Intracranial atherosclerosis: Review of imaging features and advances in diagnostics

Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.

Reply: “Possible Takotsubo Syndrome”: A Refreshing Start Towards the path to Detect the True Prevalence of Takotsuobo Syndrome

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“Possible Takotsubo Syndrome”: A Refreshing Start Towards the Path to Detect the True Prevalence of Takotsubo Syndrome

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Hiatal Hernia After Esophagectomy: A Single-Center Retrospective Analysis of a Rare Postoperative Phenomenon

Development of a post-esophagectomy hiatal hernia (PEHH) is a rare, but problematic, sequela with the current reported prevalence ranging up to 20%. To determine the incidence rate of PEHH at our institution, a retrospective review of all transhiatal esophagectomies performed from 2012 to 2020 was conducted. Demographic, operative, and oncologic data were collected, rates of PEHH were calculated, and characteristics of subsequent repair were reviewed and analyzed. A total of 160 transhiatal esophagectomies were included, of which four patients (2.5%) developed a PEHH at a mean of 12 months postoperatively (range: 3-28 months) with symptomatology driving the diagnosis for three patients. The limited size of our study does not allow for statistically significant determinations regarding risk factors or method of repair. The true prevalence of a hiatal defect is likely higher than reported, as clinically asymptomatic patients are not captured in our current literature.

tPRiors: A tool for prior elicitation and obtaining posterior distributions of true disease prevalence

Background: Tests have false positive or false negative results, which, if not properly accounted for, may provide misleading apparent prevalence estimates based on the observed rate of positive tests and not the true disease prevalence estimates. Methods to estimate the true prevalence of disease, adjusting for the sensitivity and the specificity of the diagnostic tests are available and can be applied, though, such procedures can be cumbersome to researchers with or without a solid statistical background.Objective: To create a web-based application that integrates statistical methods for Bayesian inference of true disease prevalence based on prior elicitation for the accuracy of the diagnostic tests. This tool allows practitioners to simultaneously analyse and visualize results while using interactive sliders and output prior/posterior plots.Methods: Three methods for prevalence prior elicitation and four core families of Bayesian methods have been combined and incorporated in this web tool. |tPRiors| user interface has been developed with R and Shiny and may be freely accessed on-line.Results: |tPRiors| allows researchers to use preloaded data or upload their own datasets and perform analysis on either single or multiple population groups clusters), allowing, if needed, for excess zero prevalence. The final report is exported in raw parts either as .rdata or .png files. We utilize a real multiple-population and a toy single-population dataset to demonstrate the robustness and capabilities of |tPRiors|.Conclusions: We expect |tPRiors| to be helpful for researchers interested in true disease prevalence estimation and they are keen on accounting for prior information. |tPRiors| acts both as a statistical tool and a simplified step-by-step statistical framework that facilitates the use of complex Bayesian methods. The application of |tPRiors| is expected to aid standardization of practices in the field of Bayesian modelling on subject and multiple group-based true prevalence estimation.

Hepatitis D: challenges in the estimation of true prevalence and laboratory diagnosis

Hepatitis delta virus (HDV) is a defective single negative chain RNA virus, as its envelope protein synthesis is dependent on hepatitis B virus (HBV). Studies have consistently shown that coinfection of HBV and HDV is the most serious form of viral hepatitis, with accelerated progression to liver cirrhosis and hepatocellular carcinoma. About 74 million of HBV surface antigen (HBsAg) positive patients worldwide are also co-infected with HDV. Besides, patients with intravenous drug use and high-risk sexual behavior are at higher risk of HDV infection. Therapeutic schedules for HDV are limited, and relapse of HDV has been observed after treatment with pegylated interferon alpha. To reduce the transmission of HDV, all people infected with HBV should be screened for HDV. At present, several serological and molecular detection methods are widely used in the diagnosis of HDV. However, due to the lack of international standards diagnostic results from different laboratories are often not comparable. Therefore, the true prevalence of HDV is still unclear. In this manuscript, we have analyzed various factors influencing the estimation of HDV prevalence. We have also discussed about the advantages and disadvantages of currently available HDV laboratory diagnostic methods, in order to provide some ideas for improving the detection of HDV.

