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BMC Musculoskeletal Disorders May 2024Identifying remission is of high importance in rheumatoid arthritis (RA) because remission is associated with less structural progression. We investigated the efficacy...
BACKGROUND
Identifying remission is of high importance in rheumatoid arthritis (RA) because remission is associated with less structural progression. We investigated the efficacy of a new optical imaging device, HandScan, to identify RA remission, as defined by ultrasound (US).
METHODS
61 RA patients were included. Disease activity was evaluated by clinical assessment and US, using gray-scale (GS) and Power Doppler (PD). HandScan determined unitary optical spectral transmission (OST) values for wrists, metacarpophalangeal and proximal interphalangeal joints. At the patient level, three composite HandScan (HS) scores were calculated: total HS score; disease activity score OST (DAS-OST) and DAS-OST without patient global assessment (PtGA). Using ROC curves, we determined HS cut-offs to identify US-defined remission.
RESULTS
At the joint level, unitary OST values significantly correlated with GS synovitis [odds ratio (OR) 2.43, p < 0.0001] and PD positivity (OR 3.72, p = 0.0002 ). At the patient level, total HS score and DAS-OST were significantly associated with all gray-scale US (GSUS) and power doppler US (PDUS) parameters evaluated (synovitis number and grade, synovial thickness, PD grade) (p < 0.05). The cut-off to identify US-defined remission at the joint level was of 0.92, giving an 81% sensitivity and a 96% positive predictive value (PPV). At the patient level, ROC-curves failed to identify a robust cut-off for the total HS score, but did identify a cut-off (3.68) for DAS-OST to identify US-defined remission, but with lower sensitivity (75%), specificity (56%) and PPV (67%).
CONCLUSIONS
HandScan is a non-invasive optical imaging technique providing OST values that correlate with GSUS and PDUS parameters. In addition, HandScan is able to reliably identify US-defined remission in RA at the joint level, with a good sensitivity and high PPV. At the patient level, HandScan DAS-OST can also determine US remission (while total HS score failed to do so), but with lower performance.
Topics: Humans; Arthritis, Rheumatoid; Male; Female; Middle Aged; Aged; Ultrasonography, Doppler; Remission Induction; Adult; Optical Imaging; Severity of Illness Index
PubMed: 38714989
DOI: 10.1186/s12891-024-07472-4 -
Ticks and Tick-borne Diseases Jul 2024We report the case of a traveler who returned from Zambia and was diagnosed with Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii...
We report the case of a traveler who returned from Zambia and was diagnosed with Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii conorii. The patient presented to Sapporo City General Hospital with symptoms of fever, malaise, headache, and rash. The pathogen was identified by Polymerase Chain Reaction assays and subsequent analyses. The patient improved with 10-day treatment of oral doxycycline. Although some cases of MSF have been reported in sub-Saharan Africa, none have been reported in Zambia. Rhipicephalus sanguineus sensu lato, the vector of the Rickettsia conorii conorii, has been found in various areas of Zambia. Our case report highlights the potential threat of Mediterranean spotted fever in urban areas of Zambia.
Topics: Zambia; Humans; Doxycycline; Boutonneuse Fever; Rickettsia conorii; Anti-Bacterial Agents; Male; Travel; Animals; Adult; Rhipicephalus sanguineus
PubMed: 38714072
DOI: 10.1016/j.ttbdis.2024.102347 -
Cureus Apr 2024We report a case of severe mitral stenosis (MS) in a 58-year-old female from Guyana. Though rheumatic MS continues to be less prevalent in third-world countries, it...
