Single-centre Cross-sectional Observational Study Research Articles

Correlation Between Serum Copeptin and NTproBNP Levels in Heart Failure

Introduction: Heart Failure is a leading cause of morbidity and mortality worldwide. It is associated with upregulation and dysfunction of the renin-angiotensin aldosterone system, the sympathetic nervous system and the vasopressin system. In heart failure, the levels of vasopressin are elevated and out of sync with the osmotic status. Arginine Vasopressin has a half-life of only 20 minutes and is bound to circulating platelets. Hence, it is not useful as a biomarker. Copeptin, a by-product of vasopressin metabolism has been used as a surrogate marker for Arginine Vasopressin in clinical practice. Thus, our study aims to find the use of copeptin in studying heart failure and its use in predicting severity. We also sought to correlate copeptin with NTproBNP the standard biomarker used in heart failure. Methods: Our study was a single-centre cross-sectional observational study involving 90 admitted heart failure patients over 18 months. NYHA Class was used to assess the severity of heart failure. Copeptin levels were measured using Human Copeptin ELISA Kit. Results: In these patients, elevated levels of copeptin and NTproBNP were found. In patients with higher NYHA Class, a greater rise in serum copeptin and NTproBNP levels was noted. Moreover, a strong positive correlation between NTproBNP and copeptin (rho = 0.7) was found in our study. Conclusion: Our study puts forward copeptin as a simple additional cost-effective biomarker for predicting the severity of heart failure.

Systolic and global right ventricular functions of children with bronchial asthma as compared with those of healthy controls using echocardiography: a single-centre cross-sectional observational study from Nigeria

BackgroundAsthma is the most prevalent chronic airway condition in children. It is characterised by hyperresponsiveness of the small airways leading to airway narrowing, which is usually reversible, with or without treatment. Asthma is known to cause right ventricular dysfunction, but not much is known of this effect among children with highest burden of asthma. The aim of this study is to compare the right ventricular functions of children with asthma, aged 6– ≤ 13 years, with those of their age and sex-matched apparently healthy control using transthoracic echocardiography. The systolic and global right ventricular functions were assessed using Tricuspid Annular Plane Systolic Function (TAPSE) and Tei index, respectively.ResultsSeventy cases and 68 controls were included in the final analysis of the results. The male-to-female ratios are 1.9:1 and 2:1 for the cases and controls, respectively, and their mean age were 8.82 (± 2.28) and 9.05 (2.50) years. There was no statistically significant difference between their sex (X2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${X}^{2}$$\\end{document}/P = 0.810/0.85) and their mean age (P = 0.554). The mean TAPSE of the cases (20.16 ± 2.15 mm) and the controls (20.28 ± 2.71 mm) did not differ significantly (P = 0.74), but the mean Tei index of the cases (0.56 ± 0.16) was significantly higher than that of the control (0.50 ± 0.10) (P = 0.007). Among the asthmatics, 17.1% (12/70) and 2.9% (2/70) had global and systolic RV dysfunctions, respectively; 2.9% (2/70) of the controls had RV global dysfunctions, but none had RV systolic dysfunction. The global dysfunction among the asthmatics was significantly associated with their age range and frequency of hospitalisation (X2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${X}^{2}$$\\end{document} /p of 6.051/0.014 and 7.209/0.021, respectively), and significantly correlates with their Body Mass Index, and peripheral oxygen saturation (r/P of −0.236/0.049 and − 2.490/0.038, respectively). None of the participants had right ventricular systolic dysfunction.ConclusionThis study shows that asthmatic patients have global RV dysfunction, and it is suggested that better control of asthma would preserve cardiac function.

Relevance of the Immunohistochemical Expression of p53 and E-cadherin in the Grading of Urothelial Carcinoma: A Single-Center Cross-Sectional Observational Study.

