Diagnostic value of anti-CD74 antibodies in early and late axial spondyloarthritis and its relationship to disease activity

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 263-268 ◽  
Author(s):  
Marwa Mahmoud Abdelaziz ◽  
Rania M Gamal ◽  
Nadia M Ismail ◽  
Raghda A Lafy ◽  
Helal F Hetta
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Diagnostic Value ◽  
Inactive Disease ◽  
Control Group ◽  
Igg Antibodies ◽  
Control Groups ◽  
Significant Difference ◽  
Healthy Control

Abstract Objectives This study was designed to evaluate the role of anti-CD74 antibodies in diagnosis of axial spondyloarthritis (axSpA) and their relationship to disease duration and disease activity. Methods Fifty patients with axSpA, 15 patients with RA and 15 healthy subjects were included in the study. Clinical examination and laboratory tests were done. The ESR, CRP level and ASDAS were measured as markers of the disease activity. Quantitative determination of human CD74 IgG antibodies was done. Results The mean age of the patients was 38.22 (S.D.12.20) years. The level of CD74 autoantibodies was significantly higher in axSpA in comparison to control groups. Most patients with positive articular and extra-articular manifestations were positive for CD74 autoantibodies. In patients with inactive disease, 33.3% were positive for CD74 autoantibodies, as were 83% with active disease. High percentages of patients with early and late axSPA were CD74 autoantibody positive. The majority of patients with positive disease activity in early and late axSpA were CD74 autoantibody positive. CD74 autoantibodies had 80% sensitivity vs both control groups with 87% specificity vs the healthy control group and 80% vs the RA control group in the diagnosis of axSpA. Conclusions The frequency of positive anti-CD74 IgG antibodies was as high in patients with early axSpA as in those with late axSpA, with no significant differences. There was a significant difference in the frequency of positive anti-CD74 IgG antibodies between patients with positive and negative disease activity. Based on the sensitivity and specificity of anti-CD74 IgG, this is a promising diagnostic tool to support the clinical diagnosis of axSpA.

Study on the Subtypes of Dendritic Cells and the Expression of T Cell Co-Stimulating Molecules (CD80, CD86, CD40) on Dendritic Cells and B Cells in the Peripheral Blood of SAA Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3753-3753
Author(s):  
Zonghong Shao ◽  
Meifeng Tu ◽  
Hong Liu ◽  
Guangsheng He ◽  
Jun Shi ◽  
...  
Keyword(s):  
T Cell ◽  
B Lymphocytes ◽  
Normal Control ◽  
Peripheral Blood ◽  
Active Phase ◽  
Control Group ◽  
Control Groups ◽  
Significant Difference ◽  
Healthy Control ◽  
Cd40 Expression

