Subclinical Infection

Background: Evaluation of the right ventricle (RV) in patients with acute myocarditis (MY) remains challenging with both 2D transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). We examined the incremental diagnostic value of CMR feature tracking (FT) to evaluate RV involvement in patients with myocarditis. Methods: We enrolled 54 patients with myocarditis and preserved left ventricle (LV) ejection fraction (EF). The CMR protocol included T2-weighted images for edema detection and late gadolinium enhancement (LGE) images. Global longitudinal strain (GLS) of the left ventricle (LV) and RV free wall strain (CMR-FWS) were obtained with CMR-FT. We identified 34 patients (62%) with inferior and lateral segment (IL-MY) involvement and 20 (38%) noIL-MY in case of any other myocardial segment involved. Here, 20 individuals who underwent CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as the control population. Results: TTE and CMR showed normal RV function in all patients without visible RV involvement at the LGE or T2-weighted sequences. At CMR, LV-GLS values were significantly lower in patients with MY compared to the control group (median -19.0% vs. -21.0%, p = 0.029). Overall, CMR RV-FWS was no different between MY patients and controls (median -21.2% vs. -23.2 %, p = 0.201) while a significant difference was found between RV FWS in IL-MY and noIL-MY (median -18.17% vs. -24.2%, p = 0.004). Conclusions: CMR-FT has the potential to unravel subclinical RV involvement in patients with acute myocarditis, specifically in those with inferior and lateral injuries that exhibit lower RV-FWS values. In this setting, RV deformation analysis at CMR may be effectively implemented for a comprehensive functional assessment.

A relationship is emerging between SARS-CoV-2 infections and ANCA-associated vasculitis (AAV) because: (i) the pulmonary involvement of COVID-19 may mimic that observed in patients with AAV; (ii) the two diseases may occur together; (iii) COVID-19 may trigger AAV. However, few cases of AAV have been identified so far in COVID-19 patients. To define the frequency of ANCA autoimmunity in patients with SARS-CoV-2 infection, we analyzed the serum ANCAs and the serum PR3 and MPO antigens by immunoassays in 124 adult patients with a diagnosis of SARS-CoV-2 infection (16 were asymptomatic and 108 were hospitalized) and 48 control subjects. The serum ANCAs were significantly higher in the hospitalized patients compared with either the controls or the asymptomatic patients and increased with the progression of the COVID-19 severity. After one week of hospitalization, the values were significantly lower. In contrast, no differences emerged among the controls, asymptomatic and hospitalized pat...

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first coronavirus that has caused a pandemic. Assessing the prevalence of anti-SARS-CoV-2 in healthcare worker groups offers a unique opportunity to study the correlation between seroconversion and immunization because of their occupational exposure and a higher risk of contagion. The study enrolled 3242 asymptomatic employees of “Policlinico Riuniti”, Foggia. After the first screening, we collected sequential serum samples for up to 23 weeks from the same subjects. In order to perform a longitudinal follow-up study and get information about the titration of IgG levels, we analyzed data from subjects (33) with at least two consecutive serological IgG—positive tests; 62 (1.9%; 95% CI: 1.4–2.3) tested positive for at least one anti-SARS-CoV-2 antibody. The seroprevalence was lower in the high-risk group 1.4% (6/428; 95% CI: 0.5–2.6) vs. the intermediate-risk group 2.0% (55/2736; 95% CI: 1.5–2.5). Overall, within eight...

Background: Internal parasites are common in pigs worldwide and may induce clinical disease or subclinical infections with negative effects such as poor weight gain and reduced welfare, which in turn affect productivity. Effective parasite control to reduce the negative impact of parasitic infections demands a combination of antiparasitic drugs as well as various hygiene and biosecurity practices. The aim of this study was to obtain information on current management practices and parasite control routines used on Swedish pig farms using an online questionnaire. Results: Antiparasitic drugs were used on 69% of the farms routinely and were mainly administered to sows just prior to farrowing. Less than 5% of the herds conducted faecal analysis for parasites. Batchwise, age segregated rearing was common and overall, it was practiced for piglets, growers, and fatteners on 88, 80 and 75% of the farms, respectively. Large and medium sized farms appeared to apply stricter hygiene and biosecurity measures to the growing pigs compared to small farms. Dry sows were mainly housed in groups on deep litter straw beds and cleaning, as well as disinfection, between each group was less common compared to what was practiced for growing pigs. Outdoor access was rare and only occurred on organic and small farms. Most of the farms, 54, 74 and 82% of small, medium, and large sized herds respectively, reported to have less than 5% white spot lesions, caused by migrating A. suum larvae, registered at slaughter. Several risk factors for parasite infections, such as bedding material, group housing and solid floors, are mandatory requirements by national law. However, it was evident from this study that although strategic hygiene and biosecurity practices appeared common, they were not practiced in all herds and less so for dry sows. Antiparasitic drugs were used frequently and mainly through routine prophylactic treatments without prior testing for parasites. A holistic approach is necessary when designing efficient parasite control programs, and it is essential that management factors and routine monitoring of parasites are given attention. This to achieve efficient parasite control and reduce the risk of unnecessary use of antiparasitic drugs.

Introduction Some common symptoms of coronavirus disease 2019 (COVID-19) are fever, cough, and shortness of breath. But ear, nose, and throat (ENT) manifestations such as loss of smell and taste are also very common. Objectives To compare the general and otorhinolaryngological manifestations of COVID-19 and to compare the treatments given and mortality rate during its two waves. Methods This retrospective study was conducted on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in a tertiary care teaching hospital. Six hundred patients were included in the 1st wave sample and 516 were in the 2nd wave sample. The data collected included demographics, comorbidities, general, and ENT symptoms, need for ventilatory support, oxygen therapy, and mortality for both the waves. Results Fever, malaise, and myalgia were more frequently presented in the first wave than in the second, whereas shortness of breath was more common in the second wave. In the second wave, a significant increase in anosmia cases was reported, whereas sore throat, nasal obstruction, dysphagia, nasal discharge, and sneezing were significantly reduced compared with the first wave (p < 0.001). The case fatality rate increased from 11.33 to 21.55% (p < 0.001) from the 1 st to the 2 nd wave. The patients who died in the second wave were younger than those in the first wave. Two doses of vaccination showed protection from the death over those not vaccinated and those who only received one dose (p < 0.05). Conclusion Ear, nose, and throat (ENT) manifestations are very common along with the general symptoms. As anosmia and dysgeusia are early presenting symptoms in COVID-19 patients, all physicians should screen patients for ENT symptoms.

