Screening the adequacy of hydroxychloroquine prescription and monitoring of ocular toxicity in patients with rheumatic disease

Background: Hydroxychloroquine (HCQ) an anti-inflammatory drug used in treatment of rheumatic diseases causes retinal toxicity in a minority of patients which are both time and dose dependent. The aim of this study was to assess the compliance with guidelines of American Association of Ophthalmology for screening and dosage of this drug. Patients and methods: In this cross-sectional analysis, the medical records of patients who were on HCQ, attending Rheumatology Outpatient Department of Fatima Memorial Hospital Shadman, Lahore from 25-05-2019 to 30-05-2019 were reviewed. The dosage and, duration of HCQ were collected, files were reviewed for physician recommendation of screening tests for retinal toxicity. HCQ dose of 5mg/kg/day was labeled as adequate dose; dose below 4.5mg/kg/day under dosed, while dose of 6mg/kg/day and above was considered overdose. Results: Data was collected from 81 patients during the study period, 74 (91.4%) of them being female, with mean age 35.15 ± 12.6 years. Based on total body weight, 23 patients (28.4%) were receiving the correct dosage of the drug around 5mg/kg/day whereas 39 (48.1%) patients were under-dosed below 4.5mg/kg/day, and 19 patients (23.5%) were over dosed, out of which 5 (6.17%) were receiving doses above 6.5mg/kg. Baseline eye screening examination by ophthalmologist was performed within 1 year of commencing treatment in 54 (66%) patients. Of the 27 patients receiving HCQ more than 5 years, 6 patients underwent Spectral coherence Ocular CT scan (SD-OCT) evaluation at 5 years. There was minimal compliance (less than 70% of Patients) to optimum drug dosage, partial compliance (70-89% patients) to preventing over-dosage of the drug, and full compliance (more than 90% patients) was achieved in baseline screening exam recommendation. Follow-up screening documentation and 5-years screening examination had minimal compliance. Conclusion: A significant proportion of patients are underdosed, especially the obese population where the recommended dosage is not prescribed.

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Detection of Hydroxychloroquine Retinal Toxicity by Automated Perimetry in 60 Rheumatoid Arthritis Patients with Normal Fundoscopic Findings

Global Journal of Health Science ◽

10.5539/gjhs.v8n3p59 ◽

2015 ◽

Vol 8 (3) ◽

pp. 59 ◽

Cited By ~ 2

Author(s):

Qader Motarjemizadeh ◽

Naser Samadi Aidenloo ◽

Mohammad Abbaszadeh

Keyword(s):

Rheumatoid Arthritis ◽

Early Detection ◽

Anterior Segment ◽

Field Testing ◽

Retinal Toxicity ◽

Screening Tests ◽

Automated Perimetry ◽

Cross Sectional ◽

Dry Eyes ◽

Significant Difference

<p>Hydroxychloroquine (HCQ) is an antimalarial drug used extensively in treatment of autoimmune diseases such as rheumatoid arthritis. Retinal toxicity is the most important side effects of this drug. Even after the drug is discontinued, retinal degeneration from HCQ can continue to progress. Consequently, multiple ophthalmic screening tests have been developed to detect early retinopathy. The aim of the current study was to evaluate the value of central 2-10 perimetry method in early detection of retinal toxicity. This prospective cross-sectional investigation was carried out on 60 rheumatoid arthritis patients, who had been receiving HCQ for at least 6 months and still were on their medication (HCQ intake) at the time of enrollment. An ophthalmologist examined participants using direct and indirect ophthalmoscopy. Visual field testing with automated perimetry technique (central 2-10 perimetry with red target) was performed on all included subjects twice in 6 months interval: The first one at the time of enrollment and the second one 6 months later. Males and females did not show any significant difference in terms of age, duration of therapy, daily and cumulative HCQ dose, anterior or posterior segment abnormalities, hypertension, body mass index, and best corrected visual acuity. Anterior segment was abnormal in 9 individuals including 3 subjects with macular pigmentary changes, 4 individuals with cataract and 2 cases with dry eyes. Moreover, 12 subjects had retinal pigmented epithelium (RPE) in their posterior segments. After 6 months, depressive changes appeared in 12 subjects. Additionally, HCQ therapy worsened significantly the perimetric results of 5 (55.6%) patients with abnormal anterior segment. A same trend was observed in perimetric results of 6 (50.0%) subjects with abnormal posterior segments (P=0.009). The daily dose of HCQ (P=0.035) as well as the cumulative dose of hydroxychloroquine (P=0.021) displayed statistically significant associations with perimetric results. Central 2-10 perimetry is a useful method for early detection of HCQ retinal toxicity, but more comprehensive studies, with larger sample size, longer-term follow-up and more precise techniques are mandatory to confirm HCQ retinal toxicity.</p>