Background Urothelial carcinoma (UC) is a prevalent cancer worldwide, primarily affecting the urinary bladder. It is more common in men than women and is often linked to factors like tobacco smoking, occupational exposure, and chronic infections. UC can be classified into different subtypes based on its growth pattern (papillary or non-papillary) and the extent of invasion into the bladder wall. The management of UC depends on its grade and stage, with treatment options ranging from transurethral resection of bladder tumor (TURBT) for non-invasive tumors to cystectomy for muscle-invasive disease. This study aimed to investigate the expression of p53 and E-cadherin in low-grade and high-grade UC and their correlation with histomorphological parameters. Materials and methods A cross-sectional observational study was conducted on 50 histopathologically confirmed UC cases. Immunohistochemical (IHC) staining for p53 and E-cadherin was performed, and the results were correlated with clinicopathological features. Statistical analysis was performed to find the correlation between p53 and E-cadherin immunoexpression and the grade of UC. Results The cohort's mean age was 58.18±12.99 years, with a male predominance (76%). Most cases (52%) were from rural areas and unskilled workers (52%). Hematuria was present in all cases (100%), while urgency and frequency were reported in 32% each. High-grade UC was more common (76%), with 48% being invasive. Muscle invasion was absent in 56%. p53 overexpression was seen in all cases, with 38% moderate and 36% strong staining. Twenty-two out of 24 cases (91.7%) of invasive UC showed low E-cadherin expression, while all 26 cases (100%) of low-grade papillary UC and high-grade papillary UC displayed high E-cadherin expression. This suggests that reduced E-cadherin expression is strongly associated with invasive UC, potentially as a tumor aggressiveness and progression marker. Conclusion Considering that elevated p53 protein expression is linked to aggressive tumor behavior, a more intensive treatment strategy is recommended for patients with non-muscle-invasive bladder cancer (NMIBC) who show high p53 protein scores. On the other hand, the downregulation or absence of E-cadherin expression has been recognized as a strong indicator of advanced grade and higher clinical stages.

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

BackgroundAs with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.MethodsThis is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED.ResultsThere were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care.ConclusionOur findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

DermatopathologyOral presentationsDP01 A single-centre cross-sectional observational study on dermoscopy of genital mucosal disorders and histopathological correlation in a tertiary care centre

DermatopathologyOral presentationsDP01 A single-centre cross-sectional observational study on dermoscopy of genital mucosal disorders and histopathological correlation in a tertiary care centre

#52 Pulmonary hypertension in hemodialysis patients: prevalence and risk factors: a single center study

Abstract Background and Aims Pulmonary hypertension (PH) is an underestimated cardiovascular trouble in patients on hemodialysis (HD). Therefore, we studied its prevalence, risk factors, association with inflammation, and cardiac changes in HD patients. Method This was a single-center cross-sectional observational study conducted at Sfax CNSS polyclinic hemodialysis center during October 2023. Patients on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters, and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure (PAP) of > 25 mmHg at rest, and it was further divided as mild (26–39 mmHg), moderate (40–60mmHg), and severe (> 60 mmHg). Mean levels of PAP were compared in different groups according to the main clinical parameters. Results Of 30 patients, 21 patients had PH (mild:15, moderate:4, and two had severe PH) with a prevalence of 70%, and a mean age of 58 years old. No difference was found in clinical characteristics, dialysis-related factors, and biochemical parameters. Inflammation seemed to be more important in the PH group but the difference was not statistically significant (mean C-reactive protein in the PH group vs. 5,69 in the non-PH group; p=0,34). Otherwise, according to echocardiography findings, PAP was significantly higher in patients with left ventricular failure(HF) (mean PAP in HF group vs. 31,12 in the non-HF group; p=0,011), in patients with right ventricular dilation(RVD)(mean PAP in RVD patients=47,83mmHg vs 28,88mmHg in the non-RVD group; p=0,05) and in patients with mitral regurgitation(MR) (mean PAP in MR group=40,18mmHg Vs 28,32mmHg in the non-MR group; p=0,04). Conclusion Haemodialysis patients have a high prevalence of PH, especially in patients with heart failure and ventricular dilation. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Inflammation was slightly higher in PH but our study did not find significant differences in traditional risk factors, and HD-related factors between the groups with and without PH.

Co-prevalence of arterial aneurysm location - a correlation analysis based on a retrospective cross-sectional observational study.