Том 11, № 2 (41), 2023 165 165 ВОСПРИЯТИЕ БОЛЕЗНИ ПАЦИЕНТАМИ С ВОСПАЛИТЕЛЬНЫМИ ЗАБОЛЕВАНИЯМИ КИШЕЧНИКА THE ILLNESS PERCEPTION IN PATIENTS WITH INFLAMMATORY INTESTINAL DISEASES Аннотация: На течение и лечение различных заболеваний оказывают влияние такие психологические факторы как восприятие болезни и самоэффективность в преодолении болезни. В настоящее время у лиц молодого трудоспособного возраста отмечается увеличение распространенности воспалительных заболеваний кишечника (ВЗК). Наряду с этим, отмечается недостаточная осведомленность о восприятии пациентами с ВЗК своей болезни, что в свою очередь может снижать эффективность оказываемого лечения. В Клинических рекомендациях 2021 года, разработанных Российской гастроэнтерологической ассоциацией, упоминается не только м е д и к а м е н т о з н о е л е ч е н и е , н о и п с и х отерапевтическое воздействие. В связи с чем объясняется потребность в усовершенствовании ² Московский государственный медикостоматологический университет имени

Background Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. Methods Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, †

Hypothyroidism has a gradual onset and non-specific symptoms, which might be subtle, and which might therefore be ignored or misdiagnosed. Subclinical hypothyroidism is a well-established phenomenon where a patient does not have thyroid symptoms, but shows biochemical evidences of hypothyroidism. However, diagnosis and treatment of these patients may prevent development of overt hypothyroidism and cardiovascular symptoms. Replacement therapy with levothyroxine (T4) is the treatment of choice for hypothyroidism; levothyroxine is taken daily, provides stable plasma levels and is suitable for the majority of patients. Patients with certain forms of hypothyroidism -central hypothyroidism, thyroidectomy patients and patients with "low T3 syndrome" -may benefit from treatment with liothyronine (T3), which is more potent and has a shorter onset of action. The use of liothyronine in combination with levothyroxine is controversial, but there is evidence that some patients, particularly those with deiodinase 2 and thyroid hormone transporter expression polymorphisms, may benefit from combination therapy.

To identify endocrinologic problems, particularly those concerning growth, in collodion babies (CBs). Clinically identified newborn CBs were included in the study group (group 1). Because CBs are generally born premature, small for gestational age (SGA), or both, a control group matched to the study group in terms of gestational age and birthweight (group 2) was also established. Blood specimens were collected from both groups for thyroid function tests and to measure serum growth hormone (GH), insulinlike growth factor 1 (IGF-1) and IGF binding protein-3 (IGFBP-3) levels. Group 1 consisted of 42 CBs (25 male, 17 female) with gestational ages of 32 to 42 weeks and birthweights of 1,400 to 4,000 g. Twelve were assessed as premature and 17 as SGA. Serum IGF-1 and IGFBP-3 levels were lower and serum GH levels higher than in controls. Primary hypothyroidism was diagnosed in 10 patients in the study group, subclinical hypothyroidism in 2, and central hypothyroidism in 1. A statistically ...

Objectives-We compared olfactory function in pesticide-exposed Latino farmworkers and nonfarmworkers to explore its use as a subclinical indicator of neurological pesticide effects. Methods-We recruited 304 current farmworkers and 247 non-farmworkers. All completed odor identification (14 odors) and threshold tests (16 concentrations of n-butanol) using a wellestablished methodology. Results-Farmworkers reported significantly greater lifetime pesticide exposure. Performance on both olfactory tests declined with age. Odor identification performance did not differ between groups. For odor threshold, farmworkers needed significantly higher concentrations to detect the odor. Results were unchanged when adjusted for sex, age, and smoking. Conclusions-Olfactory function differences between farmworkers and non-farmworkers suggest possible neurological effects. Because declining olfactory function is an early symptom of Parkinson's disease and related conditions, it is a possible subclinical indicator of neurodegenerative disease in this vulnerable worker population.

peripheral neuropathy were excluded. All participants gave an The aim of the present prospective study was to substantiate informed consent and underwent neurological and neurophysiological possible side eOE ects of short-term oral acitretin therapy (1 mg/ evaluation, before, 1 and 3 months after initiation of acitretin treatkg/day) on peripheral nerve function of 13 patients with severe ment. The clinical evaluation of neuropathy was based on Neuropathy keratinization disorders. Clinical neurological examination Symptom Score (NSS) and Neurologic Disability Score (NDS) (7). NSS selected symptoms such as weakness, numbness or pain, which before and 1 and 3 months after onset of treatment was occur in neuropathy were scored as present (1) or absent (0 ). NDS unremarkable in all patients; however, a signi® cant alteration of functions of cranial nerves, tendon re¯exes, muscle strength and one or more neurophysiological, predominantly sensory, parasensation were scored as no de® cit (0), mild de® cit (1 ), moderate meters was demonstrated in 3 out of 13 patients (23%) after 1 de® cit (2), severe de® cit (3) or absence of function/severest de® cit (4). All neurophysiological studies were unilaterally (right side) performed month and in 9 out of 13 (69%) after 3 months of oral acitretin by the same investigator (E.C.) employing standard methods and by therapy. These ® ndings indicate that oral acitretin might be means of surface stimulation and recording (8). In order to avoid the capable of causing a dysfunction of predominantly sensory nerve eOE ects of high input resistance, only subjects with healthy skin over the ® bres in some individuals. Although in the investigated patients stimulation and recording areas were included in the study. The distal this dysfunction remained subclinical, it seems reasonable to skin temperature was maintained between 32ß C and 34ß C; if necessary, the limb under investigation was warmed up by immersion in a hot suggest that neurological and neurophysiological evaluation of bath. The neurophysiological pro® le consisted of the following paraperipheral nerves should be added to the list of investigations meters: 1. Motor conduction of ulnar and peroneal nerves with measurethat are routinely performed in patients receiving oral acitretin. ments of peak to baseline amplitude of compound muscle action

