Search

A certain level of endometrial bacterial infection and inflammation is involved in bovine uterine involution during the puerperal period. Factors that hamper normal uterine involution expose the uterine environment to pathological conditions, causing different endometritis levels. The lack of proper diagnostic tools extends the time to conception. Efforts have been made to elucidate the postpartum uterine environment, including bacterial flora, changes in transient endometrial inflammation, and the pathophysiology of endometritis, to improve bovine reproductive performance. E. coli and Trueperella pyogenes in the uterus are likely to cause persistent infection, and Mycoplasma bovigenitalium infection is associated with dystocia and cytological endometritis in postpartum dairy cows. Due to the widespread use of cytobrush as a diagnostic tool for bovine subclinical endometritis (SE) that enables quantification of the degree of inflammation, we found that endometritis at week 5 postpartum was associated with delayed first ovulation. Approximately 30% of open cows have SE during the postpartum period, and cows with low blood glucose during prepartum have a high risk of developing SE. Additionally, cows with purulent vaginal discharge do not always have endometritis but only vaginitis and/or cervicitis. Intrauterine infusion of polyvinylpyrrolidone-iodine (PVP-I) improves fertility and promotes endometrial epithelial cell regeneration after inducing transient uterine inflammation, suggesting that PVP-I could be a good alternative to antibiotics. In conclusion, prepartum management to prevent glucose deficiency, prompt diagnosis to identify causative agents and intrauterine inflammation levels, and appropriate treatment to minimize antimicrobial resistance is beneficial for tackling endometritis and improving reproductive performance in bovine herds.

Subclinical hypothyroidism (SH) is associated with hemodynamic and metabolic abnormalities that cause endothelial dysfunction and atherosclerotic cardiovascular diseases. Aortic velocity propagation (AVP), epicardial fat thickness (EFT), and carotid intima-media thickness (CIMT) may provide additional information in SH patients. This study aimed to evaluate thyroid stimulating hormone (TSH), AVP, EFT, and CIMT in SH patients, and determine the associations among these parameters. Eighty patients with SH and 43 euthyroid (EU) individuals were enrolled. Blood samples were collected to measure laboratory parameters. Patients were divided into two groups based on their TSH values (TSH ≥10 or TSH

Background and study aims Wilson’s disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders . The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS). Patients and methods A total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity. Results According to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1. Conclusion The current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.

Thyroxine (T4)+triiodothyronine (T3) combination therapy can be considered in case of persistent symptoms despite normal serum thyroid stimulating hormone in levothyroxine (LT4)-treated hypothyroid patients. Combination therapy has gained popularity in the last two decades, especially in countries with a relatively high gross domestic product. The prevalence of persistent symptoms has also increased; most frequent are complaints about energy levels and fatigue (80% to 90%), weight management (70% to 75%), memory (60% to 80%), and mood (40% to 50%). Pathophysiological explanations for persistent problems are unrealistic patient expectations, comorbidities, somatic symptoms, related disorders (Diagnostic and Statistical Manual of Mental Disorders [DSM-5]), autoimmune neuroinflammation, and low tissue T3. There is fair circumstantial evidence for the latter cause (tissue and specifically brain T3 content is normalized by T4+T3, not by T4 alone), but the other causes are viewed as more relevant in current practice. This might be related to the ‘hype’ that has emerged surrounding T4+T3 therapy. Although more and better-designed trials are needed to validate the efficacy of T4+T3 combination, the management of persistent symptoms should also be directed towards alternative causes. Improving the doctor-patient relationship and including more and better information is crucial. For example, dissatisfaction with the outcomes of T4 treatment for subclinical hypothyroidism can be anticipated as recent trials have demonstrated that LT4 is hardly effective in improving symptoms associated with subclinical hypothyroidism.

Objective Childhood absence epilepsy (CAE) is a disease with distinct seizure semiology and electroencephalographic (EEG) features. Differentiating ictal and subclinical generalized spikes and waves discharges (GSWDs) in the EEG is challenging, since they appear to be identical upon visual inspection. Here, spectral and functional connectivity (FC) analyses were applied to routine EEG data of CAE patients, to differentiate ictal and subclinical GSWDs. Methods Twelve CAE patients with both ictal and subclinical GSWDs were retrospectively selected for this study. The selected EEG epochs were subjected to frequency analysis in the range of 1–30 Hz. Further, FC analysis based on the imaginary part of coherency was used to determine sensor level networks. Results Delta, alpha and beta band frequencies during ictal GSWDs showed significantly higher power compared to subclinical GSWDs. FC showed significant network differences for all frequency bands, demonstrating weaker connectivity between channels during ictal GSWDs. Conclusion Using spectral and FC analyses significant differences between ictal and subclinical GSWDs in CAE patients were detected, suggesting that these features could be used for machine learning classification purposes to improve EEG monitoring. Significance Identifying differences between ictal and subclinical GSWDs using routine EEG, may improve understanding of this syndrome and the management of patients with CAE.

Objectives Myocardial injury during active coronavirus disease‐2019 (COVID‐19) infection is well described; however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID‐19 recovered patients and its correlation with various parameters. Methods A total of 134 subjects within 30–45 days post recovery from COVID‐19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results Of the 134 subjects, 121 (90.3%) were symptomatic during COVID‐19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID‐19 illness. Asymptomatic COVID‐19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients, respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease, respectively. LVGLS was significantly lower in patients recovered from severe illness(mild: ‐21 ± 3.4%; moderate: ‐18.1 ± 6.9%; severe: ‐15.5 ± 3.1%; p

As of other dairy animals, dromedary camel could be affected by mastitis, a complex disease occurring worldwide among dairy animals, with heavy economic losses largely due to clinical and subclinical mastitis. Yet, little is known about the occurrence and potential risk factors exposing to lactating camel mastitis in Ethiopia. Consequently, a cross-sectional study was carried out from November 2018 to April 2019 so as to determine the prevalence, associated risk factors, and major bacterial pathogens causing mastitis in traditionally managed lactating camels in Gomole district of Borena Zone. Consequently, 348 lactating camels were examined for clinical and subclinical mastitis, using California Mastitis Test (CMT). The overall prevalence of mastitis was 22.4% (78/348), including clinical 4.3% (15/348) and subclinical 18.1% (63/348) cases, respectively, whereas the quarter level prevalence of mastitis was 16.6% (232/1,392). Of the total 1,392 examined teats, the right hind (RHQ) (4.3%, 60/1392) and left hind quarters (LHQ) (4.3%, 60/1392) were the most frequently infected quarter, whereas the left front quarter (LFQ) (3.9%, 55/1392) was the least infected quarter. Age, body condition score, and lactation stages were significantly associated ( p < 0.05 ) with lactating camel mastitis prevalence among the putative risk factors. Among 312 quarters milk samples subjected to bacteriological examination, 69.9% (218/312) yielded mastitis causing pathogens, both Gram-positive and -negative bacterial isolates, while no growth was observed in 30.1% (94/312) of quarters sampled. Of the bacterial isolates obtained by culturing, Streptococcus spp. excluding Streptococcus agalactiae (S. agalactiae) (26.1%; 57/218) and Coagulase negative Staphylococci (22.9%, 50/218) were the dominant isolates identified, whereas S. agalactiae (3.2%, 7/218) was the least isolates obtained. The prevalence of camel mastitis in the study area was found to be considerably high. Hence, implementation of integrated approaches has great importance in the study setting for the prevention and control of mastitis so as to improve quality of camel milk, minimize economic loss, and prevent significant public health risks.

신경성 폭식증 증상과 우울 증상은 청소년기와 초기성인기에 공병할 위험이 높은 것으로 알려져 있으나, 두 증상의 양방향적 관련성을 조사하려는 시도는 부족하였다. 이에 본 연구에서는 고위험 여자대학생들을 대상으로 신경성 폭식증 증상과 우울 증상이 시간에 따라 서로 예측하는 과정을 종단자료 분석을 통해 검증하고자 하였다. 이때 신경성 폭식증과 우울장애의 중요한 위험요인으로 여겨지는 부정정서와 정서조절곤란을 통제함으로써, 두 증상 간 양방향적 관계를 더 엄격히 분석하였다. 이를 위해 이미 일정 수준 이상의 섭식문제를 경험하고 있는 신경성 폭식증 고위험 여자대학생 117명을 표집 하여 자기보고식 설문지를 이용해 신경성 폭식증 증상과 우울 증상, 부정정서, 정서조절곤란을 6개월 간격으로 총 3회 측정하였다. 자기회귀교차지연 모형 분석 결과, 이전 시점의 우울 증상이 6개월 후 시점의 신경성 폭식증 증상을 유의하게 예측하였으며, 이는 부정정서와 정서조절곤란의 효과를 통제한 후에도 유의하였다. 반면, 이전 시점의 신경성 폭식증 증상은 이후 시점의 우울 증상을 예측하지 못하였다. 본 연구의 결과를 바탕으로 연구의 이론적, 임상적 함의와 한계점을 논하였다.

