SCH Patients Research Articles

Comparative Study of Inflammatory Markers in Schizophrenia, FirstEpisode Psychosis, and Bipolar Disorder

Objective: An elevated level of NLR level is defined as an indicator of systemic inflammation, and it is stated that it can be used as an effective tool in navigating psychosis. The aim of the present study is to explore the blood parameters such as neutrophil, lymphocyte, and monocyte and their ratios (NLR, MLR, PLR) in both affective and non-affective psychosis. Materials and Methods: This is a retrospective case-control study conducted on schizophrenia(Sch), first-episode psychosis(FEP), and bipolar disorder(BD). Digital medical records were retrospectively analyzed between 2016 to 2021. The total number of patients recruited for this study is 437. Patients were divided into 3 groups which are schizophrenia (n:199), FEP (n:127), and Bipolar Disorder (n:111). The healthy control (HC) group (n:200) was selected who had never been diagnosed with any psychiatric disorders. Results: In this study, no difference was found between the patient groups in terms of substance use (Chi-square= 5.008; p= 0.082), platelet count was lower in SCH patients and no difference was found between the other groups in terms of platelet count. There was no statistical difference between the study groups in terms of lymphocyte, neutrophil, and monocyte counts and their ratios (NLR, MLR, PLR) (p>0.05 for each). Conclusion: In contrast to the previous findings, we did not show any significant differences in NLR, MLR, and PLR levels in both affective and non-affective psychosis. To better understand the pathophysiology of psychosis, it might be more suitable to conduct a clinical trial with drug-naive FEP patients in a prospective manner.

Exploring the role of TNF-α, TGF-β, and IL-6 serum levels in categorical and noncategorical models of mood and psychosis

Psychotic and mood disorders are discussed as part of the same continuum. The potential role of immune dysregulation in defining their clinical presentations, however, remains unclear. Differences in TNF-α, IL-6 and TGF-β levels were investigated in 143 patients with schizophrenia (SCH = 63) and bipolar disorder (BD = 80), in remission. Cytokines were evaluated against the dimensional assessment of psychosis and affective symptoms using the schizo-bipolar scale, together with the severity of the same symptom domains measured by the brief psychiatric rating scale (BPRS). Lower TGF-β was associated with more lifetime episodes, family risk for psychosis, and more severe mood and psychotic symptoms in all patients. BPRS Affect symptoms domain correlated with lower TGF-β levels in BD, and higher TGF-β levels in SCH patients. Using moderated mediation analysis, TGF-β was a relevant predictor only in the setting of non-categorical symptom distribution, with familial risk for psychosis confirmed as a significant moderator. Severity of BPRS Affect symptoms domain was an independent predictor of inclination towards the psychosis spectrum. The underlying immune dysregulation may be shared by the disorders, rather than a unique characteristic of each, having significant implications for our understanding of the continuum vs. categorical approach to psychosis and mood disorders.

The association between dyslipidaemia in the first trimester and adverse pregnancy outcomes in pregnant women with subclinical hypothyroidism: a cohort study

