Silent Disease Research Articles

Self-Care Behaviour: The Life-Changing Magic in Type 2 Diabetes Mellitus Care

Diabetes Mellitus is a ‘silent disease’ with minimal symptoms at the beginning and rapidly progresses until target organ damage. Moreover, because of its serious consequences, it has become a significant public health concern. Though genetics play an essential role in the development of diabetes, studies on monozygotic twins have shown the importance of environmental influences. Diabetes education is essential but must ultimately be transferred to action to benefit the patient. Individuals with diabetes have been shown to dramatically impact their disease’s progression and development by participating in their care. Because a high percentage of the world’s diabetes cases belong to Type 2 Diabetes (T2D) with modifiable risk factors such as an unhealthy diet, being obese or overweight, a sedentary lifestyle, and smoking, therefore, individuals with T2DM can be helped to modify these factors through behavioural changes to achieve and maintain optimum blood glucose levels.

Access barriers to care for patients with silent cerebrovascular disease (SCD) in rural China: A cross-sectional questionnaire-based study

BackgroundTimely diagnosis and treatment of silent cerebrovascular disease (SCD) are critical for future cerebrovascular disease prevention, whereas asymptomatic specificity of SCD can lead to a lack of reasonable healthcare utilization. In China, access barriers to care for SCD patients is rarely studied. This study aimed to estimate the access barriers to care for SCD patients in rural China and explored associated factors. MethodsWe constructed a demand-side questionnaire using the six-dimensional model of access barriers to care, and collected survey data in Guizhou province, China. Data from SCD patients were collected including demographics, health status, and self-perceived access barriers to care. Linear regression was used to estimate the association between access barriers to care and self-reported health status. ResultsA total of 162 SCD patients were included in the analysis. The questionnaire’s measures are adoptable with reliability (Cronbach’s α = 0.86) and validity (KMO = 0.774, Bartlett’s test p-value < 0.05). The average score of access barriers to care for SCD patients in Guizhou was 13.41 (SD = 4.08). Average scores vary across the six dimensions, and affordability has the highest score of 3.07 (SD = 0.13), indicating the highest level of access barriers in terms of affordability. The lowest scored dimension is acceptability which score is 1.62 (SD = 0.33), indicating SCD patients had a relatively high willingness in receiving healthcare services. Regression outcome reported that self-reported worse health status was significantly associated with higher level of access barriers (p-value < 0.01). ConclusionThis study estimated overall and by-dimension access barriers to care for patients with SCD in rural China and investigated the association between health status and access barriers to care. The varied level of different dimensions of access barriers to care suggested that interventions designed to facilitate healthcare utilization should be specific and target those SCD patients who are in poorer health status and have difficulty affording healthcare expenses.

Evidence of Equine Genital Leptospirosis (EGL) syndrome in a mare with chronic placentitis

Leptospirosis is an important disease in equine reproduction. Recently, a specific genital syndrome, named Equine Genital Leptospirosis (EGL), distinct from renal/systemic disease, was described (Di Azevedo & Lilenbaum, Theriogenology. 2022; 192:81-8). Herein we present a typical case of EGL in a pregnant mare diagnosed in the northeastern region of Brazil. A mixed-breed mare of 436kg at 243 days of gestation, presented with hyperechogenic allantoic fluid, placental edema, and fetal tachycardia in a routine obstetrics examination. Serum progesterone and estradiol (RIA) were normal (6.26ng/mL and 1404.76pg/mL, respectively). The serology for equine herpes virus1 or –4) was negative. Placentitis treatment was started with flunixin meglumine (1.1mg/kg, IV, SID, 5 days) and trimethoprim-sulfamethoxazole (30mg/kg, PO, BID). On subsequent evaluation (272 days of gestation), the placenta was heterogeneous, showing mild edema, with multiple folds in the cervical star region and placental detachment was suspected. The fetal evaluation did not show any abnormalities. Serum progesterone and estradiol were 9.86ng/mL and 872.73pg/mL, respectively. Cervicovaginal mucous (CVM) cytology did not show any abnormalcharacteristics. A PCR for leptospirosis was conducted from urine (negative) and from CVM (positive). Serology (Microscopic Agglutination Test) for Leptospira spp was positive (titre 200) for serogroup Australis. The low titers against this Leptospira serogroup (which includes serovar Bratislava), together with a negative PCR on urine and positive PCR on CVM, strongly supports a diagnosis of EGL syndrome. Trimethoprim-sulfamethoxazole was then substituted with doxycycline (10mg/kg, PO, BID) until parturition, which was uneventful at 332 days of pregnancy. The placenta had mild macroscopic lesions on the cervical star and at the tip of the gravid horn. The foal had normal general clinical parameters at birth, but physical signs of immaturity and leukopenia with a shift to the left. Treatment with amikacin (25mg/kg, IV, SID) and one liter of plasma was established and the foal made a full recovery. EGL is primarily a reproductive syndrome and is characterized by a chronic, silent, and genital-focused disease, distinct from renal or systemic syndromes. It is vastly underdiagnosed, and the disease is little studied and underestimated. This is the first case fully reported.