Background: The aim of this retrospective single-centre cross-sectional observational study was to investigate co-prevalence of arterial aneurysm location systematically. Patients and methods: Patients with the diagnosis of any arterial aneurysm from January 2006 to January 2016 were investigated in a single centre. Patients with hereditary disorders of connective tissue, systemic inflammatory disease, or arterial pathologies other than true aneurysms were excluded. Aneurysm locations were assessed for every patient included. For patients with at least two co-existing aneurysms, co-prevalence of aneurysm location was investigated by calculating correlation coefficients and applying Fisher's exact test. This study report is prepared according to the STROBE statement. Results: Of 3107 identified patients with arterial aneurysms, 918 were excluded. Of the remaining 2189 patients, 951 patients with at least two aneurysms were included in the study. Bilateral aneurysm combinations of paired iliac, femoral and popliteal arteries showed the highest correlation (ϕ=0.35 to 0.67), followed by bilateral combinations of subclavian (ϕ=0.36) and internal carotid (ϕ=0.38) arteries. Abdominal aortic aneurysms in combination with visceral artery aneurysms (ϕ=-0.24 to -0.12), popliteal arteries (ϕ=-0.22) and the ascending aorta (ϕ=-0.19) showed the lowest correlation, followed by the descending aorta in combination with the common iliac arteries (ϕ=-0.12 to -0.13). Conclusions: In our study sample, aneurysm co-prevalence was highly non-random. This should be considered in the context of aneurysm screening programs.

Serum biomarkers associated with liver fibrosis in patients with type 2 diabetes

BACKGROUND: The diagnosis of liver fibrosis is an important task in the management of patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes. The currently used diagnostic methods have a number of disadvantages such as invasiveness and high cost, or insufficient sensitivity and specificity. Therefore, the search for new non-invasive markers of liver fibrosis remains an actual challenge.AIM: To assess a diagnostic value of serum growth differentiation factor-15 (GDF-15), microfibril-associated glycoprotein 4 (MFAP-4), collagen type IV alpha1 (COL4alpha1), Mac-2 binding protein (M2BPGI) and chitinase-3-like protein 1 (YKL-40) as markers of liver fibrosis in patients with type 2 diabetes and NAFLD.MATERIALS AND METHODS: A single center cross-sectional observational study was performed. The study included 74 patients, 23 men and 51 women, aged 18 to 74 years. Liver elastography was used as reference method for the fibrosis evaluation. APRI and fib-4, non-invasive fibrosis indices, were assessed. Serum concentrations of GDF-15, MFAP-4, COL4alpha1, M2BPGI, and YKL-40 were determined by ELISA. ROC analysis was used to evaluate the sensitivity and specificity of serum markers for the diagnosis of the liver fibrosis.RESULTS: Liver fibrosis stage 1 was verified in 16 subjects, stage 2 in 12, stage 3 in 7, and stage 4 in 19. Patients with advanced liver fibrosis (stages 3–4), compared with those without severe fibrosis (stages 0–2), had higher levels of GDF-15 (p=0.003), COL4alpha1 (p=0.007), and YKL-40 (p=0.04). Patients with stage 1-2 liver fibrosis had higher levels of COL4alpha compared to those without any signs of fibrosis (p=0.02). There were no significant differences in the level of MFAP-4 and M2BPGI between patients with different severity of fibrosis. According to the ROC analysis, GDF-15, COL4alpha1 and YKL-40 have diagnostic value in the detection of severe liver fibrosis comparable to that of the APRI and fib-4 indices.CONCLUSION: GDF-15, COL4alpha1 and YKL-40 could be considered as promising non-invasive markers of liver fibrosis in patients with type 2 diabetes and NAFLD.

An observational study ascertaining the prevalence of bullae and blebs in young, healthy adults and its possible implications for scuba diving.

Introduction: Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers. However, literature is unclear about the prevalence of bullae in healthy adults, ranging from 2.3-33.8%. While this could in part be explained due to increasing quality of radiologic imaging, such as computed tomography (CT) scans, other methodological factors may also affect these findings. This study aims to ascertain the prevalence of bullae in young and healthy adults. Methods: This single-center cross-sectional observational study re-assessed the CT scans of adults (aged 18-40) performed for a clinical suspicion for pulmonary embolism, from 1 January 2016 to 1 March 2020. Presence of bullae was recorded in an electronic database. Chi-square and Fisher exact tests were used for statistical analyses. Additionally, a multivariate logistic regression analysis was performed to study the independent predictive value of identified risk factors. Results: A total of 1,014 cases were identified, of which 836 could be included. Distribution amongst age groups (18-25, 26-30, 31-35, and 36-40) was almost equally, however, 75% of the population was female. Of the male proportion, 41% smoked, compared to 27% in females. In 7.2% (95% CI 5.6-9.1) bullae were identified. The prevalence increased with increasing age (p < 0.001), with odd ratios up to 5.347 (95% CI 2.164-13.213, p < 0.001) in the oldest age group. Males and smokers had higher odds ratios for bullae of 2.460 (95% CI 1.144-4.208; p = 0.001) and 3.406 (95% CI 1.878-6.157, p < 0.001), respectively. Similar results were seen in the multivariate logistic regression analysis, where age, male sex and smoking were all statistically significant independent risk factors for bullae. Discussion: Bullae were seen in 7.2% of a healthy population up to 40years old. Increasing age, smoking, and being male were identified as statistically significant risk factors, both in independent and in multivariate logistic regression analyses. Our observations may warrant a re-evaluation of the contribution of bullae to PBT and AGE, as the latter two occur very rarely and bullae appear to be more frequently present than earlier assumed.