BackgroundSubclinical hypothyroidism (SCH) is linked to dyslipidaemia and adverse pregnancy outcomes. However, the impact of dyslipidaemia on the outcome of pregnancy in SCH is unclear.MethodsWe enrolled 36,256 pregnant women and evaluated their pregnancy outcomes. The following data was gathered during the first trimester (≤ 13+ 6 weeks of gestation): total cholesterol (TC), low-density lipoprotein (LDL-C), triglyceride (TG), high-density lipoprotein (HDL-C), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) concentrations. The reference ranges for lipids were estimated to range from the 5th to the 95th percentile. Logistic regression assessed the relationships between dyslipidaemia and adverse pregnancy outcomes, including abortion, preeclampsia/eclampsia, low birth weight, foetal growth restriction, premature rupture of foetal membranes, gestational hypertension, preterm birth, macrosomia and gestational diabetes mellitus (GDM). Additionally, the best thresholds for predicting adverse pregnancy outcomes based on TSH, FT4, and lipid levels were determined using receiver operating characteristic curves.ResultsIn the first trimester, LDL-C > 3.24 mmol/L, TG > 1.92 mmol/L, HDL-C < 1.06 mmol/L, and TC > 5.39 mmol/L were used to define dyslipidaemia. In this cohort, 952 (3.56%) patients were diagnosed with SCH, and those who had dyslipidaemia in the first trimester had higher incidences of gestational hypertension (6.59% vs. 3.25%), preeclampsia/eclampsia (7.14% vs. 3.12%), GDM (22.53% vs. 13.77%), and low birth weight (4.95% vs. 2.08%) than did those without dyslipidaemia. However, after adjusting for prepregnancy body mass index (pre-BMI), dyslipidaemia was no longer related to these risks. Furthermore, elevated TG dyslipidaemia in SCH patients was connected to an enhanced potential of gestational hypertension (odds ratio [OR]: 2.687, 95% confidence interval [CI]: 1.074 ~ 6.722), and elevated LDL-C dyslipidaemia correlated with increased preeclampsia/eclampsia risk (OR: 3.172, 95% CI: 1.204 ~ 8.355) after accounting for age, smoking status, alcohol use, pre-BMI, and levothyroxine use. Additionally, the combination of TC, TG, LDL-C, pre-BMI, and TSH exhibited enhanced predictive capabilities for gestational hypertension, preeclampsia/eclampsia, and GDM. Values of 0.767, 0.704, and 0.706 were obtained from the area under the curve.ConclusionsAmong pregnant women with SCH, dyslipidaemia in early pregnancy was related to elevated risks of adverse pregnancy consequences. The combined consideration of age, pre-BMI, TSH, and lipid levels in the first trimester could be beneficial for monitoring patients and implementing interventions to reduce adverse pregnancy outcomes.

Case-based music teaching practice for lower grades: taking SCH patients as an example

BackgroundMusic education plays an important role in primary and secondary school teaching, not only cultivating students’ artistic appreciation ability, but also having potential therapeutic value. For special groups, such as patients with schizophrenia, music education may provide a way for them to express and communicate, thereby promoting mental health. This study is based on actual cases and discusses the intervention effect of music on mental illness patients in primary and secondary schools.Subjects and MethodsThis study selected 60 primary and secondary school age group schizophrenia patients and designed a specific music education course for 12 weeks. This course includes music appreciation, vocal music, and instrument training. The effectiveness is measured through the Minnesota Multiple Personality Inventory (MMPI), music composition assessment, and feedback from parents and teachers. Statistical analysis was performed on experimental data using SPSS 24.0.ResultsAfter the course, participants showed significant progress in emotional expression, social interaction, and self-awareness. Music education not only enhances their music skills, but also promotes communication and self understanding with others. Parents and teachers have also reported that students perform more stably and positively in their daily lives.ConclusionsCase-based music teaching in primary and secondary schools has significant benefits for patients with schizophrenia. Through music education, these students can better communicate with the outside world, express themselves, and have a deeper understanding of themselves. It is recommended to further explore the diverse applications of music teaching in the field of special education.AcknowledgementScientific Research Program Funded by Shaanxi Provincial Education Department (No.22JK0168).

Renal function changes in patients with subclinical hyperthyroidism: a novel postulated mechanism