THU-487 - Assessment of silent coronary artery disease with functional and anatomic tests in liver transplantation: analysis of the diagnostic and prognostic capacity of a risk-adapted protocol

THU-487 - Assessment of silent coronary artery disease with functional and anatomic tests in liver transplantation: analysis of the diagnostic and prognostic capacity of a risk-adapted protocol

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort.

Prevalence of Antibodies to COVID-19 Due to Infection or Vaccination in US Adults.

-Determine the seroprevalence of SARS-CoV-2 infection and vaccination in a population applying for life insurance. -This is a cross-sectional study of 2584 US life insurance applicants, to determine the seroprevalence of antibodies to COVID-19. This convenience sample was selected on two consecutive days April 25-26, 2022. -For COVID-19, 97.3% are seropositive, and 63.9% have antibodies to nucleocapsid protein, a marker of prior infection. An additional, 33.7% have been vaccinated with no serologic evidence of infection. -Serum and urine samples from a nationwide group of insurance applicants for routine risk assessment were collected. The examination of applicants typically occurs, in their homes, their place of employment, or a clinic. The paramedic exam occurs 7-14 days after the insurance application. Before the exam, an office assistant calls the applicant and inquires if they have been in contact with a person with SARS-CoV-2, been ill within the last 2 weeks, felt sick, or recently had a fever. If the applicant answers yes, the exam is rescheduled. Before sample collection, the applicant reads and signs a consent form to release medical information and testing. Next, the examiner records the applicant's blood pressure, height, and weight. Then, a blood and a urine sample are collected and sent with the consent form to our laboratory via Federal Express. On April 25-26, 2022, we tested 2584 convenience samples from adult insurance applicants for the presence of antibodies to nucleocapsid and spike proteins from SARS-CoV-2. As a standard practice, we reported the client-specified test profile results to our life insurance carriers. In contrast, the COVID-19 test results were only available to the authors. Patient and Public Involvement.-There was no patient involvement in study design, reporting of results, or journal publication selection. There was patient consent to publish de-identified study results. No public involvement occurred in the creation or completion of the study. The authors thank the participants in this study for approving the use of their blood samples to further society's understanding of the SARS-CoV-19 pandemic. Ethics Review.-Western Institutional Review Board reviewed the study design and determined it to be exempt under the Common Rule and applicable guidance. Therefore, it is exempt under 45 CFR § 46.104(d)(4) from using de-identified study samples for epidemiologic investigation, WIRB Work Order #1-1324846-1. In addition, all test subjects had signed a consent allowing research of their blood and urine samples with the removal of personally identifiable information. -The combined seroprevalence for antibodies to nucleocapsid, a marker of prior infection, and antibodies to spike protein, an indicator of either previous infection or vaccination, was 97.3%. Higher infection rates occur in younger vs older age groups, with a non-statistical difference for vaccinated and acquired natural immunity. For the age group 16-84, the total estimated seroprevalence of COVID-19 in the US is 249 million cases. -The US population has widespread immune resistance to current variants of COVID-19 due to prior infection or vaccination. The infectivity of new variants and silent disease, independent of previous infection or vaccination, are the driving force behind the sporadic increase in clinical SARS-CoV-2 cases.