Background: Subclinical neurophysiologic abnormalities mainly suggestive of sensory fibers dysfunction were observed in some patients after 1 and 3 months of treatment with oral acitretin. Moreover, two cases of peripheral sensory neuropathy and one of sensorimotor polyneuropathy were observed after short-term oral administration of this compound. Objective: The objective of this prospective study was to investigate whether short-term treatment with oral isotretinoin can also affect peripheral nerve function. Methods: Serial neurologic and neurophysiologic examinations were performed on 18 young patients with severe nodulocystic acne prior to and 1 and 3 months after the onset of oral isotretinoin treatment (1 mg/kg per day). Results: Clinical neurologic examination before and under treatment disclosed no abnormalities in any of the patients. There were no significant differences between the pre-and post-treatment neurophysiologic parameters. Furthermore, evaluation of the serial neurophysiologic measurements in each patient separately under oral isotretinoin treatment revealed no changes fulfilling the criteria of abnormality. Conclusions: Short-term administration of oral isotretinoin in young patients does not cause clinical or subclinical neuropathy.

To assess the function of fast somatic nerve fibers and sympathetic sudomotor system in patients with partial or generalized seizures, receiving various therapeutic regimes. The authors studied 60 patients (mean age 36.7 Ϯ 12.5 years) and 60 matched healthy controls by clinical, conventional nerve conduction study, and sympathetic skin responses (SSR) from hand and foot. Compared with controls, patients showed a tendency, occasional reaching significant level, to conduction slowing and amplitude reduction in the sensory and less often in the motor nerve study. Clinical signs of neuropathy were disclosed in 8.3% of patients, whereas at least one abnormal sensory parameter was evident in 18.3%. Mean SSR latencies in the patients were significantly prolonged. At least one SSR abnormality was shown in 20 (33.3%) patients; six of these had absent SSR from the hand or/and the foot. Polytherapy (vs. monotherapy) and topiramate, but not any other particular drug, seemed to have a negative effect on SSR measurements. The results suggested that despite the insignificant clinical manifestations of neuropathy, an electrophysiological examination was able to demonstrate some subclinical abnormalities of the fast somatic fibers in the peripheral nerves and of the sympathetic sudomotor function in a considerable number of epileptic patients.

SUMMARYThe prevalance of subclinical Johne&#39;s disease was estimated in adult cattle slaughtered at three major abattoirs in south west England. A polymerase chain reaction (PCR) based on IS900 was used to detectMycobacterium paratuberculosisin intestinal lymph nodes of 1553 cattle. Culture was also carried out on all PCR positive and inconclusive samples. The prevalence of subclinical disease in adult cattle was 3·5% (95% confidence intervals (CI) 2·6–4·7) by PCR and 2·6% (CI 1·8–3·6) by culture. The proportion of the disease in each month ranged from 1·6% (CI 0·2–5·5) in April to 4·6% (CI 2·8–6·9) in November, but the difference was not significant (P&gt; 0·05). The proportion of PCR positive lymph nodes in each abattoir ranged from 2·8% (CI 1·6–4·6) to 4·9% (CI 2·9–7·6), this difference was not significant either (P&gt; 0·05). The prevalence in young cattle was 2·0% (CI 0·6–4·5). The difference between age groups was not statistically significant (P&gt; 0·05).

The aim of this study was to evaluate ventricular functions in patients with sarcoidosis without an obvious heart disease by using tissue Doppler-derived left and right ventricular myocardial performance index (MPI). The study population included 45 patient with sarcoidosis (29 men, 16 women; mean age, 44±10 years, mean disease duration, 4.2±2.7 years) and 45 healthy control subjects (31 men, 14 women; mean age, 41±8 years). Cardiac functions were determined using echocardiography, consisting of standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Myocardial tissue Doppler velocities [peak systolic (Sa), early diastolic (Ea), and late diastolic velocities (Aa)] were recorded using spectral pulsed Doppler from the LV free wall, septum, and RV free wall from the apical four chamber view. MPI was also calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the patients and controls. Left ventri...

Background: Acute kidney injury is frequently observed at the intensive care unit, after surgery, and after toxic drug administration. A rise in serum creatinine and a fall in urine output are consequences of much earlier injury to the most sensitive part of tubular cells located at the proximal tubule. The aim of the present study was to investigate the course of two cell-cycle arrest urinary biomarkers compared to serum creatinine in four clinical settings: ischemic reperfusion injury, cardiac failure, severe acute kidney injury, and chemotherapy-induced kidney injury. Methods: A recently developed bedside test known as NephroCheck measures two urinary parameters: insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2). The test is based on a sandwich immunoassay technique. The final test output, labeled AKIRisk, is shown as a numeric result. Results: This report revealed that [IGFBP7] • [TIMP-2] in urine rise rapidly prior to any change in serum creatinine. A unique feature of all four clinical settings is that a rapid decline predicts the recovery of kidney function. Besides, a subclinical kidney injury might be detected by the test. This bedside test detects biomarkers of renal injury. A rapid decline in AKIRisk was associated with the restoration of kidney function, whereas a prolonged high AKIRisk score was associated with end-stage renal disease. However, the dynamics seem to differ, depending on the cause and the extent of injury. Further studies will be needed to clarify the issue.

