Increase In Body Surface Area Research Articles

Clinical study of vitiligo with assessment of quality of life and comparison with Vitiligo Area Severity Index score in a tertiary care center in northern India

Introduction: Vitiligo is a common, chronic, and idiopathic pigmentary disorder of the skin, characterized by well-defined depigmented macules. It has a significant negative impact on psychological health of patients. Patients report having low self-esteem and a negative body image, which may result in a reduced quality of life for them. Vitiligo also has considerable potential for social stigma and cosmetic impairment, which are aspects of the disease that are often overlooked. Aims and Objective: The aim of this study was to describe the demographic characteristics of the rural population of Uttar Pradesh, India, diagnosed with vitiligo, and to study the association of the Vitiligo Area Scoring Index (VASI) score with the quality of life in patients having vitiligo. Material and Methods: An observational study was conducted on 121 patients diagnosed with vitiligo at a tertiary care hospital for 6 months after receiving ethical approval. The patients’ demographic details were recorded, and the severity of their condition was assessed using the VASI. This information was then compared with the Dermatology Life Quality Index (DLQI) using a standard questionnaire. Statistical analysis was performed using SPSS software. Results: The study included a total of 121 patients, with 67 (55.4%) females and 54 (44.6%) males. Their ages ranged from 15 to 65 years, with a mean age of 32.28 years. The DLQI scores ranged from 3 to 21, with a mean of 11.49. There was no statistically significant difference in scores between males and females. Out of the total, 21 patients (12 males and 9 females) reported a small effect of the disease on their life, while 29 patients (comprising 9 males and 20 females) revealed a moderate effect. Additionally, 32 (59.3%) males and 35 (52.2%) females showed a very large effect on their life. Significant variations were observed between the DLQI score grades in relation to the VASI score. There was a statistically significant positive correlation between the VASI score and the DLQI score (P < 0.001). The DLQI score also showed a statistically significant association with increased body surface area. Conclusion: The severity of vitiligo should be evaluated not only based on the disease itself but also on its impact on the patients’ quality of life.

Cardiovascular crossroads - exploring the impact of atrial fibrillation on mitral valve regurgitation and MitraClip treatment

Abstract Introduction The use of the MitraClip technique is becoming increasingly popular as a treatment option for patients suffering from mitral valve regurgitation who are not suitable for surgery. It is unclear how pre-existing atrial fibrillation impacts patients during the procedure. Purpose The question arises: What is the underlying cause of atrial fibrillation in patients with significant mitral valve involvement and why do some patients remain unaffected? This study aims to compare and identify differences in cohorts of patients with and without atrial fibrillation before the MitraClip procedure. Methods We analyzed a register of 279 patients who underwent MitraClip treatment. The study classified the patients according to the presence (n=140, 50%) or absence (n=139, 50%) of atrial fibrillation prior to the procedure. We utilized univariate analysis to compare demographic, clinical, and echocardiographic parameters. Multivariate logistic regression was also performed to determine significant predictors. Results Both cohorts were of similar size, but there were significant differences in certain parameters. Women were more frequent in the group without atrial fibrillation (45% compared to 34%, p=0.045). The group with atrial fibrillation was slightly older (73 years compared to 70 years, p<0.001) and had a lager body surface area (1.95 compared to 1.87, p=0.005). Parameters such as Euroscore II, NT-proBNP and creatinine levels were not significantly different. Nevertheless, it is important to note that the group with atrial fibrillation had a greater transverse dimension of the left atrium (55 compared to 50, p<0.001). Additionally, the atrial fibrillation group exhibited a higher degree of tricuspid regurgitation (2.9 vs 2.0, p=0.007) and a slightly lower baseline VO2 max (11.63 vs 12.59, p<0.001). Multivariate logistic regression revealed that baseline tricuspid regurgitation is a significant predictor of atrial fibrillation, with and odds ratio of 2.066 (95% CI: 1.041-4.097, p=0.038). Conclusion During the MitraClip procedure, patients with atrial fibrillation demonstrate certain specific characteristics, including older age, increased body surface area, larger left atrial size, and higher grade of tricuspid regurgitation. The significant association of tricuspid regurgitation with atrial fibrillation emphasizes its potential role in clinical evaluation and subsequent treatment.