Abstract Objective To detect the quantities of monocyte-derived dendritic cell precursors (pDC1) and plasmacytoid dendritic cell precursors (pDC2) in peripheral blood mononuclear cells (PBMC) of severe aplastic anemia (SAA) patients before and after immune suppressive therapy (IST), the ratio of their pDC1 to pDC2, and the expression of T-cell co-stimulating molecules (CD80, CD86, CD40) on dentritic cells (DC) and B cells surface in the SAA patients’ peripheral blood. Methods with three-color monoclonal antibody labeling technology, the quantities and ratio of pDC1 and pDC2 in PBMC were detected in 26 patients with SAA at active phase,13 patients with SAA at recovery phase and 15 normal control respectively by FACS. The aforementioned merits of 10 SAA patients were tested before and 2 months after IST by FACS. By FACS, the expression of CD80, CD86 and CD40 on DC and B lymphocytes were detected in 16 patients with SAA and 15 normal controls. Results The percentages of total pDC, pDC1, pDC2 and the ratio of pDC1/pDC2 of controls (healthy people) were(0.72±0.32)%,(0.41±0.18)%,(0.30±0.21)%, 1.58±0.69 respectively, and those of the patients with SAA at active phase were(0.96±0.92)%,(0.67±0.65)%,(0.32±0.30)%,2.70±1.63 respectively. The differences were significant [pDC1 (P<0.05); pDC1/pDC2 ratio (P<0.01)]. The aforementioned merits of recuperating SAA patients decreased to (0.77±0.48)%,(0.43±0.37)%,(0.34±0.34)%,1.78±1.29 respectively, which were not significantly different from those of normal control group. The aforementioned merits of 10 SAA patients were(0.87±0.98)%,(0.35±0.30)%,2.65±1.27 before IST, and(0.24±0.28)%,(0.14±0.14)%,2.16±0.82 after IST, with significant decreases of pDC1 and pDC2 (P<0.05). The percentages of CD80, CD86 and CD40 expression on DC in peripheral blood of healthy control were(1.61±2.37)%,(11.97±12.18)%,(0.56±1.26)% respectively, and those of SAA patients were(9.14±12.89)%,(29.84±9.56)%,(7.04±11.99)% respectively. There was a significant difference of CD86 expression (p<0.05) between SAA patient and normal control groups. The percentages of CD19, CD80, CD86 and CD40 expression on lymphocytes in peripheral blood of healthy control group were (9.38±3.18)%,(2.57±1.51)%,(1.86±1.11)%,(7.34±4.21)% respectively, and those of SAA patients were(11.12±9.02)%,(5.17±2.72)%,(5.98±3.84)%,(8.85±9.95)% respectively. There were significant differences of CD80 and CD86 expressions (P<0.05, P<0.01) between SAA and control groups. The percentages of CD80, CD86 and CD40 expression on B lymphocytes of control were(28.22±12.32)%, 8.04±2.27% and(81.6±22.45)% respectively, and those of SAA patients were(23.06±14.9)%,(20.46±11.1)%,(81.57±21.14)% respectively. There was a significant difference of CD86 expression (p<0.05) between patient and control groups. Conclusion The pDC subtypes were abnormal and the percentage of pDC1 increased in SAA patients, which were associated with the state of this illness. DC and B Lymphocytes in SAA up-regulated the expression of T cell co-stimulating molecules (CD86) that draw the T lymphocyte abnormally activated.

scholarly journals Assessment of Carotid Artery Distensibility and Elasticity in Patients with Asthma

2021 ◽  
Author(s):  
Hatice Eylül Bozkurt Yılmaz ◽  
Mustafa Yılmaz
Keyword(s):  
Severe Asthma ◽  
Persistent Asthma ◽  
Control Group ◽  
Control Groups ◽  
Asthmatic Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Healthy Control ◽  
Carotid Distensibility ◽  
And Control

As asthma and atherosclerosis have similar pathophysiological mechanisms and risk factors, asthmatic patients may have an increased risk of atherosclerosis. This study aimed to determine the possibility of a higher risk of atherosclerosis in asthma patients compared with healthy controls by measuring carotid elasticity and distensibility. This was a cross-sectional study on 326 participants including 221 patients (129 [58.37%] females) with persistent asthma, aged 46.47±11.58 years, body mass index (BMI) of 29.74±3.99, and 105 healthy control subjects (60 [57.14%] females) aged 46.08±11.35 years, and BMI of 29.42±3.76. Of the 221 patients with asthma, 75 (33.93%) had mild, 74 (33.48%) had moderate and 72 (32.57%) had severe asthma. The carotid distensibility and elasticity were recorded and compared in both patients and control groups. There was no statistically significant difference between the patients and healthy control groups in terms of age, BMI and gender (p=0.775, p=0.482, and p=0.834, respectively). A statistically significant difference was determined between the patient and control groups in respect of both distensibility and elasticity (10.93±1.64 vs. 11.5±1.31, p=0.002 and 0.21±0.03 vs. 0.22±0.04, p=0.001, respectively). Statistically significant differences were determined between the control group and the asthma subgroups in respect of distensibility and elasticity (p<0.001, for both comparisons). The results showed that the difference was mainly due to the patients with severe asthma. Carotid distensibility and elasticity were decreased in asthmatic patients, and the main reason for this decrease was the patients in the severe asthma group. These results may suggest that the risk of subclinical carotid atherosclerosis is increased in patients with asthma, especially those with severe asthma.

scholarly journals The Diagnostic Value of N-Acetyl-β-D-Glucosaminidase and Microalbumin Concentrations in Rheumatoid Arthritis