BackgroundSubclinical hyperthyroidism (SCH) is found to be associated with renal dysfunction. Hyperthyroidism is a well-known cause of secondary systolic hypertension. However, the effect of SCH on the kidney and its vasculature is still unknown.AimTo assess the presence of renal function changes and renal vasodysfunction in SCH patients and their relation to hypertension.MethodsThe study included 321 patients with SCH and 80 healthy matched controls. Laboratory investigations included thyroid function tests, anti-TSH receptor antibody (TRAb), creatinine, estimated glomerular filtration rate (eGFR), serum osmolarity (S. Osmol), urine osmolarity (U. Osmol), Fractional Excretion of Sodium (FeNa), Fractional Excretion of Potassium (FeK), copeptin (CPP), and aldosterone/renin ratio (ARR). Ultrasound for the thyroid gland, echocardiography, total peripheral resistance (TPR), flow-mediated dilatation (FMD), and Renal Arterial distensibility (RAD) was also done.ResultsSerum creatinine was significantly lower while eGFR was significantly higher in SCH patients compared to euthyroid subjects (mean 0.59 ± 0.11 mg/dl Vs mean 0.8 ± 0.1 mg/dl, p = 0.001 and mean 128.28 ± 14.69 ml/min/1.73m2 Vs mean 100.49 ± 14.9 ml/min/1.73m2, p = 0.013, respectively). The TPR and FMD showed a significant decrease in SCH group compared to controls (mean 975.85 ± 159.33 mmHg.min/L Vs mean 1120.24 ± 135.15 mmHg.min/L, p = 0.045 and mean 7.03 ± 4.02% Vs mean 13.48 ± 4.57%, p = 0.003, respectively). RAD was significantly higher in hypertensive SCH patients compared to normotensive SCH patients (mean 17.82 ± 2.46 mmHg Vs mean 11.98 ± 3.21 mmHg, p = 0.001).ConclusionSCH patients showed vascular resistance reduction. Alterations in thyroid hormones and blood pressure could be the driving mechanisms for the change in renal functions in patients with SCH.

The Impact of Early Levothyroxine Replacement in Subclinical Hypothyroidism on Glycemic Control Parameters and Quality of Life in Adult Patients

BACKGROUND: Subclinical hypothyroidism is diagnosed by increased level of serum thyroid-stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). Controversy exists concerning the early treatment of subclinical hypothyroidism with levothyroxine when TSH level is below 10 mIU/L. AIM: This stud aims to quantify the effects of a 3-month trial of levothyroxine replacement on quality of life in SCH patients with TSH level less than 10 mIU/L as primary outcome and fasting blood sugar and HbA1C levels as secondary outcome. METHODS: This was a randomized controlled trial. It was carried out on subjects between 18 and 65 years, of both sexes attending the family medicine outpatient clinic at Cairo University Hospitals with untreated symptomatic mild subclinical hypothyroidism. Simple randomization was performed by assigning random numbers from random number table. Quality of life (Short-Form 36 Questionnaire) as well as fasting blood sugar levels and HbA1C were assessed before the replacement of levothyroxine and 3 months after starting treatment in the subclinical hypothyroidism patients (intervention group) and were compared to the control group. RESULTS: The median of role limitations due to emotional problems, social functioning, and health change was higher in the intervention group in comparison with the control group. Moreover, the median scores of all general health questionnaire items showed significant positive statistical changes in the intervention group. There was also a significant improvement in glycemic control reflected in lower HbA1C levels and FBS. CONCLUSION: The results of our study highlight the positive effect of early substitution with levothyroxine in subclinical hypothyroid patients regarding the quality of life and glycemic control in Egypt and support the argument for replacement.

Study of association among various atherosclerotic risk factors in patients of subclinical hypothyroidism

Background &amp; Objectives: Subclinical hypothyroidism is endocrine disorder where serum TSH levels are increased but FT4 levels are within the assay's reference interval. Atherosclerosis has been found to be associated with the increased level of Ox-LDL in SCH. The aim of the present study is to find out the association of Ox-LDL and lipid profile in SCH patients. Materials and methods: 120 SCH patients aged (18-70) years and 120 age &amp; sex-matched healthy controls were included in the study. BMI &amp; lipid profile were estimated in both SCH patients and controls. FT3, FT4, TSH and Ox-LDL) were estimated by enzyme-linked immunosorbent assay. Results: SCH patients and healthy controls had different BMIs (p&lt;0.001). TC, Triglycerides, HDL-C, and LDL-C were significantly greater in the SCH group than in the control group, although HDL-C was decreased (p&lt;0.001). SCH patients had a significantly higher blood TSH level than controls (p&lt;0.001), although FT3 and FT4 levels were similar. SCH patients had higher Ox-LDL than controls (p&lt;0.001). Conclusion: In our study, SCH patients had higher serum lipid profile and Ox-LDL levels than healthy persons, indicating susceptibility to atherosclerosis. Ox-LDL can be used to predict CVD risk in SCH patients.

