneous 18F-FDG-PET and MRI

In this study, we investigate the feasibility of using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI), and dynamic positron emission tomography (PET) for detection of metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) cases. Twenty HNSCC patients scheduled for lymph node dissection underwent DCE-MRI, dynamic PET, and DWI using a PET-MR scanner within one week prior to their planned surgery. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. Quantitative parameters of metastatic and normal nodes were calculated from DCE-MRI (ve, vp, PS, Fp, Ktrans), DWI (ADC) and PET (Ki, K1, k2, k3) to assess if an individual or a combination of parameters can classify normal and metastatic lymph nodes accurately. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. 34% of all normal nodes had volumes greater than or equal to the smallest metastatic node while 4 normal nodes had SUV > 4.5. Among the MRI parameters, the median vp, Fp, PS, and Ktrans values of the metastatic lymph nodes were significantly lower (p = <0.05) than those of normal nodes. ve and ADC did not show any statistical significance. For the dynamic PET parameters, the metastatic nodes had significantly higher k3 (p value = 8.8 × 10−8) and Ki (p value = 5.3 × 10−8) than normal nodes. K1 and k2 did not show any statistically significant difference. Ki had the best separation with accuracy = 0.96 (sensitivity = 1, specificity = 0.95) using a cutoff of Ki = 5.3 × 10−3 mL/cm3/min, while k3 and volume had accuracy of 0.94 (sensitivity = 0.82, specificity = 0.97) and 0.90 (sensitivity = 0.64, specificity = 0.97) respectively. 100% accuracy can be achieved using a multivariate logistic regression model of MRI parameters after thresholding the data with Ki < 5.3 × 10−3 mL/cm3/min. The results of this preliminary study suggest that quantitative MRI may provide additional value in distinguishing metastatic nodes, particularly among small nodes, when used together with FDG-PET.

Altered phenotype in LMAN1-deficient mice with low levels of residual LMAN1 expression

AbstractCombined deficiency of coagulation factors V and VIII (F5F8D) is an autosomal recessive bleeding disorder caused by loss-of-function mutations in either LMAN1 or MCFD2. The latter genes encode 2 components of a mammalian cargo receptor that facilitates secretion of coagulation factor V (FV) and factor VIII (FVIII) from the endoplasmic reticulum (ER) to the Golgi via coat protein complex II vesicles. F5F8D patients exhibit FV and FVIII levels that are ∼10% to 15% of normal. We report herein a comparative analysis for a series of murine Lman1 alleles. Consistent with previous reports, mice completely deficient in LMAN1 (Lman1−/−) exhibit ∼50% FV and FVIII levels. In contrast, mice carrying a hypomorphic Lman1 allele (Lman1cgt/cgt) that expresses ∼6% to 8% of wild-type Lman1 mRNA levels exhibit intermediate plasma FV and FVIII reductions (∼70% of wild-type levels). Lman1−/− mice exhibit ER accumulation of another LMAN1 cargo, alpha-1 antitrypsin (A1AT), with an intermediate level of A1AT ER retention observed in Lman1cgt/cgt mice. Finally, the previously reported strain-specific, partially penetrant, perinatal lethality of LMAN1-deficient mice (Lman1gt1/gt1) was confirmed in Lman1−/− mice, although it was not observed in Lman1cgt/cgt mice. Taken together, these results show a dose-dependent effect of residual LMAN1 on the secretion of its cargo proteins. The results also suggest that human subjects with hypomorphic LMAN1 mutations might present with mild bleeding phenotypes resulting from more modest reductions in FV and FVIII, which could be missed by routine clinical evaluation. Finally, these findings suggest that therapeutic targeting of LMAN1 to reduce FV and FVIII as an anticoagulant strategy may only require partial inhibition of LMAN1 function.

