Search

Background: In Belgium, the first peak of COVID-19 was observed between March and April 2020. This represented more than 300 deaths a day begin April and more than 1500 new cases every day during this period. Aims: This retrospective observational survey of homeopathic practice in Belgium has been conducted to evaluate how homeopathic medical doctors (HMD) treated their patients presenting mild symptoms of COVID-19. Methodology: 6 HMDs accepted to provide systematic data from all consecutive cases treated for COVID-19 symptoms from February up to June 2020. This observational retrospective data collection was compared with information from a free exchange HMDs’ forum. 13 HMDs regularly participated in this forum. Results and discussion: this survey includes 183 patients presenting mild COVID-19 symptoms. A shorter symptoms duration than commonly observed is relevant for 83,1% of these patients. The typical average duration of COVID-19 symptomatology is 20 days. The four most used homeopathic medicines (Bryonia alba/Arsenicum album/Phosphorus/Gelsemium sempervirens) were prescribed to 66% of them. A total of 1,1% needed hospitalization. Not any loss of chance to cure occurred for these patients that used homeopathy for COVID-19 symptoms. Market data also reveals that homeopathy has mainly been used in Belgium for prevention and healing during the early peak of COVID-19 (March/April 2020). Conclusion: This survey allows us to conclude that during an epidemic outbreak for which no effective therapy exists and no vaccination is yet possible, homeopathy could be considered a valuable approach. © International Journal of High Dilution Research. Not for commercial purposes.

Mona A Hegazy,1 Rania Mohamed Lithy,2 Hoda M Abdel-Hamid,3 Mahmoud Wahba,1 Omar Ahmed Ashoush,1 Mohamed Tharwat Hegazy,1 Maha Hossam El-Din Ibrahim,1 Dalia Abdelfatah,4 Ahmed Abdelghani1 1Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Chest Diseases Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 4Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Mona A HegazyInternal Medicine Department, Faculty of Medicine, Cairo University, P.O. Box Number: 12566, 6th October City, Giza, EgyptTel +201001421551Email monahegazy@cu.edu.egBackground: The novel coronavirus disease 2019 presents an urgent threat to global health. As the epidemic grows, prognosis prediction is essential for monitoring risky patient. It is thus important to consider gastrointestinal manifestations and the duration of symptoms as predictors of prognosis. Our aim was to determine the correlation of gastrointestinal symptoms and laboratory markers with disease outcomes and whether symptom duration varies substantially between patients. We also undertook this study to determine the optimal time to predict COVID-19 outcome.Patients and Methods: A total of 190 patients with polymerase chain reaction-confirmed COVID-19 were followed up until recovery. We proposed a correlation between gastrointestinal symptoms and disease severity (based on clinical data, and diagnostic investigations) to estimate the duration of symptoms as a predictor of COVID-19 prognosis.Results: The prevalence of gastrointestinal symptoms was 49.5%, consisting mainly of diarrhea in 27.9% of patients. In addition, a longer disease duration and higher temperature were observed in patients with diarrhea. Symptom duration was variable, with a median of 12 days and a range of 1– 55 days. Statistical analysis indicated that patients with a duration of symptoms ≥ 12 day had more severe symptoms and a worse prognosis. Patients who complained of diarrhea had 2.7 times the odds of a longer duration of symptoms, and those with a history of chronic lung disease have 7.2 times the odds of a longer duration of symptoms.Conclusion: GIT manifestations (mainly diarrhea) and the duration of symptoms of COVID-19 provide prognostic evidence of COVID-19 outcomes, irrespective of earlier categorization by the World Health Organization. Thus, patients with mild symptoms who present with diarrhea and a duration of symptoms longer than 12 days are expected to have a worse prognosis.Keywords: COVID-19, GIT manifestations, symptoms duration, prognosis

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

Background: C7-D1 disc herniation is rare in comparison with other cervical levels. The incidence rates are between 3.5% and 8%. The cervicothoracic junction disc herniation can be operated posteriorly or anteriorly. The anterior approach can be challenging because of the difficulty of access resulted from the manubrium. In this article, we present our experience about cervicothoracic junction disc herniation (C7-T1) surgery. Materials and Methods: Between January 2008 and December 2017, 21 patients have been operated for solitary C7-T1 disc herniation. We operated 12 male patients and 9 female patients. Eight patients have been operated by the anterior approach, and 13 patients underwent surgery by the posterior approach. The mean symptoms duration was 11.4 months. Results: All patients had C8 cervicobrachial neuralgia. Other clinical presentations were numbness, tingling sensation, and weakness. All patients improved after surgery. We had no significant complication. Conclusion: We did not find a great difference between the clinical features of cervicothoracic herniated disc and other cervical levels. The anterior approach seems more difficult to carry out in particularly in large patients with the short neck. The posterior approach can be used for all types of patients except in the case of medial disc herniation.

Background: To compare outcomes for complicated appendicitis treated with early versus interval appendectomy and to identify which patients would likely benefit from early appendectomy. Methods: A retrospective review of complicated appendicitis was performed from 2010 to 2015. Patients were divided into early (EA) versus interval appendectomy (IA) groups. We compared demographics, complications and outcomes. Pearson's Chi square analysis and Student's T test analysis were performed. Results: We identified 316 patients (EA group 53% vs. IA group 47%). Interval appendectomy group had longer symptom duration [IA 3.8 vs. EA 2.3 days (p = 0.0001)], increased leukocytosis [IA 18.7 vs. EA 17.2 (p = 0.008)], more initial abscesses [IA 35% vs. EA 13% (p = 0.0001)], more complications [IA 30% vs. EA 19%, (p = 0.013) and prolonged total length of stay [(LOS), p = 0.009]. Subgroup analysis of all patients revealed 80% of patients presented with ≤3 cm abscess and duration of symptoms (DOS) ≤5 days. Interval appendectomy patients with DOS ≤5 days and or ≤3 cm abscess on admission had no differences in clinical presentation. However, these patients had prolonged total LOS (IA 7.7 vs. EA 6.3 days, p = 0.01) and increased complications (IA 29% vs. EA 19%, p = 0.04). Conclusion: The majority of patients with complicated appendicitis in children present with small abscess (≤3 cm) and short symptom duration (≤5 days). This subset of patients might benefit from early appendectomy due to decreased LOS, resource utilization and reduced complications. Key Words: abscess, appendicitis, early, interval

Background There is growing evidence that tuberculosis (TB) case notifications in men have in many circumstances surpassed those in women. The increase in reported cases among men was often interpreted as the result of barriers to TB diagnosis faced by women in seeking care. Aim To assess Gender differences in patients with pulmonary TB in Abbassia Chest Hospital. Patients and methods This study was carried out between 1 January 2017 and 30 April 2017. Patients were divided into two groups based on Gender difference: males and females. All patients were subjected to history taking, clinical examination, radiological and laboratory investigations, and sputum examination (direct smear and Gene Xpert and sputum culture for relapse TB, treatment failure, default, and suspected smear-negative patients). Pleural aspiration was done for cytological, biochemical, and adenosine deaminase level. Therapy was initiated, and patients were followed up for 6 months. Results The study has been carried out on 126 cases of TB, comprising 98 males and 28 females. The highest prevalence of TB infection among men with respect to different occupations was seen to be manual workers (62%), and among women to be housewives (71.4%). The new cases were 73.5% for males and 89.3% for females. The default was 14.3% for males and 3.6% for females. The frequency of relapse was 10.2% in males and 7.1% in females, whereas cases of treatment failure were found only in males. Male patients were much more compatible with anti-TB treatment. Drug complications were more common in women. In terms of treatment outcome, the rate of cure was higher in males and defaulters in females were more common. Conclusion In our study, the male-to-female ratio of identified patients with TB is higher than the previously reported global figures. Female patients were more likely to be younger, housewives, had longer symptoms duration before diagnosis, were less compatible with anti-TB therapy, and had more drug complications.

Background The purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful. Methods Retrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values Results Nineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80–2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4–3.0) approximately 20/200 (p Conclusion The use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.