Psoriasis ve psoriatik artiritte patogenez ve tedavide yeterli endojen kortizol dengesinin önemi çeşitli çalışmalarda vurgulanmaktadır. Addison hastalığı böbrek üstü bezlerinde kortizol üretiminde kayba yol açan oto-immun bir hastalıktır. Bu hastalıkta adrenal bezlerdeki aldosteron ve kortizol hormonu eksikliği nedeniyle sıklıkla yorgunluk ve tuz regulasyonunda dengesizlik görülür. Suboptimal kortizol seviyelerinin psoriasisin ortaya çıkmasında etkisi olduğu konusu tartışılmaktadır. Addison hastalığı nadir görülmesine karşın, psoriasis veya psoriatik artirit tedavisi başlanılmadan mutlaka hatırlanması gereken bir hastalıktır. Genel populasyona göre psoriasisli hastalarda kortizol seviyelerinin incelenmesi önerilmektedir. Burada 57 yaşında 20 yıldır Addison hastalığı olan ve yaklaşık 7 yıldır psoriasisi de mevcut olan bir olgu sunulmaktadır.

Abstract: Mastitis is a common problem in Bangladeshi dairy cattle production. This study investigated the prevalence of subclinical mastitis (SCM), its impact on milk production and reproduction, and the resultant economic losses among dairy farms in the Chattogram division, Bangladesh. A cross-sectional study evaluated 161 farms, collecting 4,048 quarter milk samples from 1,012 cows to conduct a primary screening for SCM using the California mastitis test (CMT). Additional surveys were conducted on SCM-positive farms and animals to explore production and economic impacts. The prevalence of SCM at the farm level was 76.8% (43/56) in Chattogram and 69.5% (73/105) in Cox's Bazar. At the quarter level, the prevalence of SCM was found to be 32.29% (1307/4048; 95% CI: 30.9-33.8), while at the animal level, it was 41.3% (418/1012; 95% CI: 38.3-44.4). Crossbred cows exhibited a higher susceptibility to SCM at 47.2%, compared to indigenous breeds (31.2%). SCM significantly (p<0.05) altered milk's physicochemical properties, reducing fat, protein, and mineral content and negatively affecting milk quality, and market value along with some key reproductive parameters, particularly in Crossbred and Holstein Friesian cows. The economic losses due to SCM are substantial, primarily driven by decreased milk production and increased treatment costs. Crossbred and Holstein Friesian cows suffer the most significant financial losses from their higher milk production and treatment expenses. In conclusion, this study provided valuable insights for policymakers, veterinarians, and farmers, to adopt effective SCM control measures to improve the productivity of the dairy industry in Bangladesh.

arkinson's disease (PD) is traditionally conceptualized as a neurodegenerative movement disorder, but patients affected by this disease commonly experience a wide range of non-motor symptoms of PD (NMS-PD). These NMS-PD can occur at all disease stages yet are poorly understood and lack effective therapies. PD pathophysiology has been classically described following lesional models of the basal ganglia and dysfunctions at a neurotransmitter level. However, studies that describe PD utilizing wide network perspectives, demonstrate an aberrant connectome at different levels, defined as dysfunctions in neural cortical and subcortical connectivity. While connectome dysfunction is better recognized in Alzheimer's disease (AD), its clinical relevance in PD remains to be fully appreciated. Moreover, while AD has been significantly associated with an increased incidence of epileptic activity, only in recent times similar have findings been reported in patients with PD. This review aims to raise awareness on how cortical and sub-cortical disruptions in the PD connectome could generate aberrant neuronal activity, eventually resulting in an epileptogenic substrate for subclinical or atypical seizure manifestations. We will discuss how these manifestations may be easily under-recognized or mistaken for other NMS-PD. Finally, we will discuss the important practical implications for a prompt diagnosis and proper therapeutic management.

Objective. A crosssectional study was conducted between September 2015 and August 2016 in the district of Afar Regional State, Northeastern Ethiopia, to characterize the most prevalent bacterial pathogens and identify the associated risk factors of camel subclinical mastitis. California mastitis test (CMT) was used as a screening test, and standard bacteriological methods were carried out for isolation and identification of the pathogens. Results. Among the total 96 lactating camels examined, 25 were found positive with the overall prevalence of 26%, with 25% and 1% subclinical and clinical mastitis cases, respectively. Totally, 384 quarters of udder were examined; of these, 10 of them were blind while the rest 374 were nonblind teats. The quarter level prevalence of subclinical mastitis was 8.9%. The analysis showed that statistically significant difference ( P &lt; 0.05 ) of tick infestation and subclinical mastitis. Additionally, among the bacteriologically tested 34 CMT positive...

Objective: The aim of this study was to assess the right ventricular functions in patients with nasal polyposis using the strain (S) and strain rate (SR) echocardiography. Methods: A prospective, cross-sectional observational study was performed. The study included 40 patients with nasal polyposis (NP) (Group 1), and 25 healthy controls (Group 2). The study comprised patients with Stage 2 and Stage 3 nasal obstruction and no symptoms that could be associated with right ventricular heart failure. Longitudinal peak systolic strain (PSS) and peak systolic strain rate (PSSR) were measured from the basal-mid and apical segments of the right ventricle free wall. Student's t-test, Pearson's correlation analysis and Bland-Altman test were used for statistical analysis. Results: Pulmonary arterial systolic pressure was significantly higher in group 1 than group 2 (31.2±5.8, 19.7±4.3, respectively, p<0.001). PSS and PSSR values at the basal, mid and apical segments of the right ventricular lateral wall of the group I were significantly lower compared to the control group (p<0.001, p=0.002 and p=0.002 for PSS, p=0.003, p<0.001 and p<0.001 for PSSR, respectively). The comparison of Stage 2 and Stage 3 NP patients revealed a significant difference only in the SR measurement of the right ventricular mid segment (p=0.002). There was a significant correlation between the systolic pulmonary arterial pressure (sPAP) and right ventricular S and SR values (p<0.001). Conclusion: In this study, S/SR echocardiography showed a subclinical deficit of the right ventricular longitudinal functions in patients with NP who are considered to have normal right ventricular functions.