Nucleus-Mitochondria Contact Sites Are Associated With Asynthetic Fission in Zebrafish Skin.

Rapid increase in body surface area of growing zebrafish larvae (Danio rario) is partially accomplished by asynthetic fission of superficial epithelial cells (SECs) of the skin. There are two cycles of this atypical form of cell division which is unaccompanied by DNA replication; resulting in cells with a variable DNA content. Here, electron microscopy of basal epithelium cells that give rise to these SECs in zebrafish larvae shows aggregation of mitochondria around the nucleus and the formation of nucleus-mitochondria membrane contact sites. Membrane aggregates appear in the lumen of the nuclear envelope at these sites of membrane contact in some cells, suggesting lipid turnover in this vicinity. As the epithelial cells mature and stratify, the mitochondria are engulfed by extensions arising from the nuclear envelope. The mitochondrial outer membrane fragments and mitochondria fuse with the nuclear envelope and parts of the endoplasmic reticulum. Other organelles, including the Golgi apparatus, progressively localize to a central region of the cell and lose their integrity. Thus, asynthetic fission is accompanied by an atypical pattern of organelle destruction and a prelude to this is the formation of nucleus-mitochondria membrane contact sites.

Computed Tomography Assessment of Linear Splenic Dimensions and their Correlation with Anthropometric Measurements in Nepalese Population

Background: Geographical locations and ethnicity may influence variations in normal spleen dimensions, potentially leading to errors in assessment. This study aimed to correlate splenic dimensions with anthropometry and predict their variation with age and body surface area.
 Materials and Methods: Subjects (n=384) undergoing abdominal computed tomography were selected by random sampling. Splenic volume was calculated using the standard prolate ellipsoid equation. Correlation of splenic volume with body surface area and body mass index was done with Pearson’s correlation analysis. A multiple regression was run to predict splenic volume from age, height, and body surface area.
 Results: The mean age was 45±18 (range, 18-90 years). The mean splenic length, width, thickness, and volume were 7.6 ± 1.7 cm, 8.8 ± 1.5cm, 3.8 ± 0.9 cm, and 139 ± 58.2 cm3, respectively. The splenic width and splenic volume were significantly lower at extremes of age. A significant (P<0.05) correlation was seen between splenic volume, body surface area(r=0.393) and body mass index (r=0.126); a negative correlation was observed between splenic volume and age (r=-0.180). Splenic dimensions were significantly larger in males. Multiple regression revealed that an increase in body surface area (by 10 cm2), predicted increased splenic volume was 4.3 cm3. An increase in age (by 1-year), predicted decrease in splenic volume was 8.3 cm3. For 10 cm increase in height, predicted increase in splenic volume was 1.7cm3.
 Conclusion: The study showed a positive correlation between splenic volume and body surface area, as well as body mass index and provides a crucial normative data for assessing splenic enlargement in Nepalese population.

Comparative analysis of physical development and body composition of kickboxing athletes with different training experience

