Association between Hypertriglyceridemia and Disease Severity in Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a tropical disease endemic to Brazil. The clinical manifestations of the infection range from asymptomatic to severe. In VL, changes in lipid metabolism, such as hypocholesterolemia and hypertriglyceridemia, occur that are believed to be related to its progression and severity. This study investigated the associations between serum levels of cholesterol, triglycerides, and lipoproteins (high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein) with clinical and hematological parameters that predict severity in a case series of 83 VL patients. Severely ill patients had higher mean serum triglyceride levels than non-severely ill patients. There was a significant positive correlation between disease severity score and serum triglyceride levels, very low-density lipoprotein, international normalized ratio for prothrombin time test, total bilirubin, and age. An inverse correlation was detected between the disease severity score and mean platelet and neutrophil counts. Hypertriglyceridemia can be a prognostic indicator of severity in patients diagnosed with VL.

MRI-Derived Radiomics of Hemophilic Arthropathy Is Associated with Severity of Joint Disease

Introduction Joint bleeding resulting in synovial hypertrophy and articular cartilage damage are the hallmarks of hemophilic arthropathy. Early prophylaxis with extended half-life factor products and non-factor replacement therapies reduce joint bleeds but do not provide complete protection from development of arthropathy. MRI is the gold standard imaging technique to diagnose and monitor arthropathy in hemophilia. MRI changes that are associated with joint bleeding and development of arthropathy, however, are not sensitive enough to detect early changes in the synovial membranes after sub-clinical bleeding. Radiomics, the computerized extraction of sub-visual attributes from imaging scans can detect early changes of hemophilic arthropathy and help in more accurate characterizations of severe joint disease. The goal of this project was to develop and compare MRI radiomics with the International Prophylaxis Study Group (IPSG) score, an established MRI joint disease scale, in assessing the severity of joint disease. Methods After IRB approval, knee MRI scans of 17 hemophilia patients with a history of joint bleeding and 12 age-matched healthy controls were included in this study. Manual annotations were performed in consensus by a board-certified musculoskeletal radiologist to include the prefemoral fat, suprapatellar fat pad and bursa . To ensure that the signal intensities from different cases were in tissue-specific correspondence, a landmark-based histogram transformation was used to align MRI signal intensity distributions across all cases. 560 radiomic features capturing MRI pixels texture heterogeneity (Gabor wavelets, Laws texture, Haralick and GoLIAGe co-occurrence patterns) were subsequently extracted on all MRI slices with ROI for all the cases. Top 2 radiomic features (F 2) for differentiating between abnormal joint changes and control were selected by Minimum Redundancy Maximum Relevance (mRMR) algorithm with 100 iterations of 3-fold cross-validation. Consensus hierarchical clustering was then applied on F 2, from which two patient clusters were generated. A disease severity score was calculated based on historical lifetime bleed events in the joint, designation of target joint status, and history of surgical synovectomy. A previously described 17-point MRI IPSG score was also calculated by 2 independent reviewers. Both the IPSG score and the F 2 were then fit into a linear regression model separately as predictors whereas the disease severity score was set to be the response variable. The Akaike's Information Criteria (AIC) and the root mean square error (RMSE) were used to evaluate the model fitness and the likelihood ratio (LR) test was applied for model comparison. Results The dataset consisted of 17 males with moderate and severe hemophilia ranging in age from 10-55 years. The median disease severity score was 2 (0-11) and the median IPSG MRI Score was 2 (0-11). The top 2 radiomic features F 2, a Gabor wavelet feature and a Lawshc texture feature, yielded an AUC of 0.94 and an accuracy of 0.9 for differentiating between hemophilic joint changes and healthy control patients. Unsupervised clustering demonstrated good separation between the two classes (Fig panel A and B). The radiomic-based linear regression model (AIC: 86.67; RMSE: 2.86) was significantly better than the IPSG score-based model (AIC: 94.24; RMSE: 3.66) in joint disease severity characterizations (LR, p = 0.0083, Fig panel C). Conclusions Radiomic analysis of knee MRI in hemophilia patients with history of joint bleeding is correlated with the severity of joint disease. Our study demonstrates the feasibility of developing and utilizing a radiomics based tool to detect the severity of joint damage in a small population of knee joint hemophilic arthropathy. We plan to perform an Independent validation of the radiomics signature in a larger dataset of hemophilia joint MRI scans Figure 1 Figure 1. Disclosures Madabhushi: Astrazeneca: Membership on an entity's Board of Directors or advisory committees; Bristol Meyers-Squibb: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy; Caris: Consultancy; Aiforia: Consultancy; Philips: Research Funding; AstraZeneca: Research Funding; Boehringer-Ingelheim: Research Funding; Bristol Meyers-Squibb: Research Funding. Ahuja: Sanofi: Membership on an entity's Board of Directors or advisory committees; XaTek, Inc: Patents & Royalties; Genentech: Membership on an entity's Board of Directors or advisory committees; Takeda: Other: DSMB member .