Group A rotaviruses (RVs) are the most important cause of acute viral gastroenteritis in infants and young children. In this study raw and treated drinking water supplies at plants in two geographic areas, as well as selected irrigation water and corresponding raw vegetables in three regions of southern Africa, were screened for the presence of RVs using molecular techniques. Group A RVs were detected in 11.8% of partially treated and 1.7% of finally treated drinking water samples and in 14% of irrigation water samples and 1.7% of corresponding raw vegetable samples. Type-specific reverse transcriptase-PCR and sequence analysis revealed the presence of multiple types (G1, G2, G8, and G9) in irrigation water and single types (G1 or G3) in raw and treated drinking water. Group A RVs detected in all samples consisted of mixed P types (P[4], P[6], P[8], and P[9]), with P[6] predominating. The detection of types G8, G9, and P[6] reflects the emergence of these types in clinical infections. The similarity of environmental types to those in patients with clinical RV infections confirms the value of wastewater screening as a tool for assessing RVs circulating in communities, with the benefit of detecting types that cause both clinical and subclinical infections. The results provide new information on RV types in water and related environments and identify the potential risk of waterborne transmission. In addition, the presence of RVs in drinking water underlines shortcomings in quality specifications. These data provide valuable information regarding the prevalence of RVs in environmental sources, with important implications for vaccine development.

Background Switching from boosted PIs to dolutegravir in virologically suppressed HIV-infected patients with high cardiovascular risk significantly decreased total cholesterol and other proatherogenic lipid fractions at 48 weeks. The impact of this strategy on subclinical cardiovascular disease is unknown. Methods NEAT022 is a European, multicentre, open-label, randomized, non-inferiority trial. HIV-infected adults aged &gt;50 years or with a Framingham score &gt;10% were eligible if plasma HIV RNA was &lt;50 copies/mL for &gt;24 weeks on a boosted PI-based regimen. Patients were randomized 1:1 to switch from boosted PIs to dolutegravir or to continue on boosted PIs. Common carotid arteries intima–media thickness (CIMT) and pulse wave velocity (PWV) were measured following a standardized protocol in a subgroup of NEAT022 study participants at baseline and at Week 48. Results One hundred and fifty-six patients participated in the ultrasonography and arterial stiffness substudies, res...

We used a method that combined literature review and expert judgment to assess potential medical innovations for older adults. We evaluated innovations in four domains: cardiovascular disease, cancer, the biology of aging, and neurologic disease. The innovations can be categorized by common themes: improved disease prevention, better detection of subclinical or early clinical disease, and treatments for established disease. We report the likelihood, potential impact, and potential cost implications for thirty-four innovations, and we revisit this forecast five years later. Many of the innovations have the potential to greatly affect the costs and outcomes of health care. The unprecedented progress in biomedical as well as clinical and health services research during the final quarter of the twentieth century will continue to drive a revolution in medicine that is expected to last for at least the next quarter-century. Every aspect of the prevention, diagnosis, treatment, and monitoring of disease processes has been affected by this revolution. Behind this wave of advancement is a convergence of progress in many of the traditional life science fields, including anatomy, biochemistry, immunology, microbiology, physiology, genetics, pharmacology, health services, and clinical medicine, together with contributions from chemistry, physics, mathematics, computer science, and engineering. Scientists from widely divergent disciplines are now crossing over to other fields or collaborating to form multidisciplinary teams that are tackling problems of such magnitude that they could not have been approached within any one field. Keeping up with the rapidity of change is difficult enough. Predicting its possible course may be foolhardy. Nonetheless, because new technologies of all types are a driving force behind changes in health-related outcomes and costs of care, we accepted the dual challenge of developing a method to predict the impact of new technologies on health care for the elderly in the next ten and

Background: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton; peripheral joints and extraarticular structures are also frequently involved. The present study was planned to generate more data on this subject with the aim of measuring the CIMT in AS, as these patients are more prone to develop early atherosclerosis and develop early macro vascular complications like CAD. Methods: It was a cross-sectional study with a sample size of 60 patients. The study group included 30 patients with a known history or clinical features suggestive of AS. The control group included 30 normal adult subjects without any previous history. All subjects included in the study underwent detailed clinical history, analysis, physical examination and necessary investigations. Results: CIMT in the control group was 0.54±0.19 mm and in the AS group was 0.65±0.21 mm. The difference was found to be statistically significant (P&lt;0.05), showing a h...

Lee, and the Acute Liver Failure Study Group Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of >1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). Conclusion: In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome. (HEPATOLOGY 2007

Eine 45-jährige Patientin stellte sich erstmalig in unserer Sprechstunde wegen wiederholter Hornhautfadenlockerung und Transplantateinschmelzung nach lamellärer Keratoplastik vor. Bei ihr war seit der Kindheit eine schwere Atopie mit multiplen Kontaktallergien bekannt. Zudem bestand seit der Pubertät ein klinisch manifester Keratokonus, der zunächst mit harten Kontaktlinsen versorgt wurde. Im September 2005 unterzog sich die Patientin einer Quervernetzung der Hornhaut. Dennoch war eine Progredienz mit Ausbildung einer zentralen Narbe am rechten Auge zu verzeichnen. 2 Monate vor Erstvorstellung in Freiburg war am rechten Auge eine lamelläre Keratoplastik durchgeführt worden. Bereits 2 Wochen nach der Operation traten Fadenlockerungen auf. Und auch nach Entfernung der lockeren Fäden und Nachlegung von Einzelknüpfnähten ereigneten sich weitere Fadenlockerungen.