Background and Study Aim. Comparative analysis of physical development and body composition using the index method in kickboxing athletes with different training experience. Material and Methods. Participants: 30 kickboxing athletes, group 1 – 15 people, (13.20±0.60) years old, training experience (0.71±0.13) years. Group 2 - 15 people, (15.20±1.14) years old, training experience (6.80±1.16) years. 18 anthropometric indicators were determined. 21 indices were calculated based on them. The median (Me), 1 (25%) and 3 (75%) quartiles were determined. The somatotype was determined by the bioimpedance method using the OMRON BF-511 body composition monitor (Japan). The significance of differences in the groups was assessed by the nonparametric Rosenbaum test (Q). Results. A significant excess of indicators of the 2nd group in terms of Erisman's index (Q=10), Pignet's index (Q=7), Livy's index (Q=12), Isakson's body surface area (Q=11) and relative body surface (Q=21) was established , relative length of arm (Q=11) and leg (Q=14), index of arm circumference (Q=15) and leg (Q=6), shoulder index (Q=10), indices of massiveness of segments of the forearm (Q=11) and shoulder (Q=30), conditional moments of force of the forearm (Q=30), shoulder (Q=30), lower leg (Q=30) and thigh (Q=30). A trend towards a decrease in fat content and an increase in muscle tissue in more trained athletes has been confirmed. Conclusions. A comparative analysis of the physical development and body composition of kickboxing athletes with different training experience confirmed certain differences. More trained kickboxers had better indicators of the shoulder index, which reflects the posture of the athletes. The Erisman index illustrated the increase in the muscles of the torso under the influence of training loads. The increase in body surface area and relative body surface reflects the greater adaptive potential of more trained kickboxers. The large relative length of the arms and legs, the indices of the ratio of the segments of the limbs, the indices of massiveness and the conditional moments of the segments' strength reflect the best technical capabilities of more trained athletes, the ability to blow at a greater distance and with greater force. The adequacy of using the method of indices as more informative than anthropometric indicators is shown. It is proposed to use these indices in monitoring the state of kickboxing athletes.

Evaluation of a warfarin dosing algorithm including CYP2C9, VKORC1, and CYP4F2 polymorphisms and non-genetic determinants for the Iranian population.

The response to warfarin, as an oral anticoagulant agent, varies widely among patients from different ethnic groups. In this study, we tried to ascertain and determine the relationship between non-genetic factors and genetic polymorphisms with warfarin therapy; we then proposed a new warfarin dosing prediction algorithm for the estimation of drug sensitivity and resistance in the Iranian population. Overall, 200 warfarin-treated patients with stable doses were recruited, the demographic and clinical characteristics were documented, and genotyping was done using a sequencing assay. The outcomes of our investigation showed that the genetic polymorphisms of VKORC1(-1639 G > A), CYP2C9*3, CYP2C9*2, amiodarone use, and increasing age were found to be related to a significantly lower mean daily warfarin dose. In contrast, the CYP4F2*3 variant and increased body surface area were linked with an increased dose of warfarin in the Iranians. Our descriptive model could describe 56.5% of the variability in response to warfarin. This population-specific dosing model performed slightly better than other previously published warfarin algorithms for our patient's series. Furthermore, our findings provided the suggestion that incorporating the CYP4F2*3 variant into the dosing algorithm could result in a more precise calculation of warfarin dose requirements in the Iranian population. We proposed and validated a population-specific dosing algorithm based on genetic and non-genetic determinants for Iranian patients and evaluated its performance. Accordingly, by using this newly developed algorithm, prescribers could make more informed decisions regarding the treatment of Iranian patients with warfarin.

Ultra-performance liquid chromatography-tandem mass spectrometry revealed the significantly different metabolic profiles of Auricularia cornea growing on weakly acidic and weakly alkaline substrates.

Auricularia cornea is a widely prized basidiomycetous mushroom with culinary and medicine value, which is cultivated artificially on a large scale in China. However, little attention has been paid to the differences in metabolic profiles under different pH growth conditions. In the present study, weakly acidic and weakly alkaline artificial substrates were developed and used for the cultivation of A. cornea, and the metabolic profiles of its fruiting bodies were determined using ultra performance liquid chromatography-tandem mass spectrometry. The results show that the weakly alkaline substrate environment promoted mycelial growth, increased body surface area, and improved yield and transformation efficiency, but attenuated metabolite accumulation by A. cornea. A total of 412 different metabolites were identified in negative and positive ion mode, of which 99 had significantly different amounts and covered 51 metabolic pathways. Principal component analysis and orthogonal patrial least squares discriminant analysis showed clear separation between two treatments, indicating different metabolic profiles. The different metabolites mainly included seven chemical categories, including amino acids and derivatives, nucleotides and derivatives, phenolic acids, organic acids, lipids, flavonoids and alkaloids. This study revealed the biological significance of these metabolites, which could be useful for further unexplored compounds and possible biological functions of A. cornea.