A highly endemic area of Echinococcus multilocula is identified through a comparative re-assessment of prevalence in red fox (Vulpes vulpes), Alto Adige (Italy: 2019-2020)

Background: Surveillance of E. multilocularis at the edge of its range is hindered by fragmented distributional patterns and low prevalence and burden in definitive hosts. Thus, tests with adequate levels of sensitivity are especially important for discriminating between infected and non-infected areas. Aim: We reassessed the prevalence of E. multilocularis at the southern border of its distribution in Alto Adige (Italy), to improve surveillance in wildlife and provide more accurate estimates of exposure risk. Methods: We compared results from the diagnostic test currently implemented for surveillance (based on Coproscopy+Multiplex PCR - CMPCR), against a real-time quantitative PCR (qPCR) for 235 fox faeces collected in 2019-2020. The performances of the two tests were estimated using a scraping technique (SFCT) as the gold standard applied to the small intestines of a subsample (n=123) of the same hosts. True prevalence was calculated and sample size required by each faecal test for the detection of the parasite was then estimated. Results: True prevalence of E. multilocularis in foxes (14.3%) was definitely higher than reported in the last decade (never >5% from 2012 to 2018). The qPCR also had a higher sensitivity (83%) compared to CMPCR (21%). Agreement with the gold standard was far higher for qPCR (0.816) than CMPCR (0.298) as well, determining a smaller sample size required to detect the disease. Conclusions: Alto Adige should be considered a highly endemic area. Surveillance at the edges of E. multilocularis distribution should adopt qPCR diagnostics on definitive hosts on a small geographic scale.

The SARS-CoV-2 infection among students in the University of Porto: a cross-sectional study

Introduction: Incidence based on notified cases of SARS-CoV-2 infection underestimates the real extension of the infection. We aimed to quantify SARS-CoV-2 specific antibodies seroprevalence among University students in Porto. Methods: A rapid point of care testing for SARS-CoV-2 specific immunoglobulin (Ig) M and IgG antibodies was performed, and a questionnaire was applied to the 6512 voluntary students from September to December 2020. We computed the apparent IgM, IgG and IgM or IgG prevalence, and the true prevalence and 95% credible intervals (95% CI) using Bayesian inference. Results: We found an apparent prevalence (IgM or IgG) of 9.7%, the true prevalence being 7.9% (95% CI 4.9-11.1). Prevalence was significantly higher among males (10.9% vs 9.2%), international students (18.1% vs 10.4% local vs 8.8% nationally displaced) and increased with age. Those with a known risk contact, that experienced quarantine, had symptoms, or a previous negative molecular test had a higher seroprevalence. Of the 91 (1.4%) students who reported a molecular diagnosis, 86.7% were reactive for IgM or IgG. Conclusion: Based on immunological evidence infection was 5.6 times more frequent than if based on a molecular diagnosis. The higher seroprevalence among male, older, and international students emphasizes the importance of identifying particular groups.

“A PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF FOOT REFLEXOLOGY ON DIABETIC PERIPHERAL NEUROPATHIC PAIN AMONG PATIENTS WITH DIABETES FROM SELECTED URBAN COMMUNITY.”

According to the Diabetes Atlas 2006 published by the International Diabetes Federation,the number of people with diabetes is 40.9% in India is around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. It is estimated that over half of people currently living with diabetes in the country are unionized, so there is a real urgency to increase awareness and knowledge of diabetes and its associated complications. Foot ulceration is the most frequently recognized complication,estimated to affect up to 26 million people with diabetes globally.India is home to the second largest number of diabetes cases (73 million in 2017) in the world. Diabetic peripheral neuropathy (DPN) affects 20% to 30% of patients with diabetes and is a significant cause of morbidity and mortality. Although the true prevalence of DPN is difficult to determine, it may be responsible for up to 75% of non-traumatic amputations.Therefore investigator has decided to undertake a study to assess the effectiveness of foot reflexology on diabetic peripheral neuropathic pain among patients with diabetes from selected urban community and objective of the study was to compare the level of diabetic peripheral neuropathic pain before and after the intervention of foot reflexology among patients with diabetes

Drug-induced hypophosphatemia

Hypophosphatemia (GF) is defined as a decrease in the level of inorganic phosphorus in the blood serum below 2.5 mg/dl (0.81 mmol/L). One of the reasons for the development of GF can be the use of a number of medications: diuretics, some antibacterial drugs, insulin, antacids, glucose solutions for parenteral administration, antitumor drugs. The true prevalence of drug-induced (DI) HB is unknown, because the phosphate level is not evaluated routinely, but only when GF is suspected. The most common mechanism for the development of DI GF is an increase in the excretion of phosphates by the kidneys. In most cases, DI GF is asymptomatic and regresses after discontinuation of the inducer drug. To compensate for the phosphate deficiency, non-drug methods (diet) and pharmacotherapy are used. Prevention of DI GF involves avoiding the use of drugs, the reception of which is associated with the development of DI GF, especially in patients at risk of developing GF.