The correlation between knowledge, attitude and family support on compliance of outpatients with hypertension in a healthcare centre in Indonesia

Background: Hypertension is a silent killer disease in the community. The success of hypertension therapy is influenced by adherence to medication. Three factors that shape compliance behaviour are knowledge and attitudes (these are predisposing factors) and family support (as a reinforcing factor). The majority of people in Indonesia choose healthcare centers when seeking hypertension treatment. Non-adherence to treatment has an impact on the incidence of complications. Objective: This current study was conducted on outpatients in the Tanggulangin Primary Healthcare Centre, Sidoarjo, Indonesia. Method: This study used a correlational design and a cross-sectional approach, involving 72 people in the sample. The variables measured were: knowledge, attitudes of patients, family support as well as patient compliance with hypertension treatment. Data was collected through a questionnaire instrument. Data analysis was done descriptively and correlatively. Results: The most widely accepted hypertension drug was amlodipine 78.6%, and a single therapy was given to 86.1% of patients. Most patients had suffered from hypertension for less than one year (38.9%); and half of the patients had family members who suffered from hypertension (52.1%). Patient knowledge of hypertension was moderate (69.4%). Most of the patients had a positive attitude (83.3%), good family support (76.5%), however, 94.5% did not comply with medication. The Spearman Rho test showed compliance with treatment was influenced by knowledge (5.9%) and attitude (14.8%). Meanwhile, the family support variable had no effect on compliance. Conclusion: This study concludes patient compliance to hypertension medication in the Tanggulangin Primary Healthcare Centre is only influenced by patient knowledge and attitudes.

NAFLD as a Silent Disease and the Risk of Cardiovascular Mortality: The Role of Diet and Physical Exercises

NAFLD as a Silent Disease and the Risk of Cardiovascular Mortality: The Role of Diet and Physical Exercises

Self-detection System for Type 2 Diabetes Mellitus by Aspiration of the Patient's Urinalysis

Diabetes mellitus is a very silent disease, which, according to various studies, has been growing every year, among them are patients with type 2 diabetes mellitus that is characterized by why they do not produce enough insulin in their body, causing them to inject insulin in an uncontrolled way, caused discomfort by the number of times they inject. Some patients do not know if they have type 2 diabetes, and over time several inefficient and expensive diabetes screening systems have been developed, limiting their use by everyone. Similarly, if this disease is not detected in time, it can compromise other parts of the body so it is always necessary to control your eating habit, on the other hand, this type 2 disease can be detected in fasting of the patient. According to the problem exposed, in this research a self-detection system of type 2 diabetes mellitus was carried out by aspirating a urinalysis to detect through the sweet smell of urine if the patient may have type 2 diabetes mellitus by means of gas sensors and carbon nanotubes fused by a microcontroller. Through the operation of the system, it was observed that the tests were performed with an efficiency of 98.99%, being an accepted value for a reliable and safe diabetes analysis, demonstrating that it can detect type 2 diabetes mellitus by aspirating the smell of urine.

Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk.

Mitral valve prolapse (MVP) is the most frequent valvulopathy in the general population, with usually a favourable prognosis. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) are the most worrying. The estimated risk of SCD in MVP is between 0.2% to 1.9% per year, including MVP patients with and without severe mitral regurgitation (MR). The association between SCD and MVP is expressed by a phenotype called "malignant MVP" characterized by transthoracic echocardiography (TTE) findings such as bileaflet myxomatous prolapse and mitral annulus disjunction (MAD), ECG findings such as repolarization abnormalities, complex ventricular arrhythmias (c-VAs) and LV fibrosis of papillary muscles (PMs) and inferobasal wall visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Therefore, attention is raised for patients with "arrhythmic MVP" characterized from an ECG point of view by frequent premature ventricular contractions (PVCs) arising from one or both PMs as well as by T-wave inversion in the inferolateral leads. In athletes, SCD is the most frequent medical cause of death and in young subjects (< 35 years) usually is due to electrical mechanism affecting who has a silent cardiovascular disease and are not considered per se a cause of increased mortality. In MVP, SCD was reported to happen during sports activity or immediately after and valve prolapse was the only pathological aspect detected. The aim of the present paper is to explore the association between SCD and MVP in athletes, focusing attention on ECG, TTE in particular, and CMR findings that could help to identify subjects at high risk for complex arrhythmias and eventually SCD. In addition, it is also examined if sports activity might predispose patients with MVP to develop major arrhythmias.