Adrenal cysts are a rare entity that is usually nonfunctional and asymptomatic. Their association with adrenal neoplasms was rarely described in the literature. We report a unique case of a 40 -year-old woman who was referred for evaluation of a left adrenal incidentaloma with subclinical Cushing’s syndrome. The tumor was suspicious for malignancy regarding computed tomography scan (CT scan) features. Therefore, a laparoscopic left partial adrenalectomy was performed. Pathology examination showed multilocular spaces lined by endothelial cells which are compatible with endothelial adrenal cyst, associated to an adrenocortical adenoma. We further discuss the management of adrenal cyst with review of the literature.

Thyroid diseases occupy the top places in the structure of the endocrine pathology in recent years. According to the Ministry of Health of Ukraine, over the past 5 years the number of thyroid diseases has increased 5 times, and this indicator differs significantly in different regions of the country depending on a combination of environmental factors (remote stochastic effect of the Chernobyl accident, iodine deficiency, lifestyle, stress, malnutrition, micronutrient deficiencies, comorbidities, etc.). There is a close functional relationship between the thyroid and reproductive systems, which leads to a high probability of the development of combined disorders in one of these links of homeostasis. The problem of reproductive health disorders is of particular concern around the world and is relevant to the study of the nature of the effects of thyroid diseases on pregnancy. The prevalence and incidence of the thyroid disease vary in different regions of the country depending on the influence of environmental factors and their combination, one of which is iodine deficiency. The increasing number of stillborn infants, premature termination of pregnancy, infertility, deafness and strabismus of newborns, delayed physical, sexual and intellectual development of children, increa­sing cardiovascular diseases — this is not a complete list of negative effects of iodine deficiency on humans. The most common consequence of the iodine deficiency in pregnant women is subclinical hypothyroidism. Subclinical hypothyroidism is associated with many adverse events during pregnancy and with neonatal outcomes. The study of the peculiarities of the course of subclinical hypothyroidism in pregnant women in the iodine deficiency region today remains an urgent problem. This article presents an analysis of the publications of PubMed and Medline databases for the last decades., Заболевания щитовидной железы в структуре эндокринной патологии в последние годы занимают первые места. По данным Министерства здравоохранения Украины, за последние 5 лет количество заболеваний щитовидной железы увеличилось в 5 раз, причем данный показатель существенно отличается в различных регионах страны в зависимости от совокупности факторов внешней среды (удаленный стохастический эффект аварии на Чернобыльской АЭС, йодный дефицит, образ жизни, стресс, нерациональное питание, недостаточность микроэлементов, сопутствующие заболевания и т.д.). При этом известна тесная функциональная взаимосвязь тиреоидной и репродуктивной систем, что приводит к высокой вероятности развития объединенных нарушений при расстройствах одной из этих звеньев гомеостаза. Проблема нарушений репродуктивного здоровья вызывает особенно серьезное беспокойство во всем мире и является актуальной по изучению характера влияния заболеваний щитовидной железы на беременность. Показатели заболеваемости патологиями щитовидной железы и их распространенности отличаются в разных регионах страны в зависимости от влияния факторов внешней среды и их комбинации, одним из таких является дефицит йода. Увеличение количества мертворожденных младенцев, преждевременное прерывание беременности, бесплодие, тугоухость и косоглазие новорожденных, задержка физического, полового и интеллектуального развития детей, рост показателей сердечно-сосудистых заболеваний — далеко не полный перечень негативного влияния йодного дефицита на человека. Наиболее частыми последствиями йодного дефицита у беременных является субклинический гипотиреоз. Субклинический гипотиреоз ассоциируется со многими неблагоприятными событиями во время беременности и неонатальными последствиями. Изучение особенностей течения субклинического гипотиреоза у беременных в йододефицитном регионе на сегодня остается актуальной проблемой. В статье представлен анализ публикаций баз данных PubMed, Medline за последние десятилетия., Захворювання щитоподібної залози в структурі ендокринної патології останнім часом посідають перші місця. За даними Міністерства охорони здоров’я України, за останні 5 років кількість захворювань щитоподібної залози збільшилась у 5 разів, причому даний показник суттєво відрізняється в різних регіонах країни залежно від сукупності чинників зовнішнього середовища (віддалений стохастичний ефект аварії на Чорнобильській АЕС, йодний дефіцит, спосіб життя, стрес, нераціональне харчування, недостатність мікроелементів, супутні захворювання тощо). При цьому відомий тісний функціональний взаємозв’язок тиреоїдної та репродуктивної систем, що зумовлює високу ймовірність розвитку поєднаних порушень при розладах однієї з цих ланок гомеостазу. Проблема порушень репродуктивного здоров’я зумовлює особливо серйозне занепокоєння у всьому світі та є актуальною щодо вивчення характеру впливу захворювань щитоподібної залози на вагітність. Показники захворюваності на патології щитоподібної залози та їх поширеності відрізняються в різних регіонах країни залежно від впливу чинників зовнішнього середовища та їх комбінації, одним із таких є дефіцит йоду. Збільшення кількості мертвонароджених немовлят, передчасне переривання вагітності, безпліддя, туговухість та косоокість новонароджених, затримка фізичного, статевого та інтелектуального розвитку дітей, зростання показників серцево-судинних захворювань — далеко не повний перелік негативного впливу йодного дефіциту на людину. Найбільш частими наслідками йодного дефіциту у вагітних є субклінічний гіпотиреоз. Субклінічний гіпотиреоз асоціюється з багатьма несприятливими подіями під час вагітності та неонатальними наслідками. Вивчення особливостей перебігу субклінічного гіпотиреозу у вагітних у йододефіцитному регіоні на сьогодні залишається актуальною проблемою. У статті наведений аналіз публікацій баз даних PubMed, Medline за останні десятиліття.

Numerous studies by various authors indicate an association between vitamin D and autoimmune thyroid diseases. Most authors point to a correlation between lower vitamin D levels and an increased risk of developing the disease and/or higher antibody titers. After the onset of autoimmune thyroid disease, the existing vitamin D deficiency creates a vicious circle, exacerbating the deficiency. In real clinical practice, it is important to correct vitamin D deficiency/insufficiency in persons with autoimmune thyroid diseases. The approach is to achieve a level of 25(OH)D within the reference ranges proposed by international guidelines. Vitamin D deficiency is an integral part of the pathogenesis of autoimmune thyroid diseases. Because vitamin D administration reduces antithyroid antibody titers in patients with autoimmune thyroid disea­ses, vitamin D supplements are recommended for the treatment of these diseases, especially in vitamin D deficiency. Both in Graves’ disease and autoimmune thyroiditis with subclinical hypothyroi­dism, the initial dose of cholecalciferol is 4,000 IU per day for three months, followed by control of the content of 25(OH)D in the serum. When the level of vitamin D reaches 30–50 ng/ml, it is recommended to continue taking cholecalciferol in a daily dose of 2,000 IU for three months. It is desirable to conduct such courses at least twice a year. As the positive effect of the optimal level of 25(OH)D in the serum of both children and adults has been proven to date, it is advisable to maintain it for a healthy population in the range of 30–50 ng/ml in accordance with the guidelines for Central European countries. There are two cases from real clinical practice, in which a positive effect was achieved after additional administration of cholecalciferol to patients with autoimmune thyroid diseases., Результаты проведенных различными авторами многочисленных исследований указывают на наличие взаимосвязи между витамином D и аутоиммунными тиреоидными заболеваниями. Большинство авторов указывают на ассоциацию между низким уровнем витамина D и повышенным риском развития заболевания и/или высокими титрами антител. После возникновения аутоиммунного тиреоидного заболевания существующий дефицит витамина D создает порочный круг, способствуя усилению дефицита. В реальной клинической практике важно осуществлять коррекцию дефицита/недостаточности витамина D у людей с аутоиммунной тиреоидной патологией. Подход заключается в достижении уровня 25(OH)D в пределах эталонных диапазонов, предложенных международными рекомендациями. Дефицит витамина D является составной частью патогенеза аутоиммунных заболеваний щитовидной железы. Поскольку назначение витамина D уменьшает титры антитиреоидных антител у больных с аутоиммунной патологией щитовидной железы, препараты витамина D рекомендуются в составе терапии этих заболеваний, особенно на фоне дефицита витамина D. Как при болезни Грейвса, так и при аутоиммунном тиреоидите с субклиническим гипотиреозом начальная доза холекальциферола составляет 4000 МЕ в сутки в течение трех месяцев с последующим контролем содержания 25(OH)D в сыворотке крови. При достижении уровня витамина D 30–50 нг/мл рекомендуется продолжить прием холекальциферола в суточной дозе 2000 МЕ в течение трех месяцев. Желательно проводить такие курсы два раза в год. Поскольку на сегодня доказано положительное влияние оптимального уровня 25(OH)D в сыворотке крови как у детей, так и у взрослых, целесообразно поддерживать его для здоровой популяции в пределах 30–50 нг/мл в соответствии с методическими рекомендациями для стран Центральной Европы. Приведены два случая из реальной клинической практики, в которых достигнут положительный эффект после дополнительного назначения холекальциферола пациентам с аутоиммунными заболеваниями щитовидной железы., Результати проведених різними авторами численних досліджень вказують на наявність взаємозв’язків між вітаміном D і автоімунними тиреоїдними захворюваннями. Більшість авторів вказують на асоціацію між нижчим рівнем вітаміну D і підвищеним ризиком розвитку захворювання і/або вищими титрами антитіл. Після виникнення автоімунного тиреоїдного захворювання існуючий дефіцит вітаміну D створює порочне коло, сприяючи посиленню дефіциту. У реальній клінічній практиці важливо здійснювати корекцію дефіциту/недостатності вітаміну D у людей з автоімунною тиреоїдною патологією. Підхід полягає у досягненні рівня 25(OH)D у межах еталонних діапазонів, запропонованих міжнародними рекомендаціями. Дефіцит вітаміну D є складовою частиною патогенезу автоімунних захворювань щитоподібної залози. Оскільки призначення вітаміну D зменшує титри антитиреоїдних антитіл у хворих з автоімунною патологією щитоподібної залози, препарати вітаміну D рекомендуються у складі терапії цих захворювань, особливо на тлі дефіциту вітаміну D. Як при хворобі Грейвса, так і при автоімунному тиреоїдиті із субклінічним гіпотиреозом початкова доза холекальциферолу становить 4000 МО на добу упродовж трьох місяців з подальшим контролем вмісту 25(OH)D у сироватці крові. При досягненні рівня вітаміну D 30–50 нг/мл рекомендується продовжити прийом холекальциферолу в добовій дозі 2000 МО протягом трьох місяців. Бажано проводити такі курси принаймні двічі на рік. Оскільки на сьогодні доведено позитивний вплив оптимального рівня 25(OH)D у сироватці крові як у дітей, так і в дорослих, доцільно підтримувати його для здорової популяції в межах 30–50 нг/мл згідно з методичними рекомендаціями для країн Центральної Європи. Наведені два випадки з реальної клінічної практики, у яких досягнутий позитивний ефект після додаткового призначення холекальциферолу пацієнтам з автоімунними захворюваннями щитоподібної залози.