Author(s): Shah, Sachin J; Barish, Peter N; Prasad, Priya A; Kistler, Amy; Neff, Norma; Kamm, Jack; Li, Lucy M; Chiu, Charles Y; Babik, Jennifer M; Fang, Margaret C; Abe-Jones, Yumiko; Alipanah, Narges; Alvarez, Francisco N; Botvinnik, Olga Borisovna; Castaneda, Gloria; CZB CLIAhub Consortium; Dadasovich, Rand M; Davis, Jennifer; Deng, Xianding; DeRisi, Joseph L; Detweiler, Angela M; Federman, Scot; Haliburton, John; Hao, Samantha; Kerkhoff, Andrew D; Kumar, G Renuka; Malcolm, Katherine B; Mann, Sabrina A; Martinez, Sandra; Mary, Rupa K; Mick, Eran; Mwakibete, Lusajo; Najafi, Nader; Peluso, Michael J; Phelps, Maira; Pisco, Angela Oliveira; Ratnasiri, Kalani; Rubio, Luis A; Sellas, Anna; Sherwood, Kyla D; Sheu, Jonathan; Spottiswoode, Natasha; Tan, Michelle; Yu, Guixia; Kangelaris, Kirsten Neudoerffer; Langelier, Charles | Abstract: BackgroundMost data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have been presented as case series without comparison to patients with other acute respiratory illnesses.MethodsWe examined emergency department patients between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by PCR and metagenomic next generation sequencing (mNGS). We compared clinical presentation, diagnostics, treatment, and outcomes.FindingsAmong 316 patients, 33 tested positive for SARS-CoV-2; 31 without COVID-19 tested positive for another respiratory virus. Among patients with additional viral testing (27/33), no SARS-CoV-2 co-infections were identified. Compared to those who tested negative, patients with COVID-19 reported longer symptoms duration (median 7d vs. 3d, pnln0.001). Patients with COVID-19 were more often hospitalized (79% vs. 56%, pn=n0.014). When hospitalized, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, pnln0.001) and more often developed ARDS (23% vs. 3%, pnln0.001). Most comorbidities, medications, symptoms, vital signs, laboratories, treatments, and outcomes did not differ by COVID-19 status.InterpretationWhile we found differences in clinical features of COVID-19 compared to other acute respiratory illnesses, there was significant overlap in presentation and comorbidities. Patients with COVID-19 were more likely to be admitted to the hospital, have longer hospitalizations and develop ARDS, and were unlikely to have co-existent viral infections.FundingNational Center for Advancing Translational Sciences, National Heart Lung Blood Institute, National Institute of Allergy and Infectious Diseases, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative.

BackgroundTo describe whether SARS-CoV-2 viral loads (VLs) and cycle thresholds (CTs) vary by sample type, disease severity and symptoms duration.MethodsSystematic searches were conducted in MEDLINE, EMBASE, BioRxiv and MedRxiv. Studies reporting individual SARS-CoV-2 VLs and/or CT values from biological samples. Paired reviewers independently screened potentially eligible articles. CT values and VLs distributions were described by sample type, disease severity and time from symptom onset. Differences between groups were examined using Kruskal-Wallis and Dunn ‘s tests (post-hoc test). The risk of bias was assessed using the Joanna Briggs Critical Appraisal Tools.Results14 studies reported CT values, 8 VLs and 2 CTs and VLs, resulting in 432 VL and 873 CT data points. VLs were higher in saliva and sputum (medians 4.7×108 and 6.5×104 genomes per ml, respectively) than in nasopharyngeal and oropharyngeal swabs (medians 1.7×102 and 4.8×103). Combined naso/oropharyngeal swabs had lower CT values (i.e. higher VLs) than single site samples (p=ConclusionVLs are higher in saliva and sputum and in individuals who are asymptomatic of with severe COVID-19. Diagnostic testing strategies should consider that VLs vary by sample type, disease severity and time since symptoms onset.SummaryThis systematic review found a higher viral load in saliva and sputum than in nasopharyngeal swabs, in asymptomatic individuals and patients with severe COVID-19. Diagnostic testing strategies should consider the type of sample, disease severity and the time since symptoms onset.

Background/Aim. Acute appendicitis (AA) is the most frequent emergency and appendectomy is the most frequent abdominal operation in the pediatric surgery. Diagnosis of AA in children is more difficult due to a lack of cooperation and poor clinical history data, leading to significant number of misdiagnostic cases. Our aim was to explore whether neutrophil to lymphocyte ratio (NLR) may be useful in diagnosis and follow-up of AA in children. Methods. Prospective investigation of NLR values in 129 consecutive patients admitted to the Mother and Child Healthcare Institute of Serbia and referred for surgery due to AA was performed. According to the pathohistological findings, patients were divided into 3 groups: normal/early, uncomplicated (phlegmonous) and complicated (gangrenous or/and perforated) AA. Laboratory analysis was done preoperativly and on the 1st and the 3rd postoperative days. Results. Statistically significant differences of NLR values were found in the different time points in total of patients and per groups. Some statistically significant differences of NLR values among histopathological groups were recorded. Investigations of correlation of NLR and other laboratory and clinical parameters showed strong positive correlation between NLR and C-reactive protein postoperatively and between NLR and Pediatric Appendicitis Score (PAS) preoperatively. Strong negative correlation with preoperative symptoms duration (PSD) were also present. Optimal cutoff NLR value between negative and positive appendectomies was 6.14. Conclusion. NLR provides well monitoring of progression of AA in children and, its cutoff values may help in distinguishing the phases of AA. Because of that, NLR should be used in diagnosis of AA in children.

Objectives In published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self-image. Design Structural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder. Method The relationship between patients (N = 150) and their eating disorders was examined with respect to symptoms, duration of illness, and self-image. Patients were also compared on their tendency to react with affiliation in relation to their disorder. Results Patients’ responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic. Conclusions When encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real-life relationship could have theoretical implications, and its exploration may be of interest in treatment. Practitioner points Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so. Patients tended to experience their disorder as controlling and domineering. Exploring the hypothetical patient–eating disorder relationship may prove helpful in understanding dysfunctional relational patterns. Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.

Background:Currently it is unclear whether combination of tofacitinib (tofa) with methotrexate (Mtx) more effective and safe than tofa in monotherapy.Objectives:To compare efficacy and safety of tofacitinib monotherapy with combination of tofa and mtx in RA patients.Methods:Data from 450 patients from Russian national RA register OREL were included in the statistical analysis. Data from the 1st, 6, 12, 24 and 36 month after baseline were analyzed. Demographical and disease-related characteristics of RA (symptoms duration, DAS28, CDAI, SDAI, number of tender and swollen joints (NTJ, NSJ), erythrocytes sedimentation rate (ESR), C-reactive protein (CRP)) were collected. Statistical analysis performed with SPSS2017.Results:Baseline characteristics of RA patients involved in the analysis are presented in table 1. Mean dosage of mtx was 15.5±5.5 mg/week.Table 1ParameterTofa monotherapy, n=169Tofa +Mtx, n=281Male34 (20%)51 (18.14)Age, years53.0±13.349.8±12.8Symptoms duration, month149.7±110.1120.0±96.5Positive rheumatoid factor (RF)126 (75)210 (74.3)Positive antibodies to cyclic citrullinated peptide (ACCP)129 (79)233 (83)p≥0.05 for all the differences.Treatment results are presented in table 2.Table 1.A. Pre-treatment screeningParameter1 month*6 month*12 month*24 month*36 month*n mono123 (72.78)111 (65.68)90 (53.25)48 (28.40)20 (11.83)n combo205 (72.95)222 (79)150 (53.38)69 (24.55)37 (13.16)CDAI mono30.14±12.4514.49±10.7613.08±8.9113.54±5.5311.84±7.89CDAI combo28.27±13.1216.46±10.5812.78±9.519.71±10.6210.61±10.05DAS28 mono5.35±1.163.97±1.303.50±1.13.26±1.003.10±0.89DAS28 combo5.54±1.263.87±1.253.63±1.273.56±1.183.47±1.29SDAI mono30.95±13.9116.84±11.9714.33±11.3910.62±5.7912.95±12.12SDAI combo35.05±14.8915.50±11.1514.04±10.3114.31±10.8712.89±11.39CRP mono, mg/L24.01±26.668.45±11.808.79±14.015.90±5.138.74±10.46CRP combo, mg/L34.48±39.2511.76±22.368.12±12.678.54±14.3510.49±17.51ESR mono, mm/h32.96±17.2622.54±15.4521.26±15.3822.83±21.2421.29±14.02ESR combo, mm/h36.68±22.9824.24±16.8921.59±15.4019,52±12.8322.97±19.36NTJ from 28 mono10.73±6.156.26±4.654.97±5.024.13±3.093.42±4.01NTJ from 28 combo11.75±6.635.21±5.364.55±4.435.73±5.683.45±4.15NSJ from 28 mono8.0±4.782.0±2.942.0±2.641.0±1.300.0±0.45NSJ from 28 combo8.26±5.222,96±3.492.55±3.332.54±4.281.68±3.00*from the baseline ± 14 days for 1 and 6 month, ±28 days for 12, 24, and 36 monthp-value ≥ 0.05 for all the differences between monotherapy and combination therapy in all the time points.No differences were found in safety parameters between groups of tofamonotherapy and tofa plus mtx.Conclusion:The efficacy and safety of tofacitinib monotherapy is not worth than combination of tofacitinib and methotrexate in RA treatment.Acknowledgments:PfizerDisclosure of Interests:Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi, V Mazurov: None declared, Alexander Lila: None declared, Diana Abdulganieva: None declared, Svetlana Lapshina: None declared, Leysan Myasoutova: None declared, Irina Vinogradova: None declared, Olga Semagina: None declared, L Solodovnikova: None declared, E Kryukova: None declared, Ekaterina Gaydukova: None declared, N Lapkina: None declared, Diana Kretchikova: None declared, O Epifanova: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm

Objectives To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Material and methods Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. Results A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. Conclusions The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.

