Routine History Research Articles

A study on normal reference values of the left ventricular strain parameters in young adults

Background: The left ventricular (LV) function is an important prognostic determinant of cardiopulmonary pathologies in adult. Clinical application of cardiac strain by two-dimensional speckle tracking echocardiography to measure LV function requires knowledge of the range of normal values. Reference values and associated variations of the deformation measures need to be “firmly established before routine clinical adoption” of LV strain measurements can be implemented in Indian population. Aims and Objectives: This study aims to establish normal values of LV strain parameters in normal Indian population. Materials and Methods: An observational, cross-sectional, single-center, hospital-based study. The study period October 2021–October 2022 in Nil Ratan Sircir Medical College, Kolkata. Cardiologically healthy adult subjects (sample size 250) both male and female, aged 18–45 years who were healthcare professionals of this medical college and hospital were included in the study. Routine history taking and investigations were done. Echodoppler was done with special emphasis on LV strain parameters. Results: Distribution of mean LV circumferential strain (LVCS) with age in years was statistically not significant (P=0.8068). The mean value in male and female were −18.9574(±0.9049) and −19.0257(±0.8908) respectively. In the current study, LVCS did not vary in statistically significant a way among different age groups too. The mean values in male and female were −22.5887(±1.8065) and −22.3312(±1.9007) respectively. Conclusion: This current study failed to show significant differences in LV strain parameters between age groups or male and female in Eastern India Population.

Prediction of PSA Response after Dexamethasone Switch during Abiraterone Acetate + Prednisolone Treatment of Metastatic Castration-Resistant Prostate Cancer Patients.

The aim was to elaborate a predictive model to find responders for the corticosteroid switch (from prednisolone to dexamethasone) at the first prostate-specific antigen (PSA) progression (≥25% increase) during abiraterone acetate (AA) treatment of metastatic castration-resistant prostate cancer (mCRPC) patients. If PSA has decreased (≥25%) after switch, patients were considered responders. Logistic regression of 19 dichotomized parameters from routine laboratory and patients' history was used to find the best model in a cohort of 67 patients. The model was validated in another cohort of 42 patients. The model provided 92.5% and 90.5% accuracy in the testing and the validation cohorts, respectively. Overall the accuracy was 91.7%. The AUC of ROC curve was 0.92 (95% CI 0.85-0.96). After a median follow-up of 27.9 (26.3-84) months, the median AA+dexamethasone treatment duration (TD) in non-responders and responders was 4.7 (3.1-6.5) and 11.1 (8.5-12.9) months and the median overall survival (OS) was 23.2 (15.6-25.8) and 33.5 (26.1-38) months, respectively. Multivariate Cox regression revealed that responsiveness was an independent marker of TD and OS. A high accuracy model was developed for mCRPC patients in predicting cases which might benefit from the switch. For non-responders, induction of the next systemic treatment is indicated.

Incidence Rates of Risk Factors for Colorectal Cancer's Early Symptoms in the Community in Gondanglegi District, Malang, East Java, Indonesia: An Epidemiological Study

Background: Colorectal cancer (CRC) is one of the most common types of cancer worldwide. CRC is most typical symptom is hematochezia while the risk factors encompass sex, age, genetic predispositions, history of colorectal polyps or cancer, chronic inflammatory bowel diseases, physical exercise, and specific dietary choices, including high red meat intake, fried food, and low fiber consumption. This study aims to screen the risk factors of colorectal cancer.Subjects and Method: This research was conducted on residents in the Sepanjang village, Malang Regency, involved in community service by the Internist Association of Malang. Community service was carried out in July 2023 and 148 residents were involved in collecting data on risk factors for colorectal carcinoma. Data collection was carried out using a questionnaire with a cross-sectional approach. The questionnaire assesses the presence of symptoms of bloody stools and several habits related to colorectal carcinoma risk factors, including age, gender, exercise routine, and dietary history. Data presentation and analysis were carried out as in the table.Results: Among the risk factors listed assessed using the questionnaire, Men (p=0.021), lack of exercise (p= 0.008), consumption of fried food (p= 0.021), and consumption of instant noodles (p= 0.013) significantly affect the prevalence of hematochezia.Conclusion: Men, lack of exercise, consumption of fried food, and consumption of instant noodles significantly affect the hematochezia indicating CRC.