A Single-Center Cross-Sectional Observational Study on Dermoscopy of Genital Mucosal Disorders in a Tertiary Care Center in Central India.

Dermoscopy of mucosa is known as mucoscopy. Mucoscopy can aid in delineating minute aspects of mucosal lesions and will guide in the differentiation of similar-looking lesions. To date, there are only a few studies on mucoscopy of genital dermatoses especially from India. The study aims to describe mucoscopic features and correlate histopathologically in various genital mucosal diseases. The study was conducted in a tertiary care center in Central India after IHEC approval between October 2020 and April 2022, and the sampling technique was based on a convenience purposive method. Any genital mucosal diseases were included in patients above 18 years of age. Sexually transmitted diseases in general were excluded, however, warts and molluscum contagiosum were included. All patients fulfilling the inclusion criteria were examined after proper informed consent, and the clinical images were photographed using iPhone 11. Dermoscopic images were taken using a DermLite DL4 dermoscope in polarized mode at 10X magnification. A total of 206 patients were recruited, and mucoscopy features were analyzed. Dermoscopic findings of physiological conditions such as vestibular papillomatosis, pearly penile papules, and Fordyce spots were evaluated. Inflammatory conditions such as lichen planus, pemphigus, and psoriasis were analyzed. Mucoscopy of lichen sclerosus showed white structureless areas (100%), follicular plugs (35%), as well as dotted and linear vessels (80%). Circinate balanitis revealed regular red dotted vessels (100%), coalescing pustules in annular and polycyclic patterns (90%). Squamous cell carcinoma of the penis showed ulceration, serpentine, looped vessels, white structureless area, and yellow-brown crust in a pink background. In our study, because of the inclusion of various diseases, sample size was inadequate, biopsies were not performed in all cases, and variations in mucoscopic features in patients who are already on therapy could not be assessed. Haziness while capturing pictures because of mist formation was hindering the quality of pictures. As patients with premalignant and malignant cases were less, the predicting features for malignant transformation or pathognomoniic signs could not be assessed. Various dermoscopies have been studied extensively, but the mucoscopy is still a gray area. The results of this study revealed the dermoscopic features of various genital disorders and histopathological correlation in few cases. However, biopsy was not performed in all mucosal disorders; hence, conclusive correlation could not be extrapolated.

Serum level of proteins involved in apoptosis and autophagy in patients with type 2 diabetes and non-alcoholic fatty liver disease

Aim of the study was to estimate the blood serum level of microtubule-associated protein 1 light chain 3 alpha (MAP1LC3alpha), beclin-1 (BECN-1), Bcl-2 (BCL-2), caspase-3 (CASP3) and autophagy related 5 (ATG-5) protein as potential markers of liver fibrosis in type 2 diabetes (T2D) patients with non-alcoholic fatty liver disease (NAFLD).Material and methods. A single center cross-sectional observational study was performed. Seventy four patients with T2D and NAFLD were included, 23 men and 51 women, aged 18 to 74 years. Transient elastography was used for the assessment of liver fibrosis. The severity of fibrosis was estimated using the Metavir sсore. In addition, indirect liver fibrosis indices APRI and FIB-4 were calculated. Serum concentration of MAP1LC3alpha, BECN-1, BCL-2, CASP and ATG-5 was measured by ELISA. We applied ROC analysis to assess the value of studied indicators in diagnosis of liver fibrosis.Results. Liver fibrosis stage F1 was verified in 16 subjects, stage F2 in 12, stage F3 in 7, and stage F4 in 19 individuals. Patients with advanced liver fibrosis (stage 3-4) when compared to those without fibrosis (stage 0–2) had higher content of MAP1LC3alpha (p = 0.01) and BECN-1 (p = 0.01). There were no significant differences in the level of BCL-2, CASP3 and ATG-5 between patients with different severity of fibrosis. In the ROC analysis, MAP1LC3alpha and BECN-1 showed significance for the diagnosis of severe liver fibrosis, which, however, did not exceed that of the APRI index.Conclusions. In patients with T2D and NAFLD, serum levels of MAP1LC3alpha and BECN-1 are associated with severe liver fibrosis.