We report a case of severe mitral stenosis (MS) in a 58-year-old female from Guyana. Though rheumatic MS continues to be less prevalent in third-world countries, it poses a significant threat as far as morbidity and mortality are concerned. The modern definition of "Third World" is used to classify countries that are poor or developing. Countries that are part of the "third world" are generally characterized by (1) high rates of poverty, (2) economic and/or political instability, and (3) high mortality. The standard method of diagnosing MS in patients has been established as transthoracic echocardiograms (TTE), along with pertinent historical and physical exam findings. Specifically, with TTE, criteria include a mitral valve area ≤1.5 cm, severe left atrial enlargement, and elevated pulmonary artery systolic pressure >50 millimeters of mercury (mmHg). Once diagnosed with severe MS, treatment options for patients range from non-surgical percutaneous mitral balloon valvuloplasty to surgical mitral valve commissurotomy. In our case, she was a 58-year-old female with a past medical history of seizures of unknown etiology, not on any home medication regimen, presenting to the emergency department with shortness of breath, malaise, weight loss, and bilateral lower leg edema. Vitals were significant for tachycardia at 153 bpm, tachypnea at 24 breaths per minute, and saturating at 96% on room air. On the physical exam, there was an irregularly irregular rhythm, bilateral crackles at the bases, right upper quadrant tenderness to palpation, bilateral pitting edema, and no calf tenderness. Lab findings were significant for elevated brain natriuretic peptide, but three electrocardiograms were performed in the emergency department, all confirming the new onset of atrial fibrillation. A CT angiogram of the chest was performed, which ruled out pulmonary embolus but additionally found marked reflux of contrast noted within the inferior vena cava and hepatic veins, along with right atrial dilation reflective of right heart strain; additionally, mitral valve calcifications were noted. The cardiologist on duty confirmed the diagnosis using point-of-care ultrasound (POCUS) followed by TTE; the patient was rapidly transferred to a hospital with appropriate services for surgical management within the same day of arrival at the emergency department. This case highlights the importance of bedside POCUS as an additional diagnostic tool for cardiologists, along with pertinent history, physical examination findings, and laboratory findings. Proper utilization of POCUS can allow for the immediate diagnosis of severe pathologies and prevent the delay of appropriate treatment, as seen in our case. Wider adoption of POCUS practices as a part of the general initial evaluation of patients has not yet been recommended by the American Heart Association but can offer clinical benefit in morbidity/mortality with expedited progression to appropriate treatment.
PubMed: 38706999
DOI: 10.7759/cureus.57627 -
Philosophical Transactions of the Royal... Jun 2024Arthropods contribute importantly to ecosystem functioning but remain understudied. This undermines the validity of conservation decisions. Modern methods are now making...
Arthropods contribute importantly to ecosystem functioning but remain understudied. This undermines the validity of conservation decisions. Modern methods are now making arthropods easier to study, since arthropods can be mass-trapped, mass-identified, and semi-mass-quantified into 'many-row (observation), many-column (species)' datasets, with homogeneous error, high resolution, and copious environmental-covariate information. These 'novel community datasets' let us efficiently generate information on arthropod species distributions, conservation values, uncertainty, and the magnitude and direction of human impacts. We use a DNA-based method (barcode mapping) to produce an arthropod-community dataset from 121 Malaise-trap samples, and combine it with 29 remote-imagery layers using a deep neural net in a joint species distribution model. With this approach, we generate distribution maps for 76 arthropod species across a 225 km temperate-zone forested landscape. We combine the maps to visualize the fine-scale spatial distributions of species richness, community composition, and site irreplaceability. Old-growth forests show distinct community composition and higher species richness, and stream courses have the highest site-irreplaceability values. With this 'sideways biodiversity modelling' method, we demonstrate the feasibility of biodiversity mapping at sufficient spatial resolution to inform local management choices, while also being efficient enough to scale up to thousands of square kilometres. This article is part of the theme issue 'Towards a toolkit for global insect biodiversity monitoring'.
Topics: Arthropods; Biodiversity; Animals; DNA, Environmental; Remote Sensing Technology; Forests; Animal Distribution; DNA Barcoding, Taxonomic
PubMed: 38705177
DOI: 10.1098/rstb.2023.0123 -
Cadernos de Saude Publica 2024Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways,...
Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.
Topics: Humans; Brazil; COVID-19; Adult; Female; Male; Post-Acute COVID-19 Syndrome; Health Policy; Middle Aged; Surveys and Questionnaires; SARS-CoV-2; Quality of Life; Young Adult; Aged; Socioeconomic Factors; Adolescent
PubMed: 38695461
DOI: 10.1590/0102-311XPT094623 -
Cureus Apr 2024Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. There have been increasing efforts to reduce its incidence and mortality....
Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. There have been increasing efforts to reduce its incidence and mortality. Screening plays a crucial role, with various tests such as the fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy commonly used for investigation. FOBT is a Food and Drug Administration (FDA) approved screening tool commonly used in acute healthcare settings for early detection of CRC. We report a 50-year-old man presenting with shortness of breath, chills, and malaise with findings positive for pneumonia. Laboratory tests revealed anemia as an incidental finding. A subsequent FOBT came back positive, and the patient was admitted for further gastrointestinal testing. Esophagogastroduodenoscopy (EGD) and colonoscopy were performed, but no significant findings were observed. This case report focuses on the overuse of FOBT testing during hospital admission, despite its limited impact on patient care in acute settings. Key takeaways include being aware of the potential for false positive and false negative results from a FOBT. Using the test carefully can help reduce both direct and indirect healthcare costs for hospitalized patients, as well as minimize the use of hospital resources. The test should primarily be used for CRC screening in the outpatient setting.
PubMed: 38694647
DOI: 10.7759/cureus.57406 -
Annals of Medicine and Surgery (2012) May 2024Teucrium polium is one of the aromatic plants that grows in the Mediterranean region, and had been used as an herbal treatment for diabetes due to its hypoglycaemia...
INTRODUCTION AND IMPORTANCE
Teucrium polium is one of the aromatic plants that grows in the Mediterranean region, and had been used as an herbal treatment for diabetes due to its hypoglycaemia effect. Although this plant is being studied now for its therapeutic role, its side effects are not taken enough into consideration, so this unique case can shed the light on serious toxic effects of this plant.
CASE PRESENTATION
A 68-year-old woman presented to the hospital with generalized fatigue, malaise, nausea, vomiting, abdominal pain, polydipsia, polyuria, breathlessness, and no defecation for 2 days after drinking big amounts of teucrium polium. The diagnosis was diabetic ketoacidosis (DKA), complete heart block, acute liver and kidney damage, and urinary tract infection (UTI). The patient was admitted to the ICU and treated for the DKA with an insulin pump, an antibiotic treatment for UTI, in addition to a dopamine pump and atropine, and then a temporary pacemaker was placed. The patient's DKA, liver and kidney damage were improved on day 9, heart rate returned normal and she was discharged to insert a permanent pacemaker. However, the patient passed away at the end.
CLINICAL DISCUSSION
Most studies made on this plant focused on the hypoglycaemia effect, with no attention to its toxic effects, so only few studies showed that teucrium polium can cause hepatic, renal toxicity and hyperglycaemia and most of them were studied in animals. While cardiac toxicity has never been noticed before.
CONCLUSION
For this reason, herbal treatment should be used with caution to avoid catastrophic side effects.
PubMed: 38694375
DOI: 10.1097/MS9.0000000000001760 -
European Heart Journal. Case Reports Apr 2024Ventricular arrhythmias are a significant cause of morbidity and mortality in patients with ischaemic heart disease. When pharmacologic therapies, catheter ablation...
BACKGROUND
Ventricular arrhythmias are a significant cause of morbidity and mortality in patients with ischaemic heart disease. When pharmacologic therapies, catheter ablation (CA), and implantable cardioverter defibrillator (ICD) are ineffective, stellate ganglion blockade (SGB), sympathectomy, and renal sympathetic denervation are considered. However, they are invasive for patients with high bleeding risk. We present a case of successfully recovering from haemodynamically unstable ventricular tachycardia (VT) storm with stellate ganglion phototherapy (SGP) in a non-invasive manner.
CASE SUMMARY
A 73-year-old male presented to the emergency department with chief complaint of general malaise, resulting from VT storm associated with ischaemic cardiomyopathy. He had a history of CA and implantation of ICD. Despite multiple electrical cardioversions, pharmacologic therapies, and deep sedation with mechanical circulatory support (MCS), VT storm was not controlled. Thereafter, we irradiated the patient's neck with SGP to inhibit sympathetic neurological activity, which suppressed VT storm and dramatically improved his haemodynamic status.
DISCUSSION
It has been reported that SGP is an alternative to SGB for refractory VT storm. Stellate ganglion phototherapy was easy and non-invasive to perform because we just irradiated the patient's neck with the near-infrared light for 5 min per day. If conventional therapies are ineffective in suppressing VT storm, SGP may be considered as a next step, especially for patients with high bleeding risk. However, since the effect of a single SGP lasts only 1-2 days, it should be performed as a bridge therapy to CA or sympathectomy. Stellate ganglion phototherapy may be effective in suppressing VT storm that requires MCS devices.
PubMed: 38690554
DOI: 10.1093/ehjcr/ytae177