Prospective Follow-up Research Articles

Area deprivation and demographic factors associated with diabetes technology use in adults with type 1 diabetes in Germany.

Diabetes technology improves glycemic control and quality of life for many people with type 1 diabetes (T1D). However, inequalities in access to diabetes technology exist in many countries. In Germany, disparities in technology use have been described in pediatric T1D, but no data for adults are available so far. We therefore aimed to analyze whether demographic factors and area deprivation are associated with technology use in a representative population of adults with T1D. In adults with T1D from the German prospective diabetes follow-up registry (DPV), we analyzed the use of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and sensor augmented pump therapy (SAP, with and without automated insulin delivery) in 2019-2021 by age group, gender, migration background, and area deprivation using multiple adjusted regression models. Area deprivation, defined as a relative lack of area-based resources, was measured by quintiles of the German index of Multiple Deprivation (GIMD 2015, from Q1, least deprived, to Q5, most deprived districts). Among 13,351 adults with T1D, the use of technology decreased significantly with older age: CSII use fell from 56.1% in the 18-<25-year age group to 3.1% in the ≥80-year age group, CGM use from 75.3% to 28.2%, and SAP use from 45.1% to 1.5% (all p for trend <0.001). The use of technology was also significantly higher in women than in men (CSII: 39.2% vs. 27.6%; CGM: 61.9% vs. 58.0%; SAP: 28.7% vs. 19.6%, all p <0.001), and in individuals without migration background than in those with migration background (CSII: 38.8% vs. 27.6%; CGM: 71.1% vs. 61.4%; SAP: 30.5% vs. 21.3%, all p <0.001). Associations with area deprivation were not linear: the use of each technology decreased only from Q2 to Q4. Our real-world data provide evidence that higher age, male gender, and migration background are currently associated with lower use of diabetes technology in adults with T1D in Germany. Associations with area deprivation are more complex, probably due to correlations with other factors, like the higher proportion of migrants in less deprived areas or the federal structure of the German health care system.

Pathways to Health Reported by Patients With Borderline Personality Disorder With a Good Overall Outcome Versus a Fair-Poor Outcome Over 24 Years of Prospective Follow-Up.

Our objective was to determine pathways to health reported by patients with borderline personality disorder (BPD) who had and had not attained a good overall outcome over 24 years of prospective follow-up. Overall outcome symptomatically and psychosocially and 11 pathways to health related to vocation, relationships, activities, and psychiatric treatment that patients reported were helpful to their functioning or feeling better about themselves were assessed at 12 contiguous 2-year follow-up periods using a semistructured interview. Good outcome patients reported significantly higher rates of pathways related to work performance, relationships with friends, relationship with a partner/spouse, and athletic activities. In contrast, patients with a fair-poor outcome reported significantly higher rates of psychotherapy and psychotropic medication as pathways. Taken together, the results of this study suggest that a good overall outcome is significantly associated with reported vocational, interpersonal, and activity pathways, while a fair-poor outcome is significantly associated with reported treatment-related pathways.

Predictors of repeated and first-time low-energy fractures in patients with rheumatoid arthritis

Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures.Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up.Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)).Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p &lt; 0.05), with X-ray stage of RA at baseline (r = 0.280, p &lt; 0.05) and over time (r = 0.819, p &lt; 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p &lt; 0.05) and over time (r = 0.308, p &lt; 0.05), cumulative dose of GC initially (r = 0.239, p &lt; 0.05) and over time (r = 0.268, p &lt; 0.05), duration of GC use (r = 0.270, p &lt; 0.05), history of low-energy fractures (r = 0.291, p &lt; 0.05), and feedback with OP in SB (r = -0.190, p &lt; 0.05).Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi-site observational study.

Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding. A formative, multi-site, observational cohort study using convergent parallel, mixed-methods design. Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania. Moderately low birthweight infants (MLBW; 1.50-2.49 kg). We assessed infant feeding and care practices through: (1) assessment of in-facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1-year follow-up of 1114 MLBW infants. Focus group discussions and in-depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders. The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system-level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants. Hospital-level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in-facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age. Enrolment and follow-up of this vulnerable population required additional effort from researchers and the community. Using a mixed-methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence-based planning of targeted large-scale interventions. Multi-site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.

Triple motif proteins 19 and 38 correlated with treatment responses and HBsAg clearance in HBeAg-negative chronic hepatitis B patients during peg-IFN-α therapy

ObjectiveTo investigate whether the expression of triple motif protein 19/38 (TRIM19/38) mRNA in peripheral blood mononuclear cells (PBMCs) of HBeAg-negative chronic hepatitis B virus (HBV) carriers is associated with the response to pegylated interferon alpha (peg-IFN-α) treatment and HBsAg clearance.MethodsIn this prospective study, HBeAg-negative chronic HBV carriers treated with peg-IFN-α completed 48 weeks of follow-up. After treatment with peg-IFN-α, the patients were divided into responders (R group) and nonresponders (NR group) according to the changes in HBV DNA and HBsAg levels at week 48 of treatment. According to whether serum HBsAg loss or seroconversion occurred, the patients were divided into a serological response group (SR group) and a nonserological response group (NSR group). The level of TRIM19/38 mRNA in PBMCs was detected by real-time fluorescence quantitative PCR. The diagnostic performance of TRIM19/38 was analysed by calculating the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC).Results43 HBeAg-negative chronic HBV carriers, 35 untreated CHB patients and 19 healthy controls were enrolled in this study. We found that TRIM19/38 mRNA levels were significantly lower in untreated CHB patients than in healthy controls. In HBeAg-negative chronic HBV carriers who underwent prospective follow-up, TRIM19/38 mRNA levels were negatively correlated with HBV DNA and ALT at baseline. Among the patients treated with peg-IFN-α, 16 patients achieved a treatment response (R group) and 27 patients did not achieve a treatment response (NR group). Compared with baseline, HBsAg levels in the R group decreased significantly at 12 and 24 weeks of treatment; at the early stage of peg-IFN-α treatment, the dynamic changes in TRIM19/38 mRNA levels in the R and NR groups were different, and the TRIM19/38 mRNA levels in the R group were significantly higher than those in the NR group, especially at 24 weeks of treatment. ROC curve analysis showed that the changes in mRNA levels of TRIM19 and TRIM38 predicted the treatment response, with AUCs of 0.694 and 0.757, respectively. Among the patients treated with peg-IFN-α, 11 patients achieved a serological response (SR group) and 32 patients did not achieve a serological response (NSR group). Compared with baseline, HBsAg levels in the SR group decreased significantly at 12 and 24 weeks of treatment; TRIM19/38 mRNA levels were significantly higher in the SR group than in the NSR group at week 24.ConclusionThe higher level of TRIM19/38 mRNA in PBMCs of HBeAg-negative chronic HBV carriers may be related to the early treatment effect of peg-IFN-α and HBsAg clearance. TRIM19 and TRIM38 have clinical significance in predicting virological response and guiding treatment regimens.

LAMA2-Related Muscular Dystrophy Across the Life Span: A Cross-sectional Study.