Effects of Haemodialysis on Anterior Segment Parameters of the Eye in Patients with Endstage Renal Disease: A Cross-sectional Study

Introduction: Ocular manifestations of Haemodialysis (HD) are one of the important causes of morbidity in End-stage Renal Disease (ESRD) patients. According to studies, the incidence rate of glaucoma in the dialysis group was higher than that in the non dialysis group. Angle-closure glaucoma was found to be more common, which depends on anterior chamber morphology. Aim: To assess the effect of HD on Intraocular Pressure (IOP), Anterior Chamber Depth (ACD), and Lens Thickness (LT) in patients with ESRD. Materials and Methods: This was a single-centre crosssectional observational study conducted in the Department of Ophthalmology on 170 eyes of 87 patients undergoing HD for at least three months. The study was conducted between October 2020 and October 2022 at the Dialysis Centre of Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, Maharashtra, India. These patients underwent ophthalmological evaluation pre- and postdialysis. IOP, ACD, and LT were measured 30 minutes prior to and 30 minutes after the HD session. The paired t-test was used to compare differences in means, and a p-value of &lt;0.05 was considered significant. Results: The mean age of the study participants was 57.63±11.95 years. There was a decrease in mean ACD by 0.08±0.29 mm (p=0.0001) and an increase in mean LT by 0.06±0.42 mm (p-value=0.0001) postdialysis. The changes in IOP were variable and not statistically significant (p=0.45). Conclusion: Postdialysis, a significant increase in LT was observed corresponding to a decrease in ACD. Although the change in IOP was variable, this change might be more significant in pre-existing narrow-angle patients undergoing dialysis. As a result, the present study underscores the urgency of refining screening protocols for HD patients to effectively address these identified ocular changes and associated risks.

Classifying Pre-Radiographic Osteoarthritis of the Knee Using Wearable Acoustics Sensing at the Point of Care.

This study was undertaken to determine if knee acoustic emissions (KAE) measured at the point of care with a wearable device can classify knees with pre-radiographic osteoarthritis (pre-OA) from healthy knees. We performed a single-center cross-sectional observational study comparing KAE in healthy knees to knees with clinical symptoms compatible with knee OA that did not meet classification criteria for radiographic knee OA. KAE were measured during scripted maneuvers performed in clinic exam rooms or similarly noisy medical center locations in healthy (n=20), pre-OA (n=11), and, for comparison, OA (n=12) knees. Acoustic features were extracted from the KAE and used to train models to classify pre-OA, OA, and control knees with logistic regression. Model performance was measured and optimized with Leave-One-Out Cross-Validation. Regressive sensitivity analysis was performed to combine acoustic information from individual maneuvers to further optimize performance. Test-retest reliability of KAE was measured with intraclass correlation analysis. Classification models trained with KAE were accurate for both pre-OA and OA (94% accurate, 0.96 and 0.99 area under a receiver operating characteristic curve (AUC), respectively). Acoustic features selected for use in the optimized models had high test-retest reliability by intrasession and intersession intraclass correlation analysis (mean intraclass correlation coefficient 0.971 +/- 0.08 standard deviation). Analysis of KAE measured in acoustically uncontrolled medical settings using an easily accessible wearable device accurately classified pre-OA knees from healthy control knees in our small cohort. Accessible methods of identifying pre-OA could enable regular joint health monitoring and improve OA treatment and rehabilitation outcomes.