Decreased resting-state neural signal in the left angular gyrus as a potential neuroimaging biomarker of schizophrenia: An amplitude of low-frequency fluctuation and support vector machine analysis.

ObjectiveSchizophrenia (SCH) is primarily diagnosed based on specific clinical symptoms, with the lack of any objective SCH-related biomarkers often resulting in patient misdiagnosis and the underdiagnosis of this condition. This study was developed to assess the utility of amplitude of low-frequency fluctuation (ALFF) values analyzed via support vector machine (SVM) methods as a means of diagnosing SCH.MethodsIn total, 131 SCH patients and 128 age- and gender-matched healthy control (HC) individuals underwent resting-state functional magnetic resonance imaging (rs-fMRI), with the resultant data then being analyzed using ALFF values and SVM methods.ResultsRelative to HC individuals, patients with SCH exhibited ALFF reductions in the left angular gyrus (AG), fusiform gyrus, anterior cingulate cortex (ACC), right cerebellum, bilateral middle temporal gyrus (MTG), and precuneus (PCu) regions. No SCH patient brain regions exhibited significant increases in ALFF relative to HC individuals. SVM results indicated that reductions in ALFF values in the bilateral PCu can be used to effectively differentiate between SCH patients and HCs with respective accuracy, sensitivity, and specificity values of 73.36, 91.60, and 54.69%.ConclusionThese data indicate that SCH patients may exhibit characteristic reductions in regional brain activity, with decreased ALFF values of the bilateral PCu potentially offering value as a candidate biomarker capable of distinguishing between SCH patients and HCs.

Effect of Levothyroxine on Older Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis.

BackgroundSubclinical hypothyroidism (SCH) is usually treated with levothyroxine, but there is controversy as to whether SCH should be treated, especially for older patients. The aim of the systematic review and meta-analysis was to evaluate whether levothyroxine has a beneficial or harmful effect on older patients with SCH.MethodsDatabases including PubMed, Embase, Cochrane Library, Web of Science, Wanfang, Weipu and China National Knowledge Infrastructure were searched from inception until December 21, 2021. Subjects must be diagnosed with SCH, and older than or equal to 60 years of age. Interventions should be thyroid hormone therapy (e.g. levothyroxine). The literature was independently screened by 2 researchers. Statistical analysis was performed using RevMan5.3 software.ResultsA total of 13 articles were included. Meta-analysis results showed that in older SCH patients, levothyroxine can significantly reduce cholesterol (TC) (p < 0.00001), triglyceride (TG) (p < 0.00001), low-density lipoprotein cholesterol (LDL-C) (p = 0.03) and apolipoprotein B (ApoB) (p < 0.00001). In addition, levothyroxine had no significant effect on bone mineral density, fatigue, hypothyroidism symptoms, quality of life, BMI, cognitive function, depression, blood pressure, etc. in older SCH patients, and also did not significantly increase the incidence of adverse events.ConclusionsAmong older SCH patients, levothyroxine treatment may reduce TC, TG, LDL-C, and ApoB.