Young patients with type 1 diabetes mellitus are characterised by high frequency of masked hypertension that is associated with increased arterial stiffness

Abstract Background Hypertension (HTN) is a major risk factor for microvascular complications and cardiovascular disease (CVD) in individuals with type 1 diabetes (T1D). Masked and nocturnal HTN are associated with increased cardio-vascular (CV) risk and may be common in patients with T1D. Increased arterial stiffness (AS) is associated with elevated blood pressure (BP) and vascular complications. Very few studies have analyzed the association between masked HTN and markers of AS in T1D. Purpose To evaluate BP phenotypes and their associations with AS and to assess CV risk in young patients with T1D without history of HTN and other known CVD. Methods We included 81 patients with T1D without any history of known CVD. Routine clinical and laboratory evaluation was performed. Office BP was measured with a validated oscillometric device. 24-h ABPM was performed using BPLab Vasotens (“Petr Telegin”). Central BP and AS (carotid-femoral pulse wave velocity (cfPWV)) were measured with applanation tonometry. BP phenotypes were analyzed according to the criteria recommended in ESC/ESH 2018 HTN guidelines. CV risk categories were assessed with the global scale of 10-year risk (ESC 2019). P &amp;lt;0.05 was considered significant. Data are presented as median (interquartile range (IQR)). Results The study group included 39% males, age 27 (23; 34) years, 24.7 smokers, duration of T1D– 6 (2.8; 11) years, HbA1c – 6.9% (5.6; 7.9%). Brachial BP was 122 (110; 122)/80 (70; 80) mmHg; central BP was 109 (100; 118)/72 (67; 78) mmHg, cfPWV – 6.3 (5.3; 6.7) m/s. High and very high 10-year CV risk was observed in 87.7% of patients. True HTN was observed in 5 (6.2%) patients, masked – in 31 (38.3%), white-coat – in 1 (1.2%), true normotension in 44 (54.3%). Isolated nocturnal HTN was found in 30.7% of patients with office BP &amp;lt;140/90 mmHg. 41% of all patients with clinical normotension had masked HTN and isolated nocturnal HTN was present in 74.2% of them. The most common patterns of diurnal index were non-dipping (63,9%) and night-peaking (16.6%). Patients with masked HTN compared to patients with true normotension were older (31±8.6 vs 26.4±5.5 years, p=0.02), had longer duration of T1D (6 (3; 12.9) vs 4 (0.7; 8) years, p=0.009), higher urine albumin/creatinine ratio (18.5 (11; 29) vs 8 (3; 17) mg/g, p&amp;lt;0.001) and higher cfPWV (7.2 (6.2; 8.2) vs 6.3 (5.8; 6.8) m/s, p=0.002). Conclusions Young patients with T1D and clinical normotension are characterized by high frequency of masked HTN (41%) especially isolated nocturnal HTN (74.2%), and high rate of non-dipping. Masked HTN is associated with higher cfPWV and higher albuminuria. This may reflect early vascular changes and potentially lead to further CV risk elevation in this population. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The publication was prepared with the support of the “RUDN University Program 5-100”

Rationale and design of a multicenter, randomized, patients-blinded two-stage clinical trial on effects of endothelial function test in patients with non-obstructive coronary artery disease (ENDOFIND)

Abnormal peripheral and coronary endothelial function has been associated with increased risk of major adverse cardiovascular events (MACE) in cross-sectional retrospective and observational studies. However, prognostic value of routine clinical evaluation, diagnosis and treatment of endothelial dysfunction on incident MACE in patients with non-obstructive coronary artery disease (NOCAD) remains unknown. Endothelial Function Guided Management in Patients with NOCAD (ENDOFIND) is a multicenter, randomized, patients-blinded, parallel-controlled, two-stage clinical trial evaluating the impact of routine clinical peripheral endothelial function testing on initiation and/or intensification of cardiovascular preventive therapies in Stage I, and on the risk of MACE in Stage II in patients with NOCAD. One thousand participants with NOCAD on clinically indicated coronary computed tomography or invasive angiography will be enrolled and randomized 1:1, after baseline peripheral endothelial function evaluation, to either endothelial function guided treatment group or standard of care control group. In Stage I, patients will be followed for 12 months and primary outcome will be the proportion of patients receiving prescriptions for cardiovascular evidence-based lipid, blood pressure and glucose lowering medications at the clinic visit immediately after endothelial function evaluation. Secondary outcomes are change in endothelial function measured as reactive hyperemia index and patients' adherence to evidence-based medications in 12 months. Study will be extended into Stage II where sample size and follow up duration will be reevaluated to ensure statistical power, and primary outcome will be incident MACE. ENDOFIND is proof-of-concept clinical trial of a disruptive endothelial function guided clinical intervention with potential benefits to NOCAD patients. Condensed abstractENDOFIND is a proof-of-concept clinical trial of a disruptive endothelial function guided clinical intervention with potential benefits to patients with no obstructive coronary artery disease (NOCAD). It is a multicenter, randomized, patients-blinded, parallel controlled two-stage clinical trial to evaluate the impact of routine clinical peripheral endothelial function testing on initiation and/or intensification of cardiovascular disease preventive therapies in Stage I, and on the risk of MACE in Stage II.

