Risk Of Future Complications Research Articles

Anterior Cruciate Ligament Reconstruction in Young Athletes: A Comprehensive Review of Lateral Extra-Articular Tenodesis and Anterolateral Ligament Reconstruction Techniques.

Anterior cruciate ligament (ACL) injuries are prevalent among young athletes and pose significant challenges due to their impact on immediate and long-term knee function. Traditional ACL reconstruction techniques, while effective, may not always meet the unique needs of this population, particularly given their high physical demands and the risk of future complications. This review evaluates two advanced surgical techniques - lateral extra-articular tenodesis (LEAT) and anterolateral ligament (ALL) reconstruction - as potential enhancements to conventional ACL reconstruction. LEAT involves augmenting knee stability by addressing lateral compartment issues, while ALL reconstruction focuses on reconstructing the ALL to improve overall knee function. The review compares these techniques regarding surgical procedures, clinical outcomes, biomechanical effectiveness, and complications. LEAT and ALL reconstruction are examined for their impact on recovery, return-to-sport rates, and long-term knee health, highlighting their advantages and limitations. Findings suggest that both techniques offer promising benefits, with the potential for improved outcomes compared to traditional methods. However, the effectiveness of each technique can vary based on individual factors and the specific demands of different sports. Further research is needed to fully understand the long-term implications and refine these approaches. This review aims to guide clinical decision-making and optimize treatment strategies for young athletes with ACL injuries, enhancing their prospects for a successful return to athletic activity.

A Cross-Sectional Study of Cardiovascular Autonomic Reactivity in Ehlers-Danlos Syndrome.

Ehlers-Danlos syndrome (EDS) may be linked to dysfunction in the autonomic nervous system, affecting collagen production and processing. These collagen abnormalities lead to a condition called dysautonomia. Findings underscore the need for further investigation into autonomic nervous system function in EDS which involves larger studies to strengthen the evidence of non-invasive screening tools like cardiovascular reflex tests. These tests might offer a valuable way to assess an individual's risk for future complications. This study aimed to assess autonomic reactivity in EDS patients using cardiovascular reflex tests. This study was conducted at the Department of Physiology, Naraina Medical College and Research Centre, Kanpur (Uttar Pradesh). The cardiovascular reflex test was used to identify 60 individuals, 30 of whom were EDS patients and 30 were healthy controls, with a common age limit of 18-25 years. Cardiovascular reflex tests, such as the delta heart rate, lying-to-standing test (LST), deep breathing test (DBT), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data. The expiration-to-inspiration (E:I) ratio and delta heart rate of the EDS patients both significantly decreased as compared to the healthy control group (1.10±0.02 versus 1.22±0.77 and 14.03±0.31 versus 15.52±0.32). The Valsalva ratio of the EDS patients decreased (1.28±0.01) as compared to the healthy control group (1.46±0.01), which was statistically significant. The 30:15 ratio in the EDS patients was significantly decreasedcompared to the healthy control group (1.08±0.01 versus 1.15±0.01). The handgrip test and cold pressor test results were statistically insignificant. The study suggests a connection between EDS and autonomic nervous system dysfunction, causing symptoms like tachycardia and hypotension. It recommends exploring non-invasive cardiovascular reflex tests as a tool to identify autonomic dysfunction in EDS patients and predict long-term cardiovascular complications. These tests offer valuable insights into autonomic function.

Coronary Artery to Pulmonary Artery Fistula: A Congenital Rare Defect in Adult. How was it Managed?-A Case Report

Coronary artery fistula (CAF) is a rare anatomic abnormality of the coronary arteries that results from abnormal communication between a coronary artery and either the chambers of the heart or the great vessels that bypass the myocardial capillary bed. It is usually congenital, but it can be acquired. Both male and females are affected. Clinical presentation may be asymptomatic or symptomatic and it depends on the type of fistula, size of the fistula, site of the shunt and severity of the shunt. Coronary angiography is the gold standard for the diagnosis of coronary artery fistula. Surgery is indicated when a patient is clinically symptomatic, even in asymptomatic patients those are at risk for future complications.

Post-COVID-19 manifestations: A study of analyzing symptoms, complications following hospitalization.