Reference values of diaphragmatic dimensions in healthy children aged 0-8years.

Diaphragmatic thickness (Tdi) and diaphragm thickening fraction (dTF) are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children are scarce. We determined reference values of Tdi and dTF using ultrasound in healthy children aged 0-8years old and assessed their reproducibility. In a prospective, observational cohort, Tdi and dTF were measured on ultrasound images across four age groups comprising at least 30 children per group: group 1 (0-6months), group 2 (7months-1year), group 3 (2-4years) and group 4 (5-8years). Ultrasound images of 137 healthy children were included. Mean Tdi at inspiration was 2.07 (SD 0.40), 2.09 (SD 0.40), 1.69 (SD 0.30) and 1.72 (SD 0.30) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at expiration was 1.64 (SD 0.30), 1.67 (SD 0.30), 1.38 (SD 0.20) and 1.42 (SD 0.20) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at inspiration and mean Tdi at expiration for groups 1 and 2 were significantly greater than those for groups 3 and 4 (both p < 0.001). Mean dTF was 25.4% (SD 10.4), 25.2% (SD 8.3), 22.8% (SD 10.9) and 21.3% (SD 7.1) for group 1, 2, 3 and 4, respectively.The intraclass correlation coefficients (ICC) representing the level of inter-rater reliability between two examiners performing the ultrasounds was 0.996 (95% CI 0.982-0.999). ICC of the inter-rater reliability between the raters in 11 paired assessments was 0.989 (95% CI 0.973-0.995). Conclusion: Ultrasound measurements of Tdi and dTF were highly reproducible in healthy children aged 0-8years. Trial registration: ClinicalTrials.gov identifier (NCT number):NCT04589910. What is Known: • Diaphragmatic thickness and diaphragm thickening fraction are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children to compare these with are scarce. What is New: • We determined normal values of diaphragmatic thickness and diaphragm thickening fraction using ultrasound in 137 healthy children aged 0-8years old. The diaphragmatic thickness of infants up to 1year old was significantly greater than that of children from 2 to 8years old. Diaphragmatic thickness decreased with an increase in body surface area. These normal values in healthy children can be used to assess changes in respiratory muscle thickness in mechanically ventilated children.

Factors Affecting Pulmonary Artery Catheterisation in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding costeffectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&amp;R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value &lt;0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p&lt;0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter.

Analysis of Hemodynamic Effect on Different Stent Strut Configuration in Femoral Popliteal Artery during the Physical and Physiological Conditions

Peripheral arterial disease (PAD) is a narrowing of the peripheral arteries that might result in blockage if not immediately treated. Normally, an invasive technique called stenting is used at the stenosed arterial region to restore normal blood flow. Thus, it promotes the formation of thrombosis on the stented artery due to the presenting flow recirculation. However, the rate of thrombosis growth was reported to be different for both genders. This is due to an increase in body surface area, body mass index, and weight of the body. Thus, this study aims to investigate the effect of the physiological and physical conditions of men and women with different hemodynamic parameters on the strut configuration in FPA. Five different stent strut configurations were modelled and inserted into the FPA. The computational fluid dynamic (CFD) method was implemented to solve the continuity and N-S equations. The hemodynamic performance of the stent was analyzed based on hemodynamic parameters consisting of time- averaged wall shear stress (TAWSS), time-averaged wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). According to the observations, the distal region of the stented FPA had more dominant flow re-circulation than the proximal region. The high void area contributed to less growth of the thrombosis.

Bundling gentle body massage along with regular position change under phototherapy among full-term neonates with hyperbilirubinemia: Is it effective?