The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism andeuthyroid patients

Background. Hypothyroidism is a common thyroid disorder with female predominance. In general population its prevalance is 2–5% while 10 times higher in female than in men. Insulin resistance, one of the most discussed issues recently, is an inadequate response to insulin in peripheral tissues despite the normal secretory function of pancreatic islet cells. In this study, we analyzed relationship between thyroid hormone levels, body mass index and insulin resistance calculated with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and Atherogenic Index of Plasma (AIP) in SCH and euthyroid patients under levothyroxine treatment. Materials and methods. The clinical and laboratory data of approximately 14000 patients between the ages of 18–60 were retrospectively evaluated. After these exclusion criteria were applied, 371 eligible individuals were included in the study. All 371 individuals divided into three groups according to TSH levels. Group 1 is eutyhroid patients under levothyroxine treatment with TSH levels between 0.27–4.2μIU/mL. Group 2 is subclinical hypothyroid patients with TSH levels between 4.2–10 μIU/mL. Group 3 is healthy control group with TSH levels between 0.27–4.2 μIU/mL. Results. The euthyroid patient group has the highest (25.66±3.36 kg/m2) mean BMI. On the other hand the mean BMI was higher in SCH (24.0400±3.8436kg/m2) group than in control group (22.48±2.74 kg/m2) (p&lt;0.05). Fasting plasma glucose (FPG), serum triglyserid, low density lipoprotein (LDL), anti-thyroid peroxidase (TPO) and insulin levels were significantly higher in euthyroid patient and SCH groups (p&lt;0.05). Notably, total cholesterol, LDL and TPO levels were higher in euthyroid patient group (p&lt;0.05). On the other hand, there were no difference between euthyroid patients and SCH group. Conclusions. This study found significantly elevated insulin resistance and cholesterol levels in SCH patients, so we hypothesized that SCH is also a risk factor for insulin resistance disorders such as cardiovascular diseases and metabolic syndrome. As a consequence, lipid metabolism defects and insulin resistance should be screened and treated in SCH patients. Thanks to the strong and significant correlation between HOMA and QUICKI in our study, we suggest the combined use of HOMA and QUICKI in these patients. Further and large-scale studies are needed to evaluate the relationship of HOMA, QUICKI, AIP, and BMI in detecting insulin resistance in SCH patients.

Hypothyroidism and its relationship to cholesterol levels in premenopausal women: A cross-sectional study

Background: A brief overview of the disease: Thyroid dysfunction is a common premenopausal ailment characterized by subtle signs and symptoms that may go unnoticed for a lengthy period of time. Female hypothyroidism is common in the older population. In patients with SCH, primary hypothyroidism is a prevalent consequence. Aim: To determine the prevalence of thyroid dysfunction and the associated clinical symptoms in premenopausal women who attended gynecology outpatient appointments. Methods: The purpose of this study was to determine the prevalence of thyroid dysfunction and its associated clinical symptoms in premenopausal women who were seen as outpatients in gynecology. The participants in this research ranged in age from 42 to 52 years. Thyroid function and blood cholesterol were measured in all of the SCH patients using an ELISA assay. Results: Seventy women between the ages of 42 and 52 participated in the research. Patients with menorrhagia accounted for 56% of all cases of menstrual disturbance in the study population. Women who experienced oligomenorrhea, a premenopausal symptom, accounted for 40% of the total. Thyroid impairment was shown to be associated with irregular menstruation (80% of cases) and weight gain (80 %). irritability and mood fluctuations (59 %) are common (70 %) Anxiety and depression are the most prevalent symptoms (58 %), followed by the loss of one's job. astonishment (6 % ) TSH levels were elevated in SCHs, while free T3 and T4 levels remained normal. There were 17 with SCH, 4 with hypothyroidism, and 49 with normal thyroid function. Seventy percent of individuals with SCH had hypercholesterolemia. Conclusion: Our findings encourage regular screening of premenopausal women, regardless of whether or not they are experiencing symptoms. Early detection and treatment of issues can help to avoid difficulties. Keywords: Thyroid dysfunction, premenopausal ailment, hypothoridism

Study of Lung Function Tests and ECG Changes in Subclinical Hypothyroid Female Subjects