LAMA2-related muscular dystrophy (LAMA2-MD) is a rare neuromuscular disease characterized by proximal and axial muscle weakness, rigidity of the spine, scoliosis, and respiratory impairment. No curative treatment options exist, yet promising preclinical studies are ongoing. Currently, there is a paucity on natural history data, and appropriate clinical and functional outcome measures are needed. We aim for deep clinical phenotyping, establishment of a well-characterized baseline cohort for prospective follow-up and recruitment for future clinical trials, improvement of clinical care, and selection of outcome measures for reaching trial readiness. We performed a cross-sectional, single-center, observational study. This study included neurologic examination and functional measurements among others the Motor Function Measure 20/32 (MFM-20/32) as primary outcome measure, accelerometry, questionnaires, muscle ultrasound, respiratory function tests, electrocardiography and echocardiography, and dual-energy X-ray absorptiometry. Twenty-seven patients with genetically confirmed LAMA2-MD were included (21 ± 13 years; M = 9; ambulant = 7). Axial and proximal muscle weakness was most pronounced. The mean MFM-20/32 score was 42.0% ± 29.4%, with domain 1 (standing and transfers) being severely affected and domain 3 (distal muscle function) relatively spared. Physical activity as measured through accelerometry showed very strong correlations to MFM-20/32 (Pearson correlation, -0.928, p < 0.01). Muscle ultrasound showed symmetrically increased echogenicity, with the sternocleidomastoid muscle most affected. Respiratory function was impaired in 85% of patients without prominent diaphragm dysfunction and was independent of age. Ten patients (37%) needed (non)invasive ventilatory support. Cardiac assessment revealed QRS fragmentation in 62%, abnormal left ventricular global longitudinal strain in 25%, and decreased left ventricular ejection fraction in 14% of patients. Decreased bone quality leading to fragility fractures was seen in most of the patients. LAMA2-MD has a widely variable phenotype. Based on the results of this cross-sectional study and current standards of care for congenital muscular dystrophies, we advise routine cardiorespiratory follow-up and optimization of bone quality. We propose MFM-20/32, accelerometry, and muscle ultrasound for assessing disease severity and progression. For definitive clinical recommendations and outcome measures, natural history data are needed. This study was registered at clinicaltrials.gov (NCT04478981, 21 July 2020). The first patient was enrolled in September 2020.

Collaborative plasma biomarkers for Parkinson's disease development and progression: a cross-sectional and longitudinal study.

Relying on a single biomarker for early diagnosis of Parkinson's Disease (PD) may not yield accurate results. We aimed to assess the combined diagnostic value of multiple biomarkers, including plasma CCL2, plasma CXCL12, and plasma neuronal exosomal α-synuclein (α-syn) for early-stage PD diagnosis and their predictive value in PD progression. This study included both cross-sectional and longitudinal designs. The CCL2, CXCL12, and neuronal exosomal α-syn levels were analyzed in 50 healthy controls (HCs) and 50 early-stage PD patients. Then, a prospective follow-up of 30 early-stage PD patients was performed. In early-stage PD, we observed a significant increase in CCL2, CXCL12, and plasma neuronal exosomal α-syn compared to HCs (P < 0.05). Utilizing a combined diagnostic approach of CCL2, CXCL12and α-syn significantly improved the area under the curve (AUC= 0.89, P < 0.001). Spearman correlation analysis revealed that CCL2 levels were correlated with PD clinical stage and autonomic symptoms (P < 0.05). CXCL12 levels were associated with non-motor symptoms (P < 0.05). Plasma neuronal exosome α-syn levels were connected to the clinical stage, motor symptoms, and non-motor symptoms in early-stage PD (P < 0.01). In the longitudinal cohort, the Cox regression analysis showed that high CCL2 levels were associated with motor progression after a mean follow-up of 24 months. Our study suggested that the combined measurement of plasma CCL2, CXCL12, and neuronal exosomal α-syn can improve early-stage PD diagnosis, and CCL2 may serve as a prognostic marker for PD progression.

Long-Term Impairment in Activities of Daily Living Following COVID-19 in Residents of Long-Term Care Facilities.