2007 ◽  
Vol 26 (4) ◽  
pp. 300-308 ◽  
Author(s):  
Dejan Spasovski ◽  
Todor Gruev ◽  
Nada Marina ◽  
Jordan Calovski ◽  
Snežana Percinkova ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Colorimetric Assay ◽  
Diagnostic Value ◽  
Control Group ◽  
Rf Test ◽  
Diagnostic Values ◽  
Healthy Control ◽  
Laboratory Variables ◽  
Higher Sensitivity

The Diagnostic Value of N-Acetyl-β-D-Glucosaminidase and Microalbumin Concentrations in Rheumatoid ArthritisThe purpose of this research was to compare the diagnostic values of laboratory variables, to present quantitative evaluations of the diagnostic sifted test with reference to sensitivity and specificity, the predictive value of the positive and negative test and precision of the test for N-acetyl-β-D-glucosa-minidase (NAG), microalbumin, rheumatoid factor (RF), Creactive protein (CRP), DAS 28 index, in early diagnosis of untreated rheumatoid arthritis (RA), and to define the effect of untreated rheumatoid arthritis on glomerular and tubular function. Using a colorimetric assay for the determination of Nacetyl-β-D-glucosaminidase and an immunoturbidimetric assay for the determination of urinary albumin, the samples of serum and urine have been examined in 70 participants (35 RA who were not treated, 35 healthy controls). RF was defined with the test for agglutination (Latex RF test) in the same participants. Out of 35 examined patients with RA, in 13 we found the presence of NAG enzymuria (sensitivity of the test 37.14%), while microalbuminuria appeared in 4 patients (sensitivity of the test 11.42%). RF appeared in 17 patients (sensitivity of the test 48.57%). Four patients were NAG and RF positive, while 3 patients were microalbuminuria and RF positive. Among 18 RF negative patients, 9 patients were NAG positive, and 1 patient presented with microalbuminuria. Among 17 RF positive RA, the presence of NAG was found in 4 patients, and the presence of microalbuminuria in 3 patients. Among 18 RF negative RA, NAG enzymuria appeared in 9 patients. Microalbuminuria was present in 1 patient. In the healthy control group, 8 patients were NAG positive, 2 patients were positive for microalbuminuria. RF appeared in 2 patients. NAG has higher sensitivity than microalbuminuria in the detection of asymptomatic renal lesions in untreated RA.

Evaluation of the impact of a nurse-led program of patient self-assessment and self-management in axial spondyloarthritis: results of a prospective, multicentre, randomized, controlled trial (COMEDSPA)

Rheumatology ◽  
2020 ◽  
Author(s):  
Anna Molto ◽  
Laure Gossec ◽  
Serge Poiraudeau ◽  
Pascal Claudepierre ◽  
Martin Soubrier ◽  
...  
Keyword(s):  
Physical Activity ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Activity Score ◽  
Self Management ◽  
Control Group ◽  
Self Assessment ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Impact

Abstract Objective To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. Methods Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). Results A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores &gt;6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). Conclusion This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.

scholarly journals Serum Calprotectin a Potential Biomarker in Juvenile Idiopathic Arthritis: A Meta-Analysis

2021 ◽  
Vol 10 (21) ◽  
pp. 4861
Author(s):  
Emma Altobelli ◽  
Paolo Matteo Angeletti ◽  
Reimondo Petrocelli ◽  
Giuseppe Lapergola ◽  
Giovanni Farello ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Meta Analysis ◽  
Systemic Disease ◽  
Inactive Disease ◽  
Control Group ◽  
Funnel Plot ◽  
Potential Biomarker ◽  
Statistical Heterogeneity ◽  
Significant Difference