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Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

Current Diabetes Reviews ◽

10.2174/1573399815666190531093238 ◽

2020 ◽

Vol 16 (3) ◽

pp. 270-277 ◽

Cited By ~ 1

Author(s):

Mutasem Ababneh ◽

Mousab Y. Al Ayed ◽

Asirvatham A. Robert ◽

Mohamed A. Al Dawish

Keyword(s):

Diabetic Foot ◽

Statistical Significance ◽

Ankle Brachial Index ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Cross Sectional Study ◽

Screening Tests ◽

Cross Sectional ◽

Toe Brachial Index

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

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Differential Effects of Dietary Fatty Acids on Body Composition and Adiposity

Current Nutrition & Food Science ◽

10.2174/1573401314666181010100002 ◽

2020 ◽

Vol 16 (2) ◽

pp. 142-154 ◽

Cited By ~ 1

Author(s):

Hadi Emamat ◽

Zahra Yari ◽

Hossein Farhadnejad ◽

Parvin Mirmiran

Keyword(s):

Fatty Acids ◽

Body Composition ◽

Unsaturated Fatty Acids ◽

Saturated Fatty Acids ◽

Total Body Weight ◽

Fat Distribution ◽

Monounsaturated Fatty Acids ◽

Dietary Fatty Acids ◽

Dietary Fats ◽

Total Body

Recent evidence has highlighted that fat accumulation, particularly abdominal fat distribution, is strongly associated with metabolic disturbance. It is also well-recognized that the metabolic responses to variations in macronutrients intake can affect body composition. Previous studies suggest that the quality of dietary fats can be considered as the main determinant of body-fat deposition, fat distribution, and body composition without altering the total body weight; however, the effects of dietary fats on body composition have controversial results. There is substantial evidence to suggest that saturated fatty acids are more obesogen than unsaturated fatty acids, and with the exception of some isomers like conjugate linoleic acid, most dietary trans fatty acids are adiposity enhancers, but there is no consensus on it yet. On the other hand, there is little evidence to indicate that higher intake of the n-3 and the n-6 polyunsaturated fatty acids can be beneficial in attenuating adiposity, and the effect of monounsaturated fatty acids on body composition is contradictory. Accordingly, the content of this review summarizes the current body of knowledge on the potential effects of the different types of dietary fatty acids on body composition and adiposity. It also refers to the putative mechanisms underlying this association and reflects on the controversy of this topic.

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Colonoscopy-related injury among colonoscopists: an international survey

Endoscopy International Open ◽

10.1055/a-1311-0561 ◽

2021 ◽

Vol 09 (01) ◽

pp. E102-E109

Author(s):

Ammar Al-Rifaie ◽

Mohammed Gariballa ◽

Alhassan Ghodeif ◽

Stephen Hodge ◽

Mo Thoufeeq ◽

...

Keyword(s):