To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis in relation to operative and histopathological findings

Background: Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas. Aims: 1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis. Methods: A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS & RF under various surgical units from November 2018 to October 2020 were selected. Results: In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study. Conclusion: This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room.

Routine history and physical examinations prior to cataract surgery are not beneficial

ObjectifDéterminer l'innocuité d'une politique éliminant la prise des antécédents préopératoires et la réalisation d'un examen physique avant une chirurgie de la cataracte. NatureÉtude rétrospective de population. MéthodesÉtant donné que les antécédents préopératoires et l'examen physique n’étaient plus nécessaires en Alberta après le 1er avril 2017, on a réalisé une étude rétrospective des données issues des demandes de remboursement auprès du régime provincial d'assurance maladie afin de déterminer s'il était sécuritaire d’éliminer ces 2 exigences. Les données provenant d'Albertains qui ont subi une chirurgie de la cataracte et qui ont fait l'objet d'un examen médical préopératoire entre avril 2014 et mars 2017 ont été comparées à celles de patients qui ont subi une chirurgie de la cataracte entre avril 2017 et mai 2020 sans avoir subi d'examen médical préalable. La survenue d'effets médicaux indésirables (soit une visite au service des urgences, une admission à l'hôpital ou le décès dans les 30 jours suivant la chirurgie de la cataracte) tenait lieu de paramètre principal. RésultatsUn total de 236 046 chirurgies de la cataracte ont été réalisées pendant la période à l’étude. La probabilité d'une visite au service des urgences en période postopératoire était plus grande (rapport de cotes [RC] = 1,04; intervalle de confiance [IC] à 95 % : 1,01–1,08) dans le groupe examen préopératoire (n = 112 806 yeux), soit 4,8 % des patients, comparativement à 4,7 % des patients du groupe sans examen préopératoire (n = 123 240 yeux; p = 0,03). De même, les admissions à l'hôpital étaient plus susceptibles de se produire dans le groupe examen préopératoire (RC = 1,26; IC à 95 % : 1,18–1,34) et ont touché 1,8 % de ces patients, comparativement à 1,5 % des patients du groupe sans examen préopératoire (p < 0,0001). Le taux de décès s'est élevé à 0,09 % dans les 2 groupes (p = 0,992). ConclusionsLe taux de visites au service des urgences et d'admissions à l'hôpital dans les 30 jours suivant la chirurgie de la cataracte étaient pour ainsi dire identiques, ce qui donne à penser que les examens préopératoires, qui étaient jusqu'alors réalisés pour réduire le taux de morbi-mortalité postopératoire, offrent peu d'avantages pour les patients.

Abstract C138: Barriers to screening and diagnostic testing among patients with a confirmed triple negative breast cancer (TNBC) diagnosis

Abstract Introduction Triple negative breast cancer (TNBC) is an aggressive form of breast cancer that disproportionately affects people of racial and ethnic minority groups. TNBC is associated with poorer prognosis and lower long-term survival rates versus other subtypes. Understanding access to routine services like mammography and genetic testing may reveal areas for process improvement and enable equitable healthcare delivery. The objective of this study is to assess how screening, diagnosis, and genetic testing were described by race using a physician survey and patient-chart review. Methods Data collection consisted of a 60-min physician survey and linked retrospective review of patients’ charts conducted June-July 2022. Participating oncologists across the US (34% Central; 19% Southeast; 18% Northeast; 21% West; 9% East Coast) were required to be board-certified, in practice 3-30 years post-residency, and managing ≥ 7 patients with TNBC in the past 3 years. Oncologists extracted patient-level data from 2-4 patient records for the chart review. Selection of charts oversampled patients on Medicaid, Black and Latina patients, and patients with later stage TNBC to allow for robust disparities analyses. Data collected included tests and diagnostic procedures performed, rationale for tests and procedures, and barriers experienced in accessing care. Results 101 oncologists (73% male; 62% community vs 39% academic setting) provided information on 283 patients with TNBC [99% female; median age=46 years; race= 42% Black, 31% Latina, 25% White, 2% Other]. Most first-time mammograms were performed due to identification of symptoms (68%) as compared to annual screening (28%) or family history (4%). White patients were more likely to have a first-time mammogram for annual screening (40%) compared to Black patients (22%). Black patients were more likely to have a first-time mammogram due to identification of symptoms (72%) compared to White patients (58%). Oncologists perceived that few (4%) of their patients experienced barriers to mammogram access, though they perceived higher rates of barriers among Black patients (6%) than Latina (4%) or White (3%) patients. They listed cost, scheduling, and access to clinics as the predominant barriers patients experienced. Oncologists perceived that most patients (77%) encounter difficulty in accessing genetic testing; this varied by race, with oncologists reporting that 93% of Black patients, 86% of Latina patients, and 50% of White patients encounter difficulty in accessing genetic testing. Conclusions This study described oncologists’ perceptions of screening and diagnostic testing among patients with a confirmed TNBC diagnosis. Reasons for first-time mammogram differed by race (routine screening vs family history vs symptomology); Black patients were less likely to have a first-time mammogram for annual screening and Black and Latina patients were more likely to experience difficulty in accessing genetic testing. These barriers could delay diagnosis and impact treatment decisions, exacerbating existing disparities. Citation Format: Langa Bakhuluma-Ncube, Emily Fox, Laura Okpala, Natalia Sadetsky, Matt O’Hara, Jennifer Parr. Barriers to screening and diagnostic testing among patients with a confirmed triple negative breast cancer (TNBC) diagnosis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C138.