BACKGROUND Long-term care facilities were severely impacted during the COVID-19 (Coronavirus Disease 2019) pandemic. Residents surviving the disease might continue to suffer from the post-COVID syndrome, similar to community-dwelling persons. This study aimed to characterize the longitudinal evolution of activities of daily living in COVID-19 survivors from long-term institutional care. MATERIAL AND METHODS This was a retrospective study with prospective follow-up of consecutive COVID-19 survivors living in long-term care facilities. The Barthel Index was used to assess changes in functional independence before the disease, right after recovery, and 3 months later. RESULTS The study enrolled 201 residents of long-term care facilities, median age 79 years old, who survived 3 months after recovery from COVID-19. The disease caused hospitalization in 47% of cases. Early after COVID-19, deterioration in activities of daily living was higher in older, hospitalized patients with cardiovascular comorbidity. However, in the long-term follow-up, these factors did not predict functioning. Independence was severely affected in hospitalized and non-hospitalized COVID-19 patients. This had implications for post-COVID care and rehabilitation since these interventions were mainly offered after hospitalization. CONCLUSIONS The findings support that residents of long-term care facilities who had COVID-19, even with a mild clinical course, may have persistent impairment in function and ability to perform activities of daily living that require support and rehabilitation.

A Novel Combined Model to Predict the Prognosis of COVID-19: Radiologicalmetabolic Scoring

To investigate the performance of a novel radiological-metabolic scoring (RM-S) system to predict mortality and intensive care unit (ICU) requirements among COVID-19 patients and to compare performance with the chest computed-tomography severity-scoring (C-CT-SS). The RMS was created from scoring systems such as visual coronary-artery-calcification scoring (V-CAC-S), hepatic-steatosis scoring (HS-S) and pancreatic-steatosis scoring (PS-S). Between May 2021 and January 2022, 397 patients with COVID-19 were included in this retrospective cohort study. All demographic, clinical and laboratory data and chest CT images of patients were retrospectively reviewed. RM-S, V-CAC-S, HS-S, PS-S and C-CT-SS scores were calculated, and their performance in predicting mortality and ICU requirement were evaluated by univariate and multivariable analyses. A total of 32 (8.1%) patients died, and 77 (19.4%) patients required ICU admission. Mortality and ICU admission were both associated with older age (p < 0.001). Sex distribution was similar in the deceased vs. survivor and ICU vs. non-ICU comparisons (p = 0.974 and p = 0.626, respectively). Multiple logistic regression revealed that mortality was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe RM-S category (p = 0.010), while ICU requirement was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe V-CAC-S category (p = 0.010). RM-S, C-CT-SS, and V-CAC-S are useful tools that can be used to predict patients with poor prognoses for COVID-19. Long-term prospective follow-up of patients with high RM-S scores can be useful for predicting long COVID.

Clinical Phenomenology of Fibromyalgia Syndrome in Male Patients: Same But Different

The majority of knowledge about fibromyalgia syndrome (FMS) derives from studies of female patients. Little is known about the clinical characteristics and treatment outcomes of male patients with FMS. In this retrospective cohort study with a prospective posttreatment follow-up, we investigated whether male patients with FMS differ from female patients in terms of 1) symptom burden, 2) psychological characteristics, and 3) clinical treatment response. We identified 263 male (4%) out of 5,541 patients with FMS completing a 3-week multimodal pain-treatment program. Male patients (51.3 ± 9.1 years) were age- and time-matched (1:4) with female patients (N = 1,052, 51.3 ± 9.0 years). Data on clinical characteristics, psychological comorbidities, and treatment responses were obtained from medical records and validated questionnaires. Levels of perceived pain, psychological comorbidity, and functional capacity were similar between genders, although male patients with FMS showed a higher prevalence of alcohol abuse. Compared to female patients, male patients experienced themselves less often as overly accommodating (Cohen’s d = −.42) but more often as self-sacrificing (d = .26) or intrusive (d = .23). Regarding pain coping, male patients were less likely to utilize mental distraction, rest- and relaxation techniques, or counteractive activities (d = .18–.27). Male patients showed a slightly worse overall response rate than women (69% vs 77%), although differences between individual outcome measures were small (d < .2). Although male and female patients in our cohort were similar in clinical presentation and treatment response, the gender-specific differences in interpersonal problems and pain coping suggest consideration of these aspects in the treatment of male patients with FMS. PerspectiveKnowledge about fibromyalgia mostly derives from studies of female patients. Identifying and understanding gender-specific differences in fibromyalgia is an important roadmap in the treatment of this syndrome by focusing on specific gender aspects such as differences in interpersonal problems and pain coping mechanisms.