Body Position ◽

Health Hazard ◽

Significant Proportion ◽

Musculoskeletal Injuries ◽

British Society ◽

Treatment Modalities ◽

Cross Sectional ◽

Electronic Survey ◽

Repetitive Movements ◽

Level Of Experience

Abstract Background and study aims Colonoscopy is physically demanding for endoscopists and patients. Repetitive movements during colonoscopy can lead to overuse injuries. We aimed to explore the prevalence and range of colonoscopy-related musculoskeletal injuries (CRIs) in endoscopists. Methods A cross-sectional electronic survey of 1825 endoscopists was performed. The sample was composed of members of the British Society of Gastroenterology, European Society of Gastrointestinal Endoscopy, and National Nurse Endoscopy Group (UK). The survey comprised 20 questions. These included: endoscopists’ workload, level of experience, and their perceived CRIs. All endoscopists who perform colonoscopy independently were included in the analysis. Results A total of 368 questionnaires were completed of 1825 surveyed (20.16 %). Of those, 319 participants (17.48 %) were fully independent in colonoscopy. Of 319 endoscopists, 254 (79.6 %) have experienced musculoskeletal injuries. These were reported as either possibly (n = 143, 56.3 %) or definitely (n = 90, 35.4 %) related to colonoscopy. Commonly injured areas were the lower back (n = 85, 36.5 %), neck (n = 82, 35.2 %) and left thumb (n = 79, 33.9 %). Of the injured endoscopists, 98 (30.7 %) made some modification to their practice, such as stretching exercises and ergonomic changes. Of the endoscopists, 134 (42.0 %) thought that repetitive limb strain was a likely causative mechanism. Around 40 % believed that torquing the scope and challenging body position were precipitating CRIs. Several treatment modalities were used to treat CRIs. These included; physiotherapy (n = 109), medications (n = 70), rest (n = 43), splinting (n = 31), steroid injections (n = 26) and surgery (n = 11). Conclusions A significant proportion of colonoscopists experience CRIs. The majority of the suggested modifications to practice can be adopted by any endoscopist. These results highlight the need to recognise CRI as an important occupational health hazard and to adopt preventative strategies routinely in the future.

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Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases

Children ◽

10.3390/children8020077 ◽

2021 ◽

Vol 8 (2) ◽

pp. 77

Author(s):

Katerina Sdravou ◽

Elpida Emmanouilidou-Fotoulaki ◽

Athanasia Printza ◽

Elias Andreoulakis ◽

Athanasios Evangeliou ◽

...

Keyword(s):

Food Intake ◽

Gastrointestinal Disease ◽

Significant Proportion ◽

Gastrointestinal Diseases ◽

Healthy Children ◽

Cross Sectional ◽

Frequent Use ◽

Child Autonomy ◽

And Control ◽

Mealtime Environment

Parental feeding practices and mealtime routine significantly influence a child’s eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case–control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child’s food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals.

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Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

Insights into Imaging ◽

10.1186/s13244-020-00920-4 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Moreno Zanardo ◽

Fabio Martino Doniselli ◽

Anastassia Esseridou ◽

Massimiliano Agrò ◽

Nicol Antonina Rita Panarisi ◽

...

Keyword(s):

Body Weight ◽

Contrast Media ◽

Controlled Trial ◽

Total Body Weight ◽

Lean Body Weight ◽

Iodinated Contrast Media ◽

Abdominal Ct ◽

Iodinated Contrast ◽

Significant Difference ◽

Total Body

Abstract Objectives Iodinated contrast media (ICM) could be more appropriately dosed on patient lean body weight (LBW) than on total body weight (TBW). Methods After Ethics Committee approval, trial registration NCT03384979, patients aged ≥ 18 years scheduled for multiphasic abdominal CT were randomised for ICM dose to LBW group (0.63 gI/kg of LBW) or TBW group (0.44 gI/kg of TBW). Abdominal 64-row CT was performed using 120 kVp, 100–200 mAs, rotation time 0.5 s, pitch 1, Iopamidol (370 mgI/mL), and flow rate 3 mL/s. Levene, Mann–Whitney U, and χ2 tests were used. The primary endpoint was liver contrast enhancement (LCE). Results Of 335 enrolled patients, 17 were screening failures; 44 dropped out after randomisation; 274 patients were analysed (133 LBW group, 141 TBW group). The median age of LBW group (66 years) was slightly lower than that of TBW group (70 years). Although the median ICM-injected volume was comparable between groups, its variability was larger in the former (interquartile range 27 mL versus 21 mL, p = 0.01). The same was for unenhanced liver density (IQR 10 versus 7 HU) (p = 0.02). Median LCE was 40 (35–46) HU in the LBW group and 40 (35–44) HU in the TBW group, without significant difference for median (p = 0.41) and variability (p = 0.23). Suboptimal LCE (< 40 HU) was found in 64/133 (48%) patients in the LBW group and 69/141 (49%) in the TBW group, but no examination needed repeating. Conclusions The calculation of the ICM volume to be administered for abdominal CT based on the LBW does not imply a more consistent LCE.