PurposeNeonatal nurses are challenged by applying evidence-based interventions that maximize the photochemical effect whilst reducing the duration of exposing neonates to phototherapy and its iatrogenic adverse effects. This study aimed to investigate the effect of bundling gentle body massage along with regular position change on bilirubin level and clinical outcomes among full-term neonates with hyperbilirubinemia under phototherapy. Design and methodsA quasi-experimental study was carried out in the NICU of University Specialized Hospital in Smouha, Alexandria. Sixty full-term neonates were randomly assigned to two equal groups. The intervention group received gentle body massage twice a day and position change from supine to lateral every 2 h under the phototherapy for three consecutive days in addition to routine NICU care. ResultsThe mean difference in bilirubin level between the third and first day of receiving phototherapy among the intervention group was −4.99 ± 2.34 mg/dL compared to −2.28 ± 1.68 mg/dL for the control group (P < 0.001). Neonates who received the intervention bundle had a more frequent passage of stool at the three days (3.23 ± 1.38,4.13 ± 1.38 and 4.57 ± 1.59 times/day) compared to the control group (2.67 ± 1.21,3.03 ± 1.03 and 3.07 ± 1.01 times/day). The mean length of hospital stay for the two groups was 4.87 ± 1.46 and 6.07 ± 1.91 days, respectively (P = 0.014). ConclusionChanging position increased body surface area exposed to phototherapy light, and the manual manipulation of neonates' bodies stimulated their circulation and lymphatic blood flow, promoted bilirubin dynamic migration, and reduced its reabsorption through enterohepatic circulation. Hence, the intervention bundle effectively reduced the serum bilirubin level, increased the frequency of stool passage, percentage of consumed milk, weight gain, and shortened phototherapy duration.

Aortoiliac diameter and length in a healthy cohort.

ObjectiveDiameter is currently the only screening and diagnostic criterion for asymptomatic aneurysms. Therefore, aortic and lower-extremity arterial diameter has diagnostic, therapeutic, and prognostic importance. We aimed to determine aortic and lower-extremity arterial reference diameters in a general population and compare them according to age, sex, and other characteristics.MethodsWe evaluated consecutive 3,692 patients who underwent computed tomography as part of a general health checkup from 2015–2019 in a single tertiary center. Aortic and lower-extremity arterial diameters and the most important factor related to arterial diameters were evaluated.ResultsThe mean diameter of the abdominal aorta was 17.490 ± 2.110 mm, while that of the common iliac artery was 10.851 ± 1.689 mm. The mean diameter of the abdominal aorta was 18.377 ± 1.766 mm in men and 15.884 ± 1.694 mm in women. Significant intersex differences were observed for all mean diameters and lengths. Multilinear regression analysis showed that age, sex, and body surface area impacted mean diameters of all measured sites except aorta and common iliac artery length. Between male and female patients matched for body surface area, there were significant intersex differences for all measured sites, except for common iliac artery length.ConclusionsThe mean diameter of the abdominal aorta in this healthy cohort was 17.490 ± 2.110 mm overall, 18.377 ± 1.766 mm in men, and 15.884 ± 1.694 mm in women. Arterial diameter increased with male sex, older age, and increased body surface area, and aortic diameters were larger in men than in women with the same body surface area.