Abstract 18874: Beyond the Beat: Predicting Frailty in Cardiovascular Patients Using Heart Rate Variability

Introduction: Frailty is the increased vulnerability to health issues due to age-related changes in body composition, mobility, and autonomic control. Heart rate variability (HRV) measures the oscillations between consecutive heartbeats. The LF/HF (low frequency/high frequency) ratio, a parameter of HRV, reflects the complex balance between sympathetic and parasympathetic control and cardiac autonomic regulation. Previous studies have linked the LF/HF ratio with frailty. Our goal was to determine if this association holds true in patients with cardiovascular disease (CVD) and if the LF/HF ratio can be used as a surrogate marker of frailty in these patients. Methods: A cross-sectional study was conducted at McGill University's Jewish General Hospital, involving adult patients at the ambulatory cardiology clinic. Resting HRV was evaluated for 2 minutes and 30 seconds using the Elite HRV CorSense monitor. Patients with electrical pacing, atrial fibrillation, or other arrhythmias during the visit were excluded. Frailty was assessed using the clinical frailty scale (CFS), with a CFS ≥ 5 indicating frailty. Routine comprehensive history and physical examinations were performed. Results: The cohort included 155 patients (66.9 ± 13 years, 68 females). Frailty prevalence was 15% (78.6 ± 10 years, 12 females), with a median LF/HF ratio of 0.37. The non-frail population (64.8 ± 12 years, 56 females) showed a significantly higher LF/HF ratio of 1.01 (p&lt;0.001). This difference was driven by a decrease in LF power in the frail group (78.3 ms 2 ) compared to the non-frail group (231.9 ms 2 , p=0.01). The LF/HF ratio correlated with frailty, decreasing by 0.437 for each unit increase in CFS (p&lt;0.001). An LF/HF ratio of 0.37 best predicted frailty (54% sensitivity, 82% specificity, 0.77 ROC). Adjustment for age, sex, and comorbidities did not alter the association between LF/HF ratio and frailty. Conclusions: The LF/HF ratio exhibits an inverse correlation with frailty, making it a predictive tool for identifying CVD patients who may benefit from further frailty evaluation. Additionally, HRV parameters show potential for monitoring frailty and guiding interventions. However, additional research is needed to assess their practical implementation fully.

Standard Patient History Can Be Augmented Using Ethnographic Foodlife Questions.

The relationship between what and how individuals eat and their overall and long-term health is non-controversial. However, for decades, food and nutrition discussions have often been highly medicalized. Given the significant impact of poor nutrition on health, broader discussions about food should be integrated into routine patient history taking. We advocate for an expansion of the current, standard approach to patient history taking in order to include questions regarding patients' 'foodlife' (total relationship to food) as a screening and baseline assessment tool for referrals. We propose that healthcare providers: (1) routinely engage with patients about their relationship to food, and (2) recognize that such dialogues extend beyond nutrition and lifestyle questions. Mirroring other recent revisions to medical history taking-such as exploring biopsychosocial risks-questions about food relationships and motivators of eating may be essential for optimal patient assessment and referrals. We draw on the novel tools of 'foodlife' ethnography (developed by co-author ethnographer J.J.L., and further refined in collaboration with the co-authors who contributed their clinical experiences as a former primary care physician (D.M.E.), registered dietitian (J.W.M.), and diabetologist (H.Z.)) to model a set of baseline questions for inclusion in routine clinical settings. Importantly, this broader cultural approach seeks to augment and enhance current food intake discussions used by registered dietitian nutritionists, endocrinologists, internists, and medical primary care providers for better baseline assessments and referrals. By bringing the significance of food into the domain of routine medical interviewing practices by a range of health professionals, we theorize that this approach can set a strong foundation of trust between patients and healthcare professionals, underscoring food's vital role in patient-centered care.