The effect of post-amputation pain on health-related quality of life in lower limb amputees

Purpose There is conflicting literature on the effect of post-amputation pain on quality of life (QOL) and no available literature on the relationship of pain medications to QOL of amputees in pain. The aims of the study were to compare QOL in lower limb amputees with significant pain to those with minimal pain and compare QOL in amputees on multiple pain medications (≥3 and/or ≥ 40 mg morphine equivalent/day) to those on minimal. Methods Cross-sectional study of amputees (n = 101) utilizing standardized (brief pain inventory, pain self-efficacy, Euro QOL scale), institutional amputee specific questionnaires. Results Post-amputation pain was common (69%), but only 13% of the participants were using more pain medications. High-pain interference and poor self-efficacy were associated with poorer QOL after adjusting for age, gender and cause of amputation. High medication use was associated with high-pain interference and poor self-efficacy, but there was minimal correlation between pain scores and medication usage (p > 0.05). Quality of life was not influenced by high medication usage (p > 0.05 for pain interference; p > 0.05 for self-efficacy). Conclusion Post-amputation pain continues to be a major determinant of QOL in lower limb amputees, but the role of pain medications on an amputee’s QOL remains unclear. IMPLICATIONS FOR REHABILITATION An amputee’s QOL is affected by the severity of their post-amputation pain even beyond six months post their amputation. An amputee with more pain may not necessarily take more pain medications to manage their pain. The amount of pain medications taken may not influence their self-reported QOL. Pain and QOL assessment should be integrated into routine clinical evaluation of adult amputees. Standardized screening tools and/or formative assessment can be utilized for assessing QOL.

PATTERN OF CORONARY ARTERY DOMINANCE IN KASHMIRI POPULATION—AN ANGIOGRAPHY STUDY

Background: .In developing countries like India CAD is one of the major causes of death. The pattern of coronary artery dominance has a significant clinical role. Left dominance is said to be associated with increase in acute coronary syndrome. The aim of this study was to determine the pattern of coronary artery dominance in Kashmiri population. Materials and Methods : The study was carried on 150 patients above 18 years of age who after routine clinical evaluation were to undergo coronary angiography for various indications and their angiogram was labelled as normal by cardiologist. Results: A total of 150 patients were included in the study, among them 102 were male and 48 were female patients. The mean age for females was 56.4±10.22 years with range from 40-89 years. The mean age of males were 56.1±10.83 years with range from 30-89 years. Right coronary artery was dominant in 130 (86.67%) subjects, left coronary artery was dominant in 15 (10%) subjects and co-dominant circulation was found in 5(3.33%) subjects. Conclusion: The right coronary artery dominance is more prevalent in Kashmiri population. Knowledge about coronary artery dominance provides helpful information to anatomist and is essential for interventional cardiologist.

Ingrained Insight into Nasal Polyposis; Role of Human Papillomavirus: An Indian Study.