Epidemiology of burns at the University Teaching Hospital of Kigali, Rwanda

Introduction: Burns are the fourth most common type of injury presenting to the emergency department in Rwanda. However, there is little data on the epidemiology of burn patients, which is needed to inform public health measures for burn prevention. This study aimed to describe the characteristics and outcomes of burn patients presenting to the Emergency of the University Teaching Hospital Kigali.Methods: This single-center prospective study evaluated patients with burn injuries presenting at CHUK emergency between 1 June and 31 December 2019. Data on demographics, burn characteristics, burn management, disposition and patient outcomes were collected, stored in Excel and analyzed descriptively using SPSS 24. Results: Of the 96 patients enrolled; (58.3%) were male. The median age was 32.7 years. Most patients were pediatric (70.9%), with one to five-year-olds being the most affected age group. Scalding was the most common cause of burn at (71.9%). Most burns were accidental (95.8%) and superficial dermal in degree (72.9%). The mean time between injury and presentation was 18.1 hours. There were 12 mortalities (12.5%) within the 30 days post-injury, with scald injuries as the most frequent cause of mortality. Higher mortality was significantly associated with increased body surface area affected (p = 0.001).Conclusion: Children between the ages of one and five years are the most affected by burns and scalding is the most common burn etiology. Public health measures should aim to prevent burn injuries in the pediatric population. This study was approved by the University of Rwanda /CMHS Institutional Review Board (IRB) No 136/CMHS IRB/ 2019.

CT assessment of the height of the coronary arteries orifice location and the height of the aortic sinuses in women with structural changes in the coronary arteries

The most common form of cardiovascular disease in Ukraine is coronary heart disease, which is characterized by damage to the coronary arteries. The height of the aortic sinuses and the height of the coronary arteries are assessed when planning interventional procedures and cardiac surgery. Computed tomography can verify structural changes in the coronary arteries and morphometrically evaluate the components of the aortic sac. The purpose of the study: to measure the height of the coronary arteries orifice; height of the aortic sinuses in women with structural changes of the coronary arteries using computed tomography and assess the interdependence of measurements with anthropometric indicators (age, height, weight, body mass index, body surface area). Computed tomography-angiography of the chest of females with coronary arteries were processed. Statistical analysis: Shapiro-Francia test (correctness of distribution), Student’s t-test (comparison of the height of the coronary arteries and the height of the aortic sinuses); Pearson’s linear correlation; Fisher’s multifactorial regression analysis. The study found a direct correlation between height and measurability in women with coronary artery disease. The value of the growth rate was directly correlated with the height of the right aortic sinus (r=0.85, p=0.001), with the height of the lower edge of the right coronary artery orifice (r=0.74, p=0.01), the height of the upper edge of the left coronary artery orifice (r=0.67, p=0.03), the height of the upper edge of the right coronary artery orifice (r=0.67, p=0.03). It is proved that with increasing body surface area, the parameters of the right aortic sinus decrease: the inverse strong correlation r=-0.83, p=0.002. Significant direct relationships have been established between most of the measured components of the aortic root. Multifactor regression analysis showed a proven strong effect of anthropometric data and age on the height of the right aortic sinus: R=0.96, at p=0.009 (according to Fisher). This made it possible to build a model for predicting the height of the right aortic sinus depending on anthropometric and age parameters. Thus, in women with structural lesions of the coronary arteries, the increase in height correlates with an increase in the height of the right aortic sinus, the height of the coronary arteries orifice. An increase in body surface area correlates with a decrease in the height of the right aortic sinus in women with structural lesions of the coronary arteries.

Meta-Analysis Comparing Risk Factors, Incidence, and Outcomes of Patients With Versus Without Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Implantation

Current guidelines on the management of patients with aortic valvular disease have widened the use of transcatheter aortic valve implantation (TAVI) with an emphasis on avoidance of prosthesis-patient mismatch (PPM). This study sought to examine the incidence, risk factors, and all-cause mortality of PPM after TAVI. Medline and Embase databases were searched from inception to August 10, 2021. Patients were compared along 2 arms: (1) any degree of PPM and those without PPM, (2) severe PPM, and nonsevere PPM. A total of 22 articles involving 115,442 patients after TAVI were included. Pooled incidence for any degree of PPM was 30.1% and 10.7% in severe PPM. Incidence was significantly higher (p <0.001) for any degree of PPM in Europe (33.1%) and North America (34.4%) compared with Asia (10.4%). Incidence of severe PPM was higher (p=0.015) in older generation (13.6%) compared with current-generation valves (6.3%). Severe PPM increased the risk of all-cause mortality relative to nonsevere PPM (hazard ratio: 1.86, 95% confidence interval: 1.05 to 3.29, p=0.034). Patients of younger age, increased body surface area, lower left ventricular ejection fraction, and classified New York Heart Association Class III/IV were at greater risk of both any degree and severe PPM. Smaller prosthesis size increased the risk of any degree of PPM, whereas postdilation and larger prostheses were protective factors. In conclusion, all-cause mortality was significantly affected in severe PPM compared with nonsevere cases, whereas this excess mortality was not observed between those with any degree of PPM and those without. Closer attention to patient and bioprosthetic valve factors is required to minimize the occurrence of severe PPM.