Le lipomodelage du sein dans un contexte cancérologique : mise au point à partir d’une revue de littérature actualisée et des référentiels nationaux et internationaux

BackgroundLipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed. MethodsTwelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA guidelines. ResultsA total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7 guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in ¼ of cases), most often corresponding to cytosteatonecrosis. Most of the guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up. Discussion and perspectivesThe members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM “without cautionary periods”, excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.

Development and validation of the Personal Assessment of Responsible Drinking Identity (PARDI) with a college student sample.

Recent research shows a link between identity and behavior change. Despite the existence of several measures that assess components of drinking identity, no measures examine the idiosyncrasies of a "Responsible Drinking Identity," though responsible drinking is an aim of many alcohol-related interventions. The present study created a measure of responsible drinking identity, the Personal Assessment of Responsible Drinking Identity (PARDI). Two cross-sectional designs and a prospective follow-up were used to develop and assess the psychometric properties of the PARDI. Study 1 used a U.S. national sample of college students who endorsed alcohol use (n = 911) to conduct an Exploratory Factor Analysis. Study 2 consisted of college students from a Southeastern University (n = 1,096) and was used to conduct a Confirmatory Factor Analysis, as well as evaluate convergent, discriminant, concurrent, and incremental validity. A subsample from Study 2 was then assessed after 1 month (n = 194). The follow-up examined test-retest reliability and predictive validity. The PARDI consists of four identity-based factors that are indicative of responsible drinking. The measure had adequate validity across all domains and good test-retest reliability. The measure appears to predict future protective behaviorial strategies (safe drinking behaviors), which mediates the relationship between the PARDI and both future alcohol use and consequences, suggesting safe or responsible drinking identity may drive a key behavioral target of substance use interventions. The PARDI may offer a tool to aid in quantifying underlying constructs of identity and behavior change in substance use interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Post-COVID condition in patients with inflammatory rheumatic diseases: a prospective cohort study in the Netherlands.