Nasal polyposis (NP) are benign lesion of nasal cavity, affecting up to 1-4% of population. It is known to have up to 70% recurrence rate. The underlying pathophysiology is still undetermined. Recent literatures have thrown light on the viral aetiology for NP. To our knowledge this is the first Indian study done, that aims to evaluate the prevalence of Human papillomavirus (HPV) in NP. It was a prospective case control study done among 40 individuals with NP and 40 healthy controls in a tertiary care centre. All the patients were subjected to routine clinical evaluation, investigations prior to proposed surgeries. The mucosal samples after the surgery were subjected to HPV DNA analysis by RT-PCR. Among the cases, the male to female ratio was 1.3:1. The mean age of patients with NP was 39 ± 14.6. The mean serum IgE levels among the case were 154IU/ml and was significantly higher as compared to controls. Other inflammatory markers such as absolute eosinophil count, erythrocyte sedimentation rate, and neutrophil to leukocyte ration were found to be not significant. There was no HPV DNA detected among both case as well as controls. There seems to be strong association of IgE and NP, suggesting an IgE mediated pathway for its Causation. There is no association of HPV in NP.

Psychotropic medications and metabolic side effects in common genetic syndromes with intellectual disability-case report

Multi-systemic genetic disorders are strongly associated with psychiatric illness and may require psychotropics for their management. The choice of psychotropics is primarily determined by medical comorbidities and adverse effects. A careful assessment of behavioural phenotype and metabolic monitoring for children on psychotropics should be followed to avoid adverse consequences. Hence, the need for monitoring of metabolic syndrome during routine clinical evaluation and the use of aripiprazole which demonstrated a good response with minimal adverse effects are highlighted with a description of cases of children with intellectual disability and neurodevelopmental genetic syndromes like Down Syndrome and Prader-Willi syndrome.

FRI0298 ASAS MODIFICATION OF THE BERLIN ALGORITHM AND THE DUET ALGORITHM FOR DIAGNOSING AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE SCREENING IN AXIAL SPONDYLOARTHRITIS FOR PSORIASIS, IRITIS, AND COLITIS COHORT

Background:Patients presenting with back pain and psoriasis, iritis, or colitis, represent a high-risk population for the presence of axial spondyloarthritis (axSpA). The Dublin Evaluation Tool (DUET)1, the Berlin algorithm2, and the ASAS modification of this algorithm3are recommended referral strategies aimed at early diagnosis of axSpA. DUET was developed for patients presenting with AAU. Validation of these algorithms in inception cohorts is limited.Objectives:1. To assess the performance of referral algorithms for diagnosis of axSpA when tested against the final local rheumatologist diagnosis in an inception cohort of patients presenting with undiagnosed back pain and extra-articular manifestations. 2. To determine whether different criteria for inflammatory back pain (IBP) impact the performance of the algorithms.Methods:The multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study at 11 sites is aimed at early detection of axial SpA in patients presenting with undiagnosed back pain to the rheumatologist. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, acute anterior uveitis (AAU), or colitis diagnosed by the relevant specialist undergo routine clinical evaluation by a rheumatologist for axial SpA. The rheumatologist determines the presence or absence of axial SpA at 3 consecutive stages: 1. After the clinical evaluation; 2. After the results of labs (B27, CRP) and radiography; 3. After the results of MRI evaluation. Final diagnosis by the rheumatologist was used as external standard to test the performance of the algorithms. We tested the following criteria for IBP in the algorithm: ASAS, Berlin, rheumatologist global for likelihood of IBP &gt;5 (0-10 scale), and DUET algorithm in AAU patients.Results:A total of 246 patients were recruited, 73 presented with iritis, 46 with psoriasis, and 127 with colitis, 47.6% were diagnosed with axSpA. The diagnosis of axSpA was established in 45.7%, 61.6%, and 40.2% of patients with psoriasis, AAU, and IBD, respectively. The performance of the ASAS-modification of the Berlin algorithm was superior to the original algorithm as reported previously3, primarily for enhanced sensitivity, and this was observed irrespective of the criteria used to define IBP (Table 1). Conversely, the performance of the Duet algorithm in the subset of patients with AAU was substantially worse than previously reported1.Conclusion:The ASAS modification of the Berlin algorithm is the preferred referral strategy for patients presenting with undiagnosed back pain to the rheumatologist.