A clinical study to assess disability and stigma associated with psoriasis

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Psoriasis relatively common, chronic, inflammatory and hyper-proliferative skin disease that affects 1.4% to 2.0 % of the population. Pateints with psoriasis have to face severe problems with stigmatization, discrimination and negative attitudes in general among the public, and often bear the brunt of public rejection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional observational study was carried out on psoriasis patients attending dermatology outpatient department of Era’s Lucknow medical college and hospital between November 2018 and November 2020. Patients with pustular psoriasis, mycosis fungoides, pityriasis rubra pilaris, and other severe medical conditions like heart failure, liver cirrhosis were excluded from the study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Present study included 170 (aged 16 to 76 years; mean age 37.74±13.70 years; 62.4% males) clinically diagnosed patients of Psoriasis. P-score was observed with increase in Body Surface area, maximum for cases with BSA ≥25%. There was a strong positive significant linear correlation between stigmatization scores and disability scores (r=0.746; p&amp;lt;0.001), thus indicating that with increase in p scores there was a significant increase in PDI scores and vice versa.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Present study showed that feeling of stigmatization and disability was highly prevalent in psoriasis patients. It was seen that stigmatization and disability showed a strong correlation. The findings of study showed that there is need to create awareness regarding psoriasis as a non-communicable disease in order to increase the acceptance of psoriasis patients in society and to reduce their stigmatization.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74–Year-Old Individuals

BackgroundAortic dilations (ectasias and aneurysms) may occur on any segment of the aorta. Pathogenesis varies between locations, suggesting that etiology and risk factors may differ. Despite this discrepancy, guidelines recommend screening of the whole aorta if 1 segmental dilation is discovered. ObjectivesThe purpose of this study was to determine the most dominant predictors for dilations at the ascending, arch, descending, and abdominal part of the aorta, and to establish comprehensive risk factor profiles for each aortic segment. MethodsIndividuals aged 60-74 years were randomly selected to participate in DANCAVAS I+II (Danish Cardiovascular Multicenter Screening Trials). Participants underwent cardiovascular risk assessments, including blood samples, blood pressure readings, medical records, and noncontrast computed tomography scans. Adjusted odds ratios for potential risk factors of dilations were estimated by multivariate logistic analyses. ResultsThe study population consisted of 14,989 participants (14,235 men, 754 women) with an average age of 68 ± 4 years. The highest adjusted odd ratios for having any aortic dilation were observed when coexisting aortic dilations were present. Other noteworthy predictors included coexisting iliac dilations, hypertension, increasing body surface area, male sex, familial disposition, and atrial fibrillation, which were present in various combinations for the different aortic parts. Smoking and acute myocardial infarction were inversely associated with ascending and abdominal dilations. Diabetes was a shared protective factor. ConclusionsRisk factors differ for aortic dilations between locations. The most dominant predictor for having a dilation at any aortic segment is the presence of an aortic dilation elsewhere. This supports current guidelines when recommending a full screening of the aorta if a focal aortic dilation is discovered.