Perception and awareness of osteoporosis and its related risk factors among women: A cross-sectional study

&lt;b&gt;Objectives:&lt;/b&gt; This study was designed to assess the awareness of women of the risk factors and preventive measures of osteoporosis.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; This is a cross-sectional study that was conducted in Jordan. During the study period, a convenience sample of women were invited to participate via a survey link communicated through social media. Linear regression was used to screen independent variables affecting participants’ awareness of osteoporosis, its risk factors, and preventive measures.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 426 women agreed to participate in this study, with a median age of 38.5 years (IQR=16.0). Results showed that women have a median awareness score of 5.0 out of 9.0 (IQR=4.0) about osteoporosis risk factors, whereas women with higher educational levels (diploma or higher) and those with medical-related degrees have a higher awareness about osteoporosis risk factors compared to others (p≤0.05).&lt;br /&gt; Medical websites were the primary source used to obtain information about osteoporosis by the participating women (n=236, 55.4%). Also, results showed that more than 90% of the women believed that osteoporosis is a chronic silent disease that makes your bones less dense and more fragile (n=418, 98.1%), and that bone strength may increase by taking vitamin D and calcium (n=405, 95.0%).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; This study showed that women had an intermediate level of awareness of osteoporosis and prevention measures. The importance of medical websites and social media as sources of information was also demonstrated. More public targeted campaigns are needed to promote awareness of osteoporosis, its risk factors, prevention, and treatment.

Silent Coronary Artery Disease in Patients with Rheumatoid Arthritis in Kurdistan, Iraq: A cross-sectional study

Objectives: This study attempts to determine the silent coronary artery disease (CAD) in a sample of Iraqi Kurdish patients diagnosed with rheumatoid arthritis (RA).&#x0D; Methods: A total of 50 such patients from Duhok, Kurdistan region of Iraq, underwent multi slices computed tomography (MSCT) coronary angiography 64 slices to determine coronary artery calcium (CAC) scores and coronary stenoses.&#x0D; Results: 62% of cases had a (CAC) score &gt; zero on non-contrast MSCT scans. Coronary angiograms showed that 26 (52%) of the cases had variable coronary artery stenosis; 17(34%) of them were obstructive (&gt;50% luminal narrowing). The study demonstrated that Inflammatory markers (rheumatoid factor, Anti- cyclic citrullinated peptides, and some cardiovascular risk factors, namely (hypertension and type 2 diabetes mellitus) were significantly related to the presence of CAD in these patients.&#x0D; Conclusions: Patients with rheumatoid arthritis are at increased risk of CAD. This risk is higher in the presence of inflammatory and cardiovascular risk factors.

Genetic Analyses of Oral Health and Neuroimaging Markers of Brain Health in Persons without Stroke (S49.001)

<h3>Objective:</h3> We hypothesize that genetically-determined poor oral health leads to worse neuroimaging brain health profiles in persons without stroke. <h3>Background:</h3> Oral health is a modifiable risk factor for stroke. However, the role of oral health on brain health among clinically asymptomatic persons remains understudied. <h3>Design/Methods:</h3> We conducted a two-sample Mendelian Randomization (MR) study. As instruments, we used 105 genetic variants known to be associated (p&lt;5×10⁻⁸) with a composite of caries, dentures and missing teeth in the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) Consortium. In stroke-free participants enrolled in the UK Biobank, we tested for associations between these genetic variants and white matter hyperintensity volume (natural log-transformed), fractional anisotropy and mean diffusivity. For the last two neuroimaging traits, we evaluated composite scores defined by the first principal component of measurements obtained across 48 brain regions. <h3>Results:</h3> Our primary analysis using the inverse variance-weighted MR method indicated that genetically-increased risk of poor oral health was associated with: (1) higher burden of silent cerebrovascular disease, as represented by a 30 % increase in white matter hyperintensities volumes (beta=0.30, SE=0.06 p-value=3×10⁻⁶), and (2) increased microstructural damage, as represented by a 43% change in composite FA scores (beta=0.43, SE=0.06; p=6×10⁻¹¹) and a 10% change in composite MD scores (beta=0.10, SE=0.03; p=0.005). Sensitivity analyses identified horizontal pleiotropy in our primary results, but an outlier-corrected analysis confirmed each of our findings (all p-values &lt;0.001). <h3>Conclusions:</h3> Among persons without stroke, genetically-determined poor oral health is associated with worse neuroimaging brain health profiles. Because gene-disease associations are immune to confounding, our results suggest that this association is causal. Early treatment of poor oral health may lead to significant brain health benefits, even in persons without stroke. <b>Disclosure:</b> Dr. Rivier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pyxis Partners. Dr. Renedo has nothing to disclose. Dr. De Havenon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Integra. Dr. De Havenon has stock in Certus. The institution of Dr. De Havenon has received research support from NIH/NINDS. The institution of Dr. De Havenon has received research support from Regeneron Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMAG Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMGEN. Dr. De Havenon has received publishing royalties from a publication relating to health care. Sam Payabvash has nothing to disclose. Mr. Torres-Lopez has nothing to disclose. Thomas Gill has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.