Dengue is an important public health problem in many parts of the world. This article consolidates the current knowledge about dengue myocarditis. Cardiac involvement in dengue is a common phenomenon. Myocarditis is the predominant manifestation. It can be subclinical with no impact on the outcome, or it can cause potentially fatal arrhythmias or cardiogenic shock and even lead to cardiomyopathy. Myocardial inflammation is elicited by direct viral invasion and production of inflammatory cytokines and free oxygen radicals. The manifestations can overlap with dengue shock syndrome resulting from capillary leakage. The diagnostic criterion is not well-defined and relies on evaluation of cardiac biomarkers and electrocardiographic and echocardiographic changes in the presence or absence of symptoms. There is an emerging role of cardiac magnetic resonance imaging and strain echocardiography. Treatment involves use of supportive therapies, and there is no evidence for use of antiviral drugs, corticosteroids, and immunosuppressants. Physicians need to be wary of myocarditis in dengue. More research is needed for developing specific treatment.

Background:Hypothyroidism is the second most common endocrine disorder in women of childbearing age with an increased risk of pregnancy loss.Pregnancy loss associated with subclinical hypothyroidism (SCH), defined as elevatedthyroid-stimulating-hormone level, with normal free thyroxine. In overt hypothyroidism (OH), the free thyroxine is low. Materials and methods:Cases recruited from those attending high risk pregnancy unit of obstetrics and gynecology department of Benha university hospital Egypt from 2019 till 2020. We examined theprevalence of subclinical and undiagnosed overt hypothyroidism in women with recurrent miscarriage, late miscarriageand stillbirth.Cases with sporadic miscarriages, autoimmune disorders, thrombophilias and known hypothyroidism were excluded. Sample size: Two-hundredwomen were included. Median maternal age was 35 years (range 18-47). Subclinical andundiagnosed overt hypothyroidism was found in 24 cases (12%) of women. Sixteen women (8%) had subclinical hypothyroidism,eight (4%) had undiagnosed overt hypothyroidism. Results were compared to women with ongoing pregnancies. Results: The prevalence of subclinical and undiagnosed overt hypothyroidism in the pregnancy loss population was 12% (24 /200), where 8 %( 16/200) were subclinical, and 4% (8/200) were undiagnosed overt. In the control population, prevalence of hypothyroidism was 1.5% (3/200).

Endocrine disorders are common in patients with Prader-Willi syndrome (PWS). Whether hypothyroidism is present in patients with PWS, and especially infants and young children, remains unclear. The aims of this study were to evaluate thyroid function in patients with PWS, to assess the prevalence of thyroid dysfunction, and to evaluate the effect of growth hormone on thyroid function. Subjects were 23 patients with PWS ages 3 months to 3 years who were followed for up to one year. Four patients were lost to follow-up after the first visit. The remaining 19 patients were treated with recombinant human growth hormone (rhGH). PWS was diagnosed based on a genetic analysis. Free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were evaluated before and after growth hormone treatment. A total of 9 patients (9/23 = 39.1%) developed abnormal thyroid function. Five out of 23 patients (21.7%) had abnormal thyroid function before growth hormone treatment. Four patients developed thyroid dysfunction during the 3- to 9-month period of rhGH treatment. Of the 9 patients with abnormal thyroid function, 7 (5 boys, 2 girls) had central hypothyroidism, and the other 2 patients had subclinical hypothyroidism. TSH levels were higher in patients with PWS due to maternal uniparental disomy (UPD) than in patients with PWS due to a 15q11-q13 deletion. The prevalence of hypothyroidism was high in infants and young children with PWS. Thyroid function should be regularly monitored in patients with PWS at both diagnosis and follow-up.