Postoperative Management Early Active Mobilization of Extensor Tendon Repair at Zone (V-VII)

Background: The extensor tendons are particularly vulnerable to trauma because their superficial location in a clenched fist, the thin mobile subcutaneous tissue offers little protection, and lacerations of the extensor tendons are common over joints that are easily exposed to contamination. Objective: To assess the evaluation of the postoperative early active mobilization protocol of extensor tendon repair at zone (V-VII). Methods: In this prospective study was carried out at Orthopedic Dept., 250 Bed General Hospital, Kishoreganj, Bangladesh from January to June 2023. Total 40 cases of fresh injury of extensor tendon at zone V to VII were treated. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Routine history taking with details of the injury, the object causing the injury, the dominant hand and the position during the injury, Physical examination, included the zone, and the possible tendons involved together with any associated injury. Results: Forty patients of fresh extensor tendon injuries were included in this study, their ages ranged from 20 to 55 years. There were 33 males (82.5%) and 7 females (17.5%). The dominant hand was involved in 29 of patients (72.5%). The nature of injuries was sharp cut in 34 patients (85%), with crush injuries in 6 patients (15%). The most common site of injuries was zone VI, VII and zone V respectively, and the most common tendon injured was EDC, EI, and EDM. Only 7 patients (17.5%) had single tendon injury, While 33 patients (82.5%) had multiple tendon injuries. At the end of the 6th weeks post operatively, the overall outcome result are summarized. Conclusion: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient. It will give fairly acceptable results.

Implementation of Hypertension Exercise in Elderly with Hypertension in Cinta Rakyat Village Deli Serdang Regency

ABSTRACT Elderly is someone who is aged 60 years or more. Many problems are often found in the elderly, one of them is hypertension. Hypertension is a serious medical condition that can increase the risk of heart, brain, kidney, and other diseases. Hypertension is the main cause of premature death worldwide, most (two-thirds) live in low-and-middle-income countries. Various efforts can be made to control blood pressure, including hypertension exercise. Hypertension exercise is believed to be able to control blood pressure because when carrying out exercise movements, blood vessels will dilate and relax so that blood pressure decreases. This community service aimed to improve the community's healthy lifestyle in controlling hypertension by implementing Hypertension exercise. This activity was carried out on the elderly with 22 respondents. Before the implementation of this activity, the first was carried out by filling in demographic data, drugs consumed, and routine control history every month as well as measuring vital signs before and after the implementation of the Hypertension exercise. The findings show that the majority of respondents who participated in the implementation of this Hypertension Exercise were &gt;70 years old (45.5%); Female (59.1%); not taking hypertension medication (54.5%); not routine control (86.4%); and classification of hypertension majority degree 1 (31.8%). The average value of blood pressure before the implementation of the Hypertension Exercise was 2.95 and decreased significantly after the implementation of the Hypertension Exercise to 2.32. It can be concluded that there was a significant decrease in blood pressure after the implementation of hypertension exercises, the pre-test average value was 2.95 and the post-test was 2.32. It is recommended that village officials and Public Health Care officers conducted a Hypertension Exercise program as an implementation discourse in improving the quality of life of the Elderly with Hypertension. The implementation can be carried out in Cinta Rakyat Village, Deli Serdang Regency, regularly 2-3 times a week. Keywords: Elderly, Hypertension, Hypertension Exercise

Impulse Control Disorders in the Polish Population of Patients with Parkinson's Disease.