Understanding the relationship between domestic and intimate partner violence, adverse childhood experiences, and chronic opioid use disorder: The patient perspective.

Opioid dependence and misuse are a plague of epidemic proportions in our communities and globally. Prior trauma in childhood may contribute to opioid dependence, while one consequence of opioid misuse is increased risk for involvement as both perpetrators and victims in domestic and intimate partner violence (DV and IPV). The aims of this study were to understand the proportion of patients who identified as having an opioid use disorder (OUD), if OUD was associated with higher rates of DV and IPV as both perpetrators and victims, and whether adverse childhood experiences (ACEs) as well as demographic factors related to instability in their social life were higher among those with OUD compared to those without. The sample consisted of 124 patients who were identified as having an OUD in their medical records based on ICD-10 codes. Each participant completed an anonymous survey about basic demographics, their alcohol, drug, and opioid intake, and their history of domestic and IPV. Descriptive statistics, univariate, and multivariate regression analyses were conducted in STATA 17.1 software. A sample of patients with an OUD diagnosis in their medical record found that 64 percent of patients acknowledged having a history of opioid addiction. Patients acknowledging OUD were more likely to not be married (divorced or single) (p < 0.01), younger than 50 years of age (p < 0.01), non-White (p < 0.01), and had higher average ACEs scores (p < 0.0X). Patients who reported OUD were also more likely to be both victims and perpetrators of DV/IPV compared to patients who denied OUD. OUD needs to be treated holistically to ensure that the adverse consequences of DV and IPV do not become a silent disease perpetuated on this population, their families, and society.

Use of the Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Saudi Postmenopausal Women.

Osteoporosis is commonly referred to as the "silent disease," as bone loss is gradual and asymptomatic. In older women and men, osteoporosis can lead to increased bone fragility, thus increasing the risk of fractures. These fractures are associated with healthcare costs, physical disabilities, impaired quality of life, and mortality. Therefore, the study's main objective was to assess the applicability of the osteoporosis self-assessment tool (OST) in predicting osteoporosis in Saudi postmenopausal women who are 60 years of age and older and to give a thorough understanding of how such a method can aid in the early diagnosis of osteoporosis in Saudi Arabia and give physicians enough time to treat it. Methods: This study was done at King Abdulaziz Medical City, Riyadh, Saudi Arabia, where we included postmenopausal Saudi women 60 years of age and older who took the bone mineral density (BMD) test in the family medicine department. The approximate target population in this group, between the years 2016 and 2022, was 2969 patients. All data was taken from the BestCare database at King Abdulaziz Medical City in Riyadh. Data weretyped in an Excel sheet (Redmond, USA), then transferred to the R Studio software. The data collection method was chart review, so no informed consent was needed from patients. Names and medical record numbers were not stored. Results: The study included 2969 participants. According to the bone mineral density (BMD) T score results, 490 participants (16.5%) were normal, 1746 participants (58.8%) had osteopenia, and 733 participants (24.7%) suffered from osteoporosis. BMD T scores for normal, osteopenia, and osteoporosis participants were -0.6 (-0.9, -.3), -1.8 (-2.1), and -3 (-3.5, -2.7), consecutively. Estimated OSTI scores for those patients were 2 (0, 4), 1 (-2, 3), and -1 (-4, 1), consecutively. According to the OSTI score for normal participants, 4.29% were classified as being at high risk of osteoporosis. A high risk of osteoporosis was identified in 0.74% of those with osteopenia. 27.83% of osteoporosis patients were classified as being at high risk of osteoporosis. To differentiate normal individuals from those with osteopenia, the cutoff value with optimal sensitivity was 3.5. At such a cutoff value, the test sensitivity was 81.04%. To differentiate normal participants from those with osteoporosis, the cutoff value with optimal sensitivity was 2.5. At such a cutoff value, the test sensitivity was 86.49%. To differentiate osteopenia from osteoporosis patients, the cutoff threshold with optimal sensitivity was 1.5. At such a threshold, sensitivity was 78.44%. Conclusion: OSTA is a simple and validated tool that can identify subjects at increased risk of osteoporosis. Its use could facilitate a more cost-effective use of BMD; by avoiding measurements in low-risk groups.