Background. Autoimmune thyroiditis is the most common cause of hypothyroidism. If the therapy of overt hypothyroidism by prescribing hormone replacement therapy is quite clear, then the problem of treating the patients with subclinical hypothyroidism remains open. The purpose of this study was to determine the effectiveness of using the combined natural drug Thyreos in the treatment of autoimmune thyroiditis without thyroid dysfunction, at the stage of subclinical hypothyroidism as monotherapy and in the comprehensive therapy of overt hypothyroidism in the combination with L-thyroxine. Materials and methods. Forty-nine patients aged 48.26 ± 13.52 years with autoimmune thyroiditis were examined. All individuals were divided into 3 groups. Group 1 included 20 patients with autoimmune thyroiditis without thyroid dysfunction, group 2 consisted of 16 people with newly diagnosed subclinical hypothyroidism, and group 3 included 13 patients, who previously received L-thyroxine therapy for overt hypothyroidism. All patients were prescribed Thyreos 1 capsule twice a day for a period of 3 months as monotherapy (groups 1 and 2) or in addition to hormone replacement therapy (group 3). Results. When evaluating complaints, it was found that after 3 months of taking the drug, weakness and rapid fatigue were observed in a significantly smaller number of patients in all three groups (p < 0.05). Complaints of dryness and hair loss in individuals of the first two groups (p < 0.05) were also probably less frequent after 3 months of therapy with Thyreos. As a result of treatment, dry skin was significantly reduced in patients of only the first examined group (p = 0.024). In people with newly diagnosed subclinical hypothyroidism, a significant dynamics of thyroid-stimulating hormone level was determined. In patients with overt hypothyroidism, the supplementation of Thyreos to L-thyroxine significantly reduced thyroid-stimulating hormone content and increased free thyroxine level without changing the dose of hormone replacement therapy. All examined individuals tolerated the drug well, without any adverse reactions. Conclusions. In the presence of subclinical and overt hypothyroidism on the background of autoimmune thyroiditis, the use of a combined natural remedy Thyreos is quite justified. The drug showed a clinically significant positive effect, which manifested itself in the improvement of well-being and hormonal status parameters of patients, both as monotherapy in subclinical hypothyroidism and in combination with L-thyroxine — in overt one. Preliminary results of Thyreos effect on the suppression of the autoimmune process in the thyroid gland need further clarification with the involvement of more patients and extension of treatment., Актуальность. Аутоиммунный тиреоидит является наиболее частой причиной гипофункции щитовидной железы. Если тактика лечения манифестного гипотиреоза путем назначения заместительной гормональной терапии довольно однозначна, то вопрос по лечению пациентов с субклиническим гипотиреозом остается открытым. Целью данного исследования было определить эффективность использования комбинированного натурального препарата Тиреос при лечении аутоиммунного тиреоидита без нарушения функции на стадии субклинического гипотиреоза в качестве монотерапии и в комплексной терапии манифестного гипотиреоза — в комбинации с L-тироксином. Материалы и методы. Обследовано 49 больных аутоиммунным тиреоидитом в возрасте 48,26 ± 13,52 года, разделенных на три группы. В первую группу включены 20 больных аутоиммунным тиреоидитом без нарушения функции, во вторую группу — 16 больных с впервые выявленным субклиническим гипотиреозом, в третью группу — 13 больных, предварительно получавших терапию L-тироксином по поводу манифестного гипотиреоза. Всем пациентам был назначен Тиреос по 1 капсуле два раза в сутки на период 3 месяца в качестве монотерапии (больным первой и второй групп) или в дополнение к заместительной гормональной терапии (больным третьей группы). Результаты. При оценке жалоб выявлено, что через 3 месяца приема препарата слабость и быструю утомляемость отмечали достоверно меньше больных во всех трех группах (р < 0,05). Также достоверно реже после трехмесячной терапии Тиреосом регистрировалась жалоба на сухость и выпадение волос у больных первых двух групп (р < 0,05). В результате лечения сухость кожи доказанно уменьшилась у больных только первой обследуемой группы (р = 0,024). У больных с впервые выявленным субклиническим гипотиреозом определена достоверная позитивная динамика ТТГ. У лиц с манифестным гипотиреозом добавление Тиреоса к терапии L-тироксином позволило существенно снизить уровень тиреотропного гормона (ТТГ) и повысить показатель свободного тироксина без изменения дозы заместительной гормональной терапии. Все обследуемые больные хорошо переносили прием препарата, какие-либо побочные реакции отсутствовали. Выводы. При наличии субклинического и манифестного гипотиреоза на фоне аутоиммунного тиреоидита полностью оправданным является использование комбинированного натурального препарата Тиреос. Он показал клинически значимый положительный эффект, который проявлялся в улучшении самочувствия и показателей гормонального статуса больных как в монотерапии при субклиническом гипотиреозе, так и в комбинации с L-тироксином — при манифестном. Предварительные результаты по эффективности Тиреоса в подавлении аутоиммунного процесса в щитовидной железе требуют дальнейшего уточнения с привлечением большего числа больных и удлинением курса лечения., Актуальність. Автоімунний тиреоїдит (АІТ) — найчастіша причина гіпофункції щитоподібної залози. Якщо тактика лікування маніфестного гіпотиреозу шляхом призначення замісної гормональної терапії є доволі однозначною, то питання щодо лікування пацієнтів із субклінічним гіпотиреозом залишається відкритим. Мета: визначення ефективності застосування комбінованого натурального препарату Тіреос при лікуванні АІТ без порушення функції на стадії субклінічного гіпотиреозу як монотерапії і в комплексній терапії маніфестного гіпотиреозу — в комбінації з левотироксином. Матеріали та методи. Обстежено 49 хворих на АІТ віком 48,26 ± 13,52 року, розподілених на три групи. До першої групи залучено 20 хворих на АІТ без порушення функції, до другої групи включено 16 хворих з уперше виявленим субклінічним гіпотиреозом, до третьої групи — 13 хворих, які попередньо отримували терапію L-тироксином з приводу маніфестного гіпотиреозу. Усім пацієнтам було призначено Тіреос по 1 капсулі двічі на добу на період 3 місяці як монотерапію (хворим першої і другої груп) або на додачу до замісної гормональної терапії (хворі третьої групи). Результати. При оцінці скарг виявлено, що через 3 місяці прийому препарату слабкість і швидку втомлюваність відзначали вірогідно менше хворих в усіх трьох групах (р < 0,05). Також вірогідно рідше після тримісячної терапії Тіреосом виявлялася скарга на сухість і випадіння волосся у хворих перших двох груп (р < 0,05). У результаті лікування сухість шкіри вірогідно зменшилась у хворих лише першої обстежуваної групи (р = 0,024). У хворих з уперше виявленим субклінічним гіпотиреозом визначено вірогідну динаміку рівня тиреотропного гормону (ТТГ). У хворих на маніфестний гіпотиреоз додавання Тіреосу до L-тироксину дозволило вірогідно зменшити рівень ТТГ і підвищити показник вільного тироксину без зміни дози замісної гормональної терапії. Усі обстежувані хворі добре переносили прийом препарату за відсутності будь-яких побічних реакцій. Висновки. За наявності субклінічного й маніфестного гіпотиреозу на тлі автоімунного тиреоїдиту цілком виправданим є використання комбінованого натурального засобу Тіреос. Препарат показав клінічно значущий позитивний ефект, що проявлявся в покращенні самопочуття й показників гормонального статусу хворих як у монотерапії при субклінічному гіпотиреозі, так і в комбінації з L-тироксином — при маніфестному. Попередні результати щодо здатності Тіреосу пригнічувати автоімунний процес у щитоподібній залозі потребують подальшого уточнення із залученням більшої кількості хворих і подовженням курсу лікування.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension.Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017.Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged

Objective: Objective of this study was to determine the frequency of sub clinical hypothyroidism among chronic kidney disease patients in our population. Study Design: Descriptive Cross sectional study. Settings: Department of Nephrology, Khyber Teaching Hospital Peshawar. Period: February 2018 to September 2018. Material & Methods: A total of 145 chronic kidney disease patients were included in this study. Thyroid function tests (TFT, s) were performed in all patients along with history and clinical examination. Sub clinical hypothyroidism was defined as high TSH (normal value 0.27-4.0 µIU/ml) and normal Free T47. (0.93 – 1.70 ng/dl). Results: Our study shows that Mean age was 55 years with standard deviation ± 2.83. Eighty seven (60%) patients were male and 58(40%) patients were female. Moreover, 25% patients had subclinical hypothyroidism. Conclusion: Our study concludes that the incidence of subclinical hypothyroidism in chronic kidney disease was found to be 25% in our population.

A review of the literature on the epidemiology of autoimmune thyroiditis (AT) is presented. This review examines the etiological factors of autoimmune thyroid damage. In case of damage to thyroid cells, the formation of antibodies and lymphoid infiltration of the gland is of great importance. It is noted that genetic factors precede the occurrence of pathological changes. Loss of immune tolerance to thyroid autoantigens such as thyroid pero­xidase (TPO), thyroglobulin underlies the development of AT. The role of oxidative stress and reactive oxygen species is important in the pathogenesis of the disease. It is shown that at the beginning, AT is asymptomatic and the formation of TPO and thyroglobulin antibodies precedes the onset of the disease and may indicate latent AT. The prevalence of latent AT varies from country to country and ranges from 2 to 20 %, and among women it was 4–6 times higher than among men. Subsequently, latent AT progresses to subclinical and overt thyroiditis with hypothyroidism. The incidence of mani­fest AT in various countries is from 27 to 273 per 100,000 population. Often, the disease began in childhood and adolescence. The frequency of pathology, including latent subclinical and manifest AT, in this cohort of the population according to different authors is from 0.3 to 9.6 %. Pregnancy was also accompanied by the pre­sence of TPO antibodies but with reduced aggression of cellular ele­ments and antibodies to the thyroid gland. The postpartum period was characterized by exacerbation of the disease. In Ukraine, the incidence of AT is 43.1 per 100,000, the prevalence is almost 10 times higher — 421.2 per 100,000. It is concluded that AT is the most common organ-specific autoimmune disease., Наведений огляд літератури з питання епідеміології автоімунного тиреоїдиту (АІТ). В огляді розглянуті етіологічні чинники автоімунного ураження щитоподібної залози (ЩЗ). У виникненні ушкодження клітин ЩЗ важливе значення надається утворенню антитіл та лімфоїдній інфільтрації залози. Відзначено, що генетичні фактори передують виникненню патологічних змін. Втрата імунної толерантності до автоантигенів ЩЗ — тиреоїдної пероксидази (TПO), тиреоглобуліну (TГ) є основою для розвитку АІТ. Зазначена важлива роль оксидативного стресу і реактивних форм кисню в патогенезі захворювання. Показано, що на своєму початку АІТ перебігає безсимптомно, утворення антитіл до ТПО і ТГ передує виникненню захворювання і може свідчити про латентний АІТ. Поширеність латентного АІТ відрізняється в різних країнах світу і сягає від 2 до 20 %, причому серед жінок вона була в 4–6 разів вища, ніж у чоловіків. Згодом латентний АІТ переходить у субклінічний та явний тиреоїдит із гіпотиреозом. Захворюваність на маніфестний АІТ у різних країнах становить від 27 до 273 на 100 000 населення. Нерідко захворювання розпочиналося в дитячому та підлітковому віці. Частота патології, включаючи латентний субклінічний та маніфестний АІТ, у цієї когорти населення, за даними різних авторів, сягає від 0,3 до 9,6 %. Вагітність також супроводжується наявністю антитіл до ТПО, але зі зменшеною агресією клітинних елементів й антитіл до ЩЗ. Післяпологовий період характеризується загостренням захворювання. В Україні захворюваність населення на АІТ становить 43,1 на 100 000, поширеність майже в 10 разів вища — 421,2 на 100 000. Зроблено висновок, що АІТ є найбільш поширеним органоспецифічним автоімунним захворюванням.