Background: Patients (pts) with axial spondyloarthritis (axSpA) have increased cardiovascular morbidity and mortality, compared to the general population. However, assessment of cardiovascular risk (CVR) in axSpA is complicated, as in age Objectives: To measure CVR in young pts with low activity of axSpA, and to evaluate the interrelation between CVR, measured with QRISK and gene predisposition. Methods: The study included 46 pts 25-40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was measured with ASDAS and BASDAI. CVR was calculated with the modified QRISK (QRISK3) (https://qrisk.org/three/). All parameters of QRISK3 were collected: smoking and diabetes statuses, angina or heart attack in a 1st degree relative Results: Mean age ± SD of included pts was 32.5±3.87 years (26% of pts aged 25 – 30, 28.3% – 30-35, 28.3% – 35-40 years), 36 (78.3%) patient were male, symptoms duration 8.71±4.72 years, duration of TNF-α inhibitor treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8. All three age groups were comparable (p≥0.05). Out of the 46 pts 25 – 40 years old 34 (75.6%) had a low CVR and 11 (23,9%) had increased CVR (fig.1). Average QRISK3 score of all the patients was 1.18±1.64%. In the 25-30 year old age QRISK3 was 1.51±0.25%, in pts 30-35years old – 1.09±0.6%, in 35-40 years old–2.31±1.0% (p All patients with increased CVR had a direct associations with homozygous in CC allele IL17F-11139 gene, heterozygous in GA allele of TNF-308 and heterozygous in CG allele IL6-174. Negative associations were found between CVR and heterozygosity in His/Arg and homozygous in His/His of IL17F7, homozygosity in GG allele TNF-308, homozygosity in CC IL6-174, table 1. Interrelation of CVR with another gene polymorphisms was not significant (data are not present). Conclusion: A quarter of young axSpA pts had an increased 10-year probability of cardiovascular events. Gene polymorphisms in IL-6, IL17F, and TNF-α locuses are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA. Further larger studies are needed for evaluation of CVR factors in axSpA. Reference [1] Julia Hippisley-Cox, et al. BMJ2017; 357 doi: https://doi.org/10.1136/bmj.j2099. Disclosure of Interests: Elizaveta Vasilenko: None declared, Olga Nikolaeva: None declared, Anna Dadalova: None declared, Maxim Korolev: None declared, V Mazurov Grant/research support from: JSC BIOCAD, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros

Background Efficacy and safety of netakimab (NTK), a humanized anti-IL17A antibody, was established in phase 2 clinical trials in patients (pts) with radiographic axial spondyloarthritis (r-axSpA)1 and psoriasis2. Objectives The abstract presents 16-week data from ongoing ASTERA study (NCT03447704) in pts with active r-axSpA. Methods ASTERA is a phase 3 international double-blind placebo (PBO)-controlled study. 228 adult pts with r-axSpA, active (BASDAI ≥ 4) despite the standard NSAIDs, were randomly assigned (1:1) to receive 120 mg NTK or PBO SC at Week (Wk) 0,1,2 and then q2w through Wk 16. After Wk 16 all pts will start to receive NTK up to Wk 52. Primary endpoint was ASAS40 rate at Wk 16. Results The mean age at baseline was 39.14±9.9 years, the mean symptoms duration was 4.3±4.5 years. 76.8% of pts were naive to biological treatment. At Wk 16 ASAS40 rate was higher in NTK arm compared to PBO: 40.35% versus (vs.) 2.63% pts (95% CI for the difference in ASAS40 rate was [27.37%; 48.07%] (p Conclusion NTK at a dose 120 mg is well-tolerated drug with favorable safety profile that leads to decline in r-axSpA activity, function improvement and axial mobility in 16 Wks. References [1] Mazurov V, et al. Ann Rheum Dis 2018;77:A64. 2Samtsov A, et al. Vestn Dermatol Venerol 2017;0(5):52-63. Disclosure of Interests Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros, V Mazurov Grant/research support from: JSC BIOCAD, Shandor Erdes Grant/research support from: JSC BIOCAD, Speakers bureau: JSC BIOCAD, Tatiana Dubinina: None declared, Olga Nesmeyanova Grant/research support from: JSC BIOCAD, Elena Ilivanova Grant/research support from: JSC BIOCAD, Alena Kundzer: None declared, Nikolaj Soroka: None declared, Aleksander Kastanayan Grant/research support from: JSC BIOCAD, Tatyana Povarova Grant/research support from: JSC BIOCAD, Elena Zhugrova Grant/research support from: JSC BIOCAD, Tatyana Plaksina Grant/research support from: JSC BIOCAD, Pavel Shesternya Grant/research support from: JSC BIOCAD, Tatyana Kropotina Grant/research support from: JSC BIOCAD, Olga Antipova Grant/research support from: JSC BIOCAD, Elena Smolyarchuk Grant/research support from: JSC BIOCAD, Oksana Tciupa Grant/research support from: JSC BIOCAD, Diana Abdulganieva: None declared, Diana Kretchikova Grant/research support from: JSC BIOCAD, Ivan Gordeev Grant/research support from: JSC BIOCAD, Vadim Tyrenko Grant/research support from: JSC BIOCAD, Aleksandra Strelkova Grant/research support from: JSC BIOCAD, Anna Eremeeva Grant/research support from: JSC BIOCAD, Ekaterina Chernyaeva Employee of: JSC BIOCAD, Roman Ivanov Employee of: JSC BIOCAD

Antibiotic therapy is the cornerstone of medical management for community-acquired pneumonia.To assess the associations between 3 key aspects of antibiotic therapy (optimal time to antibiotic initiation, initial antibiotic selection, and criteria for the transition from intravenous to oral therapy) and short-term mortality in adults hospitalized with community-acquired pneumonia.Bibliographic databases of MEDLINE, EMBASE, and the Cochrane Collaboration were searched for studies of adults hospitalized with radiographically confirmed community-acquired pneumonia published from January 1, 1995, until November 5, 2015.Twenty studies (17 observational and 3 randomized trials) met eligibility criteria. Among 8 observational studies identified, the 4 largest (study populations of 2878 to 1,170,022) found that antibiotic initiation within 4 to 8 hours of hospital arrival was associated with relative reductions of 5% to 43% in mortality; the 4 smallest studies (study populations of 451 to 2076) found no associations between the timing of antibiotic initiation and mortality. One cluster randomized trial (n = 1737) demonstrated noninferiority of β-lactam monotherapy (n = 506) vs β-lactam plus macrolide combination therapy (n = 566), with an absolute adjusted difference of 2.5% (90% CI, -0.6% to 5.2%) in 90-day mortality favoring β-lactam monotherapy. A second randomized trial (n = 580) failed to demonstrate noninferiority of β-lactam monotherapy vs β-lactam plus macrolide combination therapy, with an absolute difference of 7.6% (1-sided 90% CI upper limit, 13.0%) in attainment of clinical stability on hospital day 7 favoring β-lactam plus macrolide combination therapy. Six of 8 observational studies (study populations of 1188 to 24,780) found that β-lactam plus macrolide combination therapy was associated with relative reductions of 26% to 68% in short-term mortality and all 3 observational studies (study populations of 2068 to 24,780) reported that fluoroquinolone monotherapy was associated with relative reductions of 30% to 43% in mortality compared with β-lactam monotherapy. One randomized trial (n = 302) reported significantly reduced hospital length of stay (absolute difference, 1.9 days; 95% CI, 0.6 to 3.2 days), but no differences in treatment failure when objective clinical criteria were used to decide when to transition patients from intravenous to oral therapy.In adults hospitalized with community-acquired pneumonia, antibiotic therapy consisting of β-lactam plus macrolide combination therapy or fluoroquinolone monotherapy initiated within 4 to 8 hours of hospital arrival was associated with lower adjusted short-term mortality, supported predominantly by low-quality observational studies. One randomized trial supports the use of objective clinical criteria to guide the transition from intravenous to oral antibiotic therapy.