Post-COVID-19 symptoms and diseases appeared on recovered from COVID-19. Hence, the study aims to investigate and characterize the manifestations which appear after recovery from the corona virus infection. To investigate the post-COVID-19 Manifestation, to demonstrate different symptoms or signs that appeared during COVID and after recovery from the disease and to see association of independent factors (like age, sex, BMI, Comorbidities) with Post-COVID complication. The study was conducted using cross-sectional study among COVID positive patients admitted and then recovered in Bangur Hospital, Pali, Rajasthan, including ICU and Isolation wards from March to December 2020. Sample size calculated was 423 with simple random sampling. In our study of these 421 COVID-19 cases, median age was 36 year (Interquartile Range: 26-55 years). Post-COVID manifestation (at least one symptom) significantly associated with age of subjects (p = 0.001), subjects who were in ICU during COVID-19 positive (p = 0.003), symptomatic subjects (p = 0.009) during COVID positive and SPO2 level at the time of admission during COVID positive (p = 0.01). The recovered subjects should be highly vigilant in maintaining and monitoring their health status as there is a risk of future complications after recovery.

Reimagining care for young adults living with type 1 diabetes.

Young adults living with type 1 diabetes often struggle to achieve what clinicians consider to be optimal levels of metabolic control. Despite the impact that this can have on a young person's future risk of complications, there are relatively few studies reporting new ways of organizing or delivering care to this cohort. In this article, we explore some of the reasons why young adult diabetes care is challenging, and describe approaches to “re‐imagining” how care might be improved. The work is informed by the ‘Making Care Fit’ collaborative and by a program of research, entitled D1 Now, involving co‐design of a complex person‐centered intervention with young adults.

O10 Multi-disciplinary working in SpA diagnosis: case study

Case report - IntroductionHigh-intensity exercise is effective in treating Axial Spondyloarthritis (SpA). A reduction in morbidity therefore should be gained from accurate diagnosis early in the disease history. In 2021 the National Axial Spondylarthritis Society (NASS) released a statement to reduce time to diagnosis (TTD) of Axial SpA from 8 years to 1, to reduce morbidity and long-term complications of chronic inflammation.This case study aims to provide an example of how a multidisciplinary team working in close clinical proximity (CCP MDT) can be utilised to reduce the TTD and optimise treatment and biomechanics of acute and chronic SpA.Case report - Case descriptionCases 1 and 2 compare patients presenting to a musculoskeletal clinic with lower back pain, stiffness, and reduced range of movement. Case 1. Subacute presentation: 25-year-old male with a 3-month history of lower back pain and stiffness. This progressed to a month of not being able to walk, disturbed sleep and morning stiffness of > 1hr. Clinical examination showed no extra musculoskeletal manifestations, and no other joint pain. Tests showed HLA B27 positive status with florid bilateral sacroiliitis on MRI.Case 2. Chronic presentation: 34-year-old male with 20-year history of insidious onset lower back pain previously diagnosed as “non-specific” back pain by a series of health care professionals (HCPs). HLA B27 negative, MRI showed acute on chronic SIJ arthropathy with juxtarticular sclerosis.Patients were seen by a HCP who referred to a rheumatologist. In both, clinical and radiological signs indicated Axial SpA which was treated with 120mg of IM Depo-Medorone and 8-weeks of strength-based active intervention from a physiotherapist and strength and conditioning coach. BASDAI, 5-rep max single leg press scores were recorded pre- and post-intervention (Table 1.). Case 1Pre-interventionPost-interventionBASDAI5.10.9Single leg press 5RM55kg75kgCase 2Pre-interventionPost-interventionBASDAI 6.14.2Single leg press 5RM65kg115kgCase report - DiscussionConventional therapies for SpA back pain are effective even in chronic cases; this is reflected in the improvements made across both cases. Using a similar approach of high-intensity exercise and mobility both were able to significantly improve BASDAI scores and lower limb strength.We can hypothesise that attempts to innovate the biomechanics of the treatments is missing the fundamental issue surrounding SpA back pain highlighted by NASS; TTD takes too long for too many. There is a feasible argument therefore that it is the structures of how we operate as HCPs that is reducing the efficacy of said treatments. This is evidenced by case 2 (Table 1), whose multiple presentations to different HCPs over 20 years led to potentially preventable prolonged morbidity as well as increased the risk of future complications due to chronic inflammation. This is a story that is sadly reflective of the disease histories of many SpA patients.Much like any primary care provider, patients at this clinic will first present to a HCP. The difference is that all HCPs are trained to recognise features of SpA back pain and encouraged to flag concerns to a doctor.HCPs work in adjacent spaces allowing for better sharing of ideas and concerns that is often reduced by physical separation. This creates the concept of a CCP MDT. HCPs are encouraged to share concerns face to face without reproach or the formality or delay of a written request. This structure has proven to be effective in diagnosis in both of these cases but has proven to be as useful in many more instances to rule out a differential or allay a concern.These cases argue that the low lying fruit of improving clinical outcomes in this cohort is addressing how we as HCPs interact and cooperate. Case report - Key learning pointsBiomechanics of the treatments of SpA are effective in the majority of cases when applied by sufficiently skilled practitioners. It is the TTD that we should address to aid the reduction in morbidity in this patient group through the following recommendations: Foster education of SpA in allied health professionals. This allows us to be aware of the boundaries of our own knowledge and at what point a different clinical perspective should be sought.Diversify clinical environments and encourage MDT working. The use of CCP MDT structures allows more nuanced access to different opinions in a safe supportive manner, allowing for sharing of ideas and concerns – allowing for supporting diverse expertise and insight. If we are to reduce TTD to the 1-year NASS hopes for, we should first look at how we work, not what we do. Ongoing research and auditing of patients is being carried out to better assess how educational practices can be optimised to help meet the NASS targets. For more information or to collaborate contact matthew.virden@puresportsmed.com