Objective: Determine the frequency of hypothyroidism in recurrent pregnancy loss. Study Design: This is cross sectional. Place and Duration of Study: This study was conducted at Obstetrics and Gynaecology department of Dow Medical University & Hospital, Ojha Campus, Karachi, from 7th July 2018 to 6th July 2019. Methodology: This study was conducted on 83 patients. Detailed history was taken from all the patients with special regard to demographics like age, parity and recurrent pregnancy loss. A 3 ml venous blood was drawn by the staff on duty and sent to institutional laboratory for TSH and free T4 level. TSH values more than 4.5 μIU/L and normal free T4 level (0.7 to 1, 8 ng/ml) were considered as hypothyroidism. All pregnant female was between age 20-35 years with > 6 months gestational age and history of parity 3 and gravida 4 were included in the study. Exclusion criteria were known case of hypothyroidism or history of taking medication for hypothyroidism, history of Hypertension and DM. Results: This study was conducted on 83 patients. There was wide variation of age ranging from a minimum of 20 years to 35 years. The mean age was 28.4+ 4.49 years. Mostly patients were parity 3 and gravid 4 in 55(66.26%) cases followed by parity 4 and gravid 4 in 28(33.73%) cases. Gestational age was measured on ultrasound ranging from 8 weeks to 22 weeks. The mean gestational age was 14.20+4.71 years. Patient's thyroid profile mean Thyroid-stimulating hormone (TSH) level was 2.39+1.66 mU/L, mean free T4 was 17.23+6.41 nmol/L and mean free T3 was 4.87+1.18 μmol/L. Observed hypothyroidism was in 11(13.3%) cases while rest of 72(86.7%) cases within normal range. Conclusion: We concluded that hypothyroidism is problem in recurrent pregnancy loss. 11(13.3%) cases Frequency of hypothyroidism in women with pregnancy, the possible role of thyroid functional disorders in etiology of at least some part of recurrent pregnancy loss, had emphasized the importance of thyroid functions tests screening as routine in all pregnancies. Keywords: Thyroid disease, Pregnancy outcome, Hypothyroidism.

Viral infection is a common complication among pediatric kidney transplant recipients, causing significant morbidity and mortality. Sources of viral infection in pediatric transplant recipients include donor allografts, blood products, and latent virus reactivation. Major risks of viral infection include kidney donor-derived, nosocomial and community-acquired infections as well as the immunosuppressive status of recipients. Clinical presentations are variable, ranging from no symptoms to severe disease. Preventive strategies such as immunization and pretransplant-specific viral screening in both donors and recipients are performed before kidney transplantation to identify high-risk recipients. Posttransplant prophylactic strategies include universal prophylaxis and preemptive therapy. Universal antiviral prophylaxis is required for high-risk cytomegalovirus (CMV)-mismatch pediatric recipients. Preemptive therapy requires the administration of sensitive viral surveillance tests to detect subclinical viral infections to optimize individualized immunosuppressive drugs and initiate antiviral therapy. This review summarizes current knowledge regarding common viral infections in children after kidney transplantation, including CMV, BK polyomavirus, Epstein-Barr virus (EBV), and coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Introduction Corneal confocal microscopy (CCM) is a rapid non‐invasive ophthalmic imaging technique that identifies corneal nerve fiber damage. Small studies suggest that CCM could be used to assess patients with diabetic peripheral neuropathy (DPN). Aim To undertake a systematic review and meta‐analysis assessing the diagnostic utility of CCM for sub‐clinical DPN (DPN−) and established DPN (DPN+). Data sources Databases (PubMed, Embase, Central, ProQuest) were searched for studies using CCM in patients with diabetes up to April 2020. Study selection Studies were included if they reported on at least one CCM parameter in patients with diabetes. Data extraction Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and inferior whorl length (IWL) were compared between patients with diabetes with and without DPN and controls. Meta‐analysis was undertaken using RevMan V.5.3. Data synthesis Thirty‐eight studies including ~4,000 participants were included in this meta‐analysis. There were significant reductions in CNFD, CNBD, CNFL, and IWL in DPN− vs controls (P, This meta‐analysis of ~4,000 participants shows that corneal confocal microscopy is a rapid objective ophthalmic technique for the assessment of subclinical and clinical diabetic neuropathy. Forest plot of corneal nerve fiber length (CNFL) in patients with diabetic peripheral neuropathy (DPN+) and without diabetic peripheral neuropathy (DNP−).

Objective – to investigate the features of platelet-vascular hemostasis in women with abnormal uterine bleeding on the background of submucosal uterine fibroids.Material and methods. The study included 30 women with abnormal uterine bleeding with submucosal uterine fibroids. Features of thrombocyte-vascular hemostasis were studiedResults. There are new data in relation to the features of certain links of the adjusting system of the aggregate state of blood on a background development of post hemorrhage anaemia. It is clearly shown that changes in the system of adjusting of the aggregate state of blood in women with a severe degree of anaemisation are the display of subclinical inopexi.Conclusions. Changes in the fibrinolytic potential of blood in women with chronic posthemorrhagic anemia on the background of abnormal uterine bleeding and submucosal uterine fibroids are secondary, due to the activation of thrombin and fibrinogenesis by external mechanisms.

Background: Human immunodeficiency virus infection leads to a variety of Cardiovascular manifestations. Pericardial effusion, systemic hypertension, dilated cardiomyopathy, coronary artery disease, pulmonary hypertension, primary as well as secondary cardiac tumours etc are seen in about 30% of patients and the incidence has increased with improved longevity. Coronary artery disease ranging from subclinical atherosclerosis to coronary plaque rupture causing acute coronary syndrome have been documented. The main underlying pathophysiological process is a state of perennial inflammation which leads to initiation and acceleration of coronary atherosclerosis. Objective: To study the coronary angiographic profile in HIV patients. Methodology: HIV patients undergoing coronary angiography were assessed clinically, biochemically and finally by coronary angiography to see the coronary pathoanatomy. Results: Of the 37 HIV patients studied between Jan to Dec 2019, the mean age was 47 years.(19-66 years). Two thirds were males; most common traditional risk factor was dyslipidemia followed by hypertension. Most patients were already on ART and the CD 4 counts ranged from 67-366cells/cumm. Anterior wall MI and unstable angina were the most common clinical presentations. Coronary angiography revealed diffuse disease (both insignificant and significant) of the left anterior descending artery as the most common pattern of angiographic involvement. Conclusion: Coronary artery disease both subclinical and syndromic occurs with increased frequency in HIV patients. The dominant angiographic presentation correlates with the clinical presentation and in our study, left anterior descending artery was more frequently diseased as compared to other coronaries. The most common coronary angiographic pattern was the presence of ectasia and diffuse disease. Keywords: Human immunodeficiency virus, cardiovascular manifestations, coronary artery disease, coronary angiography.

Summary Circulating donor‐specific antibodies (DSA) do not necessarily indicate antibody‐mediated rejection (ABMR). Here, we evaluated the diagnostic value of donor‐derived cell‐free DNA (dd‐cfDNA) as an add‐on to DSA detection. The study included two independent cohorts of DSA+ kidney allograft recipients, 45 subclinical cases identified by cross‐sectional antibody screening (cohort 1), and 30 recipients subjected to indication biopsies (cohort 2). About 50% of the DSA+ recipients had ABMR and displayed higher dd‐cfDNA levels than DSA+ABMR− recipients (cohort 1: 1.90% [median; IQR: 0.78–3.90%] vs. 0.52% [0.35–0.72%]; P, Analyzing two independent cohorts of kidney allograft recipients, we found that detection of donor‐derived cell‐free DNA as an add‐on to donor‐specific antibody detection may be a useful non‐invasive surveillance tool to uncover antibody‐mediated kidney allograft rejection.

Sarcoidosis is a multisystem granulomatous disease of unknown cause. With cardiac sarcoidosis (CS), patients represent a wide range of cardiac manifestations from subtle to overt morphological and functional abnormalities. The advent of ultrasound technologies has enabled to identify not only typical findings to CS such as basal thinning of the ventricular septum, but also subclinical myocardial alterations. Based on our recent experiences, we currently introduce a variety of myocardial manifestations evaluated by echocardiography on seven CS patients being selected. Most of the patients exhibited typical cardiac involvement and the remaining fairly unusual.

This review attempts to investigate the link between subclinical thyroid dysfunction (SCH) and major depressive disorder (MDD). It has been speculated that SCH may be related to MDD through an autoimmune mechanism. A comprehensive literature search was conducted in the PubMed database for relevant research and review articles. There appears to be an association between an autoimmune mechanism, possibly involving the thyroid gland, and depressive disorders, but the available evidence is so far inconclusive. Lifetime prevalence of depression is significantly higher in patients with SCH, a finding reflecting a possible effect of SCH in lowering the threshold for the emergence of MDD. The relationship between SCH and MDD is, however, not clear, with large and well-designed studies investigating possible links between reference-range thyroid hormone levels and MDD having as yet found no relation between the two.