Studies on long-term consequences of COVID-19, commonly referred to as post-COVID condition, in patients with inflammatory rheumatic diseases are scarce and inconclusive. Furthermore, classifying patients with inflammatory rheumatic diseases as having post-COVID condition is complicated because of overlapping symptoms. Therefore, we investigated the risk of post-COVID condition and time until recovery, and compared the prevalence of symptoms seen in post-COVID condition, between patients with inflammatory rheumatic diseases and healthy controls, with and without a history of COVID-19. In this substudy we used data from an ongoing prospective cohort study in the Netherlands. All adult patients with inflammatory rheumatic diseases from the Amsterdam Rheumatology and Immunology Center in Amsterdam, the Netherlands, were invited to participate in the study between April 26, 2020, and March 1, 2021. All patients were asked, but not obliged, to recruit their own control participant of the same sex, of comparable age (< 5 years), and without an inflammatory rheumatic disease. Demographic and clinical data, including data on the occurrence of SARS-CoV-2 infections, were collected via online questionnaires. On March 10, 2022, all study participants received a questionnaire on the occurrence, onset, severity, and duration of persistent symptoms during the first 2 years of the COVID-19 pandemic, independent of their history of SARS-CoV-2 infection. Additionally, we prospectively monitored a subset of participants who had a PCR or antigen confirmed SARS-CoV-2 infection in the 2-month period surrounding the questionnaire in order to assess COVID-19 sequelae. In line with WHO guidelines, post-COVID condition was defined as persistent symptoms that lasted at least 8 weeks, started after the onset and within 3 months of a PCR or antigen-confirmed SARS-CoV-2 infection, and could not be explained by an alternative diagnosis. Statistical analyses included descriptive statistics, logistic regression analyses, logistic-based causal mediation analyses, and Kaplan-Meier survival analyses for time until recovery from post-COVID condition. In exploratory analyses, E-values were calculated to investigate unmeasured confounding. A total of 1974 patients with inflammatory rheumatic disease (1268 [64%] women and 706 [36%] men; mean age 59 years [SD 13]) and 733 healthy controls (495 [68%] women and 238 [32%] men; mean age 59 years [12]) participated. 468 (24%) of 1974 patients with inflammatory rheumatic disease and 218 (30%) of 733 healthy controls had a recent SARS-CoV-2 omicron infection. Of those, 365 (78%) of 468 patients with inflammatory rheumatic disease and 172 (79%) of 218 healthy controls completed the prospective follow-up COVID-19 sequelae questionnaires. More patients than controls fulfilled post-COVID condition criteria: 77 (21%) of 365 versus 23 (13%) of 172 (odds ratio [OR] 1·73 [95% CI 1·04-2·87]; p=0·033). The OR was attenuated after adjusting for potential confounders (adjusted OR 1·53 [95% CI 0·90-2·59]; p=0·12). Among those without a history of COVID-19, patients with inflammatory diseases were more likely to report persistent symptoms consistent with post-COVID condition than were healthy controls (OR 2·52 [95% CI 1·92-3·32]; p<0·0001). This OR exceeded the calculated E-values of 1·74 and 1·96. Recovery time from post-COVID condition was similar for patients and controls (p=0·17). Fatigue and loss of fitness were the most frequently reported symptoms in both patients with inflammatory rheumatic disease and healthy controls with post-COVID condition. Post-COVID condition after SARS-CoV-2 omicron infections was higher in patients with inflammatory rheumatic disease than in healthy controls based on WHO classification guidelines. However, because more patients with inflammatory rheumatic disease than healthy controls without a history of COVID-19 reported symptoms that are commonly used to define a post-COVID condition during the first 2 years of the pandemic, it is likely that the observed difference in post-COVID condition between patients and controls might in part be explained by clinical manifestations in the context of underlying rheumatic diseases. This highlights the limitations of applying current criteria for post-COVID condition in patients with inflammatory rheumatic disease, and suggests it might be appropriate for physicians to keep a nuanced attitude when communicating the long-term consequences of COVID-19. ZonMw (the Netherlands organization for Health Research and Development) and Reade foundation.

Clinical Effectiveness of Single Lumbar Periradicular Infiltration in Patients with Sciatica.

Periradicular therapy (PRT) is a minimally invasive radiological procedurein patients with chronic lumbar pain.The aim of the study is to identify clinical and radiological predictive factors for treatment success after a single PRT treatment in patients with sciatica.The study includes a prospective follow-up of 166 patients treated with PRT. The pain intensity is determined according to the VAS scale and the degree of improvement is presented as excellent (over 75%), good (50-70%), moderate (25-49%), and weak (less than 25%). The follow up of the treated patients was done at 2 weeks, 3 and 6 months. In patients with pain duration up to 3 months, the improvement was excellent in n=32 (58.18%) after 2 weeks, after 3 months n=41 (74.55%) and after 6 months n=41 (74.55%). This stands in contrast to patients with pain over 1 year. The percentage of improvement after 6 months, post-intervention, was highest in patients without nerve root compression (86.25±19.2),and the highest improvement after 6 months was in patients with localization of pain at the L4-L5 level (69.69±29.7), the greatest improvement after six months was in patients with extraforaminal hernia (62.82±34.3), and the lowest in patients with central stenosis (40.21±30.7).Our study results suggest that the shorter a pain duration, low-grade root compression, injection level and type of herniation area predictor the more favourable response patients have to transforaminal epidural steroid injection in patients with sciatica.

Role of Reassurance and Proper Mechanical Support Advice on Quality of Life and Pain Relief in Patients of the Mastalgia-A Prospective Follow-up Study at A Tertiary Care Center in a Developing Country.