Juvenile idiopathic arthritis (JIA) is the most common inflammatory chronic disease affecting children and adolescents. Today, there are no specific biomarkers of inflammation. Therefore, it is important to identify new markers as predictors of disease activity. Recently, some researchers have directed their interest toward a protein, calprotectin (CLP), as a potential biomarker. The primary objective of our systematic review and meta-analysis was to analyze the possible role of CLP in JIA. Method: A literature search was conducted using PubMed, EMBASE, Scopus, Science Direct on 10 August 2021. The selection of studies was made using the PRISMA 2020 guidelines. Cohen’s d with 95% CI and p-value were used as a measure of effect size. The random effects model was used to account for different sources of variation among studies. Heterogeneity was assessed using Q statistics and I2. The publication bias was analyzed and represented by a funnel plot, and funnel plot symmetry was assessed with Egger’s test. Results: Our results at follow-up showed a statistically significant difference between patients with active disease compared to patients with inactive disease: 0.39 (0.16; 0.62), p = 0.001; without statistical heterogeneity. Another important aspect that emerged were the differences between the systemic disease form and any form of inactive disease showing a different concentration of calprotectin: 0.74 (0.40; 1.08), p < 0.001; without statistical heterogeneity. On the other hand, meta-regression analyses performed on gender, age, duration of disease, percentage of patients with ANA+ or RF+, medium value of ESR or CRP were not statistically significant. A statistically significant difference in serum calprotectin concentration between patients with JIA and healthy controls were observed. In fact, it presented lower values in the control group. Conclusions: The use of serum CLP could represent, in the future, a useful tool in JIA in order to stratify disease activity more accurately and may aid a more tailored approach to drug of choice in children with JIA. Further studies are needed to evaluate CLP as a predictor of flare in combination with other potential biomarkers of subclinical disease activity.

Assessment of the Diagnostic Value of GFAP, IGFBP-2, and YKL-40 in Patients with Glioblastoma

2021 ◽  
Author(s):  
Anahita Ebrahimpour ◽  
Guive Sharifi ◽  
Karimollah Hajian-Tilaki ◽  
Shirin Haghighifashi ◽  
Durdi Qujeq
Keyword(s):  
Diagnostic Value ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Plasma Samples ◽  
Tissue Samples ◽  
Tissue Levels ◽  
Significant Difference ◽  
Healthy Control ◽  
Newly Diagnosed Glioblastoma ◽  
History Of

Background and Aims: An effective marker search in glioblastoma is precious in controlling and detecting the progression and monitoring of patients with glioblastoma. In this regard, the present study aimed to evaluate the diagnostic and prognostic role of glial fibrillary acidic protein (GFAP), insulin-like growth factor-binding protein -2 (IGFBP-2), and chitinase-3-like protein -1 (YKL-40) tissue and plasma levels in patients with GBM. Materials and Methods: A total of 22 patients with newly diagnosed glioblastoma (the fourth grade of glioma) who had undergone surgery at the Erfan Hospital were included in the current study. The levels of GFAP, IGFBP-2 were evaluated in 22 tumor tissues, and non-timorous matched adjacent tissue samples of patients with glioblastoma using the enzyme-linked immunosorbent assay . Besides, 22 healthy subjects with no history of glioblastoma served as controls for plasma samples. All analyses were evaluated using the SPSS version 22.0. Results: The tissue levels of GFAP, IGFBP-2, and YKL-40 were significantly higher in patients with glioblastoma when compared to the healthy controls (p=0.001). Nevertheless, there was no significant difference in comparison to the healthy control group in the plasma samples. Conclusions: Tissue levels of GFAP, IGFBP-2, and YKL-40 may be potential biomarkers for predicting and the progression in patients with glioblastoma.

scholarly journals Anthropogenetic variability in groups of children from regular and special schools from different localities in Serbia

Genetika ◽  
2016 ◽  
Vol 48 (2) ◽  
pp. 743-751 ◽  
Author(s):  
Slavko Brankovic ◽  
Suzana Cvjeticanin
Keyword(s):  
Control Group ◽  
Population Genetic Study ◽  
Control Groups ◽  
Special Schools ◽  
Mean Values ◽  
Significant Difference ◽  
Mental Abilities ◽  
The Mean ◽  
Physical Capacities