Neospora caninum is one of the most prevalent Apicomplexa parasites that causes abortion in cattle, as it infects dogs as its definitive host, causing subclinical disease or active neosporosis, marked by meningoencephalitis, and myopathies with muscle and neuromuscular signs of disease. This study aimed to evaluate the acute phase protein response in dogs seropositive and seronegative for N. caninum. Serum samples of 72 dogs were tested by an immunofluorescence antibody test using N. caninum NC-1 strain, and the study population was divided into four groups: symptomatic - muscular and/or neuromuscular signs - and seropositive (n = 16); symptomatic and seronegative (n = 9); asymptomatic and seropositive (n = 34); and asymptomatic and seronegative (n = 13). C-reactive protein (CRP) was measured via immunoturbidimetric assay and serum haptoglobin (Hp) via hemoglobin-binding capacity assay. In the symptomatic groups, seropositive dogs had higher levels of Hp, but not CRP, while seronegative dogs had higher CRP levels. There was no difference in CRP concentration in asymptomatic dogs. Dogs with neuromuscular signs had higher concentrations for Hp in the group seropositive. Hp concentration did not differ between dogs seropositive and seronegative dogs for each group. Serum Hp and CRP could not sufficiently alone flag subclinical infections. Measurement of CRP and Hp concentrations could be clinically valuable to the diagnosis of neurological diseases, and their relative change may indicate the stage of the infection, although their sole use is not able to support the diagnosis of canine neosporosis. Further studies are encouraged to evaluate the specific dynamics of acute phase proteins in canine neosporosis. Serum samples of 72 dogs were tested by an immunofluorescence antibody test using N. caninum NC-1 strain, and the study population was divided into four groups: (1) dogs with muscular and/or neuromuscular signs and seropositive for N. caninum; (2) dogs with muscular and/or neuromuscular signs and seronegative for N. caninum; (3) dogs seropositive for N. caninum with no neuromuscular signs; and (4) healthy dogs and seronegative for N. caninum. The study evaluated if N. caninum infection could have pathophysiological changes activating the acute phase response and an increase in the concentration of acute phase proteins in serum.

OBJECTIVE This study aimed to investigate the presence of obsessive-compulsive symptoms (OCS) in patients being followed for schizophrenia and their first-degree relatives (mother, father, siblings, and children) and the relationship between OCS and clinical/subclinical psychotic symptoms. MATERIALS AND METHODS The study included 110 schizophrenia patients followed up in a community mental health center and their first-degree relatives. Patients and relatives were evaluated using the SCID-I (Structured Clinical Interview Form for DSM-IV Axis-I Disorders) to ascertain their diagnosis and exclude other axis-I diagnoses. The Yale-Brown Obsessive Compulsive Scale was used to measure OCS severity. Psychotic symptom severity was evaluated in patients using the Positive and Negative Syndrome Scale (PANSS) and subthreshold psychotic symptoms and psychosis proneness were assessed in relatives using the Schizotypal Personality Questionnaire. RESULTS The prevalence of clinically significant OCS was 41.8% in schizophrenia patients and 28.2% in their relatives. PANSS positive and general psychopathology subscale scores were higher in patients with OCS. Suspiciousness and interpersonal schizotypy scores were significantly higher in relatives with OCS compared to those without. The first-degree relatives of patients with OCS did not exhibit a higher prevalence of OCS or psychotic symptoms compared to the relatives of patients without OCS. CONCLUSION Our study demonstrates that obsessive-compulsive phenomena are common in schizophrenia patients and their relatives. Although there seems to be a positive association between OCS and psychotic symptoms in patients and their first-degree relatives, the intergenerational transmission of these two symptom groups may occur independently.

Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13–18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e′ ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.

Background: The relationship between subclinical hypothyroidism (SCH) and dyslipidemia is still debatable about whether SCH is constantly associated with lipid disorder. The aim of this study was to assess the lipid abnormalities in patients with SCH and to evaluate the relation between thyroid stimulating hormone (TSH) and lipid profile. Methods: This cross-sectional observational study was conducted in outpatient department (OPD) of the Hormone and Diabetes Clinic at MARKS Medical College & Hospital in Dhaka, Bangladesh from May 2018 to October 2019. A total of 308 subjects (age 30 - 60 years) were included in this study using covenience sampling. Among them, 156 were diagnosed case of SCH, while 152 were euthyroid healthy individuals in control group (matched for age, gender and weight). Laboratory test included serum TSH and free thyroxine (FT4) and fasting lipid profile. Data were analyzed using SPSS version 18 statistical software. Results: In this study, dyslipidemia was more prevalent in patients with SCH compared to control group [p

BackgroundSubclinical tuberculosis (TB) is well recognized and defined as a disease state with absent or nonrecognized symptoms. The study identifies factors associated with subclinical TB and diagnostic strategies in a low-burden, high-resource country.MethodsData were collected between December 2013 and November 2019 through the Swiss Pediatric Surveillance Unit (SPSU). Children with culture/molecular confirmed TB, or who were treated with ≥3 antimycobacterial drugs, were included.ResultsA total of 138 (80%) children with TB disease were included in the final analysis, of which 43 (31%) were subclinical. The median age of children with subclinical compared to symptomatic TB was 3.7 (interquartile range [IQR] 2.2–7) and 9.7 (IQR 2.7–14.3) years, respectively (P = .003). The cause of investigation for TB was recorded in 31/43 (72.1%) of children with subclinical TB and included contact exposure in 25 (80.6%) of children. In children with subclinical TB, diagnosis was made by a combination of the following abnormal/confirming results: culture/molecular + immunodiagnostic + chest radiography in 12 (27.9%) cases, immunodiagnostic + chest radiography in 19 (44.2%) cases, culture/molecular + chest radiography in 2 (4.7%) cases, culture + immunodiagnostic in 1 (2.3%) case, chest radiography only in 8 (18.6%) cases, and immunodiagnostic only in 1 (2.3%) case.ConclusionsA notable proportion of children with TB had subclinical disease. This highlights the importance of non-symptom-based TB case finding in exposed children and refugees from high-TB-prevalence settings. TB screening in these asymptomatic children should therefore include a combination of immunodiagnostic testing and imaging followed by culture and molecular testing.

PURPOSE OF REVIEW Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation. RECENT FINDINGS The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation. SUMMARY Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.

This cross-sectional study was performed on healthy volunteers and those who had been referred with a diagnosis of subclinical hypothyroidism (TSH10 mIU/L). Subjects with the age of 18-35 years were enrolled. The sera were analyzed for Cortisol, FT4, FT3, TSH, Ani-TPO, and Anti-Tg.Final sample of 36 in group A (TSH2.5), 45 in group B (TSH: 2.5-4.2), and 71 in group C (TSH: 4.3-10) were included. Cortisol levels were significantly different in the three groups, the lowest for the A group and higher for the C group, and the two-to-two difference in the groups was also significant (p 0.001). There was a positive and significant correlation between cortisol levels with TSH (r = 0.740; p 0.001).There was a potential link between TSH and serum cortisol in young people so that with an increase in TSH from 2.5, the serum cortisol level also increases, but this positive correlation in TSH ≤2.5 was not observed.

Objective: This study was planned to determine the relationship between quality of life, emotional and nutritional status of individuals diagnosed with primary hypothyroidism. Methods: The research was carried out on 106 individuals who applied to the endocrinology and metabolism polyclinic of a university hospital in Anatolia and diagnosed with overt and subclinical hypothyroidism by a doctor. A questionnaire was applied to the individuals participating in the study by face-to-face interview method,24-hour food consumption records and anthropometric measurements were taken, and some biochemical parameters were analyzed. Thyroid Patients' Quality of Life Scale was used for the quality of life of the patients, and the Profile of Mood States scale was used to evaluate their mood. Results: Participants were divided into two groups as overt and subclinical hypothyroidism. The mean age of patients with overt hypothyroidism (n=44) was 45.30±9.98 years, the mean age of patients with subclinical hypothyroidism (n=62) was 44.48±10.80 years. It was determined that the body mass index was positively correlated with the quality of life subscale, goiter symptom, cognitive and cosmetic complaints sub-dimension, moderately positive, positively weakly correlated with hypothyroid symptom and ocular symptom sub-dimension. Among the mood profile subscales, only tension-anxiety and BMI were negatively and weakly significant. When biochemical parameters were examined, serum vitamin D, sodium and hemoglobin levels were found to be higher in the subclinical hypothyroidism group than in the overt hypothyroid group. Conclusion: It has been determined that the quality of life of individuals diagnosed with hypothyroidism is low and individuals should be given nutrition education and studies to improve physical and mental health should be done.

Background . A critical condition of any genesis may be accompanied by the development of multiple organ failure, one of the manifestations of which is acute renal injury. Often, the process is subclinical in nature and the «classical» approaches to diagnose renal damage by creatinine concentration, urea level and assessment of glomerular filtration rate may not fully reflect the degree of impaired renal function, while acute kidney injury is a well-known predictor of high hospital mortality among critically ill patients. Aims. The purpose of this study was to assess functional state of the kidneys by determining the serum concentration of the markers of kidney injury NGAL and Cystatin C in patients with pneumonia associated with influenza A/H1N1. Materials and methods . 85 patients with pneumonia associated with influenza A/H1N1 were examined, 30 patients with severe pneumonia, 55 with non-severe pneumonia. The control group was formed by 15 healthy donors. The serum concentration of NGAL and Cystatin C molecules was determined by flow cytometry on a Beckman Coulter analyzer (USA), using a Human Immune Checkpoint Panel 1 multiplex assay kit (Biolegend, USA). The glomerular filtration rate was calculated using the CKD-EPI formula. Results . It was found that in patients with severe pneumonia with the influenza A/H1N1, the concentration of NGAL increased 3.8 times compared with the control group, the concentration of Cystatin C increased 1.4 times, the glomerular filtration rate did not change. Conclusion . Timely diagnosis of subclinical kidney injury makes it possible to objectify the severity of the condition, make adjustments to therapy, which can help to an increase in the survival rate of critically ill patients.