Riley's (1994) Stuttering Severity Instrument (SSI) has three components: a symptom frequency measure (%SS), average duration of the three longest stutters, and a physical concomitant (PC) score. An assessment of whether it was necessary to use all of these when using SSI-3 to identify which children are at risk of speech difficulties was performed. Participants were 879 reception class children aged 4-6 years from UK schools. The distributions of the separate components of SSI-3 were examined. Departures from normality were noted for each component. The features seen in the distribution of the individual components were also apparent in the distribution of the overall scores (this was not normal and had multiple modes). These findings undermine the usefulness of the overall measure for identifying children at risk of speech difficulties. Prior work used a fixed SSI-3 threshold to identify at risk children. Classification of children as fluent or at risk based on this threshold was compared with classifications based on thresholds applied to the individual components. Classifications were comparable for %SS, but less satisfactory for duration and PC. These findings suggest that %SS performs similarly to the overall SSI-3 scores when used to identify at risk children. Procedures for identifying at risk children in schools need to be short and easy to administer. Thus, since there is no justification for including all components of SSI-3 and duration and physical concomitants are not sensitive measures of fluency, a procedure based on the frequency measure alone is appropriate for use in schools.

Introduction: Hemilaminectomy is one of the surgical options for managing cervical spondylotic myelopathy. However, it has not gained the expected popularity. This paper aims to review the utilization of hemilaminectomy, the outcome, and complications observed among patients managed with the procedure for advanced multilevel degenerative cervical myelopathy. Methods: Retrospective longitudinal analysis was done at a neurosurgical hospital in Enugu, Nigeria, between years 2010 and 2019. The Study analyzed 46 patients that had cervical hemilaminectomy for multilevel degenerative cervical myelopathy. Excluded from the study were patients offered cervical hemilaminectomy for other indications including tumor and trauma. Patients were assessed by comparing preoperative, and follow-up modified Japanese Orthopedic Association (mJOA) score and Cobb lordotic angles. The minimum postoperative follow-up period was for 1 year. Results: The mean age was 61 (43–88) years; male-to-female ratio was 3.6:1. Symptoms duration ranged from 6 months to 10 years, and 31 (67.4%) patients had significant comorbidities. The average operation time was 2 h 36 min (0.5–3.0 h). The mean blood loss was 260 mL (100–800 mL). Right hemilaminectomy was done for 37 (80.4%) patients. The average preoperative and postoperative Cobb lordotic angles were 10.90° ± 2.4° and 9.98° ± 2.1°. The mean preoperative mJOA was 8.2 ± 1.4. On follow-up 1 year after surgery, the mean mJOA score was 12.2 ± 1.1 (P = 0.0001). The neurological recovery rate at 1-year follow-up was 50.5%. One patient each experienced a transient postoperative drop in neurology, postoperative respiratory distress, and surgical site infection. Conclusion: Cervical hemilaminectomy for multilevel degenerative cervical spine myelopathy has the potential to achieve clinically satisfactory neurological improvement without significantly compromising stability and other serious long-term complications.

Background:Tofacitinib is an oral Janus Kinase inhibitor for the treatment of rheumatoid arthritis (RA).Objectives:To evaluate the three-year effectiveness of tofacitinib in RA conventional synthetic (cs) DMARDs non-responders.Methods:Data from 374 patients from Russian national register OREL of patients with RA treated with tofacitinib not less than 3 years after failure of conventional DMARDs were included in the statistical analysis. Clinical and laboratory data from 4 consecutive visits with an interval of 12 months between the visits (± 28 days) were analyzed. Treatment with any biologics ever was an exclusion criteria. Demographical (age, sex) and disease-related characteristics of RA (symptoms duration, RF- and ACCP positivity, presence of joint erosions, DAS28, CDAI, number of tender and swollen joints (NTJ, NSJ), erythrocytes sedimentation rate (ESR), C-reactive protein (CRP)) collected. Statistical analysis performed with statistical programs SPSS2017 and GraphPadPrizm. p-value < 0.05 considered as significant.Results:Baseline characteristics of RA patients, involved in the analysis are presented in table 1.Table 1.Baseline characteristics of the patients with RA (n=374).ParameterCharacteristicsMale, n (%)92 (24.5)Age, years (mean±SD)53.4±13.38Symptoms duration, month (mean±SD)140±137Positive rheumatoid factor (RF), n (%)123(32.8)Positive antibodies to cyclic citrullinated peptide (ACCP), n (%)329(87.9)Erosions of hand joints (X-rays), n (%)372 (99.4)BMI, kg/m2(mean ±SD)26.8 ± 6.14Smokers (current and in the past), n (%)54 (14.4)Changes in the diseases activity parameters in patients with RA, treated with tofacitinib not less than 3 years after cs DMARD failure are presented in table 2, figure 1, and figure 2.Figure 1.DAS28 of patients with RA, treated with tofacitinib (n=374) – 3-years follow-up (time-points are presented in years ± 28 days).Figure 2.DAS28 of patients with RA, treated with tofacitinib (n=374) – 3-years follow-up (time-points are presented in years ± 28 days).Table 2.Changes in RA parameters in patients treated with tofacitinib, n=374 (M±SE).Disease characteristicsBaselineYear 1#Year 2#Year 3#C-RP, mg/L30.1±35.08.3±12.87.6±10.79.4±13.5ESR, mm/h35.2±21.222.7±17.221.9±17.722.3±17.3NTJ from 2811.2±6.54.6±4.94.8±5.03.9±3.8NTJ from 287.6±5.12.4±3.21.7±3.11.4±2.8*difference with baseline is significant with p#- ±28 daysConclusion:According to the real world data treatment with tofacitinib may provide good response rates in RA patients, refractory to the previous csDMARDs treatment in long-term perspective.Acknowledgments :PfizerDisclosure of Interests: :Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi, V Mazurov: None declared, Alexander Lila: None declared, Andrey Baranov Grant/research support from: Bayer, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Evgeniy Zhilyaev Speakers bureau: Novartis, UCB, Pfizer, Biocad, Abbvie, MSD, Roche, Ekaterina Koltsova: None declared, Evgeniya Shmidt Speakers bureau: MSD, Novartis, Pfizer, Oxana Fomina: None declared, Irina Bondareva: None declared, Olga Anoshenkova: None declared, Aleksey Vasilenko: None declared, Elizaveta Vasilenko: None declared, Natalya Yudina: None declared, Larisa Knyazeva: None declared, Vyacheslav Poncratov: None declared, Ekaterina Gaydukova: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm

Background:Due to current data mean diagnostics delay in axial spondyloarthritis (axSpA) is 7.4 ± 8.4 years (mean ± SD) [1]. However, development of specific and high sensitive criteria of axSpA do not improve the situation because one of the main reasons of late axSpA diagnostics is the increased period when the patient with typical axSpA symptoms do not referred by general practitioner (GP) to the rheumatologists (so called «human factor»). The increasing role of internet online technologies can make way from GP to rheumatologist shorter and decrease the diagnostics delay in axSpA.Objectives:To develop the online questionnaire that calculates probability of having axSpA and evaluate the advantages of the method of online based detection of axSpA under the traditional ways of axSpA search.Methods:Based on positive and negative predictive values of symptoms from ASAS axSpA criteria (2009) the axSpA Early Diagnostics Questionnaire (aEDQ) was developed. The aEDQ was available on website of Russian Ankylosing Spondylitis Association from October 2018. Link to the aEDQ could be obtained directly on the site and additionally by using one of 1,500 related to axSpA keywords approved by 5 rheumatologists from Russian SpA Expert Group. Those of participants who had high risk of axSpA according aEDQ were recommended to visit the rheumatologist, related to axSpA diagnostics. Participants with low risk of axSpA were sent to their GP. Collected data of diagnostics delay and capacity of the aEDQ were compared with data from demographically matched populations from EMAS online survey from 13 European countries (n=2,846), and SPACE cohort results (n=461) [1, 2], and from Russian North-Western axSpA LADOGA register (n=1,544). This study used only anonymized data. Statistical analysis was performed with Statistica SPSS2017, GraphPadPrizme 2016.Results:Since October 2018 until January 2019 in Saint-Petersburg 22,925 people visited the aEDQ, 21,939 (95.6%) people filled out the questionnaire. Out of 21,939 people filled out questionnaire 7,888 (35.95%) people has high risk of axSpA. Within one month after passed the questionnaire 424 people with high risk of axSpA (5% out of all who had the recommendation) consulted by rheumatologist (mean age 42±6.6 years, male 275 (65%), symptoms duration 4.4 ± 3.0 years, HLA-B27 positive 292 (68.3%)). In 254 patients out of 424 (59.9%) presence of axSpA was confirmed as compared with 44.6% in SPACE cohort results (χ2 = 19.24, pMean diagnostics delay in aEDQ cohort was 4.4 ± 3.0 years (mean ± SD), n = 254, in axSpA patients with traditional way of axSpA search in LADOGA register was 8.8 ± 4.8 years, n=1,544 (LADOGA study results), and 7.4 ± 8.4 years in EMAS survey [1], p < 0.0001 for all the differences.Conclusion:Online axSpA Early Diagnostics Questionnaire with function of calculation of axSpA probability can decrease diagnostics delay and increase percentage of confirmed by rheumatologist axSpA diagnosis as compared with another forms of axSpA search.References:[1]Garrido-Cumbrera M, EMAS Working Group. Curr Rheumatol Rep. 2019; 21(5): 19. doi: 10.1007/s11926-019-0819-8[2]Poddubnyy D, et al. RMD Open. 2018 Dec 5;4(2):e000825. doi: 10.1136/rmdopen-2018-000825. eCollection 2018.Acknowledgments:Alexey SitaloDisclosure of Interests:Ekaterina Gaydukova: None declared, V Mazurov: None declared, Oxana Inamova: None declared, Elizaveta Vasilenko: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi

To present the clinical course and management of pediatric orbital complications (OC) secondary to acute rhinosinusitis (ARS), focusing on subperiosteal orbital abscess (SPOA) in toddlers (2 years). A secondary aim was to identify and evaluate unique variables in toddlers which distinguish them from the older age group.A retrospective cohort study of all children with OC secondary to ARS admitted to a secondary medical center between 2005 and 2014 was conducted. Variables analyzed included age, gender, symptoms duration, previous antibiotic therapy, highest recorded temperature, physical and ophthalmologist's examination results, laboratory results and imaging findings.Of the 123 children with OC, 52 (42%) were toddlers. Of them, 30(58%) were boys, with a mean age of 1.4 years. Toddlers presented with higher fever measurements and leukocyte/lymphocyte counts than older children. 69% had Chandler's 1 stage vs 45% in older children (p = 0.015). Ophthalmoplegia was less common in toddlers, who were also less likely to develop late ophthalmoplegia, an important indicator for good treatment response. Eighteen (35%) toddlers underwent computerized tomography (CT) scans, compared to 50 (70%) in the older aged group. Of them, 16/18 (89%) had SPOA. Five (10%) toddlers underwent drainage (31% of Chandler's 3 in this age group) compared to 19 (27%) older patients who underwent surgical treatment (53% of Chandler's 3 in this age group).Toddlers with OC have a milder disease and better outcomes, measured in lower rates of delayed ophthalmoplegia, number of CT scans and SPOA rates, and with fewer surgical interventions.

Background and objective Identifying factors that influence the course of low back pain (LBP) is important to help clinicians to identify those patients at higher risk of non-recovery. The objective of this systematic review was to investigate the prognostic role of physical activity in the course of LBP. Databases and data treatment Literature searches were conducted in five electronic databases from their inception to February 2018. Prospective cohort studies investigating the influence of any type of physical activity in people with LBP were considered eligible. The primary outcomes were pain intensity and disability. Two independent reviewers extracted the data and assessed the methodological quality of the included studies. Results were stratified according to participants' symptoms duration at baseline. Results Twelve studies were considered eligible for this review. Of these, six included patients with chronic LBP, four studies did not specify the patients' duration of symptoms, one study included patients with acute LBP, and one study included patients with subacute LBP. Included studies were heterogeneous in terms of physical activity assessment, outcomes, follow-up duration, and statistical methods, therefore, pooling of results was not performed. We found limited evidence to support the prognostic role of physical activity in the course of LBP. Conclusions Our review identified limited evidence supporting physical activity as a prognostic factor in LBP. Future cohort studies are needed to clarify the strength and importance of this association. Significance Despite recent research in the area, this systematic review shows that there is low quality evidence that physical activity may not be a prognostic factor for predicting pain and disability in patients with LBP.

Background In rheumatoid arthritis (RA) the “window of opportunity” has a crucial role for better long-term outcomes.1 The ACR/EULAR remission criteria for RA are mostly represented by clinical parameters, while ultrasound (US) is not included.2 However, in early diagnosed and early treated patients, who fulfil the remission criteria, residual US modifications can be identified.3 Objectives The aim of this study was to investigate whether significant US-detectable differences between early RA (ERA) patients treated for one year and healthy controls (HC) are present. Methods We enrolled in this cross-sectional study consecutive patients with ERA at 1 year after having initiated RA disease-modifying (DMARD) therapy and who had received treatment following RA recommendations. Only patients who had fulfilled EULAR/ACR 2010 criteria for RA4 and with symptoms duration of less than 1 year at treatment initiation were included. US exams were performed in 10 joints bilaterally (wrist, MCP II-V) by using both gray-scale and Doppler for evaluating synovitis was graded according to a semi-quantitative 4-point scale (0–3). A total US score for synovitis was calculated by adding the values recorded at each joint site. The presence of erosions was also recorded. Finally, US results obtained in patients were compared to those detected in HC. Results 84 subjects were enrolled – 45 ERA patients and 39 HC. In ERA patients the mean duration of symptoms prior to diagnosis was 3.5±3.5 months. The demographic, clinical and US data are reported in table 1. Conclusions Patients with RA, who had been early diagnosed and early treated, after 1 year of tight control had still US inflammatory and erosive changes compared to HC. US assessment gives an added value to clinical evaluation in ERA, for its capacity to detect residual inflammatory abnormalities, even under optimised treatment and consequent structural lesions. References [1] van Nies JAB, et al. Ann Rheum Dis2015;74:806–812. [2] Bykerk VP1, Massarotti EM. Rheumatology2012;51(Suppl 6):vi16–20. [3] Vergara F, et al. Reumatol Clin2017Mar 18. [4] Aletaha D, et al. Arhritis Rheum2010;62:2569–2581. Disclosure of Interest None declared

Background The structural damage of RA usually develops within the first two years of disease and the risk of joint destruction is still difficult to predict1 Objectives To assess predictive value of the clinical, laboratory and echosonographic parameters activity of early RA in progression of structural damage in DMARDs/glucocorticoid naive patients in the first 6 months. Methods Sixty-five pts. (56 females, mean age 53±14.1 years) with early RA (EULAR/ACR 2010 criteria) and symptoms duration of ≤1 years. (mean duration of 3.6 months) were included during the 2012–14 years. and followed up 6 months. Patients were DMARDs/glicocorticoid naive and had no X-ray visible structural damage. The ESR, CRP, RF, ACPA and MMP3 were measured. DAS28 index was calculated. US assessment was performed blindly to patient‘s medical history, on the same day when early RA diagnosis was established and repeated after 6 months, using 18MHz linear probe by ESAOTE My Lab 70 machine. Presence of bone erosions and Power Doppler (PD) signal, were recorded at each hand‘s joint, as well as at MTP1–5 joints of both side, according to OMERACT US group definition. The semi quantitative method (0–3) was applied for assessing US synovitis and total Power Doppler joint score (TPDJs)/pts. was calculated. Results Fifty-nine pts. had finding of US bone erosions at baseline visit and 62 pts had it after 6 months. The significant increase of bone erosions and significant decrease of TPDJs/pts were found after follow-up (2.2. vs. 3.1 respectively; 10. vs. 4.5 respectively; Wilcoxon test: p Conclusions Initial finding of US bone erosion is the most important risk factor for progression of structural damage with our DMARDs/glucocorticoid naive early RA patients in the first 6 months of disease duration. Reference [1] Morel J, Combe B. How to predict prognosis in early rheumatoid arthritis. Best Pract Res Clin Rheumatol2005;19:137–46. Disclosure of Interest None declared