Background and Objectives: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the world. It is characterized by the presence of not only typical motor symptoms but also several less known and aware non-motor symptoms (NMS). The group of disorders included in the NMS is Impulse Control Disorders (ICDs). ICDs are a group of disorders in which patients are unable to resist temptations and feel a strong, pressing desire for specific activities such as gambling, hypersexuality, binge eating, and compulsive buying. The occurrence of ICDs is believed to be associated primarily with dopaminergic treatment, with the use of dopamine agonists (DA), and to a lesser extent with high doses of L-dopa. The aim of our study was to develop a profile of Polish ICDs patients and assess the frequency of occurrence of ICDs, as well as determine the risk factors associated with these disorders against the background of the PD population from other countries. Materials and Methods: Our prospective study included 135 patients with idiopathic PD who were hospitalized between 2020 and 2022 at the Neurological Department of University Central Hospital in Katowice. In the assessment of ICDs, we used the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Other scales with which we assessed patients with PD were as follows: MDS-UPDRS part III and modified Hoehn-Yahr staging. Clinical data on age, gender, disease duration and onset, motor complications, and medications were collected from electronic records. Results: ICDs were detected in 27.41% of PD patients (binge eating in 12.59%, hypersexuality in 11.11%, compulsive buying in 10.37%, and pathological gambling occurred in only 5.19% of patients. In total, 8.89% had two or more ICDs). The major finding was that ICDs were more common in patients taking DA than in those who did not use medication from this group (83.78% vs. 54.07%, respectively; p = 0.0015). Patients with ICDs had longer disease duration, the presence of motor complications, and sleep disorders. An important finding was also a very low detection of ICDs in a routine medical examination; only 13.51% of all patients with ICDs had a positive medical history of this disorder. Conclusions: ICDs are relatively common in the population of Polish PD patients. The risk factors for developing ICDs include longer duration of the disease, presence of motor complications, sleep disorders, and use of DA and L-dopa. Due to the low detectability of ICDs in routine medical history, it is essential for physicians to pay more attention to the possibility of the occurrence of these symptoms, especially in patients with several risk factors. Further prospective studies on a larger group of PD patients are needed to establish a full profile of Polish PD patients with ICDs.

Prevalence and determinants of cognitive impairment in an elderly population: A hospital based study

: Dementia and cognitive impairment (CI) are some of the common problems associated with ageing. However, a lot of other factors apart from ageing can increase this risk. In this study, prevalence of CI and its correlation with different sociodemographic and clinical factors was assessed among patients attending outpatient department of a geriatric healthcare facility.: A total of 240 elderly OPD patients (&amp;#62;60 years) having recovered from different acute illnesses or making follow-up visits were enrolled in the study. Critically ill, hospitalized patients and those with history of COVID-19 exposure were excluded from the study. Demographic and social profile of the patients was noted. Mini Mental State Examination (MMSE) was used for assessment of cognition. MMSE score &amp;#60;27 was considered as CI. Data was analyzed using chi-square test for univariate and binary logistic regression for multivariate assessment. Mean age of patients was 72.58±6.46 years (range 62-91 years), majority of patients were males (55%). Prevalence of CI was 41.2%. There were 59 (24.6%) elderly with mild and 40 (16.7%) with moderate cognitive impairment. On univariate assessment, older age (p=0.003), male sex (p=0.024), living without spouse (p=0.040) and history of hospitalization in last one year (p=0.031) were found to be significantly associated with CI. On logistic regression age (OR=1.072), female sex (OR=0.561), ability to perform routine work (OR=0.461) and hospitalization history (OR=1.823) were identified as independent predictors of CI.: Prevalence of CI was 41.2% in our study. Age, sex, ability to perform routine works and hospitalization history were independently associated with CI risk.

Forensic investigation of small-scale digital devices: a futuristic view

Small-scale digital devices like smartphones, smart toys, drones, gaming consoles, tablets, and other personal data assistants have now become ingrained constituents in our daily lives. These devices store massive amounts of data related to individual traits of users, their routine operations, medical histories, and financial information. At the same time, with continuously evolving technology, the diversity in operating systems, client storage localities, remote/cloud storages and backups, and encryption practices renders the forensic analysis task multi-faceted. This makes forensic investigators having to deal with an array of novel challenges. This study reviews the forensic frameworks and procedures used in investigating small-scale digital devices. While highlighting the challenges faced by digital forensics, we explore how cutting-edge technologies like Blockchain, Artificial Intelligence, Machine Learning, and Data Science may play a role in remedying concerns. The review aims to accumulate state-of-the-art and identify a futuristic approach for investigating SSDDs.

Potential blindness from nutritional xerophthalmia in autistic patients

Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.