To study the effect of reassurance and proper mechanical support on quality of life (QOL) and visual analogue score (VAS) pain assessment in patients with mastalgia at a range of follow-ups. A prospective follow-up study was conducted among women aged 15-45 years, complaining of breast pain without any abnormality detected clinically and radiologically. After consent to participate and enrollment, all the study participants were counseled and reassured about the non-neoplastic nature of the disease and about wearing proper mechanical support/Bra; this was repeated at each follow-up. VAS was used to assess the pain intensity perceived by the woman at each follow-up, post intervention. The Short Form-36 (SF-36) scale was used to evaluate health related QOL (HRQOL). Among 80 patients, 31.2% were wearing a Bra of fabric other than cotton, 21.2% were wearing a loose fit mechanical support/Brassiere, while 10% were not wearing any mechanical support at baseline. The overall mean VAS score was significantly reduced with each follow-up, indicating decreased perception of breast pain over time. There was a significant difference between the mean SF-36 score between base line and after three months (p<0.0001). Mean scores in all domains of the SF-36 increased. The greatest reduction in mean VAS score was seen in 26-35 years age group and women with a body mass index <18.5 kg/m2. Reassurance and wearing proper mechanical support/Bra are effective for improving QOL and alleviating breast pain/mastalgia. These simple processes should be used for the management of mastalgia.

Republication of "Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review".

Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. IV, prospective case series.

Prevalence of Thyroid Peroxidase and Thyroglobulin Autoantibodies in the Swedish Population.

Autoimmune thyroid disease (AITD) may be detected prior to clinical symptoms through the presence of autoantibodies against thyroid peroxidase (TPOab), thyroglobulin (TGab), or both.The present study aimed to develop a novel radiobinding assay (RBA) for TPOab and to determine the prevalence of TPOab and TGab in the Swedish population.Patient samples from 27 newly diagnosed Graves' disease patients in longitudinal follow-up and 124 AITD autoantibody-positive children in prospective follow-up for increased risk of type 1 diabetes were included to validate the novel RBA for TPO. The results of RBA were compared with those obtained by commercial radioimmunoassay (RIA) and electrochemiluminescence (ECL). Furthermore, 476 serum samples from adult blood donors and 297 from 13-year-old school children were analyzed for the presence of TPOab and TGab.Receiver operating characteristics analysis for the novel TPOab resulted in an area under curve (AUC) value of 0.82 (p<0.0001), a sensitivity of 77.8%, and a specificity of 91.9% in adult blood donors, and an AUC value of 0.70 (p<0.0001), a sensitivity of 53.2% and a specificity of 95.3% in the 13-year-old school children, respectively. TPOab levels in RBA correlated with both ECL (r=0.8950, p<0.0001) and RIA (r=0.9295, p<0.0001). The prevalence of TPOab and TGab was 6.3% and 7.6% in adult blood donors and 2.9 and 3.7% in 13-year-old school children.In conclusion, a novel RBA for the determination of TPOab was developed and validated with current methodologies. This study also reports an increasing prevalence of thyroid autoantibodies from adolescence to adulthood.

Device-related thrombus after left atrial appendage occlusion in patients with atrial fibrillation: a prospective follow-up