One year of Lung Ultrasound in children with SarsCoV2 infection admitted to a tertiary referral children’s hospital: a retrospective, single-center study, during 2020-2021 period.

Background: The aim of this study was to analyze the lung ultrasound (LUS) patterns in combination with clinical-laboratory profiles of children hospitalized for COVID-19 infection in relation to temporal trend of the Italian epidemic. Methods: This was a retrospective study conducted at a pediatric tertiary referral hospital from 15th March 2020 to 15th March 2021. We compared the characteristics of two periods of the pandemic outbreak, the first one in spring and summer (15th March-30th September 2020) and the second one in autumn and winter (1st October 2020-15th March 2021). Results: 28 patients (53.85%) were in the first period, 24 patients (46.15%) were in the second period. The disease severity score was significantly higher in the second period (p=0.02). We observed that the occurrence of the irregular pleural line was seen more frequently in the second period (87.5% vs 60.71%; p=0.03). The B-lines were significantly more frequent in children in the second period (87.5% vs 60%; p=0.03). The several but not-coalescent B-lines were significantly more frequent in the second period (80% vs 41.7%; p=0.05). The LUS score correlated significantly with the disease severity score with a strong relationship (r=0.51, p=0.002). The second phase of the COVID-19 epidemic outbreak had a higher disease severity score than the first phase with a moderate correlation (r= 0.42; p=0.01). Conclusion: The LUS plays an important role in the evaluation of pulmonary involvement in children affected by COVID-19 during different periods of the pandemic in combination with clinical-laboratory findings.

Validación del puntaje de valoración de la gravedad de la enfermedad pulmonar obstructiva crónica en población colombiana en un servicio de atención primaria

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un importante problema de salud mundial con una alta morbimortalidad. Se requiere la medición de la gravedad de la enfermedad mediante una herramienta de fácil aplicación, bajo costo y fácil disponibilidad en áreas rurales.Objetivo. Evaluar la validez y confiabilidad del puntaje de valoración de la gravedad de la EPOC (Chronic Obstructive Pulmonary Disease Severity Score, COPDSS) en una población de atención primaria en Colombia.Materiales y métodos. Se hizo un estudio de corte transversal en una muestra de 100 pacientes con diagnóstico de EPOC según las guías GOLD. La validez concurrente se evaluó correlacionando los resultados del COPDSS con otras variables de importancia como las del cuestionario sobre la enfermedad respiratoria crónica (Chronic Respiratory Disease Questionnaire, CRQ) y el volumen espiratorio forzado en el primer segundo (Forced Expiratory Volume in one second, FEV1).Resultados. El COPDSS presentó una correlación significativa con el FEV1 (r=-0,33), con el CRQ (r=-0,57) y sus dimensiones: disnea (r=0,51), fatiga (r=0,53), función emocional (r=0,43) y control de la enfermedad (r=0,50). En el análisis factorial se determinó un solo factor con una varianza acumulada de 59,1 %. El análisis de coherencia interna mostró un alfa de Cronbach de 0,76, valor este considerado adecuado.Conclusiones. Se observó que el uso del COPDSS como cuestionario de valoración de la gravedad de pacientes con EPOC en Colombia tenía validez y confiabilidad adecuadas y que es de fácil aplicación en la atención primaria.

Prevalence of Nonalcoholic Fatty Liver Disease in Familial Mediterranean Fever

Introduction: Nonalcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome (MetS), insulin resistance (IR) and chronic inflammation. Although familial Mediterranean fever (FMF) patients have no symptoms in the periods between attacks, their subclinical inflammation continues. The aim of the present study was to determine the NAFLD frequency in FMF patients and to evaluate their MetS, IR and lipid profiles. Methods: The study included 54 FMF patients and 54 control subjects. The clinical and demographic characteristics of the subjects were recorded, and the patients’ Pras disease severity score was calculated. IR was determined using the homeostasis model assessment (HOMA) index. MetS was diagnosed using the revised National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP ATP III). Hepatic ultrasonography was used to diagnose NAFLD. Results: NAFLD was observed in 15 FMF patients (27.8%) and 14 controls (25.9%). The difference between the groups was not significant (p=0.828). Similarly, no significant difference was found between the two groups for MetS frequency and HOMA index levels. Fasting plasma glucose was significantly higher in FMF patients, whereas differences between the two groups were not significant for lipid levels and other parameters. When FMF patients with and without NAFLD were compared, no significant difference was found in Pras disease severity score, duration of the disease and daily colchicine dose. Conclusion: The present study showed that NAFLD frequency was not increased in FMF patients, and that patients’ MetS frequency, IR and lipid profiles were not different from control subjects.