Extensor mechanism tendinopathy in patients with lateral patellar maltracking.

Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2years versus 48.2years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49mm versus 14.99mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4mm versus 15.4mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.

Perceptions of Diabetes Self-Efficacy and Glycemic Control in Youth With Type 1 Diabetes.

Type 1 diabetes is a chronic disease affecting ∼3 million Americans (1). The disease is characterized by autoimmune destruction of insulin-producing cells; affected individuals depend on insulin therapy for survival. Although type 1 diabetes is the third most common chronic disease in childhood, 85% of individuals with type 1 diabetes are adults (2). Optimal management of type 1 diabetes comes at the expense of heavy burden for those with the disease. Although major advances have been made both in the pharmacology of insulin analogs and technological tools to assist in glucose management, only 21% of individuals with type 1 diabetes are able to meet their glycemic targets (3). These struggles are more apparent during adolescence and young adulthood, a developmental period during which adherence levels are low and glycemic control is poorest. In fact, only 17% of youth achieve glycemic targets (3). Type 1 diabetes increases morbidity and mortality from microvascular and macrovascular disease. The Diabetes Control and Complications Trial and its Epidemiology of Diabetes Interventions and Complications follow-up study examined the effect of intensive blood glucose control on the risk of future complications in patients >13 years of age with type 1 diabetes. These studies demonstrated that intensive blood glucose control profoundly reduces the risk of future microvascular complications (4–6). Despite the many technological advances during the past several years, A1C has worsened rather than improving in the adolescent years, and the period from late adolescence through early adulthood remains a challenging time for youth with type 1 diabetes. The unrelenting day-to-day management of type 1 diabetes becomes particularly difficult (7) at this time of many transitions, as these emerging adults make important decisions about their education, career, and health care. Some move away from their home support to attend college, whereas others face …

Axillary Fibromyxoid Sarcoma with an Aspergillus Niger in a Tumor Cavity Compressing the Chest Wall: A Rare Tumor with Fungus