Frequency of instrumental activities of daily living is associated with objectively measured physical activity in stable patients with cardiovascular disease

Abstract Introduction Implementation of instrumental activities of daily living (IADL) has the necessary items for independent living in community-dwelling, which is reported as a relevant factor for better prognosis in patients with cardiovascular disease (CVD). Physical activity (PA) is well-known to have benefits in reducing the risk of all-cause mortality and CVD. Although IADL and PA are similar behaviors and crucial intervention targets to prevent the recurrences of CVD in patients who participate in phase III cardiac rehabilitation, these interrelations remain unclear. Purpose This study aimed to evaluate the association between IADL frequency and objectively measured PA, including step counts and time of vigorous activity, in stable patients with CVD. Additionally, we examined whether detailed types of IADL frequency were associated with PA. Methods This was a single-center cross-sectional observational study. We included patients with CVD who received outpatient care with stable condition for at least six months. Participants completed Frenchay Activities Index (FAI) questionnaire as an assessment of IADL frequency. The FAI contains 15 items, classified as housework and leisure activity. We used accelerometers to measure the objective number of steps and minutes of moderate to high-intensity physical activities for two weeks and calculated their averages per day as indicators of PA levels. The associations of FAI total score and 15 FAI sub-items with physical activities (the number of steps and minutes of moderate to high-intensity physical activities per day) were analyzed using a multivariate linear regression model. Results Studied patients consisted of 1126 stable patients with CVD (mean age, 72.6 ± 10.0 years; 848 males). After adjusting for clinical confounding factors, high FAI total score was significantly associated with higher levels of physical activities (the number of steps per day: unstandardized coefficient [В] for FAI increase of 1 point = 78.1 [95% confidence interval {CI}, 54.9–101.4], Figure 1-A; the minute of moderate to high-intensity PA per day: В = 0.184 [95%CI, 0.063–0.304], Figure 1-B). In the sub-items of FAI, four items of housework activities (washing up, light housework, heavy housework, and local shopping) and six items of leisure activity (walking outside for &amp;gt; 15 minutes, actively pursuing hobbies, driving a car or bus travel, gardening, reading books and gainful work) were also positively associated with the number of steps per day. Conversely, only two items of leisure activity (walking outside and actively pursuing hobbies) were associated with moderate to high-intensity PA per day (Figure 2). Conclusions The frequency of IADL has a positive association with objectively measured PA, suggesting that IADL might be useful behavior to administrate PA in stable patients with CVD. Moreover, leisure activity in IADL is especially relevant to vigorous PA in these patients.Figure 1Figure 2

Improvement of microcirculatory vessel density in the early post-operative period of heart valve surgery: an observational study

Abstract Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is associated with microcirculatory perfusion disturbances that persist after the surgery and that can cause multiple organ dysfunction. Little is known about the effects of heart surgery on the microcirculation of patients in the postoperative period of heart valve surgery. Purpose The purpose of the study is to identify the alterations that occur in the sublingual microcirculation of patients submitted to heart valve surgery using cardiopulmonary bypass. Such findings may guide future implementation of routine microcirculation assessment in the postoperative period of cardiac surgery. Methods This was a single-center cross-sectional observational study that included thirty patients aged 52 ± 14 years and enrolled during a period of four months, scheduled for heart valve surgery with CPB at a quaternary public hospital. Sublingual microcirculatory density and perfusion were assessed using a handheld camera based on incident dark-field (IDF) imaging. Each recruited patient was evaluated in two stages: 1) during hospitalization, in the preoperative period of cardiac surgery to be performed within the next 48 hours; 2) in the early postoperative phase of cardiac surgery, within the first four hours of the patient's arrival at the intensive care unit. At least three videos of 5 seconds each were obtained in both stages. Images were analyzed using automated software as well as visual analysis. For analysis purposes, we considered vessels as capillaries if diameter ranges between 6.04-15.9 µm and non-capillaries if diameter ranges between 16-50 µm. Results We observed a statistically significant increase in the total number of vessels (TVN) after surgery (1076 ± 156) compared to values obtained before surgery (943 ± 117, P=0.0004). In addition, the total number of capillaries vessels (TNCV) was also greater after surgery (998 ± 132) compared to the preoperative period (877 ± 106; P=0.0001), the same being observed in the total length of capillaries vessels (TLCV) after surgery (28.7 ± 3.3 mm) compared to before surgery (25.8 ± 3.0 mm; P=0.0005) and capillary vessel density (CVD) (16.4 ± 1.9 and 14.8 ± 1.7 mm/mm2) after and before surgery, respectively (P=0.0005). With regard to non-capillary vessels, no difference was observed in total number of non-capillary vessels (TNNCV) after [68 (49-104)] and before surgery [69 (49-78)] (P=0.21), as well as in total length of non-capillary vessels (TLNCV) after [1.6 (1.2-2.4)] mm and before [1.5 (1.1-1.8.)] mm (P=0.25) surgery. Finally, non-capillary vessel density (NCVD) was also similar after [0.89 (0.67-1.36)] mm/mm2 and before surgery [0.83 (0.66-1.06)] mm/mm2 (P=0.34). Conclusion In patients undergoing heart valve surgery, there was a significant increase in postoperative microvessel number, mainly due to the increase in the density of capillaries vessels.