Echocardiographic Findings and Cardiovascular Profile of the Very Old Indian Population

Background : Age-related changes in the cardiovascular system are significant, increasing the risk of cardiovascular diseases (CVDs) in older adults. CVDs are currently the leading cause of mortality among older Indian adults, yet very few studies are presently available evaluating the older adults for CVDs and risk factors. We aim to assess the very old adults for the prevalence of CVDs and risk factors using non-invasive assessment tools. Methodology : This hospital-based cross-sectional study included 200 adults aged 75 years and above, visiting a tertiary care hospital in India. They underwent routine clinical evaluation, a comprehensive geriatric assessment and detailed cardiovascular evaluation using non-invasive tools like echocardiography and blood investigations. Results : The overall prevalence of CVDs in this population was 76%. Among the cardiovascular risk factors, hyperhomocysteinemia was present in 83.5%, hypertension in 59.5%, dyslipidemia in 41.5%, sedentary lifestyle in 35%, and obesity in 30.5%, and Diabetes Mellitus in 24.5%. In echocardiographic assessment, valvular dysfunction was present in 33% of the population, though moderate to severe valvular disease was seen in 6.5%. Left ventricular diastolic dysfunction was seen in 81%, systolic dysfunction in 10% and pulmonary hypertension in 5% of the subjects. Conclusion : The very old adults had significant age-related changes in echocardiographic assessment, along with the high prevalence of cardiovascular diseases and risk factors. These findings should encourage physicians to screen the very old adults for cardiovascular risk factors and diseases, for their early identification and effective management.

M50. THE PERSIAN VERSION OF THE SCREEN FOR COGNITIVE IMPAIRMENT IN PSYCHIATRY (SCIP-P) AS A VALID SCREENING TOOL FOR COGNITIVE IMPAIRMENT IN SCHIZOPHRENIA

BackgroundThe Screen for Cognitive Impairment in Psychiatry (SCIP; Purdon, 2005) is a screening tool of cognitive impairment that includes measures of verbal learning (immediate and delayed), working memory, verbal fluency, and psychomotor speed. The test has three alternative forms that require less than 15 minutes to complete.The main objective of this preliminary study was to examine the Persian version of SCIP as a screening tool for cognitive dysfunction in schizophrenia.MethodsReliability and validity data were collected from a sample of 98 patients diagnosed with schizophrenia who completed three alternate forms of the Persian translations of the SCIP within a three-week period separated by a one-week delay.ResultsThis study presents the first results of the Persian version of the SCIP in a sample of patients diagnosed with schizophrenia and compares the results with those derived from the English and Spanish versions.DiscussionThe SCIP-P scores were reliable and valid for the detection of cognitive impairment in schizophrenia. Analyses confirmed that the three forms of the SCIP-P are equivalent and may prove useful for the rapid screening during routine clinical evaluation of schizophrenia.

Sexual Arousal in Obsessive-Compulsive Disorder With and Without Contamination/Washing Symptoms: A Moderating Role of Disgust Sensitivity.

Different findings would indicate that obsessive-compulsive disorder (OCD), a common psychiatric condition, might significantly impair intimate relationships and sexual well-being. The aim of the present study was to ascertain whether OCD outpatients with contamination/washing symptoms experience a lower sexual arousal than those experiencing other symptoms. In addition, we explored whether a higher disgust propensity/sensitivity might moderate the relation between contamination/washing symptoms and impaired sexual arousal. A total of 72 outpatients (27 with contamination/washing symptoms and 45 with other obsessive-compulsive symptoms) were selected for this study and assessed by a battery of specific rating scales. The results highlighted how OCD patients with contamination/washing symptoms and higher disgust sensitivity showed an increased propensity to inhibition due to threat of sexual performance failure and consequences. It may be speculated that the disgust sensitivity may be a mechanism involved in the impairment of this well-being domain. In conclusion, these findings suggest that the sexual wellbeing should be evaluated during routine clinical evaluation of OCD patients.

Normal-Weight Obesity Is Associated with Poorer Cardiometabolic Profile and Lower Physical Fitness Levels in Children and Adolescents.