Velopharyngeal dysfunction (VPD) occurs when the muscular soft palate (velum) and lateral pharyngeal walls are physically unable to separate the oral and nasal cavities during speech production leading to hypernasality and abnormal speech reduction. Because VPD is often associated with overt or submucous cleft palate, it could be present as a subclinical phenotype in families with a history of orofacial clefting. A key assumption to this model is that the overt and subclinical manifestations of the orofacial cleft phenotype exist on a continuum and therefore share common etiological factors. We performed a genome-wide association study in 976 unaffected relatives of isolated CP probands, 54 of whom had VPD. Five loci were significantly (p < 5 × 10 -8 ) associated with VPD: 3q29, 9p21.1, 12q21.31, 16p12.3 and 16p13.3. An additional 15 loci showing suggestive evidence of association with VPD were observed. Several genes known to be involved in orofacial clefting and craniofacial development are located in these regions, such as TFRC, PCYT1A, BNC2 and FREM1. Although further research is necessary, this could be an indication for a potential shared genetic architecture between VPD and cleft palate, and supporting the hypothesis that VPD is a subclinical phenotype of orofacial clefting. Velopharyngeal dysfunction (VPD) refers to an inability to close the opening between the nasal cavity and the oral cavity during speech. This occurs because the muscular soft palate (velum) and lateral pharyngeal walls are physically unable to make a sufficient seal of the oral cavity from the nasal cavity during speech production. As a consequence, air tends to escape into the nasal cavity during speech, resulting in hypernasality and excess air emissions. The causes of VPD are heterogeneous and are the basis of three subtypes of VPD: velopharyngeal incompetency (caused by a lack of neuromotor competency), velopharyngeal mislearning (caused by maladaptive articulatory habits) and velopharyngeal insufficiency (VPI, caused by insufficient tissue or mechanical restriction) 1,2 . For example, a congenitally short palate and/or deep nasopharynx can alter the geometry of the velopharyngeal apparatus, such that the soft palate is no longer able to effectively create a seal against the posterior wall of the nasopharynx 2,3 . Although VPD can occur as the result of surgical procedures, such as adenoidectomies, the most common congenital cause of VPD is cleft palate (CP) or submucous cleft palate (smCP), which can occur as isolated malformations or as part of a syndrome 4 . After primary palatal repair surgeries, approximately 30% of CP patients require additional surgery for VPD 1 . VPD can also occur in the absence of an overt orofacial cleft 5 , and some cases have been reported with autosomal-dominant inheritance 6,7 . Detailed phenotyping in these "isolated" VPD cases shows that these result from structural deficiencies in the anatomical components that comprise the velopharyngeal mechanism. The genetic basis of isolated VPD is poorly understood and the autosomal-dominant families have yet to be

To evaluate the relationship between periodontal diseases and subclinical atherosclerosis in a younger and lean South Asian population. We conducted a cross-sectional study in 917 subjects (mean age 46 years and mean body mass index 21.1 kg/m(2) ) from the Health Effects of Arsenic Longitudinal Study in Bangladesh. Multivariate linear regression models were used to assess the associations between multiple clinical measures of periodontal diseases and carotid intima-media thickness (IMT). Mean attachment loss (AL) and percentage of sites with AL ≥ 4 mm (% AL ≥ 4) were associated with increased IMT. The IMT was 20.0-μm (95% CI: 2.2, 37.8) and 26.5-μm (95% CI: 8.9, 44.1) higher in those in the top quartile of mean AL (&gt; 3.72 mm) and % AL ≥ 4 (&gt; 58.4%), respectively, compared to those in the bottom quartile. In a subset of 366 subjects, mean AL was positively associated with plasma levels of matrix metalloproteinase-9 (P &lt; 0.05) and soluble intercellular adhesion molecule-1 (P ...

eyes without subclinical DME developed CSME (6.3%). Eyes/ patients with subclinical DME presented a risk for DME progression 3.686 times higher than that of eyes/patients without subclinical DME (95% confidence interval 1.221-7.988). Conclusions: Subclinical DME in eyes with NPDR identified by center point thickness measured on a Stratus OCT is a good predictor of CSME development.

eyes without subclinical DME developed CSME (6.3%). Eyes/ patients with subclinical DME presented a risk for DME progression 3.686 times higher than that of eyes/patients without subclinical DME (95% confidence interval 1.221-7.988). Conclusions: Subclinical DME in eyes with NPDR identified by center point thickness measured on a Stratus OCT is a good predictor of CSME development.

Context Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates. However, OSCM has high iodine content and long half-life, leading to potential iodine excess. Objective This work aimed to determine the pattern of iodine excess after OSCM HSG and the effect on thyroid function. Methods A prospective cohort study was conducted of 196 consecutive consenting eligible women without overt hypothyroidism or hyperthyroidism. All completed the study with compliance greater than 95%. Participants underwent OSCM HSG (Auckland, 2019-2021) with serial monitoring of thyrotropin (TSH), free thyroxine (FT4), and urine iodine concentration (UIC) for 24 weeks. The main outcome measure was the development of subclinical hypothyroidism (SCH), defined as a nonpregnant TSH greater than 4 mIU/L with normal FT4 (11-22 pmol/L) in those with normal baseline thyroid function. Results Iodine excess (UIC ≥ 300 μg/L) was almost universal (98%) with UIC peaking usually by 4 we...

Human papillomavirus (HPV) is widespread and can cause latent infection in basal cells, with low HPV DNA copy-number insufficient for transmission of infection; can cause subclinical infection that is active but without clinical signs; or can cause clinical infection leading to benign, potentially malignant or malignant lesions. The HPV cycle is influenced by the stage of maturation of the infected keratinocytes, and the production of virions is restricted to the post-mitotic suprabasal epithelial cells where all the virus genes are expressed. Low-risk HPV genotypes are associated with the development of benign oral lesions, whereas highrisk HPV genotypes are implicated in the development of malignant epithelial neoplasms. The rôle of high-risk HPV as a causative agent in epithelial malignancy is different at different anatomical sites: it is almost invariably implicated in squamous cell carcinoma of the uterine cervix, fairly frequently implicated in squamous cell carcinoma of the oropharynx, and it is seldom implicated in squamous cell carcinoma of the mouth.

Many patients with hepatitis C chronic infection (HCV+ patients) experience symptoms (fatigue, dyspnea) not proportional to the liver involvement and resemble symptoms of heart failure (HF). To our knowledge, no study evaluated at the same time serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tumor necrosis factor α (TNF-α) in HCV+ patients. Circulating NT-proBNP and TNF-α were assayed in 60 HCV+ patients, and in 60 sex-and age-matched controls. HCV+ patients showed signifi cantly higher mean NT-proBNP and TNF-α levels than controls ( P < 0.003). By defi ning high NT-proBNP level as a value higher than 125 pg/mL (the single cutoff point for outpatients under 75 years of age), 28% of HCV+ and 7% controls had high NT-proBNP (chi-square; P < 0.002). With a cutoff point of 900 pg/mL (that should be used for ruling in HF in patients age 50-75; such as the patients in our study), 3% HCV+ and 0 controls had high NT-proBNP. In conclusion, the study demonstrates high levels of circulating NT-proBNP and TNF-α in HCV+ patients. The increase of NT-proBNP may indicate the presence of a subclinical cardiac dysfunction. Further prospective studies quantifying symptoms and correlating these with echocardiographic parameters are needed to confi rm this association.