A cross-sectional study of Latino patients screened for psoriasis clinical trials at the University of California–Irvine

To the Editor: Recent evidence suggests that there are notable differences in the presentation of psoriasis between ethno-racial groups, with the Latino population often presenting to physicians with more severe psoriasis1 and increased body surface area (BSA).2 However, the specific clinical characteristics, such as the distribution of severity and BSA, in Latino patients remain unspecified. Additionally, there is a scarcity of Latino patients enrolled in psoriasis clinical trials and a clear lack of data on the relationship between psoriasis and comorbidities in this population.

Quality Of Life In Patients With Chronic Dermatophytosis

Introduction: The term “chronic dermatophytosis” can be described as patients who have suffered tinea infections for more than 6 months, with or without recurrence. Since last few years we are facing an onslaught of chronic and recurrent dermatophytosis. These infections are increasingly becoming debilitating with severe symptoms like itching and increasingly showing lack of response to traditional treatment, hence it has become utmost important to assess impact of dermatophytosis today on quality of life of patients.&#x0D; Objectives: To determine quality of life in patients with chronic dermatophytosis using Dermatology Life Quality Index (DLQI).&#x0D; Materials and Methods: Adult literate patients having chronic dermatophytosis which was confirmed by KOH mount were included in the study. History, clinical features and other relevant details were included in a proforma. All patients were asked to fill DLQI questionnaire in Hindi. Controls having disease for less than six months were also included. Data thus obtained was collected and tabulated. The data was analysed using SPSS software and relevant statistical tests were used.&#x0D; Results: Total number of cases collected were 263, 137 controls were also included. In gender distribution, cases had 71.86% males and 28.14% female while controls had 63.5% males and 36.5% females. Mean DLQI of cases was 14.28+/-5.16 and controls was 11.56+/-3.60. DLQI distribution of cases -162(61.6%) had very large effect, 64(24.33%) had moderate effect, and 32(12.17%) had extremely large effect on DLQI. Domains of Symptoms and feelings (72.67%), work and school related activities (69%) and treatment related problems (67.67%) posed maximum impairment. Quality of life derangement increased significantly with presence of lesions on both exposed and non exposed sites and increase in body surface area.&#x0D; Conclusion: While superficial dermatophytosis affects quality of life (QoL) in all patients, chronic dermatophytosis has a significantly more derogatory effect on the QoL of a person with some of the patient also showing extremely large effect on QoL.

Evaluation of IHC Ki-67 with Clinical Correlation in Psoriasis

Abstract Introduction. Psoriasis is a chronic inflammatory skin disease with hyperproliferation, abnormal differentiation and inflammatory infiltration in epidermis and dermis. Sometimes it is clinically and histopathologically challenging to distinguish psoriasis from other non-psoriatic psoriasiform dermatoses (NPPD) like eczema, pityriasis rosea, pityriasis rubra pilaris, and lichen simplex chronicus. Ki-67 is a non-histone nuclear protein complex that regulates the cell cycle and is the most widely used proliferation immunohistochemistry (IHC) marker. Its levels have been shown to be raised in psoriasis compared to normal skin. Aim. To elucidate and compare expression of IHC Ki-67 in psoriasis and NPPD, correlate these levels with clinical variants and disease severity in psoriasis and to observe change in levels with demographic and psoriasis-related variables. Material and Methods. Thirty patients, each with clinically diagnosed psoriasis (cases), and NPPD (controls) were enrolled. Biopsy was taken for histopathology and IHC Ki-67 immunohistochemistry. Statistical analysis was performed. Results. We found a significantly higher expression of IHC Ki-67 in psoriasis as compared to all types of NPPD. The higher level of Ki-67 in pustular and erythrodermic psoriasis compared to plaque-type emphasizes the greater severity and activity of these forms. The Ki-67 expression was found to increase with increasing body surface area involvement and disease severity (PASI) in chronic plaque type. Pityriasis rubra pilaris had the highest Ki67 expression among NPPD group. Conclusion. Ki-67 is a promising tool with diagnostic and prognostic utility in psoriasis, particularly when it comes to its differentiation from nonpsoriasis psoriasiform disorders.