How Can We Prevent Mother-to-Child Transmission of HTLV-1?

The perception of human T-cell leukemia virus type 1 (HTlV-1) infection as a "silent disease" has recently given way to concern that its presence may be having a variety of effects. HTLV-1 is known to cause adult T-cell leukemia (ATL), an aggressive cancer of peripheral CD4 T cells; however, it is also responsible for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Most patients develop ATL as a result of HTLV-1 mother-to-child transmission. The primary route of mother-to-child transmission is through the mother's milk. In the absence of effective drug therapy, total artificial nutrition such as exclusive formula feeding is a reliable means of preventing mother-to-child transmission after birth, except for a small percentage of prenatal infections. A recent study found that the rate of mother-to-child transmission with short-term breastfeeding (within 90 days) did not exceed that of total artificial nutrition. Because these preventive measures are in exchange for the benefits of breastfeeding, clinical applications of antiretroviral drugs and immunotherapy with vaccines and neutralizing antibodies are urgently needed.

Screening of celiac disease in children with growth failure

Celiac disease is a chronic enteropathy caused by intolerance to gluten. Its clinical spectrum is broad. Presentation of celiac disease varies from absence of symptoms to gastrointestinal (classic) and/or extraintestinal (non-classic) symptoms. Patients without symptoms may have latent or silent celiac disease. Because celiac disease can be atypical or even clinically silent, many patients remain undiagnosed and at risk for the long-term, sometimes serious complications of untreated celiac disease.The aim of this study is to determine the prevalence of celiac disease (CD) in children with growth failure and the diagnostic value of tissue-transglutaminase (TTG) IgA antibodies and IgA antigliadin antibodies (AGA) for celiac disease.Patients and Methods: A total of 104 children (43 male, 61 female) with growth failure without a specific etiology were studied. Extensive investigations had shown no abnormalities in any subject. Anthropometric parameters and IgA AGA and IgA TTG antibodies were evaluated in this study group. These antibodies were measured by enzyme-linked immunosorbent assay. All patients were referred for an endoscopic intestinal biopsy. The biopsy samples were classified according to revised Marsh criteria .Results: the prevalence of properly diagnosed CD among patients with growth failure in this study was 25.9% (27 of 104patients).Out of 104 patients 57 of them were positive upon screening with the serological tests. IgA -AGA, and IgA -TTG antibodies were found in 81.4% (n = 22 out of 27 with confirmed CD), and 88.8% (n = 24 out of 27 with confirmed CD) of patients with growth failure, respectively. Sensitivity,Specificity ,the positive predictive value (PPV),negative predictive value(NPV) for TTG antibodies were found to be 88.8%, 94.2%, 85.7%, and 94.7% for CD in the group of patients with growth filure in this study and for IgA AGA: sensitivity 81.4%, specificity 88.4%, positive predictive value( PPV) 75.8%, negative predictive value (NPV) 90.6% were found in this study.Conclusion: We conclude that the prevalence of celiac disease is high in patients with idiopathic growth failure and it is important to test all children with idiopathic growth failure for celiac disease by measuring serologic markers and performing an intestinal biopsy.