Objectives: To study changes in electrocardiogram AND pulmonary function tests in a group of women with newly diagnosed subclinical hypothyroidism. Methodology: The study was conducted on 30 women between the ages of 20 and 40 with subclinical hypothyroidism and compared to 30 age and gender-matched controls. The student's test was used to do statistical analysis in SPSS version 23. Results: A total of 30 women who had subclinical hypothyroidism and 30 healthy, age- and sex-matched controls were included. The mean±SD height of the controls was 152.9 ± 3.7 cm and that of SCH patients was 153.1 ± 4.08 cm. Height differences between the two groups were insignificant. The mean±SD weight of the controls was 51.9 ± 4.5 kg and that of SCH subjects was 53.2 ± 4.3 kg. Weight differences between the two groups were insignificant. The mean±SD BMI of the controls was 22.16 ± 1.64 kg/m2 and that of SCH subjects was 22.71 ± 1.99 kg/m2. BMI differences between the two groups were insignificant. Conclusion: Results have suggested that the changes will occur in spirometry and electrocardiogram, even in the subclinical state of hypothyroidism. Precautions can be taken at this stage to prevent progression to overt hypothyroidism. Keywords: Subclinical hypothyroidism; TSH; spirometry; ECG; muscle strength; QTc; females; early treatment

UCP2 and CFH Gene Variants with Genetic Susceptibility to Schizophrenia in Turkish Population.

Schizophrenia (Sch) is a complex, multifactorial psychiatric disorder. Growing evidence shows that oxidative damage and immunological dysfunction exist in the Sch physiopathology. In the present study, we aimed to evaluate whether the Uncoupling protein 2 and Complement factor H gene variants play any role in susceptibility to Sch. This study was carried out on 200 individuals (100 Sch patients and 100 healthy controls). Genomic DNA was extracted from blood samples. UCP2-866G /A (rs659366) and CFHY402H variants were analyzed by PCR-RFLP analysis. The UCP2 -866G/A variant G/G genotype and G allele were associated significantly with increased risk of Sch (p=0.001, p=0.001, respectively). The subjects were carrying UCP2 -866G/A variant G/G genotype had 4.377-fold increased risk for Sch. There was no significant difference between the groups for the genotype and allele frequencies of the CFH Y402H variant (p>0.05). The observed genotype counts deviated significantly from those expected in Sch patients according to the HWE for UCP2 -866G/A variant (p=0.001). We present the first results investigating UCP2 -866G/A/ and CFH Y402H variants for susceptibility to Sch in a Turkish population. These results indicate that the UCP2 -866G/A, but not CFH Y402H variant, might play an important role in the development of Sch.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

BackgroundImpairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. Methods120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. ResultsBoth groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LimitationsThe cross-sectional design does not allow for causal inferences. ConclusionBD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

Characteristics of coronary artery disease in patients with subclinical hypothyroidism: evaluation using coronary artery computed tomography angiography

BackgroundSubclinical hypothyroidism (SCH) has recently been acknowledged as an independent risk factor for coronary artery disease (CAD). However, the characteristics of CAD in patients with SCH are not fully understood. This study aims to evaluate the features of CAD in patients with SCH using coronary computed tomographic angiography (CCTA).Materials and methodsFrom 1 April, 2018 to 30 June, 2020, 234 consecutive SCH patients with coronary plaques identified on CCTA were included retrospectively. They were further subdivided into different degree of SCH groups (mild SCH vs. moderate SCH vs. severe SCH: 143 vs 62 vs 28) and different gender groups (men with SCH vs. women with SCH:116 vs 118). The distributions and types of plaques, luminal narrowing, segment involvement scores (SIS) and segment stenosis scores (SSS) were evaluated and compared among the different groups.ResultsPatients with severe SCH had fewer calcified plaques (0.7 ± 0.9 vs. 2.0 ± 1.9, p < 0.001) and more non-calcified plaques (0.9 ± 1.0 vs. 0.3 ± 0.5, p < 0.001) than those with mild SCH. As the SCH condition worsened, the proportion of non-calcified plaques significantly increased. Whereas there were no significant discrepancies in SIS and SSS among patients with different grades of SCH (all p > 0.05). Men with SCH had higher SIS (3.9 ± 2.3 vs. 3.0 ± 2.3, p = 0.004) and SSS (7.8 ± 5.4 vs. 5.4 ± 3.0, p = 0.002) than women. Multivariate logistic and linear regression analysis demonstrated that grades of SCH (Moderate SCH, odds ratio [OR] 2.11; 95% CI 1.03–4.34, p = 0.042; severe SCH, OR: 10.00; 95% CI 3.82–26.20, p < 0.001, taken mild SCH as a reference) was independently associated with the presence of non-calcified plaques, whereas sex (B: 1.67; 95% CI 0.27–3.10, p = 0.009) was independently associated with SSS.ConclusionsSevere SCH is associated with non-calcified plaques, and men with SCH have higher total plaque burden than women. We suggest that it is important to evaluate for coronary plaque in SCH patients, especially those with severe SCH and men with SCH.