Cardiovascular diseases (CVD) are considered the leading cause of morbidity and mortality from chronic diseases in the world. In addition, about 20% of first and recurrent acute myocardial infarctions (MI) are silent. In this context, subclinical atherosclerosis culminates in evident CVD, through the evolution of early risk factors such as hypercholesterolemia, hypertriglyceridemia and others. The main problem in CVD is related to the long-time between the start of the subclinical atherosclerosis and the manifestation of the disease. The identification of subjects at risk of such events is obviously substantial, since identification leads to implementation and compliance with effective preventive measures that reduce such risk. In this sense, this review demonstrates biomarkers as an alternative to early detection of subclinical atherosclerosis. One of the proposed biomarkers is the Ischemia-modified albumin (IMA), being considered a promising biochemical biomarker for atherosclerot...

The present study entitled "Carotid Intima Media Thickness in Hypothyroidism" was conducted in the department of General medicine, A.V.B.R.H and J.N.M.C, Sawangi, Meghe, Wardha. C-IMT was measured by recording ultrasonographic images of both the left and right common carotid artery with a 7-MHz linear array transducer. Patients were examined in the supine position, with the head turned 45° from the side during the scanning procedure. The aim of the study is to evaluate carotid intima media thickness (C-IMT) in hypothyroidism. The study included 100 cases of newly detected hypothyroidism not on thyroid replacement therapy, and 50 matched healthy controls. Body mass index (BMI), thyroid profile, lipids, blood pressure and the mean of C-IMT were determined. Mean values of C-IMT, triglycerides, and total cholesterol were significantly high in hypothyroidism group versus controls. Carotid intima-media thickness was significantly increased in SCH and overt hypothyroidism group as compared to controls (p <0.001). On comparing all independent variables like BMI, lipids and blood pressure with dependent variable C-IMT, statistically significant difference was found with FT4 (p=0.024), TSH (p=0.041) and with HDL (p=0.021). In overt and subclinical hypothyroidism groups, values of diastolic blood pressure (DBP), triglycerides (TG), low density lipoprotein (LDL) were deranged. All these may contribute to atherosclerosis and an increase in C-IMT, causing potential risk for future cardiovascular disease, stroke. So, hypothyroidism group having deranged lipid profile and other risk factors like obesity should be screened for atherosclerosis by measuring C-IMT. This group can be targeted for primary prevention of coronary artery diseases (CAD) and its early management like lipid lowering agents apart from being treated for hypothyroidism.

In order to reexamine the possible association between bacterial presence and capsular contracture, 55 silicone devices (mammary implants or tissue expanders) were cultured at the time of their removal from 40 patients. Special culture techniques were used in an attempt to recover bacteria adhering to the smooth-surfaced implant and encased in glycocalyx biofilm. Bacteria were detected on 56% (15 of 27) of implants surrounded by contracted capsules and on 18% (5 of 28) of those without capsular contracture (p < 0.05). Only three implants tested positive using routine plating techniques. The predominant isolate was Staphylococcus epidermidis. The concept that capsular contracture is associated with subclinical infection of silicone implants is supported by this study. With changes in the microbiological technique, bacterial recovery and growth occurs at a frequency greater than previously thought.

Resumen Objetivo: conocer el nivel de insomnio no orgánico posterior a una estrategia de higiene del sueño con medición del índice de severidad de insomnio antes y después de la estrategia educativa en pacientes de la unidad de medicina familiar (umf) no. 7, en un periodo de dos meses. Métodos: se realizó un estudio cuasiexperimental, no ciego, longitudinal prospectivo con base en una estrategia educativa en 20 pacientes (muestra no probabilística) con diagnóstico de insomnio no orgánico en la umf no. 7, para valorar la mejoría del insomnio después de una estrategia educativa de higiene del sueño. Resultados: se presentó disminución en el grado de insomnio, con los siguientes porcentajes: 0% insomnio grave, 20% insomnio moderado, insomnio subclínico 55% y 25% ausencia de insomnio. Conclusiones: una estrategia educativa en higiene de sueño es capaz de modificar la severidad del insomnio en pacientes, mejorando la calidad de vida que presentaban antes de la aplicación de la estrategia.

Presentation of familial hyperckemia secondary to relatively unknown caveolin-3 mutation causing asymptomatic bilateral calf hypertrophy in father and son. Supplemental digital content is available in the text. Abstract Idiopathic hyperckemia has been described as persistent serum creatine kinase elevation at least 1.5 times the upper limit of normal in individuals with otherwise normal laboratory findings and neurological examination. This type of hyperckemia encompasses both sporadic and familial cases, which have been found to be asymptomatic or subclinical, presenting with mild symptoms, such as myalgias or cramps. Genetic causes of hyperckemia have been rarely described. The authors aim to describe a benign autosomal dominant condition caused by a rare mutation in the caveolin gene. Caveolin gene encodes for structural membrane proteins in muscle. The purpose of this article was to discuss the presentation, pathophysiology, and diagnosis of familial hyperckemia secondary to a relatively unknown mutation in caveolin-3 gene.