Axillary tumors constitute about 0.11% of all malignancies. More rare tumors arise from the soft tissue component of the body that includes muscles, nerves, or 􀏐ibrous tissues. Low-Grade Fibromyxoid Sarcoma (LGFMS) is a rare, malignant, soft tissue tumor often seen in young and middle-aged adults. A number of cases are found in the literature of LGFMS that can arise from different locations like thigh, breast, head, neck, masseter muscle, uterine cavity, and mesentery, but a huge axillary 􀏐ibro-myxoid sarcoma with Aspergillus Niger fungal infection within the sarcoma cavity is not yet reported. We present here a young male with a two-year history of painful swelling in the right axillary region which was foul-smelling with a discharging sinus containing pus. The patient was empirically treated with anti-tuberculous drugs and was also operated twice. The patient was admitted, and a chest computed tomography scan with contrast was done which showed an asymmetrical right chest with a large heterogeneous mass in the right posterosuperior aspect of the chest wall extending into the axillary region. Operatively the draining sinus along with the mass was excised and sent for histopathology. A 17-18x8 cm hard calci􀏐ied capsule was removed. On crosssection, a thick hard cavity laden with debris was noted. Immunohistopathology con􀏐irmed a low-grade 􀏐ibro-myxoid sarcoma. Therefore, a discharging chest wall sinus should be reviewed. Broad differentials including tuberculosis must be ruled out especially after effective anti-tuberculous therapy. The risk of metastasis is signi􀏐icantly reduced with ef􀏐icient excision and aggressive surgical intervention reducing further risk of future complications.

Too close to call: uterine closure technique at caesarean section.

As caesarean section rates around the world rise, attention has begun to turn to the impact of variations in surgical technique, particularly their effect on post-operative recovery and risk of future complications. A common surgical variation is either a single- or double-layer uterine closure. When assessing immediate and short-term outcomes both methods appear similarly effective (Dodd et al. Cochrane Database Syst Rev. 2014 Jul 22;(7):CD004732.). The analysis of longer-term sequelae for women following caesarean section may provide a more nuanced understanding of the impacts of varying surgical techniques to better inform whether there is an optimal method for uterine closure.

S0408 Esophageal Food Bolus Impaction and the Missed Opportunity to Diagnose and Manage EoE

INTRODUCTION: Esophageal food impaction may be the initial presentation for patients with undiagnosed eosinophilic esophagitis (EoE). These acute encounters offer physicians an opportunity to biopsy and potentially diagnosis the condition. Though prior studies are limited, they have shown patients presenting with food impaction are often not biopsied and have high inadequate follow-up. This creates concerns that patients are undertreated and at risk for future complications. We aim to augment and expand on prior studies by examining follow-up, treatment recommendations, and other EGD findings in patients presenting with acute food bolus impaction. METHODS: We conducted an IRB approved retrospective chart review at a tertiary medical center of patients presenting with esophageal food bolus removed by EGD. Exclusion criteria were esophageal blockage not due to a food bolus, patients with prior established diagnosis of EoE, and patients with other etiologies for food impaction including: esophageal cancer, external compression of the esophagus, or underlying esophageal dysmotility. Over a 3-year period, 134 EGD’s were performed for food bolus impaction with 100 patients ultimately meeting inclusion and exclusion criteria. Categorical data was analyzed using the Chi-Square test while quantitative data was analyzed with the t-test. RESULTS: Our patients were 68% male, 93% Caucasian, and an average age of 62 years. 84% had a follow-up scheduled, but only 49% of total patients followed-up. Only 28% of the patients were biopsied at the time of food bolus impaction. Patients who didn't receive a biopsy were less likely to be given treatment recommendations (7.1% vs. 31.9%, P = 0.011) and more likely to have subsequent food bolus impactions (13.9% vs 0%, P < 0.039). Patients who were younger (54 years vs. 65.7 years) and had gross findings suggestive of EoE (46.2% vs. 15.3%) were also more likely to receive a biopsy. CONCLUSION: Our study suggests that patients presenting with a food impaction of unknown etiology should receive an esophageal biopsy during that initial encounter to exclude EoE. Many patients with EoE do not have typical findings of EoE on gross inspection. Without biopsy, numerous patients will go undiagnosed and be lost to follow-up placing them at risk for future complications. Currently, no guidelines establish clear guidance on this matter. In addition, methods to improve follow-up adherence in these patients may be beneficial.Table 1.: Follow-up and Biopsy

P1514PERIPHERIAL VASCULAR DISEASE IN DIABETIC PATIENTS ON HEMODIALYSIS - RISK OF HOSPITALIZATION AND MORTALITY IN A LARGE EUROPEAN COHORT