Normal-weight obesity (NWO) syndrome has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in Latin American children and adolescents. The aim of this study was two-fold: (i) to investigate whether Colombian youth with NWO syndrome have a poorer cardiometabolic profile and physical fitness performance than normal-weight lean (NWL) peers; and (ii) to determine if physical fitness levels are related to prevalence of normal-weight obesity in youth. This was an analytical cross-sectional study of 1919 youths (9–179 years old, 53.0% girls) in the capital area of Colombia. NWO was defined as a body mass index < 25 kg/m2 and a validated body fat percentage above the sex-age-specific 90th percentile for Colombian children and adolescents. Body fat was estimated using bioelectrical impedance analysis, cardiorespiratory fitness (CRF) was estimated using the 20-meter shuttle run test, and muscular fitness with the handgrip test. Biochemical profile blood samples were collected for cardiometabolic risk factors. After adjusting for chronological age, pubertal stage, and Mediterranean diet adherence, the NWO group (boys and girls) had significantly higher values for cardiometabolic risk factors, and waist circumference (WC) than the NWL group. The prevalence of NWO was lower in youth classified with healthy CRF (boys, odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37 to 0.78; girls, OR = 0.35, 95% CI 0.24 to 0.50), p < 0.001. Our findings indicate that using only body mass index for the assessment of cardiometabolic risk likely misrepresents true adiposity and suggest the need to include the assessment of body fat in the routine clinical evaluation of individuals during childhood and adolescence.

Left ventricular hypertrophy and linked cardiovascular risk factors among Congolese licensed civilian aircrew

Objective: To assess the prevalence of left ventricular hypertrophy (LVH) and linked cardiovascular risk factors in civilian aircrew.Methods: Cardiovascular risk factors were assessed among flight and cabin crew undergoing routine clinical and biological evaluation for initial or renewal of aeromedical license. The evaluation also included a standard 12-lead ECG and echocardiography. Echo-based LVH was LVM ≥ 49 g/m2.7 (men) or ≥ 45 g/m2.7 (women). LVH was categorized as mild (men: 49-55 g/m2.7; women: 45-51 g/m2.7), moderate (men: 56-63 g/m2.7; women: 52-58 g/m2.7), or severe (men: ≥ 64 g/m2.7; women: ≥ 59g/m2.7) according to Lang’s report.Results: Among the 379 aircrew members (70.4% men; 23% Caucasians; 62.5% flight crew; mean age 40.6 ± 12.8 years), LVH was present in 36 individuals (9.5%) with mild, moderate and severe pattern observed respectively in 19.4%, 33.3% and 47.2% of the cases. The rate of LVH amounted to 16.7% in normotensive subjects, 25.0% in those with prehypertension, and 58.3% among hypertensive individuals. In addition to age of 40-59y (OR: 8.48; 95% CI: [2.23-12.23]; p = .002) or more (4.22 [1.57-11.35]; p = .004), hypertension (3.55 [1.50 - 8.41]; p = .004), overweight/obesity (5.33 [1.14 - 25.05]; p = .034) and hyperuricemia (5.05 [2.11 - 12.09]; p = .001), all well-known constituents of the metabolic syndrome, were the main factors significantly associated with LVH.Conclusion: The frequency and link of LVH to the components of the metabolic syndrome highlights the need for a comprehensive approach to the management of cardiovascular risk factors in civilian aircrew.

Clinical Application of Body Composition Methods in Premature Infants.

Monitoring whole body composition (fat mass and fat-free mass) in preterm infants may assist in optimizing nutrition and promoting growth and neurodevelopment in the neonatal intensive care unit. Currently, body composition assessment is not part of routine clinical evaluation of premature infants. Instead, weight and length are used to assess growth but are known to be poor predictors of adiposity shortly after birth. Although body composition methods, such as magnetic resonance imaging, stable-isotope dilution, and dual-energy x-ray absorptiometry, have been examined in infants, they involve exposure to radiation and are invasive, expensive, and/or unsuitable for repeated measurements in a medically fragile population. Several body composition methods with potential for clinical use have been explored in premature infants, including air displacement plethysmography, bioimpedance, skinfold measurements, and ultrasound. In this review, we examine each method and evaluate its feasibility for incorporation into clinical care. Although these methods show promise for use in premature infants, further research is needed before they can be recommended for routine body composition assessment in the clinical setting.