How do parents of wheezing children report their symptoms? A single centre cross-sectional observational study.

Reported wheeze is of major relevance in the diagnosis and management of asthma and epidemiological studies on asthma prevalence. Our aim was to investigate the understanding of this term by parents and how they reported it to clinicians. A single-centre cross-sectional observational study was carried out at a tertiary care hospital. Parents of wheezing children self-completed a written questionnaire, which was analysed to understand parental understanding of the term wheeze and the main symptoms noticed by them. Their responses were compared to the operational definition used in the ISAAC study. Questionnaires from 101 parents were analysed, out of which 50 children had an audible wheeze and 51 had an auscultatory wheeze. In our study, when asked about the main thing they noticed, 90 parents (89%) used non-auditory cues to identify wheeze, with the main presenting complaint being cough (n = 43, 42.6%), and only 4 (4%) reported wheezing. Even among the audible wheezers, only 7 (14%) used an auditory cue (alone or with some other cue) to describe their child's symptoms. Forty-seven parents knew the term wheeze, of which 19 parents (18.8%, N = 101) localised it to the chest, matching the epidemiological definition used in the ISAAC study. The word wheeze was not commonly used to describe a child's symptoms in our setting, even when the child was actively wheezing. Parents often use colloquial equivalents, nonspecific terms and other clinical cues such as coughing while reporting their child's symptoms. The parental concept of "wheezing" is different from epidemiological definitions.

Evaluation of Lipid Profile Changes In Patients With Inflammatory Bowel Disease: A Single Center Experience

Introduction: Inflammatory Bowel Disease (IBD) encompasses chronic inflammatory disorders of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. While initially considered a localized disorder, IBD has emerged as a systemic disease with a growing recognition of its potential impact on lipid metabolism and cardiovascular health. This study aims to comprehensively investigate lipid profiles and dyslipidemia prevalence among IBD patients, shedding light on potential associations with disease characteristics. Materials and Methods: A single-center cross-sectional observational study was conducted on 707 IBD patients between December 2007 and February 2021. Inclusion criteria comprised confirmed IBD diagnosis, age 18-65, and informed consent. Demographic data, medical history, anthropometric measurements, and fasting blood samples for lipid profile analysis were collected. Lipid profiles included total cholesterol, high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), and triglycerides. Statistical analyses, including t-tests, chi-square tests, and multivariate regression, explored associations. Results: This study reveals a high prevalence of dyslipidemia in IBD patients (58%), surpassing the general population. Notably, male IBD patients displayed significantly higher levels of total cholesterol, LDL-C, and triglycerides than their counterparts in the general male population. Differences in HDL-C levels were also observed. There were no significant variations in lipid profiles between Crohn's disease and ulcerative colitis patients within the IBD subgroup. Conclusion: The findings underscore the importance of regular lipid profile assessments in clinical management, particularly for male IBD patients. The significantly elevated prevalence of dyslipidemia in this population implies a potential influence of IBD on lipid metabolism and cardiovascular risk. Further research is needed to elucidate mechanisms and potential therapeutic interventions. Addressing dyslipidemia among IBD patients holds promise for reducing cardiovascular risk and enhancing overall health outcomes in this complex patient group.

A fact-finding survey on pre-ulcerative lesions of foot in patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2018 (DIACET 2018).