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Associations between exposure to perfluoroalkyl substances and body fat evaluated by DXA and MRI in 109 adolescent boys

Environmental Health ◽

10.1186/s12940-021-00758-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Mathilde Lolk Thomsen ◽

Louise Scheutz Henriksen ◽

Jeanette Tinggaard ◽

Flemming Nielsen ◽

Tina Kold Jensen ◽

...

Keyword(s):

Body Fat ◽

Study Design ◽

Sulfonic Acid ◽

Standard Deviation Score ◽

Cross Sectional Study ◽

Mass Spectrometry Data ◽

Perfluoroalkyl Substances ◽

Sectional Study ◽

Cross Sectional ◽

Total Body

Abstract Background Exposure to perfluoroalkyl substances (PFASs) has been associated with changes in body mass index and adiposity, but evidence is inconsistent as study design, population age, follow-up periods and exposure levels vary between studies. We investigated associations between PFAS exposure and body fat in a cross-sectional study of healthy boys. Methods In 109 boys (10–14 years old), magnetic resonance imaging and dual-energy X-ray absorptiometry were performed to evaluate abdominal, visceral fat, total body, android, gynoid, android/gynoid ratio, and total fat percentage standard deviation score. Serum was analysed for perfluorooctanoic acid, perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid, perfluorononanoic acid, and perfluorodecanoic acid using liquid chromatography and triple quadrupole mass spectrometry. Data were analysed by multivariate linear regression. Results Serum concentrations of PFASs were low. Generally, no clear associations between PFAS exposure and body fat measures were found; however, PFOS was negatively associated with abdominal fat (β = -0.18, P = 0.046), android fat (β = -0.34, P = 0.022), android/gynoid ratio (β = -0.21, P = 0.004), as well as total body fat (β = -0.21, P = 0.079) when adjusting for Tanner stage. Conclusions Overall, we found no consistent associations between PFAS exposure and body fat. This could be due to our cross-sectional study design. Furthermore, we assessed PFAS exposure in adolescence and not in utero, which is considered a more vulnerable time window of exposure.

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Examining Bone, Muscle and Fat in Middle-Aged Long-Term Endurance Runners: A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm9020522 ◽

2020 ◽

Vol 9 (2) ◽

pp. 522

Author(s):

Ulrike H. Mitchell ◽

Bruce Bailey ◽

Patrick J. Owen

Keyword(s):

Exercise Training ◽

Aerobic Exercise ◽

Fat Mass ◽

Lean Mass ◽

Aerobic Exercise Training ◽

Middle Aged ◽

Cross Sectional ◽

Endurance Runners ◽

Total Body

Aerobic exercise training has many known cardiovascular benefits that may promote healthy aging. It is not known if long-term aerobic exercise training is also associated with structural benefits (e.g., lower fat mass, higher areal bone mineral density (BMD) and greater muscle mass). We evaluated these parameters in middle-aged long-term endurance runners compared to sex-, age-, height-, and weight-matched non-running controls. Total and regional lean and fat mass and areal BMD were assessed by dual-energy X-ray absorptiometry. Sagittal magnetic resonance images captured the cross-sectional area and thickness of the lumbar multifidus. Runners (n = 10; all male) had a mean (standard deviation; SD) age of 49 (4) years, height of 178.9 (4.9) cm, weight of 67.8 (5.8) kg, body mass index (BMI) of 21.4 (1.4) kg/m2 and had been running 82.6 (27.9) km/week for 23 (13) years. Controls (n = 9) had a mean (SD) age of 51 (5) years, height of 176.0 (5.1) cm, weight of 72.8 (7.1) kg, and BMI of 23.7 (2.1) kg/m2. BMI was greater in controls (p = 0.010). When compared to controls on average, runners had a 10 percentage-point greater total body lean mass than controls (p = 0.001) and 14% greater trunk lean mass (p = 0.010), as well as less total body (8.6 kg; p < 0.001), arm (58%; p = 0.002), leg (52%; p < 0.001), trunk (73%; p < 0.001), android (91%; p < 0.001), and gynoid fat mass (64%; p < 0.001). No differences were observed between groups for BMD outcomes or multifidus size. These results underscore the benefits of endurance running to body composition that carry over to middle-age.