Abstract Background and Aims Patients with diabetes mellitus on hemodialysis (HD) are at increased risk of development and progression of vascular calcification, atherosclerosis and peripheral vascular disease (PVD). Presence of PVD constitute a major risk factor for the development of cardiovascular events, such as myocardial infarction, stroke, hospitalization or cardiovascular death. The presence of PVD is also associated with a reduced quality of life and disability. A significant proportion of patients with PVD are asymptomatic with no or few classical symptoms and early detection to prevent progressive disease is therefore very important. Both the ACC/AHA and KDIGO guidelines recommend screening of individuals who are at risk. Method We analyzed the frequency of foot complications following implementation of a standardized foot examination in 345 prevalent diabetic hemodialysis patients in 12 DaVita centers; 8 in Poland (n=177 patients) and 4 in Portugal (n=168 patients). The protocol includes: history of ulcers, amputation and examination of the pedal pulses (a dorsalis pedis and a tibialis posterior). Foot complications were classified according to Wagner (grade 0-5). PVD was classified by clinical pulse measurement (normal vs weak or missing). We analyzed associations between foot complications and peripheral pulses with risk of hospitalization and mortality using Cox proportional hazard models. Results The mean age in all diabetic HD patients (58% men) was 70.4 (14 SD) yrs. Charlson comorbidity index (CCI) was 8.8 (2.4), Kt/V 1.8 (0.4), s-albumin 39 (4) g/L, Hb 11.1 (1.3) g/dL. A normal pulse in both a dorsalis pedis and both a tibialis posterior was found in 18% and 10% of patients. All other patients had weak or absent pulses. The Wagner classification score was 0 in 79% of patients, 1-3 in 16 % patients and 4-5 in 5 %. All-cause mortality was 31% during the 2 year follow up and 71% of patients had at least one hospital stay In patients hospitalized during follow up, a dors ped was normal/abnormal in 12% and 88% respectively (p&amp;lt;0.05); a tib post was normal/abnormal in 8% and 92%, respectively (p&amp;lt;0.05). There were no associations between Wagner score 0-5 and hospitalization or mortality. In unadjusted Cox models presence of weak or absent pulses in a dorsalis pedis was significantly associated with all-cause mortality RR 2.1 (CI 1.1-4.3; p&amp;lt;0.05). In adjusted analyses including age, sex, Hb, albumin, Kt/V, vascular access, phosphorus, PTH and CCI, only albumin was associated with mortality (RR 0.89, CI 0.84-0.94; p&amp;lt;0.001) and risk of hospitalization (RR 0.92, CI 0.89-0.96; p&amp;lt;0.001). Conclusion Diabetic patients on HD have a high prevalence of PVD that warrant close clinical attention. Documentation of peripheral foot pulses for early detection of PVD is simple and suitable to identify patients at high risk of future complications and mortality. This standardized protocol could be the basis of a program to improve overall health outcomes in this vulnerable group of patients.

16-OR: Codesigning an Intervention for Adults with New-Onset Type 1 Diabetes to Improve Psychological and Social Adaptation

Adults newly diagnosed with type 1 diabetes (T1D) can experience significant psychosocial disruption, leading to maladaptive emotional and behavioral responses which may increase the risk of future complications. The aim of the study was to co-design an intervention with people with diabetes (PWD) and healthcare-professionals (HCPs) to address the psychosocial disruption associated with new onset T1D in adults. We used a co-design approach to stimulate the target populations to reflect on their experiences and generate ideas for the intervention. This involved the use of illustrations depicting common experiences of the time of diagnosis identified in a previous study among PWD and HCPs. Illustrations were used as conversation tools in six parallel workshops exclusively for PWD (n=24) and HCPs (n=55); and four workshops that brought PWD (n=31) and HCPs (n=19) together to prioritize intervention components. Data comprising of transcribed audio recordings and notes from participants were analyzed thematically with a view to intervention development. The workshops identified that the intervention should be phasic, with an initial focus on the psychosocial disruption of diagnosis, followed by the early experience of diabetes and how to adapt positively to a life with it. Participants constructed two integrated intervention components: 1) one-to-one sessions soon after diagnosis, with a HCP trained in using a psychologically modelled conversation tool addressing PWD’s experiences, thoughts and feelings about the diagnosis; and 2) a group-based intervention addressing common diabetes challenges, emotional issues and thinking traps, focusing on normalizing emotions and developing strategies for managing diabetes in day-to-day life. The co-design process revealed the benefit of adopting a bio-psycho-social perspective and introducing methods of support involving both HCPs and peers to activate positive adaptive strategies in adults with new onset T1D. Disclosure M. Due-Christensen: Research Support; Self; Novo Nordisk Foundation. Stock/Shareholder; Self; Novo Nordisk A/S. L.E. Joensen: None. S. Sarre: None. J.L. Wad: None. E. Romanczuk: None. R. Forde: None. I. Willaing: None. A. Forbes: None. Funding National Institute for Health Research (PB-PG-0317-20012); Novo Nordisk Foundation (NNF17OC0028274)