Higher order theory of mind in patients with bipolar disorder and schizophrenia/schizoaffective disorder.

Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition (p < 0.001, [Formula: see text] = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores (R2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance (R2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.

Insomnia associated with neutrophil/lymphocyte ratio in female patients with schizophrenia

IntroductionWorse sleep quality and increased inflammatory markers in women with schizophrenia (Sch) have been reported (Lee et al. 2019). However, the physiological mechanisms underlying the interplay between sleep and the inflammatory pathways are not yet well understood (Fang et al. 2016).ObjectivesAnalyze the relationship between Neutrophil/Lymphocyte (NLR), Monocyte/Lymphocyte (MLR) and Platelet/Lymphocyte (PLR) ratios, and insomnia in Sch stratified by sex.MethodsFinal sample included 176 Sch patients (ICD-10 criteria) [mean age: 38.9±13.39; males: 111(63.1%)]. Assessment: PANSS, Calgary Depression Scale (CDSS), and Oviedo Sleep Questionnaire (OSQ) to identify a comorbid diagnosis of insomnia based on ICD-10. Fasting counting blood cell were performed to calculate ratios. Statistics: U Mann-Whitney, logistic regression.ResultsInsomnia as comorbid diagnosis was present in 22 Sch (12.5%) with no differences between sex [14 males (12.6%), 8 females (12.3%)], neither in their age. Female patients with insomnia showed increased NLR [2.44±0.69 vs. 1.88±0.80, U=122.00 (p=0.034)]. However, no differences in PLR and MLR were found, neither in any ratio in males. Regression models using insomnia as dependent variable and covariates (age, PANSS-positive, PANSS-negative, CDSS) were estimated. Females: presence of insomnia was associated with NLR [OR=3.564 (p=0.032)], PANSS-positive [OR=1.263 (p=0.013)] and CDSS [OR=1.198 (p=0.092)]. Males: only PANSS-positive [OR=1.123 (p=0.027)] and CDSS scores [OR=1.220 (p=0.005)] were associated with insomnia.ConclusionsNLR represent an inflammatory marker of insomnia in Sch but only in female patients. Improving sleep quality in these patients could help to decrease their inflammatory response.DisclosureNo significant relationships.

Single-centre study comparing surgically and conservatively treated patients with spinal cord herniation and review of the literature

IntroductionSpinal cord herniation (SCH) is a rare cause of progressive myelopathy and Brown-Séquard-Syndrome. Research questionEvaluation of functional outcome after SCH treatment compared to conservatively treated patients. Material and methodsWe retrospectively analysed functional outcome in SCH patients treated between 2009 and 2020. We conducted a systematic search using PubMed, MEDLINE and EMBASE to perform a pooled analysis in SCH patients. ResultsOur hospital cohort included 17 patients of which 9 were treated surgically. Mean age was 51.9 years, 58.8% of the patients were female. In 4/9 patients (44.4%) the neurological state remained stable after surgery. Four patients improved (44.4%) and one deteriorated after surgery (11.1%). Conservatively treated patients had a higher deterioration rate on follow-up with 3/8 patients deteriorating (37.5%). In our pooled analysis, 109/145 (75.2%) of patients improved, 32/145 (22.1%) remained stable and 4/145 patients deteriorated (2.8%). Among the available data of nine cohorts, mean recovery rate measured by the JOA score was 36.6% (SD 14.4). In our pooled multivariable model lower preoperative JOA score was associated with worse functional outcome (OR 0.86, 95%CI 0.74–0.99, p ​= ​.04). Discussion and conclusionOur data shows that patients who are treated surgically have a higher improvement rate and acceptable perioperative morbidity compared to conservatively treated patients. Lower preoperative JOA score decreases chances of improved functional outcome on follow-up. We therefore advocate early surgery for symptomatic patients. Wait and see appears outdated due to progressive impairment and decreased chances of recovery. However, it is still an option in asymptomatic incidental SCH patients.