Aim. To study the incidence, predictors, and clinical outcome of device-related thrombus (DRT) after left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF).Methods. A prospective observational study included 120 patients with non-valvular AF who underwent LAAO with Watchman (n=92) and Amplatzer Amulet (n=28). The presence of device-related thrombus (DRT) was assessed at visits 45 days, 6 months, 1 year, 2 years, 3 years after implantation by transesophageal echocardiography.Results. A total of 11 (9.2%) patients had DRT during the follow-up period. The greatest number of thrombosis was observed after 45 days (n=4) and after 6 months (n=4). There was no significant difference in the incidence of DRT between device types. Independent predictors of thrombosis were: history of myocardial infarction (hazard ratio (HR) 12.88 [95% confidence interval (CI) 3.21-51.62]; p&lt;0.001), chronic heart failure (HR 8.83 [95% CI 1.91-40.77]; p=0.005), residual leak size &gt;5 mm in the early postoperative period (HR 6.13 [95% CI 2.53-14.86]; p&lt;0.001) and the degree of spontaneous echo contrast during the initial examination (HR 9.09 [95% CI 1.36-60.58], p=0.023). There were no cases of thromboembolic complications associated with DRT. One patient developed a non-fatal stroke at 35 weeks of follow-up, while DRT was detected at the visit at the end of the 3rd year of follow-up.Conclusion. DRT after LAAO was observed in the early and long-term follow-up periods. This event was associated with the baseline patients’ characteristics and post-procedural aspects with no dependence on type of antithrombotic therapy.

Five-year clinical follow-up of arthroscopically treated chronic ankle instability

IntroductionArthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability. HypothesisThe functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term. Material and methodsThe prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure. DiscussionArthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair. Level of evidenceII.

P-779 School performance of children conceived by assisted reproductive technology

Abstract Study question Does elementary school performance differ between children conceived through assisted reproductive technology (ART) compared to children born to subfertile couples not conceived by ART? Summary answer Children born after ART perform equally well at age 12 (end of elementary school) compared to children born to subfertile couples not conceived by ART. What is known already It is well established that pregnancies conceived by ART are at higher risk of adverse outcomes, such as pre-term birth and a lower birth weight, also when restricted to singleton pregnancies. However, whether ART also affects outcomes in later life, such as school performance, is less clear. Although some studies indicate that there might be subtle differences in the school performance of ART and spontaneously conceived children, it remains unclear whether this is due to the ART treatment, parental factors or a combination of both. Study design, size, duration Data were used from the OMEGA-cohort, a historical nationwide cohort with prospective follow-up in the Netherlands. The cohort comprises all offspring of women who were treated in one of the 13 IVF clinics or 2 regional fertility centers in 1983-2010. Of 89,249 live-born children, 54,417 were ART-conceived and 37,832 were not ART-conceived (conceived naturally with or without ovarian stimulation) by subfertile women. Participants/materials, setting, methods Data on type of fertility treatment and maternal risk factors were available from medical records of the mothers and through the national perinatal registry. The OMEGA-cohort was linked to the education dataset of Statistics Netherlands, including school performance data for the period 2006-2017, leaving 24,806 children in the analytical cohort. The overall test Z-score and Z-scores on the separate domains (Dutch language and mathematics) between ART and non-ART children were compared using multivariable linear regression. Main results and the role of chance The cohort comprises 14,958 ART-conceived children and 9,848 non-ART children with test scores around age 12 in 2006-2017. The mean overall score was 536,5 (SD = 9.7), with scores of 536.4 (SD = 9.9) in ART-conceived children and 536.6 (SD = 9.5) in non-ART children. After adjustment for maternal age and maternal and paternal educational level, in a multivariable linear regression model, the overall test Z-score was also not different among ART-children compared to non-ART children from subfertile parents (β=-0.02, 95% CI=-0.04-0.01). Overall test Z-scores were not different according to different ART treatment modalities, IVF (β=-0.02, 95%CI=-0.05-0.01), ICSI (β=-0.01, 95% CI=-0.05-0.02) and frozen embryo transfer (β = 0.07, 95%CI=-0.01-0.14) when compared to children born to subfertile couples not using ART. ART children performed equally well on mathematics and Dutch language compared to children born to subfertile couples not conceived by ART. Limitations, reasons for caution Although the current analyses include a large proportion of the ART children in the Netherlands with data on school performance and our study had sufficient power to address the research question, it is not clear to which extent our results are generalizable to other countries. Wider implications of the findings Reassuringly, based on first results, children born after ART had comparable test scores at the end of elementary school compared to children from subfertile couples not conceived by ART. Trial registration number Not applicable