We aimed to identify the frequency and risk factors of pre-ulcerative lesions of foot in Japanese individuals with diabetes. This was a single-center cross-sectional observational study. We conducted a questionnaire survey of 5029 individuals with diabetes (mean age 63years; 2185 women; 1015 individuals with type 1 diabetes and 4014 individuals with type 2 diabetes) who (a) participated in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2018, and (b) responded to the presence of pre-ulcerative lesions of foot. A pre-ulcerative lesions of foot was defined as a calluses, ingrown nails, or symptoms of fungal infection. The associations between pre-ulcerative lesions of foot and commonly available clinical information were examined using the logistic regression analysis. 412 of 1015 (40.6%) individuals with type 1 diabetes and 1585 of 4014 (39.5%) individuals with type 2 diabetes reported having any type of pre-ulcerative lesions of foot. The frequency of calluses, ingrown nails, and symptoms of fungal infection, respectively, were 16.8%, 15.8%, and 21.9% in type 1 diabetes and 10.5%, 18.5%, and 24.7% in type 2 diabetes. In the separate analysis by type of diabetes, common risk factors found to be significantly correlated with pre-ulcerative lesions of foot were female gender, numbness in the feet and foot deformation. Proactive foot screening by health care professionals was considered important, especially in individuals with type 1 and type 2 diabetes with advanced complications and foot deformation. The online version contains supplementary material available at 10.1007/s13340-023-00649-7.

The Decline of Physical Activity with Age in School-Aged Children with Cerebral Palsy: A Single-Center Cross-Sectional Observational Study.

Maintaining physical activity is important for children with cerebral palsy (CP). This study examined whether age predicted habitual physical activity (HPA) or cardiorespiratory fitness (CRF) in school-aged children with CP and clarified the relationship between HPA and CRF. We utilized cross-sectional data from 39 children with CP (18 girls and 21 boys; mean age 7.44 years; mean body weight 24.76 kg; mean body mass index 15.97 kg/m2; hemiplegic or diplegic CP). The participants wore an accelerometer (ActiGraph) for five days to measure HPA, physical activity energy expenditure (kcal/kg/d), sedentary physical activity (%SPA), light physical activity, moderate-to-vigorous physical activity (%MVPA), and activity counts (counts/min). Participants underwent cardiopulmonary exercise tests on a treadmill using a modified Naughton protocol. Linear regression and correlation analyses were performed. p-value (two-tailed) < 0.05 was considered statistically significant. Age was positively associated with SPA. MVPA negatively correlated with resting heart rate (HR), and activity counts were negatively correlated with resting HR. In conclusion, our study found strong evidence of a negative association between HPA and age in school-aged children with CP. It highlights the importance of creating and improving recreational opportunities that promote physical activity in all children with CP, regardless of whether they are considered therapeutic.

Serum Ammonia Levels as a Non-invasive Predictor of the Presence and Severity of Esophageal Varices in Chronic Liver Disease Patients.

Background Portal hypertension leads to the formation of portosystemic collateral veins, of which esophageal varices (EV) are the most severe complications and have the greatest clinical impact. The possibility of identifying cirrhotic patients with varices by non-invasive tests is appealing, as they can lead to reduced healthcare costs and can be done in resource-limited settings. In this study, we investigated ammonia as a potential non-invasive predictor of EV. Methods This was a single-center cross-sectional observational study that was done at a tertiary health care hospital in north India. It included 97 chronic liver disease patients irrespective of etiology after excluding patients with portal vein thrombosis and hepatocellular carcinoma to participate in endoscopic screening for the presence of EV and correlate it with various non-invasive markers like serum ammonia levels, thrombocytopenia and aspartate aminotransferase to platelet ratio index (APRI ). On the basis of endoscopy, enrolled patients were divided into two groups, i.e., group A consisting of large varices (grade III and grade IV) and group B consisting of patients with low-grade varices and no varices (grade II, grade I, and no varices). Results This study included 97 patients, out of which 81 patients have varices on endoscopy, and mean serum ammonia levels were found to be significantly higher in cases with varices (135 ±69.70 ) vs. those without varices (94±43) (p value=0.026). Further, on comparing serum ammonia values between patients with large varices (Grade III/IV) (Group A) with a mean value of 176 ± 83vs. Grade I/II/No varices (Group B) with a mean value of 107±47, which were significantly higher in Group A patients (<0.001). In our study, we also found a correlation between blood urea level as a non-invasive predictor of varices, but no statistically significant relation was found between thrombocytopenia and APRI. Conclusion This study found that serum ammonia can be used as a useful marker for the prediction of EV and can also be used to determine the severity of varices. Apart from ammonia, serum urealevels can also prove to be a good non-invasive marker for the prediction of varices although further multicentric studies are warranted to reach this conclusion.