Quantification of ectopic fat storage in the liver and pancreas using six-point Dixon MRI and its association with insulin sensitivity and β-cell function in patients with central obesity.

To assess the association of ectopic fat deposition in the liver and pancreas quantified by Dixon magnetic resonance imaging (MRI) with insulin sensitivity and β-cell function in patients with central obesity. A cross-sectional study of 143 patients with central obesity with normal glucose tolerance (NGT), prediabetes (PreD), and untreated type 2 diabetes mellitus (T2DM) was conducted between December 2019 and March 2022. All participants underwent routine medical history taking, anthropometric measurements, and laboratory tests, including a standard glucose tolerance test to quantify insulin sensitivity and β-cell function. The fat content in the liver and pancreas was measured with MRI using the six-point Dixon technique. Patients with T2DM and PreD had a higher liver fat fraction (LFF) than those with NGT, while those with T2DM had a higher pancreatic fat fraction (PFF) than those with PreD and NGT. LFF was positively correlated with homeostatic model assessment of insulin resistance (HOMA-IR), while PFF was negatively correlated with homeostatic model assessment of insulin secretion (HOMA-β). Furthermore, using a structured equation model, we found LFF and PFF to be positively associated with glycosylated hemoglobin via HOMA-IR and HOMA-β, respectively. In patients with central obesity, the effects of LFF and PFF on glucose metabolism. were associated with HOMA-IR and HOMA-β, respectively. Ectopic fat storage in the liver and pancreas quantified by MR Dixon imaging potentially plays a notable role in the onset ofT2DM. We highlight the potential role of ectopic fat deposition in the liver and pancreas in the development of type 2 diabetes in patients with central obesity, providing valuable insights into the pathogenesis of the disease and potential targets for intervention. • Ectopic fat deposition in the liver and pancreas is associated with T2DM. • T2DM and prediabetes patients had higher liver and pancreatic fat fractions than normal individuals. • The results provide valuable insights into pathogenesis of T2DM and potential targets for intervention.

Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart?

This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. The average patient age was 57.8years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p=0.003 and -0.237 for the left eye, p=0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. NCT04233619.

Autopsy for Medical Diagnostics: Finding the Cause of Sudden Unexpected Death through Investigation of the Cardiac Conduction System by Serial Sections.

Sudden unexpected death (SUD) is a fatal event that occurs in an apparently healthy subject in a way that such an abrupt outcome could have not been predicted. SUD-including sudden intrauterine unexplained death (SIUD), sudden neonatal unexpected death (SNUD), sudden infant death syndrome (SIDS), sudden unexpected death of the young (SUDY), and sudden unexpected death in the adult (SUDA)-occurs as the first manifestation of an unknown underlying disease or within a few hours of the presentation of a disease. SUD is a major unsolved, shocking form of death that occurs frequently and can happen at any time without warning. For each case of SUD, a review of clinical history data and performance of a complete autopsy, particularly focused on the study of the cardiac conduction system, were carried out according to the necropsy protocol devised by the Lino Rossi Research Center, Università degli Studi di Milano, Italy. Research cases collected and selected for this study were represented by 75 SUD victims that were subdivided into 15 SIUD, 15 SNUD, 15 SUDY, and 15 SUDA victims. After a routine autopsy and clinical history analysis, death remained unexplained, and hence a diagnosis of SUD was assigned to 75 subjects, which included 45 females (60%) and 30 (40%) males ranging in age from 27 gestational weeks to 76 years. Serial sections of the cardiac conduction system disclosed frequent congenital alterations of the cardiac conduction system in fetuses and infants. An age-related significant difference in distribution among the five age-related groups was detected for the following anomalies of the conduction system: central fibrous body (CFB) islands of conduction tissue, fetal dispersion, resorptive degeneration, Mahaim fiber, CFB cartilaginous meta-hyperplasia, His bundle septation, sino-atrial node (SAN) artery fibromuscular thickening, atrio-ventricular junction hypoplasia, intramural right bundle branch, and SAN hypoplasia. The results are useful for understanding the cause of death for all SUD cases that were unexpected and would have otherwise remained unexplained, so as to motivate medical examiners and pathologists to perform more in-depth studies.

Concurrent syphilis, gonorrhea, and monkeypox: A case report.