Background As there are no biological markers, a detailed description of symptoms, particularly temporal characteristics, is crucial when diagnosing migraine aura. Hitherto these temporal aspects have not been studied in detail. Methods We conducted a prospective diary-aided study of the duration and the succession of aura symptoms and their temporal relationship with headache. Results Fifty-four patients completed the study recording in a diary the characteristics of three consecutive auras ( n = 162 auras). The median duration of visual, sensory and dysphasic symptoms were 30, 20 and 20 minutes, respectively. Visual symptoms lasted for more than one hour in 14% of auras ( n = 158), sensory symptoms in 21% of auras ( n = 52), and dysphasic symptoms in 17% of auras ( n = 18). Twenty-six percent of patients had at least one aura out of three with one symptom lasting for more than one hour. In aura with multiple symptoms the subsequent symptom, second versus first one or third versus second, might either start simultaneously (34 and 18%), during (37 and 55%), with the end (5 and 9%), or after (24 and 18%) the previous aura symptom. The headache phase started before the aura (9%), simultaneously with the onset of aura (14%), during the aura (26%), simultaneously with the end of aura (15%) or after the end of aura (36%). Conclusion We provide data to suggest that symptoms may last longer than one hour in a relevant proportion of auras or migraine with aura patients, and that there is a high variability of scenarios in terms of time relationship among aura symptoms and between aura and headache.

Objectives: To describe characteristics of children developing Bacillus Calmette-Guerin (BCG) lymphadenitis, and to evaluate needle aspiration treatment. Methods: Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration. Results: The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis ( p >0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes ( p =0.001). Most (91.3%) had axillary lesions; with a mean lymph node size of 3.2 cm. Abscesses were detected by ultrasound in 8 (80%). Non-suppurative lymphadenitis was conservatively managed, while suppurative was aspirated. The mean duration for resolution was 3.25 months. Lymph nodes aspirate were positive for acid and alcohol fast bacilli in 10 patients (66.6%), and 3 of them grew Staphylococcus aureus. Conclusion: Bacillus Calmette-Guerin adenitis occurs in young children, mainly as unilocular suppurative left axillary group with a mean size of 3.2 cm. Needle aspiration is safe in treatment of suppurative lymphadenitis. Mycobacteria stained positive in most of the suppurative lesions. Excision is not needed. Saudi Med J 2015; Vol. 36 (3): 280-285 doi: 10.15537/smj.2015.3.10294

PURPOSE To report the outcomes of pars plana vitrectomy with internal aspiration under perfluorocarbon liquid for large macular holes (MH). METHODS Retrospective consecutive case series of patients with large (>400 µm) MH. All treated were with pars plana vitrectomy, internal limiting membrane peeling, internal fluid aspiration under perfluorocarbon liquid, and gas/oil tamponade. Outcomes included closure rate and visual acuity at 6 months. RESULTS Twenty eyes of 20 patients were included. Mean age of patients was 67.6 ± 7.3 years. Mean MH size was 609.4 ± 154.7 μm. Mean symptoms duration was 9.05 ± 7.3 months. Unfavorable prognostic factors included chronic MHs (≥4 months) in 15 eyes (75%), refractory MH in 6 eyes (30%), and poor initial visual acuity (≤20/200 logarithm of minimal angle of resolution) in 18 eyes (90%). Gas tamponade was used in 18 eyes (90%). Nineteen MHs (95%) had closed after a single operation. Two (10.5%) had Type-II closure. Mean visual acuity improved significantly from 20/330 to 20/140 Snellen acuity (1.22 ± 0.31-0.85 ± 0.35 logarithm of minimal angle of resolution; P < 0.001). Fifteen eyes (75%) had visual acuity improvement of more than 0.2 logarithm of minimal angle of resolution. Thirteen eyes (65%) achieved visual acuity better than 20/200. CONCLUSION Pars plana vitrectomy combined with internal fluid aspiration under perfluorocarbon liquid is an effective and safe surgical technique for the management of large MH. This innovative technique offers improved closure rates and visual acuity results.

Background: IMT assessment as a non-invasive imaging test is quite widely used especially among RA patients, the clinical applications of using such knowledge is scarce, hence study was conducted to compare the carotid artery intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA) with healthy controls also to study the correlation between duration of rheumatoid arthritis, the activity of rheumatoid arthritis and other factors influencing (CIMT).Methods: In analytical cross-sectional study, of 80 participants of RA and 40 healthy controls, “DAS28” was used to assess disease activity. Carotid intima-media thickness assessed using carotid ultrasonography.Results: Mean age of the cases and controls was 43.9 and 44.38 years. Subjects with duration of disease 5 years were 35%, 45% and 20%. The mean carotid intima-media thickness was 5.61mm in controls, and CIMT was 6.11mm in people below 2 years and 7.08 mm in people between 2 to 5 years and 8.00mm in people above 5 years which was statistically significant. The mean carotid intima-media thickness was 5.61mm controls and 6.86mm in people with low, 7.00mm in people with moderate and 6.95mm in people with high disease activity, which was statistically significant.Conclusions: Study findings revealed risk of increase in carotid intima-media thickness higher among RA patients in the later stages and can increase the patients’ susceptibility to cardiovascular events. The factors showing strong association with intimal medial thickness were the age and symptoms duration.

Purpose Predicting cardiac recovery (CR) in advanced heart failure (HF) patients before left ventricular assist device (LVAD) implantation remains challenging. This study sought to investigate whether CR after LVAD unloading can be predicted by cardiac functional and structural parameters together with clinical characteristics. Methods From 2008 to 2016, consecutive advanced chronic HF patients (N=347) supported with durable continuous-flow LVADs were prospectively evaluated. Patients with acute HF etiologies or without adequate post-LVAD follow up ( Results CR occurred in 13.7% of patients. Univariate analysis showed that responders were more likely to be young, female, non-ischemic cardiomyopathy, with shorter HF symptoms duration and no prior heart surgery. They had lower blood urea nitrogen and were less likely to be on temporary mechanical support before LVAD. The multivariable UCAR model (AUC=0.755; p Conclusion Univariate and multivariable predictors of CR include both modifiable and non-modifiable patient characteristics that are known prior to LVAD implantation. The UCAR score can serve as a practical tool for targeted patient selection to implement protocols that facilitate CR in the advanced HF patient subpopulation that is most likely to respond.

At the age of 1-7 years, the common cold is prevalence among children. It usually happens 6 to 7 times a year among children. An effective and safe drug is needed to reduce the duration of common colds symptoms in children and reduce subsequent complications. In some studies, zinc sulfate has showed an antiviral effect and immune enhancing activity. Therefore, this study was designed to evaluate the efficacy of zinc sulfate in duration of colds’ symptoms in children. In this study, 112 children with common cold who are between 6-7 years old divided into two groups. Case group received zinc sulfate within 10 days and Control group didn’t receive this drug. The symptoms like rhinorrhea and nasal obstruction, cough, sneezing, fever and duration of illness were checked out in both groups by questionnaire. In children with common cold, a significant decrease was observed in the mean duration of rhinorrhea, cough and nasal obstruction .Compared to the group that didn’t receive zinc sulfate, the zinc group had shorter mean duration of sneezing and fever. The mean duration of illness in patients who had received the zinc sulfate was significantly less than the other group. No side effect was observed in subjects received zinc sulfate. Based on our result, zinc sulfate can be administered with other supportive treatments of common cold, for reduction of symptoms duration and complications in children.