Spontaneous dental abscesses in hereditary hypophosphataemic rickets: a preventive restorative approach in the primary dentition

Patients with Hereditary Hypophosphatemic Rickets (HHR) commonly present with spontaneous dental abscesses and are often faced with a life-long burden of multiple endodontic treatments and/or extractions. Early diagnosis and management is essential to reduce risk of infection and maintain function and wellbeing. This is a case report of a 3-year-old boy with HHR, who presented with recurrent spontaneous abscesses in multiple primary teeth that subsequently required extraction. A preventive/restorative approach to protect the unaffected primary teeth is described and demonstrates how early clinical intervention can result in a symptom- and disease-free patient one year following treatment. CPD/Clinical Relevance: Oral manifestations are common in patients with HHR and early intervention by the clinician can contribute to reducing the risk of future complications.

Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial

BackgroundDiabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. The relationship of these microvascular changes with systemic factors such as metabolic control or duration of the disease still needs to be elucidated.MethodsProspective, consecutive, large-scale OCTA study. A complete ocular examination including a comprehensive series of OCTA images of different scan sizes captured with 2 OCT devices (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA, and Triton Deep Range Imaging OCT, Topcon Corp, Topcon, Japan) will be obtained as part of the yearly routine follow up visits in type 1 DM patients seen in the Diabetes Unit of the Endocrinology department which give written informed consent to participate in the project. The aim of this study is to investigate the relationship between OCTA-derived parameters and systemic factors, as metabolic control (Hb1Ac, lipid profile, cholesterol, etc), and other relevant clinical factors as demographics or duration of the disease.DiscussionThis study is directed to investigate the relationship between the status of the perifoveal vascular network and systemic markers of the disease, and in particular to study whether these changes reflect those occurring elsewhere in the body affected by diabetic microvascular disease, as the kidneys or the brain. If these relationships were demonstrated, early detection of these microvascular changes by OCTA could lead to modifications in the pharmacological management of type 1 diabetic patients, as a way to reduce the risk of future complications in both the eye and other organs.Trial registrationClinicalTrials.gov, trial number NCT03422965.

STUDY ON THE ASSOCIATION OF OBESITY INDICES WITH INFLAMMATORY MARKERS IN PRE-DIABETES AND DIABETES

Objective: In this study, the main objective was to evaluate the association of markers of obesity with the inflammatory markers in pre-diabetes and diabetes.&#x0D; Methods: This study recruited 300 participants (100 control group, 100 pre-diabetic group, and 100 diabetic group). The anthropometric variables such as body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC), and biochemical variables such as fasting blood glucose, glycated hemoglobin, uric acid, C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), and adiponectin were analyzed in each participant by standard methods.&#x0D; Results: The present study documented significantly high values of BMI and WHR in patient (pre-diabetic and diabetic) groups compared to the control group. Similarly, the level of adiponectin decreased and that of uric acid, CRP, fibrinogen, and IL-6 increased significantly. Both BMI and WC were correlated significantly with inflammatory mediators in diabetic patients. The correlation with adiponectin was negative. In the pre-diabetic group, a significant correlation was observed only between WHR, adiponectin, and uric acid.&#x0D; Conclusion: This study supports the fact that obesity-induced systemic inflammation of low grade is significantly associated with pre-diabetes and diabetes, thereby keeping these individuals at high risk of future complications especially cardiovascular diseases.