The estimated prevalence of subclinical hypothyroidism (SCH) in the general population is 3% to 8%. As the average age of the population in the United States and other countries continues to increase, the overall prevalence of SCH may also be expected to increase. Although age-related changes in thyroid function are well described, normal thyroid-stimulating hormone (TSH) reference limits, derived for age-specific populations, are not routinely used to identify thyroid dysfunction in elderly adults. Therefore, currently accepted values for the upper limit of normal of TSH may be inappropriate for diagnosing SCH in individuals aged 65 and older, resulting in potential overestimation of the prevalence of SCH in this population. This review discusses the current evidence of the effects of SCH on cardiovascular health and neuropsychiatric function in older adults. Although the results of some studies are conflicting, the overall evidence suggests that the consequences of SCH may be different for elderly adults than for younger populations. Treatment of SCH in older individuals requires special consideration with regard to thyroid hormone replacement therapy and expected clinical outcomes. Although careful identification of individuals with persistent SCH who could benefit from levothyroxine treatment is necessary, current evidence suggests that individuals with TSH levels greater than 10 mIU/L who test positive for antithyroid antibodies or are symptomatic may benefit from levothyroxine treatment to reduce the risk of progression to overt hypothyroidism, decrease the risk of adverse cardiovascular events, and improve their quality of life. After treatment is initiated, careful monitoring is essential.

Importance. Subclinical hypothyroidism (SCH) is a common clinical entity with a putative role in a wide range of disorders. The impact of SCH on mortality and markers of morbidity has been demonstrated, but studies have shown inconsistent results. Evidence regarding the effect of levothyroxine treatment on reversing morbidity markers is emerging, but the value of treatment is still unclear. Objective. The objectives of this review were to assess recent, high-quality studies evaluating the role of SCH in cardiovascular health, cognition, mood, pregnancy, anemia, and renal disease; to examine the effects of levothyroxine on reducing mortality or reversing markers of morbidity in these conditions; and to consider how new research insights may help guide clinical practice. Evidence review. A PubMed search was conducted (using 'subclinical hypothyroidism' [Title/Abstract] AND morbidity [MeSH Subheading] as search criteria) and was restricted to human studies published in the English language between 1990 and 2013. Subsequent searches of retrieved articles yielded further studies, which were included based on quality. Emphasis was given to large observational studies, well-conducted meta-analyses, and randomized controlled trials. Findings. The difficulty of diagnosing SCH, particularly in the elderly, may underlie many of the conflicting results seen in the literature. Increased understanding of the at-risk patient population will result in better selection of study subjects and, likely, unequivocal results. Regardless of the current confusion, emerging evidence suggests that certain markers of morbidity are reversed by levothyroxine therapy across the disorders examined here. Conclusion and relevance. Future large, well-controlled studies will not only clarify the role of SCH but also help identify patients for whom levothyroxine treatment will provide the most benefit.

Accurate diagnosis and treatment of subclinical hypothyroidism (SCH) is challenging in clinical practice because of differing upper limits of normal (ULN) for thyroid-stimulating hormone (TSH). This review summarises the various definitions of SCH and their impact on reported SCH prevalence. Articles reporting the prevalence of SCH in relation to the ULN of TSH in human studies were identified through an English-language PubMed search for &#39;subclinical hypothyroidism,&#39; &#39;prevalence,&#39; and &#39;TSH&#39; within the title and/or abstract. Relevant articles and related literature were selected for inclusion. Estimates for the prevalence of SCH varied by sex, age, race/ethnicity, and geographic location (range, 0.4-16.9%). Higher rates of SCH were consistently reported in women (0.9-16.9%) and older individuals (2.7-16.9%). However, the ULN of TSH in those considered free of thyroid disease and not at risk increased progressively with age, suggesting that reports of SCH prev...

In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism, and the results were mixed. Subclinical hypothyroidism is defined as raised thyrotropin combined with a normal serum free thyroxine level. The normal range of thyrotropin varies according to geographic region and ethnic background. In the absence of local normative data, the recommended upper limit of thyrotropin in the first trimester of pregnancy is 2.5 mIU/L, and 3.0 mIU/L in the second and third trimester. The thyroid gland needs to produce 50% more thyroid hormone during pregnancy to maintain a euthyroid state. Consequently, most women on levothyroxine therapy before pregnancy require an increase in dose when pregnant to maintain euthyroidism. Ongoing prospective trials that are evaluating the impact of levothyroxine therapy on adverse outcomes in the mother and fetus in women with subclinical hypothyroidism will provide crucial data on the role of thyroid hormone replacement in pregnancy. We created a list of all relevant topics related to subclinical hypothyroidism in pregnancy and then performed a comprehensive literature review, carrying out a systematic PubMed and Medline search for original articles, reviews, and guidelines published from 1990 to February 2014. Primary papers published before 1990 that were seminal in the field were also analyzed. The search terms used were thyrotropin, levothyroxine, pregnancy, subclinical hypothyroidism, adverse effects, abortion, miscarriage, iodine, thyroid antibodies, and Hashimoto's thyroiditis. We prioritized randomized controlled trials, meta-analyses, and important studies in the field.

Purpose Although it is well known that obesity increases the risk of atherosclerosis in carotid arteries, it is not clear whether this risk changes after obesity surgery. The aim of this study was to investigate whether weight reduction with a laparoscopic sleeve gastrectomy (LSG) has any effect on distensibility and elasticity which show subclinical atherosclerosis in the carotid arteries of obese individuals. Materials and Methods This prospective study included 130 patients (body mass index (BMI) 48.21 ± 6.97 kg/m 2 ) who underwent LSG. The patients were followed up for 1 year. Comparisons were made of the distensibiliy and elasticity values calculated preoperatively and at 1, 3, 6, and 12 months, postoperatively. Results There was a statistically significant increase in distensibility and elasticity values from baseline to 1, 3, 6, and 12 months postoperatively (p < 0.001 for both comparisons). The multiple linear regression analysis was used to find the variables affecting both distensibility and elasticity. According to the results, the presence of BMI decreases distensibility percentage change level by 0.38 units (β= -0.38, 95% CI -0.51;-0.25, p < 0.001). The presence of fasting plasma glucose decreases elasticity percentage change level by 0.20 units. (β= -0.20, 95% CI -0.39; -0.01, p = 0.037). Conclusion Carotid artery distensibility and elasticity values increase after LSG, and this change could be caused by the change in metabolic parameters and heart geometry. These results may indirectly suggest that subclinical atherosclerosis in carotid arteries has decreased after obesity surgery.