Aim: To examine the relationship of duration of symptoms with the disease outcomes in patients with COPD. Background: COPD patients have varying degree of symptoms. We hypothesized that duration of symptoms may be useful to understand the disease progression. Methods: This observational study carried out in England. The patients were recruited and followed up between September 1999 and December 2002 and then 2007-2008, respectively. Patient’s demographics were recorded. Medical Research Council Dyspnoea (D) score were used to measure degree of breathlessness and spirometry were utilized to evaluate the severity of disease. Patients were asked about the COPD symptoms and for how long they have these symptoms including shortness of breath, cough, and the duration of their symptoms. Results: A total of 269 subjects were recruited. Of those 227 were with the diagnosis of COPD and 42 as non COPD or control group. The data is normally distributed. The study results show that there is a strong correlation between duration of symptoms and physiological variables both at baseline and at follow up. These include age (p=0.04), pack years (p=0.02), MRC score (p=0.04) and FEV1 (p

Objectives Studies in the carpal tunnel syndrome (CTS) are supported ischemia-induced changes rather than inflammation of the flexor tenosynovium. In this study, total antioxidant status (TAS), total oxidative stress (TOS) and oxidative stress index (OSI) in patients with CTS has been investigated. Methods Forty-three patients (38 female and 5 male, 81 hands in total) diagnosed as CTS after the physical examination and electrophysiological findings included in study. The mean age of patients was 43.30 ± 10.49 years. Results Bilateral CTS in 38 (88%) patients and unilateral CTS in five patients were detected. Dominant hand was involved in all patients. The mean symptoms duration was 30.9 months (range, 5–67 months). TAS in patients with CTS was significantly lower compared with control (1.01 ± 0.14 versus 1.11 ± 0.20 mmol Trolox equiv./l), (P = 0.008). TOS and OSI in patients with CTS were significant higher compared with control (15.60 ± 7.03 versus 11.86 ± 2.18 µmol H2O2 equiv./l and 1.57 ± 0.72 versus 1.09 ± 0.28), (respectively P = 0.002 and

Objectives: This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the efficacy of low intensity laser therapy (LILT) in treating myofascial trigger points (MTrPs). Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified. Methods: A search of the literature was conducted by a single reviewer. Only randomised controlled and clinical trials were included. Results: Sixteen studies were critically reviewed and showed considerable variability in treatment parameters, techniques, symptoms duration and diagnoses. Discussion: Studies that have investigated the use of LILT in treating MTrPs produce conflicting results regarding the efficacy of this treatment modality. However, these are probably due to varying symptoms duration, treatment parameters and techniques, non-homogenous populations, and inaccessible and/or poor laser machine specifications.

Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The localized form of bronchiectasis is the indication for surgical treatment if recurrent respiratory infections make normal life and professional activity impossible. Less frequently, the operation is necessary independently on the symptoms duration, if massive hemoptysis are life threatening for the patient. Compared with the period 10-15 years ago, the diagnostics of bronchiectasis changed in terms that bronchography has been replaced by high resolution CT scan. Owing to angiographic studies performed on sufficient number of patients, the patophysiology of bronchiectasis is fatherly highlighted, but without significant changes in the process of patient selection. In the text, particular accent was given to situations that usually represent practical problems: billateral bronchiectasis, hemoptysis, bronchiectasis after pleural empyema, abscending bronchiectasis and bronchiectasis in children. The outcome of the surgical treatment is good in 90% patients, with operative mortality thatis comparable to that after lung resections for other indications.

Background: Asthma in the elderly is underdiagnosed and consequently undertreated because age of patients detains diagnosis of disease Aims and Objectives: The aim of this study was to determine the risk factors especially age of patients which may be connected with the delay of asthma diagnosis. Methods: We evaluated 59 asthmatics: 40 female and 19 male. Diagnosis of asthma was confirmed by positive results of bronchodilator reversibility test and methacholine challenge. Skin prick tests with aeroallergens were performed. Participants answered a questionnaire regarding smoking status, atopy, how long have the symptoms been present, when did the patient9s doctor made the initial asthma diagnosis, and comorbidities. Results: Age of asthmatics ranged from 22 to 89 years old (median 71). Average symptoms duration period related to asthma was 15 years, while median delay of asthma diagnosis was 0,98 years. The average age of patients whose delay of diagnosis did not exceed 1 year was 68 years old. The average age of patients whose delay of asthma diagnosis was more than one year was 75 years old . Median difference between these two groups was 7 years CI95% (1, 14.5). The odds ratio for more than one year delay of asthma diagnosis increased by 7,3% per each year of patient9s life (OR=1,073). The other findings showed that the delay of asthma diagnosis was not correlated with patients9 gender or history of past smoking (p=0.4253). We also did not find any evidence of relation between delay of asthma diagnosis and atopy, presence of cardiovascular disease, or number of other chronic diseases ( p=0.7048). Conclusion: Old age is a risk factor of delayed asthma diagnosis, regardless of gender, atopy, history of past smoking and comorbidities.

There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bell's palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bell's palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bell's palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bell's palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to “absence of evidence” rather than “evidence of absence.”

Principal differences in natural history, therapeutic approaches, and functional prognosis of acute and chronic central serous chorioretinopathy (CSC) requires that they were distinguished.to define differential diagnostic criteria for acute and chronic CSC basing on the chorioretinal complex analysis by EDI-optical coherence tomography (OCT).A retrospective analysis was performed that included data of 112 patients with CSC, who were assigned to either the 'acute' (52 patients) or 'chronic' (60 patients) group depending on symptoms duration (3 months) and fluorescein angiography findings. With the enhanced depth imaging (EDI) module mounted on OCT (Spectralis, Heidelberg, Germany), the structure of the chorioretinal complex was studied.In acute CSC, the height of the neuroepithelium detachment (310.73±113.63 μm) was greater than that in chronic CSC (205.68±90.80 μm), p=0.03. The frequency of subretinal deposits also differed (17.3% and 100% of cases, respectively), p0.01. The subfoveal choroidal thicknesses were similar (462.7±110.7 and 494.7±132.1 μm, respectively, p=0.6), however, in acute CSC, diffuse thickening of the choroid was noted (39 patients, 75% of cases), while chronic CSC was marked by local dilatation of the Haller's layer (39 eyes, 65% of cases). The diameter of hyporeflective pockets in the Haller's layer in the 'acute' (324±98.1 μm) and 'chronic' (352.0±84.3 μm) groups correlated with choroidal thicknesses (r=0.68, r=0.75). Hyperreflective intrachoriodal dots were more common in the 'chronic' group (acute - 1.9%, chronic - 68.3%), so did hyperreflective vascular walls -13.5% and 68.3%, respectively, p0.01. Dome-shaped RPE detachments were observed equally often in both groups (acute - 67.3%, chronic - 68.3%, p=0.9), while the 'double-layer sign' was only characteristic of chronic CSC (86.7%).OCT criteria of acute CSC include a dome-shaped detachment of neuroepithelium and diffuse thickening of the choroid in the absence of deposits; of chronic CSC - subretinal deposits, local dilatation of the Haller's layer vessels, hyperreflective vascular walls, intrachoroidal dots, and the 'double-layer sign'.Принципиальная разница в характере течения, лечебных подходах и функциональном прогнозе острой и хронической форм центральной серозной хориоретинопатии (ЦСХ) требует их дифференциальной диагностики. Цель - определить дифференциально-диагностические критерии острой и хронической форм ЦСХ на основе анализа хориоретинального комплекса по данным EDI-оптической когерентной томографии (ОКТ). Материал и методы. Проведен ретроспективный анализ данных 112 пациентов с ЦСХ, разделенных на группы острой (52 пациента) и хронической (60 пациентов) формы по длительности симптомов (3 мес) и картине флюоресцентной ангиографии. С помощью модуля улучшенной глубины изображения (EDI-ОКТ) к оптическому когерентному томографу изучалась структура хориоретинального комплекса. Результаты. При острой форме ЦСХ высота отслойки нейроэпителия была выше (310,73±113,63 мкм), чем при хронической (205,68±90,80 мкм) (p=0,03). Группы различались по наличию субретинальных депозитов (17,3 и 100% случаев, p0,01). Субфовеальная толщина хориоидеи не различалась (462,7±110,7 и 494,7±132,1 мкм, p=0,6), однако при острой форме отмечалось диффузное утолщение хориоидеи (39 пациентов, 75% случаев), а при хронической - локальное расширение слоя Галлера (65% - 39 глаз). Диаметр гипорефлективных просветов в слое Галлера при острой (324±98,1 мкм) и хронической (352,0±84,3 мкм) формах коррелировал с толщиной хориоидеи (r=0,68, r=0,75 соответственно). Группы различались по наличию гиперрефлективных интрахориоидальных точек (при острой форме в 1,9%, при хронической - в 68,3% наблюдений) и гиперрефлективных сосудистых стенок (13,5 и 68,3% соответственно) (p0,01). Куполообразные отслойки ретинального пигментного эпителия встречались одинаково часто (67,3 и 68,3%, p=0,9), а признак 'двойного слоя' - только на глазах с хронической ЦСХ (86,7%). Заключение. ОКТ-критерии ЦСХ: острой формы - куполообразная отслойка нейроэпителия, отсутствие депозитов, диффузное утолщение хориоидеи; хронической формы - субретинальные депозиты, локальная дилатация сосудов слоя Галлера с гиперрефлективными сосудистыми стенками и гиперрефлективными интрахориоидальными точками, признак 'двойного слоя'.