Preliminary Program Guide: Wednesday, May 24, 2023

Preliminary Program Guide: Wednesday, May 24, 2023

Abstract P671: Association Between Renal Function and Silent Cerebrovascular Disease in Japanese Men

Background and Aim: To determine whether a mild decrease in renal function is an indicator of early detection of silent cerebrovascular disease, we conducted a cross-sectional study in 735 community-dwelling Japanese men. Methods: The prevalence of silent cerebrovascular disease was defined as intracranial artery stenosis (ICAS), lacunar infarctions (LIs), cerebral microbleeds (CMBs), periventricular hyperintensities (PVHs: grade ≥2), and deep and subcortical white matter hyperintensities (DSWMHs: grade ≥3), using brain magnetic resonance imaging independently evaluated by two specialists. In addition, a total cerebral small vessel disease (TCSVD) score was used, summing LIs, CMBs, PVHs, and DSWMHs. We calculated the estimated glomerular filtration rate calculated with creatinine or cystatin C (eGFRcr or eGFRcys) using the CKD-EPI formula for Japanese and the equations by the Japanese Society of Nephrology, respectively. The urinary albumin/creatinine ratio (UACR) was dichotomized at 30 mg/gCre, and the low group was further divided into tertiles. eGFRcr and eGFRcys were also dichotomized at 60 ml/min/1.73 m 2 , and the high group was further divided into tertiles. The odds ratios (ORs) and 95% confidence intervals (95%CIs) for the prevalence of silent cerebrovascular disease by renal function were calculated using binary or ordinal multivariable adjusted logistic regression models. Results: The prevalence of ICAS, LIs, CMBs, and white matter lesions (WMLs: the prevalence of PVHs or DSWMHs) was 30% (220/735), 21% (155/735), 14% (102/735), and 32% (237/735), respectively. The multivariable adjusted ORs (95%CI) of the prevalence of CMBs and TCSVD score were higher in the high UACR (&gt;30mg/gCre) group (3.83 (1.90-7.73) and 1.75 (1.12-2.74), respectively) than in the low UACR (≤4.7 mg/gCre) group; the linear trend was significant (p &lt;0.001 and p=0.025, respectively). The multivariable adjusted ORs (95%CI) of TCSVD score was higher in the decreased (&lt;60 ml/min/1.73 m 2 ) eGFRcr or eGFRcys group (1.70 (0.998-2.91) and 1.85 (1.10-3.10), respectively) than in the high eGFRcr group (≥75.9 ml/min/1.73 m 2 ) or the high eGFRcys group (≥83.3 ml/min/1.73 m 2 ); the linear trend was shown (p=0.036 and p=0.072, respectively). The multivariable adjusted ORs (95%CI) of the prevalence of WML was higher in the decreased (&lt;60 ml/min/1.73 m 2 ) and mildly decreased (60-69.9 ml/min/1.73 m 2 ) eGFRcr groups (2.41 (1.31-4.43) and 1.78 (1.05-3.02), respectively) than in the high eGFRcr group (≥75.9 ml/min/1.73 m 2 ); the linear trend was significant (p&lt;0.001). eGFRcys and the prevalence of WML also showed similar associations. Conclusion: Decreased renal function was associated with the presence of silent cerebrovascular disease. Our results suggest that even a mild decline in renal function may be an indicator of early detection of silent cerebrovascular disease.

Performance of the 2019 ESC/EASD guideline strategy for the screening of silent coronary artery disease in patients with diabetes

BackgroundThe 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy) or high coronary artery calcium (CAC) score. This study aimed to test the validity of this strategy.MethodsIn this retrospective study, we included 385 asymptomatic patients with diabetes and no history of coronary disease but with TOD or ≥ 3 risk factors in addition to diabetes. CAC score was measured using computed tomography scan and a stress myocardial scintigraphy was performed to detect silent myocardial ischemia (SMI), with subsequent coronary angiography in those with SMI. Various strategies to select patients to be screened for SMI were tested.ResultsCAC score was ≥ 100 Agatston units (AU) in 175 patients (45.5%). SMI was present in 39 patients (10.1%) and among the 30 patients who underwent angiography, 15 had coronary stenoses and 12 had a revascularization procedure. The most effective strategy consisted in performing myocardial scintigraphy in the 146 patients with severe TOD and, among the 239 other patients without severe TOD, in those with CAC ≥ 100 AU: this strategy provided 82% sensitivity for SMI diagnosis, and identified all the patients with stenoses.ConclusionThe ESC-EASD guidelines suggesting SMI screening in asymptomatic patients with very high risk assessed by severe TOD or high CAC score appears effective and could identify all the patients with stenoses eligible for revascularization.