Findings from several studies have shown that amnestic mild cognitive impairment (aMCI) older adults have significantly lower performance on phonemic fluency tasks relative to cognitively unimpaired (CU) older adults. These findings suggest that nonmemory domains, such as executive function, are impacted in aMCI. As Alzheimer's disease (AD) research has shifted toward identifying and characterizing preclinical AD, there is a need to identify subtle but significant cognitive changes that are below the threshold for clinical impairment. The aim of this meta-analysis was to examine phonemic fluency differences between aMCI and CU older adults. Data from 18 studies were included in this analysis that found that aMCI individuals' phonemic fluency performance was approximately seven points lower than CU individuals (Δ = -7.31, 95% CI [-9.10, -5.52], z = -8.01, p

Post-COVID syndrome can develop in all patients who have had COVID-19, regardless of the disease severity. Clinical manifestations postCOVID syndrome vary greatly, but the most common symptoms include fatigue, anxiety and depression disorders (ADDs), and cognitive impairment (CI).Objective: to evaluate the efficacy and safety of Cholytilin (choline alfoscerate) and the combined drug MexiB 6 in patients with post-COVID syndrome and fatigue, ADDs, and CI.Patients and methods. The study included 100 patients aged 22 to 71 years who have had COVID-19 5.4 months ago. Inclusion criterion: cognitive complaints, fatigue, and emotional disturbances. The evaluation included neurological exam, Montreal Cognitive Assessment Scale (MoCA), Frontal Assessment Battery (FAB), 10-words list task, Multidimensional Fatigue Inventory (MFI-20), Hospital Anxiety and Depression Scale (HADS). Study participants were divided into two groups. Patients who had ADDs (anxiety/depression level according to HADS ≥8 points; n=50) were prescribed with MexiB 6 (1 tablet three times per day). Patients with CI (mean MoCA score ≤25 points; n=50) were prescribed with Cholytilin (2 capsules (800 mg) in the morning and 1 capsule (400 mg) at lunchtime). The follow-up period was 60 days.Results and discussion. According to MoCA scores, a decrease in cognition was observed in 58% of participants, while 28% did not notice CI earlier. ADD fere present in 51%, and fatigue — in 100% of patients. We observed a significant reduction in fatigue severity (from 62.42±7.18 to 52.32±16.36 points; pConclusion. Patients who have had COVID-19, regardless of the disease severity, have a high prevalence of fatigue, ADDs and CI, and MexiB 6 and Cholytilin have a potential in their treatment.

Plasmodium falciparum infection in blood donors is common in malaria endemic countries, including Ghana. To date, there are no established exclusion criteria to defer a donor carrying malaria parasites. Therefore, based on significant independent variables identified in this study, donor malaria screening algorithm was developed to be used by blood banks to screen blood donors for subclinical malaria. Each significant variable was weighted one (1) point and its alternative response was weighted negative one (−1) point. Accumulation of the points determines the risk level of the donor. These weighted points were used to categorize infected donors as having negligible (9 points) risk. Based on accumulated weight of ≥5 points, the algorithm was 94.7% (54/57) sensitive but 82% (298/364) specific. With this level of specificity, 18% of the blood donors without malaria would have been deferred. Therefore, it is imperative that all donors with accumulated risk ≥5 be screened for malaria using either malaria rapid test kit or microscopy.

Objective Cognitive dysfunction is known to occur in many individuals with multiple sclerosis (MS). However, little is currently known about MS patients without cognitive impairment, including protective factors associated with intact cognition. The present study considered these issues in a sample of MS patients screened for intact subjective and objective cognitive functioning. Methods Two MS participant groups from a larger sample were derived: i) participants within 1 standard deviation of controls on measures of objective cognition, subjective cognition, and informant-observed subjective cognition [cognitively resilient MS group (MScr)], and ii) those classified as not cognitively resilient (MSncr). Both groups were compared with age- and gender-matched controls. Results Findings indicated that the MScr group was similar to the MSncr group on most disease and demographic variables, and level of fatigue. The MScr group showed higher estimated baseline intellectual ability and reported less anxiety, subclinical depressive symptoms, and pain interference. MScr participants also showed a trend toward more reported compensatory cognitive strategy use than MSncr participants. The MScr group showed comparable reading recognition and pain symptoms to controls. Conclusions Our findings provide preliminary information on factors associated with cognitive resilience in MS. Future research should examine resilient individuals with MS to further clarify positive outcomes in this condition.

Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.

No existe consenso sobre el patrón de liberación de cortisol y su relación con la ansiedad subjetiva en situaciones de estrés en población con ansiedad social. Nuestro objetivo fue determinar la respuesta de cortisol y ansiedad subjetiva en individuos con ansiedad social sometidos a un estresor psicosocial agudo. 26 universitarios (58.6% hombres), edad media = 21.62 ± 0.43, fueron expuestos a la versión estrés o control del Maastricht Acute Stress Test. El cortisol salival y la ansiedad subjetiva fueron medidos antes, durante y post-estrés. Los participantes mostraron un incremento en los niveles de cortisol durante las fases de estrés y post-estrés, con una respuesta significativamente mayor en aquellos con ansiedad social. Los participantes con alta ansiedad social mostraron, a nivel muestral, mayores niveles de ansiedad subjetiva, especialmente post-estrés. Sólo en la fase de estrés, el cortisol y la ansiedad subjetiva correlacionaron significativamente en los participantes socialmente ansiosos. Los hallazgos apoyan una hiperresponsividad de cortisol en población no clínica y joven con alta ansiedad social. Futuras investigaciones deberían estudiar los factores involucrados y efectos de esta respuesta fisiológica en la salud. Asimismo, se resalta la necesidad de controlar la ansiedad social en experimentos que utilicen un estresor psicosocial de laboratorio. There is no consensus about the pattern of cortisol release and its relationship with subjective anxiety in situations of stress in the population with social anxiety. Our aim was to determine the cortisol and subjective anxiety response in individuals with social anxiety subjected to an acute psychosocial stressor. 26 college students (58.6% males), mean age = 21.62 ± 0.43, were exposed to the stress or control adaptation of the Maastricht Acute Stress Test. Salivary cortisol and subjective anxiety were measured before, during, and after stress. Participants showed an increase in cortisol levels during the stress and post-stress phases, with a significantly higher response in those with high social anxiety. Participants with high social anxiety also showed, as a tendency, higher levels of subjective anxiety, especially in the post-stress phase. Only in the stress phase, cortisol and subjective anxiety correlated significantly in socially anxious participants. The findings support a cortisol hyperresponsiveness in a young, non-clinical population with high social anxiety. Future research should focus on the factors involved and the effects of this physiological response on health. Furthermore, the need to control social anxiety in experiments using a laboratory psychosocial stressor is highlighted.

Uterine perforation is an intrauterine problem that can occur with any therapy. It is a rare but possibly dangerous consequence of uterine manipulation, evacuation of retained products of conception or pregnancy termination (TOP), hysteroscopic treatments, and coil implantation. Injury to blood arteries or viscera, such as the bladder or the intestine, might be related. Severe bleeding or infection may ensue if not discovered at the time of surgery; nevertheless, the most majority of uterine drilling is subclinical and safe without treatment, with no substantial long-term damage. Perforation can be caused by cervical stenosis during trans-cervical operations or by a reduction in myometrial wall strength during pregnancy or menopause. Uterine abnormalities, infection, recent pregnancy, and postmenopause are all factors that raise the chance of uterine perforation. The treatment of uterine perforation is determined by the operation and the equipment employed. Admission to the hospital, intravenous antibiotics, and close supervision are required following a uterine perforation and any accompanying injuries. In this paper, we overview common causes and updated management of uterine perforation. Data was collected during a period of 6 months searching Pubmed, EPISCO, Web of science data bases to include studies with relative topics.

Background: Hypothyroidism is known to cause reversible cardiac dysfunction in humans. Thyroid hormone alters the cardiovascular hemodynamics. This study was performed to assess echocardiographic changes in untreated newly diagnosed primary hypothyroid states as such studies are scarce in our setting.Methods: This hospital based cross-sectional study was conducted among 71 patients with newly diagnosed primary hypothyroidism who presented to the medicine outpatient department, at Universal College of Medical Sciences and Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from December 2018 to June 2020 after taking ethical clearance from institutional review committee (UCMS/IRC/212/18). Thyroid function test and echocardiography were carried out in patients under study. The data was analyzed with SPSS Version 16.Results: A total of 71 patients (52 females and 19 males) with primary hypothyroidism were enrolled for the study. Among these 58 cases were overt/clinical hypothyroidism, and 13 cases were subclinical hypothyroidism. Echocardiography was abnormal in 63.4% of cases with 43.7% showing diastolic dysfunction, 18.3% diastolic interventricular septal thickness abnormality, 8.5% diastolic left ventricular posterior wall thickness abnormality, and 8.4% pericardial effusion. Conclusion: Our study found diastolic dysfunction, diastolic interventricular septal thickness abnormality, diastolic left ventricular posterior wall thickness abnormality, and pericardial effusion as the common echocardiographic change in patients with newly diagnosed primary hypothyroidism. Therefore, our study highlights the need for cardiac evaluation of patients with primary hypothyroidism so that early intervention can be performed to improve the clinical outcome.