Objectives. To validate van der Helm-van Mil score (vHvM) and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA).Patients and Methods. Adult patients with UA (swelling ≥2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs).Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4), 74% females. Median symptoms duration was 2 months (IR: 1–4 months). Mean van der Helm-van Mil score was 6.9 (SD: 2). After a mean followup of 6.2 months (SD: 6), 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's) area under the curve (AUC) for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity.Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA.

and Its Impact on Asthma (ARIA) classification by correlating it to nasal eosinophilia as an objective tool. The secondary objective is to compare a Visual Analog Scale (VAS) assessment of severity to the ARIA classification. METHOD: Study design is cross-sectional correlational. We used specific serum IgE positivity along with other inclusion criteria. Nasal scrapping was done to evaluate nasal eosinophilia. We used VAS for subjective scoring of severity of the disease. Patients in the 4 ARIA classification subgroups were compared for all items. RESULTS: Our study included 33 patients. 63.6% had Persistent Allergic Rhinitis (PAR) and 26.4% Intermittent Allergic Rhinitis(IAR) with 15.1% mild and 85% moderate to severe form. Comparison for age, gender, allergen specific sensitization, asthma and severity according to ARIA criteria revealed no difference for all items. PER rated poorer (p0.002) than IAR on VAS while nasal eosinophilia was not significantly different between the 4 groups (p 0.792). CONCLUSION: Our study failed to show significant correlation between the nasal eosinophilia and the ARIA classification subgroups. The ARIA classification of AR reflects symptoms duration but does not seem to correlate with the severity of underlying inflammation. We found a correlation between the severity assessed by VAS and the IER and PER subgroups. The result of this study may open the discussion on the rationale behind the pharmacological options in ARIA recommendations.

Background Gender Incongruence (GI) is a rare condition in adolescence characterized by a marked incongruence between one's experienced gender and the assigned sex. It presents as a combination of: a strong discomfort and/or intense rejection of the behavior/attributes of the born gender, a strong desire to live (and be treated) of the experienced gender, and/or a determination to follow the process of transition (i.e. hormonal therapy, sex reassignment surgery). Psychological functioning and treatment outcome has shown significant variation across transgender individuals. Objectives This study aimed to investigate the diagnostic stability of GI in adolescents across ICD-10, DSM-IV-TR, DSM-5, and ICD-11. Methods Case series of four adolescents aged 16-17 (3 female-born and 1 male-born) with GI seen at Child and Adolescent Mental Health Services (London, UK) in 2012, who completed clinical assessments and questionnaires (Utrecht Gender Dysphoria Scale and Gender identity/GD questionnaire for adolescents and adults). Results GI diagnostic criteria varied across diagnostic systems regarding: (1) number of indicators required, (2) symptoms duration, and (3) presence of clinical distress/impairment. In our case series, the latter led to diagnostic instability: two adolescents did not fulfill DMS-IV-TR and DSM-5 criteria. Nonetheless, the dimensional approach supported the GI diagnosis for the four adolescents. Conclusions Classification systems evolved in their conceptualization of GI over time evidenced by a shift in the condition name and diagnostic criteria. Diagnostic instability across classification systems may have an impact on their clinical utility. Evidenced-based investigations are required to further assess the clinical utility of the new classification systems.

Background Inflammatory back pain (IBP) is one of the main presenting symptoms in spondyloarthropathies (SpA). The prevalence of inflammatory back pain in young people population is unknown. The identification of chronic IBP, starting before age 45 can help diagnose SpA early. Objectives To determine the prevalence of chronic low back pain and inflammatory back pain in a cohort of young people. Methods Students were asked to fill out the questionnaire containing questions about low back pain, symptoms duration, all relevant inflammatory back pain parameters (according Calin and ASAS IBP criteria). Overall 3480 questionnaires were completed. Results The average age of respondents was 24±4,75 years; 76,35% of respondents were females. 1744 (50,1%) students reported having at least one episode of low back pain. 10,3% of all respondents (358), had chronic back pain. From 2657 interviewed 10,6% females had chronic low back pain, from 823 males 9,2%. 72 students (2, 1%) fulfilled ASAS IBP criteria, 48 (1.8%) females, 24 (2.9% males) respectively.101 (2,9%) respondents were defined as suffering inflammatory back pain according Calin criteria, 73 (2,7%) females and 28 (3.4%) males. The difference between prevalence of IBP among genders was not statistically significant. Conclusions In our study prevalence of inflammatory back pain among young people cohort was 2,1-2,9%, prevalence of chronic back pain – 10,3%. The data suggest that prevalence of inflammatory back pain did not differ significantly between young men and women. Acknowledgements Sieper, J. et al . New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann. Rheum. Dis. 68, 784–788 (2009). Calin, A. et al . Clinical history as a screening test for ankylosing spondylitis. JAMA 237 , 2613–2614 (1977). Disclosure of Interest None Declared

Background and aims: combined multichannel intraluminal impedance and pH-monitoring (MII/pH) is a new technique identifying refluxes irrespective of acidity and detecting their duration, proximal extent and pH. These features are important when studying gastroesophageal-reflux-disease (GERD) in infants, in which weakly acid refluxes are prevalent. Clinical application of MII/pH is uncommon yet, owing to lack of reference values and difficult interpretation of the variables obtained. Aim of the present study was to investigate the relationship between MII-pH results and clinical outcome on a sample of GERD infants. Methods: infants (age: 0-3 months) with GERD symptoms were studied with MII/pH and submitted to a follow-up consisting in clinical examinations and structured interviews to parents at 3-6-9-12-18-24-36 months to evaluate the presence of symptoms and the therapy effects. Results: 54 patients completed the follow-up (32M; age 33.69±21.78 days; weight 3465.13±791.08 gr.; length 52.08±3.55 cm). 22 and 15 patients were still symptomatic at the age of 6 and 9 months, without difference in MII/pH values between symptomatic and non symptomatic infants. The 12 infants that were still symptomatic at the age of 12 months showed a higher bolus exposure index (BEI) with respect to the healed patients (2.63±1.72% vs 1.72±1.05; p=0.029). Conclusions: MII-pH in first months of life could be useful to identify patients with high risk of presenting GER symptoms for more than 1 year. BEI is a pH independent variable with a significant relationship with symptoms duration. Our data highlight the clinical relevance of MII/pH-detected weakly acidic refluxes in GERD infant.

Two pharmacological approaches are established in the treatment of atrial fibrillation (AF): 'rhythm control' – usage of antiarrhythmic agents, in order to restore and maintain normal sinus rhythm (NSR); and 'rate control' – usage of agents that prolong cardiac atrioventricular conduction, in order to alleviate clinical symptoms. A retrospective study was conducted, aiming to determine outcome of pharmacological treatment of patients with AF in the emergency room (ER). Discharge Letters of all patients admitted to the ER and subsequently diagnosed with AF over a 1-year period were reviewed (May 2001–May 2002). Data on symptoms duration, drugs administered and outcome of treatment were analysed. In a 1-year period, AF was registered in 242 patients, which represented 4% of total medical emergency admissions (n = 6142). In patients with AF, 64% (n = 152) had paroxysmal AF, 12% (n = 29) had persistent AF, and 24% (n = 58) had permanent AF. In a group of patients with paroxysmal AF, pharmacological conversion into NSR was attempted in 74% of patients (n = 113). 'Rhythm control' was achieved in 50% (n = 56) of patients, 'rate control' in 12% (n = 14) and 38% (n = 43) of patients required prolonged hospital treatment. The anti-arrhythmic drug of choice was propafenon, with conversion attempted in 62% of patients (n = 71) and control achieved in 61% (n = 43), and amiodarone, with conversion attempted in 7% of patients (n = 8), and rhythm control achieved in 50% patients (n = 4). In a group of patients with permanent AF (n = 58), pharmacological treatment was attempted in 69% of patients (n = 40). 'Rate control' was achieved in 50% (n = 20) patients, whereas the others required prolonged hospital treatment. The pharmacological drug of choice was a combination of verapamil and digoxine, with 81% success rate. AF is the most common cardiac arrthymia presented in the emergency room. The 'rhythm control' approach still represents the main target in the treatment of patients with AF presented in the emergency room, whereas 'rate control' is attempted in patients with persistent and permanent AF. In the study, the drug of choice for pharmacological conversion of AF into NSR is propafenon, and for 'rate control' the best results are obtained by administering the combination of verapamil and digoxine.