This population-genetic study compares morpholophysiological and genetic variability in five control groups of individuals (children from five regular schools, N= 996) with children from that many special schools (N= 736) from Serbia, by using a test of determination of homozygously recessive characteristics in humans (HRC-test). Genetic homozygosity degree showed not only statistically significant difference between the mean values obtained for two groups of studied samples (control group 6.95? 0.07; children from special schools 8.63? 0.08 HRCs, out of 30 analyzed characteristics), but also differences in the type of distribution, as well as the presence of specific combinations of such traits. Results of comparisons done in different places (Kraljevo, Nis, Vranje, Leskovac, Pirot) showed the same tendency- the increase of genetic homozygosity and relative decrease of variability in samples of children from special schools. The number of HRCs among individuals from control groups varied from 2 to 15/30, and from 3 to 16/30 among children from special schools. It is possible that increased recessive homozygosity present in the group of children from special schools leads to increase of genetic loads, what may cause easier expression of some physiological and mental abilities that children from special schools have.A great individual variation in amount of genetic homozygosity that exists among human individuals may influence their potentials for different kinds of adaptation, including their mental abilities, physical capacities or resistance to different diseases.

Effects of Virgin Coconut Oil as Adjunct Therapy in the Treatment of Allergic Rhinitis

2016 ◽  
Vol 1 (1) ◽  
pp. 22
Author(s):  
Nazli Zainuddin ◽  
Nurul Azira Mohd Shah ◽  
Rosdan Salim
Keyword(s):  
Allergic Rhinitis ◽  
Side Effects ◽  
Coconut Oil ◽  
Test Group ◽  
Nasal Symptom ◽  
Control Group ◽  
Virgin Coconut Oil ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Introduction: The role of virgin coconut oil in the treatment of allergic rhinitis is controversial. Thus, the aim of the present study is to determine the effects of virgin coconut oil ingestion, in addition to standard medications, on allergic rhinitis. We also studied the side effects of consumption of virgin coconut oil. Methods: Fifty two subjects were equally divided into test and control groups. All subjects received a daily dose of 10mg of loratadine for 28 days. The test group was given 10ml of virgin coconut oil three times a day in addition to loratadine. The symptoms of allergic rhinitis were scored at the beginning and end of the study. Results:, the symptom score were divided into nasal and non-nasal symptom scores. Sneezing score showed a significant difference, however the score was more in control group than test group, indicating that improvement in symptom was more in control group. The rest of the nasal symptom and non-nasal symptom score showed no significant difference between test and control groups. Approximately 58% of the test subjects developed side effects from consumption of virgin coconut oil, mainly gastrointestinal side effects. Conclusion: In the present study, ingestion of virgin coconut oil does not improve the overall and individual symptoms of allergic rhinitis, furthermore it has side effects.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

Thyroid Functions in Children on Levetiracetam or Valproic Acid Therapy

2020 ◽  
Author(s):  
Elif Karatoprak ◽  
Samet Paksoy
Keyword(s):  
Valproic Acid ◽  
Subclinical Hypothyroidism ◽  
Control Group ◽  
Thyroid Function Tests ◽  
Healthy Children ◽  
Control Groups ◽  
Acid Therapy ◽  
Significant Difference ◽  
And Control ◽  
Tsh Levels

AbstractThe aim of this study was to investigate the thyroid functions in children receiving levetiracetam or valproate monotherapy. We retrospectively reviewed the records of children with controlled epilepsy receiving valproic acid (VPA group) or levetiracetam monotherapy (LEV group) for at least 6 months. Free thyroxine 4 levels (fT4) and thyroid stimulating hormone (TSH) levels were compared between VPA group, LEV group, and age- and gender-matched healthy children (control group). A total of 190 children were included in the study: 63 were in the VPA, 60 in the LEV, and 67 in the control group. Although there was no significant difference regarding average fT4 levels, higher TSH levels were found in the VPA group when compared with the LEV and control groups (p < 0.001 and p < 0.001, respectively). There was no significant difference in terms of fT4 and TSH values in the LEV group when compared with the control group (p = 0.56 and p = 0.61, respectively). Subclinical hypothyroidism (defined as a TSH level above 5 uIU/mL with a normal fT4 level was detected in 16% of patients in the VPA group, none in the LEV and control groups. Our study found that VPA therapy is associated with an increased risk of subclinical hypothyroidism while LEV had no effect on thyroid function tests.

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