Documented cases of monkeypox virus outside of Africa are rare, but as of August 22, 2022, the CDC was tracking 18,101 cases in the United States. Monkeypox rash can easily mimic other sexually transmitted infections, which may occur concurrently. This case report describes a 36-year old Caucasian man who has sex with men. The patient came in for a routine history and physical examination and disclosed a perianal rash. The patient had a medical history significant for undertreated HIV, ankylosing spondylitis, and homelessness. On examination, he had multiple perianal deep-seated ulcers that were swabbed for monkeypox and herpes simplex virus 1 and 2. Samples were also collected for syphilis, chlamydia, and gonorrhea. The swabs were positive for monkeypox and pharyngeal gonorrhea. At subsequent blood draw, he was found to have elevated titers for syphilis and a positive QuantiFERON-TB gold test. In summary, this case is a clear example of an individual with concurrent monkeypox virus and other sexually and nonsexually transmitted infections, highlighting the importance of careful identification of risk factors and testing for monkeypox virus even when the clinical presentation may depict a common sexually transmitted infection, such as the herpes simplex virus.

Abstract P1-09-02: Oncological, Cosmetic and Quality of life outcomes following breast conservation surgery in patients presenting after non-oncological excsion of breast primary: A prospective follow up study

Abstract Background For early-stage breast cancer BCS followed by radiation therapy has been validated as safe alternative to Radical Mastectomy. One peculiar problem faced in developing countries is patients in whom primary tumor has been excised elsewhere. There is a lack of clear treatment history and pre-operative examination and imaging in such patients, which makes accurate staging and planning for definitive surgery much more challenging. We did this retrospective analysis to assess clinical, cosmetic and QOL outcomes in the above-mentioned group of patients. Methods Patients between 18 and 80 years diagnosed with biopsy proven carcinoma breast that had the primary tumor excised outside and underwent BCS at our institute were included. They were subjected to routine history and physical examination as per the institute standard of care. Overall survival was estimated using Kaplan Meier curve. Expected 4 years survival was calculated using percentage of people who were alive out of those patients whose follow up was known at the end of 4 years. Cosmetic outcome was assessed using patient reported BCTOS 12 scores whereas quality of life outcome was assessed using patient reported EORTC and SF 36 questionnaire scores. Results Twenty-two patients were enrolled. Overall survival at 4 years was 72% comparable in NACT and No NACT (p&amp;lt; 0.29). 5.45% patients had local recurrence. Cosmetic outcome was excellent to good in 90% patients, similar between NACT and No NACT (p 0.69). Quality of life was excellent-good in 65% patients (EORTC) which was significantly higher in No NACT group (p 0.05) Conclusion BCS after scar excision following non oncological resection of breast primary may be an acceptable modality of treatment with good cosmetic and Quality of life outcomes. Citation Format: R N NAGA SANTOSH IRRINKI, SIDDHANT KHARE, gurpreet Singh, ishita laroiya, aniket mishra. Oncological, Cosmetic and Quality of life outcomes following breast conservation surgery in patients presenting after non-oncological excsion of breast primary: A prospective follow up study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-02.

CROSS SECTIONAL STUDY OF EFFECTS AND COMPARISON OF ORAL SILDENAFIL WITH INTRACAVERNOSAL INJECTION OF PAPAVERINE IN PENILE DOPPLER ULTRASONOGRAPHY ASSESSMENT OF ERECTILE DYSFUNCTION

Introduction: This study was made to investigate the use of oral sildenal as a possible substitute for intracavernosal injection of papaverine as an erection induction agent. Materials And Method:This observational cross sectional study was performed on the patients who were referred to the department for routine history of erectile dysfunction that lasted at least 6 months. A detailed history was noted. Penile Doppler with regular dose Inj. all of the patients were given papaverine (30-60mg). All patients were given another penile Doppler with Tab. Sildenal after a week (50 mg). Both hemodynamic changes and clinical evaluation were done concurrently during penile Doppler testing. Results:There was no difference in the percentage of patients who responded properly to these two medicines. Using clinical grading of self-rating scores, the mean score for anxiety was 40.89 and for depression was 0.480.09 in the study population. Except for end diastolic velocity, the ndings of PDU of peak systolic velocity (PSD), resistive index, and acceleration time for both 5 and 15 minutes with Papaverine and oral sildenal citrate were not signicantly different. Conclusion: Oral sildenal was shown to be equally efcacious as papaverine. While erections were delayed in onset, their length and quality were equal.