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The Positive Relationship between Moderate-to-Vigorous Physical Activity and Bone Mineral Content Is Not Mediated by Free Leptin Index in Prepubertal Children: The PANIC Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105365 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5365

Author(s):

Annie M. Constable ◽

Josie E. Porter ◽

Danielle Benger ◽

Dimitris Vlachopoulos ◽

Alan R. Barker ◽

...

Keyword(s):

Physical Activity ◽

Bone Mineral Content ◽

Bone Mineral ◽

Mineral Content ◽

Vigorous Physical Activity ◽

Normal Weight ◽

Cross Sectional ◽

Prepubertal Children ◽

Total Body ◽

The Relationship

Purpose: Moderate-to-vigorous physical activity (MVPA) positively influences bone mineral content (BMC) in prepubertal children, but it is unknown whether this relationship is partially mediated by free leptin index. The aim of this study was to examine whether the relationship between MVPA and total body less head (TBLH) BMC is mediated or moderated by free leptin index in prepubertal children. Methods: We performed a cross-sectional analysis on 401 children (194 girls) from baseline examinations of the Physical Activity and Nutrition in Childhood Study. We applied the four-way decomposition mediation analysis method to assess whether free leptin index, measured from fasted blood samples, mediated the relationship between accelerometer-measured MVPA and TBLH BMC measured by dual-energy X-ray absorptiometry. Results: MVPA had a positive controlled direct effect on TBLH BMC in girls and boys (β = 0.010 to 0.011, p < 0.05). There was no mediation or interaction between MVPA, free leptin index and TBLH BMC in girls or boys (β = −0.000 to 0.001, p > 0.05). Conclusion: Our study indicates that MVPA positively influences TBLH BMC through pathways not related to free leptin index in predominantly normal-weight prepubertal children, likely primarily through mechanical loading. The relationships between MVPA, free leptin index and TBLH BMC may be influenced by other factors such as pubertal status and adiposity, so it is unknown whether these observations extend to overweight and obese children at different stages of puberty.

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Studies on reproductive biology and ecology of blue swimming crab Portunus pelagicus from Chilika Lagoon, Orissa, India

Journal of the Marine Biological Association of the United Kingdom ◽

10.1017/s0025315410000354 ◽

2010 ◽

Vol 91 (1) ◽

pp. 257-264 ◽

Cited By ~ 6

Author(s):

D. Sahoo ◽

S. Panda ◽

B.C. Guru

Keyword(s):

Gonadosomatic Index ◽

Carapace Width ◽

Food Habit ◽

Total Body Weight ◽

Fish Bone ◽

Chilika Lagoon ◽

Portunus Pelagicus ◽

Commercially Important ◽

Total Body ◽

The Relationship

Portunus pelagicus a commercially important crab species found in Chilika lagoon constitutes about 20% of the total crab production. The carapace width (CW) ranges from 4.5–10.5 cm in both the sexes during the study period. The maximum abundance of male was at 6.6 to 7.5 cm CW whereas the females predominate from 6.6 to 9.5 cm CW. The relationship between carapace length (CL) and CW is linear in both sexes which indicates isometric growth. However, the relationship between CL, CW with total body weight (TW) is exponential. The food habit from gut content analysis shows that the species is highly carnivorous and the main food items include prawn carapace and appendages (27.58%), molluscan remaining (21.55%), fish bone (7.75%), seagrass (1.72%), unidentified materials (4.31%) and the mixed food (37.06%). The feeding index was found highest (80.95%) in February whereas it is lowest (60.9%) in June. The mature females are observed from May to July with a peak in July in the lagoon. The highest gonadosomatic index is found in July with an average CW of 10.5 cm. No berried females are found in the study period, which indicates that it did not spawn inside the lagoon and migrates to the sea during the rainy season.

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