Effect of Levothyroxine on Kidney Function in Chronic Kidney Disease with Subclinical Hypothyroidism in US Veterans: A Retrospective Observational Cohort Study.

IntroductionChronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal function in overt hypothyroidism, there is no consensus on its benefits in SCH. Clinical and limited economic outcomes were evaluated in levothyroxine-treated US veterans with CKD + SCH.MethodsVeterans Health Administration claims data from April 2013 to March 2018 for levothyroxine-treated versus nontreated CKD + SCH patients were compared. Eligible patients with CKD + SCH (≥ 2 elevated TSH values recorded; ≥ 2 normal thyroxine values recorded) had ≥ 1 TSH values recorded during 24-month follow-up, and ≥ 1 estimated glomerular filtration rate (eGFR) measurement during baseline and follow-up. Continuous levothyroxine use (treatment cohort) was required during follow-up. The primary endpoint was eGFR at 6, 12, 18, and 24 months; secondary endpoints included eGFR change from baseline, CKD progression, and length of hospital stay (LOS). Propensity score matching (PSM) was performed.ResultsOf 453 eligible patients, 157 remained in each cohort after PSM. Most were male (96%) and white (88%); mean age was 75 years. No significant differences were observed between cohorts at any time point for eGFR, eGFR change from baseline, or CKD progression. Treated patients had numerically higher mean eGFR at 6 and 12 months, lower proportions of progression to higher CKD stages at 12, 18, and 24 months, and shorter mean all-cause LOS versus nontreated patients (1.92 vs. 3.30 days; P = 0.3483) within the 24-month follow-up period. A significantly shorter mean CKD-related LOS was observed versus nontreated patients (0.11 vs. 1.38 days; P < 0.0001) during the 24-month follow-up.ConclusionLevothyroxine use was associated with economic and clinical benefit in some patients with CKD + SCH, despite an absence of overall benefit on eGFR; confirmatory research is needed.

To evaluate the presence of subclinical thyroid disorder in type 2 diabetes mellitus

Objectives: Our objective is to determine the prevalence of subclinical thyroid disorders in patients with type 2 diabetes mellitus (T2DM) and to analyze the clinical and metabolic profile of patients with this dual endocrine disorder. Methods and Results: Sixty consecutive type 2 diabetic patients without clinical manifestations of thyroid disorders were screened for SCH and subclinical hyperthyroidism using serum free T 3, free T 4 and thyroid stimulating hormone (TSH) levels. Individuals of subclinical thyroid disease were further screened for thyroperoxidase (TPO) antibodies. SCH was detected in 13% of type 2 diabetic patients and none had subclinical hyperthyroidism in our study. SCH was common among females with type 2 diabetes (84.6%). Elevated TPO antibody levels were present in 84.6% SCH patients. Diabetic retinopathy among SCH patients showed significant association with higher serum TSH levels. Left ventricular diastolic dysfunction was present in 30.8% of SCH patients. Conclusion: SCH is common among type 2 diabetic patients, especially in females. It is most commonly secondary to autoimmune thyroid disease. Microvascular complications are commonly observed in this group of patients with dual endocrinal disorder and treating physician should be aware of the impact and should routinely screen SCH to prevent complications.