To investigate the frequency of initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease presenting with unilateral exudative retinal detachment. A retrospective case series. During the period between January 1998 and December 2020, we identified 135 patients with initial-onset acute uveitis associated with VKH disease. Among them, 5 (3.7%) patients were referred to have unilateral uveitis due to the presence of exudative retinal detachment in only one eye. Optical coherence tomography confirmed the presence of unilateral exudative retinal detachment, however, indocyanine green angiography (ICGA) revealed characteristic findings of bilateral granulomatous choroidal inflammation typical for initial-onset acute uveitis associated with VKH disease. Patients with initial-onset acute uveitis associated with VKH disease can present with unilateral exudative retinal detachment. ICGA assessment of the choroid revealed the presence of subclinical involvement of the fellow eyes.

Background: Anthracycline therapy-related cardiac dysfunction (ATRCD) is the most notorious adverse side-effect of chemotherapy. It has become a significant cardiovascular health concern for long-term cancer survivors. With the emerging concept of subclinical ATRCD and newer diagnostictools (Speckle Tracking Echocardiography (STE) and biomarkers), detecting anthracycline cardiac toxicity at an early stage has become an important step to prevent severe cardiac dysfunction and improve the cardiovascular outcome in cancer survivors. Despite the increasing population at risk in sub-Saharan Africa (SSA), there is no contemporary data in Uganda to address the burden, pathogenesis and risk factors of subclinical ATRCD. This big gap in knowledge has led to a lack of local guidelines for monitoring and management of ATRCD. Methods: SATRACD (Detecting Subclinical Anthracycline Therapy Related Cardiac Dysfunction In Low Income Country) study is an observational prospective cohort study. Three hundred and fifty-three anthracycline naïve cancer patients will be recruited at baseline. Patients are followed up on completion of anthracycline-based chemotherapy and at 6 months after completion of anthracycline therapy. Data on demographics, cancer profile and clinical presentation will be collected at baseline. Comprehensive cardiac assessment will be performed at each visit, including electrocardiogram, conventional echo- cardiography, STE, cardiac and oxidative stress markers. We will be able to determine the incidence of subclinical and clinical ATRCD at 6 months after completion of anthracycline therapy, determine whether hypertension is a major risk factor for ATRCD, evaluate the role of conventional echocardiography parameters, and biomarkers for detecting subclinical ATRCD. Conclusion: This SATRACD study will provide contemporary data on Ugandan cancer patients who have subclinical and clinical ATRCD, help in the development of local strategies to prevent and manage ATRCD, and improve cardiovascular outcome for Ugandan cancer survivors. Keywords: SATRACD study; subclinical anthracycline therapy; cardiac dysfunction; low income country.

Background: The two most common chronic complication softype 2 diabetes mellitus (T2DM) are peripheral neuropathy (PN) and Cardiac autonomic neuropathy (CAN).Diagnosing neuropathies at subclinical stage can prevent the morbidity and mortality. Objectives: To determine the prevalence of peripheral neuropathy and cardiovascular autonomic neuropathy and their risk factors in type-II diabetic patients attending a tertiary care hospital. Methods: An observational cross sectional study was done from December 2019 to November 2020 in the department of General medicine at tertiary care hospital. 273 type II diabetic patients were selected for this study. Toronto clinical scoring system was used for assessing PN and ewings cardiovascular reflex study was used done to assess CAN. To identify the risk factors of PN and CAN, Logistic regression analysis was used. Results: The prevalence of PN and CAN was 45.4% and 34.06% respectively, while29.3% participants had both. Smoking (OR: 12.976; 95% CI: 0.052–0.418, P

OBJECTIVE To evaluate various strategies for prevention of subclinical hypocalcemia (SH) during the first 24 hours after parturition in dairy cows. ANIMALS 165 multiparous German Holstein cows from 1 herd. PROCEDURES All cows were fed a ration with a moderate dietary cation-anion difference (approx 0 mEq/100 g of dry matter; anionic diet) for the last 2 to 3 weeks of gestation. In the first part of a 2-part study, cows were randomly assigned to 1 of 4 treatment groups (no calcium supplementation [n = 30], oral administration of a calcium bolus alone [34] or in combination with IV administration of 500 mL of a calcium solution [34] or incomplete milking during the first 24 hours after parturition [34]). In part 2, cows in their fifth or greater parity were randomly assigned to receive vitamin D3 (20,000 U/ kg, IM; n = 15) 7 days before the predicted calving date or a control group (18). A calcium bolus was orally administered within 30 minutes after parturition to all cows of part 2. Serum total calcium (Cat) concentration was measured immediately after parturition and every 2 hours thereafter for 24 hours and compared among treatment groups. Subclinical hypocalcemia was defined as a Cat concentration < 2.00 mmol/L. RESULTS In part 1, the mean ± SD Cat concentration during the 24 hours after parturition for the IV-treated group (2.28 ± 0.42 mmol/L) was greater than that for the other 3 groups, each of which had a mean Cat concentration < 2.00 mmol/L. In part 2, the mean Cat concentration for the vitamin D3– treated cows was greater than that for control cows and remained above 2.00 mmol/L for the duration of the observation period. CONCLUSIONS AND CLINICAL RELEVANCE Intramuscular administration of vitamin D3 or IV administration of a calcium solution in combination with oral administration of a calcium bolus might alleviate SH during the first 24 hours after parturition in dairy cows fed an anionic diet during late gestation.

Background: Idiopathic VA are traditionally considered benign, although occasional patients develop an ectopy-mediated cardiomyopathy (EMC). It is unclear whether patients with idiopathic VA in the absence of left ventricular (LV) dysfunction harbor a subclinical cardiomyopathy. We aim to assess for cardiomyopathic substrate in patients with idiopathic ventricular arrhythmias (VA) using imaging and electrophysiologic markers of early fibrosis. Methods: Cardiac magnetic resonance (CMR) imaging and ventricular electroanatomic mapping was performed in 3 groups: patients undergoing ablation for idiopathic VA without (Group 1, n = 17) and with LV dysfunction (Group 2 [presumed EMC], n = 12) plus a control group undergoing ablation of supraventricular tachycardia (Group 3, n = 16). Global LV strain, T1 mapping and extended electrogram (EGM) characteristics were compared. Results: Global strain was impaired in patients with presumed EMC (Group 2, p < 0.001). Native T1 times did not differ between groups, however patients in both idiopathic VA groups (Groups 1 and 2) had shorter post-contrast T1 times at 8 min compared to SVT controls (Group 3, p = 0.04). Similarly, the duration of the bipolar EGM was subtly prolonged in both Group 1 and 2 compared to Group 3 (p = 0.002). There were no between group differences in unipolar or bipolar voltage, the no. of bipolar EGM deflections or the maximal unipolar EGM dV/dt. Conclusion: Patients with idiopathic VAs and apparently structurally normal hearts may have subtle CMR and electrophysiologic changes similar in magnitude to that seen in frank presumed EMC, possibly suggestive of an occult cardiomyopathic process.

Background Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes. Methods hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years. Results In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2–21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69–3.46], P Conclusions In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.

The cardiac sequelae of coronavirus disease 2019 (COVID-19), a worldwide global pandemic, are still uncertain, particularly in the asymptomatic, low cardiac risk outpatient population. This study aims to evaluate the asymptomatic, low cardiac risk out-patient population who recently recovered from COVID-19, using 2-D left ventricular-global longitudinal strain (LV-GLS) proven to be capable of detecting subclinical myocardial injury. Out of 305 COVID-19 positive patients, 70 asymptomatic out-patients were determined as the study group and 70 age and sex-matched healthy adults as the control group. The echocardiographic examination was performed with the Philips IE33 system, and LV-GLS was measured using commercially available software QLAB 9 (cardiac motion quantification; Philips Medical Systems). The absolute value of LV-GLS ≤ 18 did deem to be impaired LV-GLS. The absolute value of LV-GLS was statistically significantly lower in the COVID-19 group than in healthy controls (19.17 ± 2.65 vs. 20.07 ± 2.19, p = 0.03). The correlation between having recovered from COVID-19 and impaired LV-GLS (≤18) did detect with the Pearson correlation test (p = 0.02). Having recovered from COVID-19 was found as a predictor for detecting impaired LV-GLS (≤18) in the multivariable logistic regression analysis (odds ratio, 0.133 (0.038-0.461); 95% CI, p = 0.001). This study suggests that COVID-19 may cause subclinical LV dysfunction detected by LV-GLS during early recovery even in a population of patients at low cardiac risk, asymptomatic, and recovered with home quarantine. The study findings indicate that the long-term cardiovascular follow-up of these patients may be more important than thought.