Personal, academic and stress correlates of gastroesophageal reflux disease among college students in southwestern Saudi Arabia: A cross-section study.

BackgroundGastroesophageal reflux disease (GERD) is a worldwide prevalent gastrointestinal disorder which has negative impacts on quality of life, health and economy. The aims of this study were to assess the prevalence of GERD among college students in southwestern Saudi Arabia and to evaluate its personal, academic and stress correlates.Materials and methodsThrough a cross-sectional study design, a self-reported questionnaire was distributed between a representative sample of students in health and non-health care colleges in southwestern Saudi Arabia. The questionnaire included data for personal characteristics, academic study, and Arabic versions of GERD questionnaire (GerdQ) and Cohen's Perceived Stress Scale.ResultsOut of 2878 studied students, GERD was reported by 28.6% and 36.6% of students in health and non-health care colleges respectively with an overall prevalence rate of 33.18%. It was associated with impacts on daily life in 17.2% of students. By multivariable regression analysis, GERD was significantly higher among males (aOR = 1.44, 95% CI:117–1.65), ex-smokers (aOR = 1.87), current smokers (aOR = 1.71), non-health care students (aOR = 1.36) and those exposed to high perceived stress (aOR = 1.30).ConclusionGERD is a prevalent problem among college students in southwestern Saudi Arabia as it affects about one third of the students. Considering high prevalence of GERD, associated daily life impacts, young age of the studied subject and the risk of future complications, this condition could represent a challenging health and economic problem. The risk of GERD is higher among; males, smokers, former smokers, non-health care colleges students and subjects exposed to high perceived stress.

Bilateral Neuroarthropathy 11 Years After Simultaneous Pancreas-Kidney Transplant for Type 1 Diabetes Mellitus

To report a case of a man who developed bilateral Charcot arthropathic feet 11 years after a simultaneous pancreas-kidney transplant (SPKT) for type 1 diabetes mellitus (DM). The patient had remained normoglycemic after surgery. We present a retrospective review of the case notes and serial imaging. The patient developed dense peripheral diabetic neuropathy due to poor glycemic control. His biochemical markers of DM all normalized following SPKT, and he was discharged by his primary and secondary care diabetes services. Eleven years later, he developed Charcot arthropathy in one foot and, within a month, the other foot as well. Individuals with DM who had preoperative end organ diabetes-related damage who went into biochemical remission after SPKT may be at risk for future complications. They should not be discharged from specialist diabetes services, and they need continued education about foot care.

Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis.

ObjectiveA systematic review and meta‐analysis was conducted to investigate if glycemic control measured by glycated hemoglobin (HbA1c) levels near diagnosis are predictive of future glycemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D).MethodsEvidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure “early glycemic control” and main outcome: “tracking of early control” and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double‐reviewed, quality assessed, and outcome data extracted for synthesis and meta‐analysis.FindingsFive studies (N = 4227 participants) were eligible. HbA1c levels were sub‐optimal throughout the study period but tended to stabilize in a “track” by 6 months after T1D diagnosis. The group with low HbA1c <53 mmol/mol (<7%) at baseline had lower long‐term HbA1c levels than the higher HbA1c group. The estimated standardized mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range −0.95% to −2.28%) from baseline. Only one study investigated the association between early glycemic control and development of vascular complications in childhood onset T1D.InterpretationsGlycemic control after the first few months of childhood onset T1D, remains stable but sub‐optimal for a decade. The low and high HbA1c levels at baseline seem to “track” in their respective tracks during the 10‐year follow‐up, however, the initial difference between groups narrows over time. PROSPERO: CRD42015024546 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024546

Case Report: Type 2 Diabetes Mellitus

.......A patient who was first diagnosed with a chronic disease often does not fully understand the meaning or significanceof the chronic disease with which his/ her body suffers, against the risk of future complications if the disease is not well-controlled. On the other hand, in this reported case, the patient’s expectation was that her chronic disease, the T2DM, can be cured. Therefore, a shared understanding between health care providers and patient is likely the key to commencing the course of managing any chronic disease in a patient effectively.......