HopeHealth

Abstract Objectives: To estimate the prevalence of silent vertebral compression fractures (VCF) in an asymptomatic population and to assess the demographic and clinical predictors using data from the UK Biobank. Design: A cross-sectional study using artificial intelligence-assisted six-point morphometry of dual-energy x-ray absorptiometry spine images. Setting: UK Biobank imaging study at Stockport clinical research facility. Participants: 2,446 asymptomatic volunteers aged 40 to 79 years with no history of spinal trauma or vertebral fracture. Main outcome measures: VCFs were defined as greater than or equal to 20 percent height loss, measured by artificial intelligence, with manual correction of annotations and confirmation by a musculoskeletal radiologist. Association with age, sex, bone mineral density, body mass index, and back pain were analyzed. Results: Of 2,446 participants, 763 (31.1 percent) had at least one vertebra with greater than 20 percent height loss. Fracture prevalence increased with age: 26.8 percent (37 of 138) in those aged 40-49 years, 26.1 percent (196 of 752) at 50-59 years, 33.0 percent (380 of 1,153) at 60-69 years, and 37.2 percent (150 of 403) at 70-79 years. Excluding mild deformities, 18 percent of those aged 40-49 years had moderate or severe fractures (greater than 25 percent height loss). Fractures were 11.5 percent more common in men than in women. Age was a significant predictor, but bone mineral density (BMD) and body mass index (BMI) were not. Predictive models showed limited performance (sensitivity 44.4 percent, specificity 68.2 percent). Interobserver agreement was substantial (Fleiss kappa = 0.74). Conclusions: Silent VCFs are frequent by midlife, including among younger adults with normal bone density. Men are affected more often than women, and conventional risk factors inadequately identify those at risk. Earlier detection through opportunistic or population imaging may enable timely intervention and inform future screening and fracture-prevention strategies.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an uncommon genetic disorder that affects small blood vessels in the brain. It leads to neurological symptoms, disability-adjusted life years, and difficult emotional and physical situations for patients and their families. As unusual brain symptoms appear, it becomes important to understand the different clinical manifestations of CADASIL. Our case report and review examine several cases to demonstrate different presentations and management strategies ofCADASIL. A 52-year-old male with a family history of strokes at a young age from his father and paternal grandfather presented to a neurology clinic for left facial droop and drooling. Brain magnetic resonance imaging showed extensive periventricular and subcortical white matter disease, including the external capsule and subcortical white matter of the temporal lobe. Findings were suggestive of small vessel vasculopathy. A cerebral angiogram showed that all large extra- and intracranial vessels were patent without evidence of aneurysm formation. There was no obvious evidence of beading of the distal intracranial vessels. Cerebrospinal fluid studies were normal. The NOTCH3 mutation was sent to test for CADASIL, which came back positive. The patient was started on aspirin (81 mg) and atorvastatin (20 mg) daily. The patient was counseled on the possibility of having an ischemic or hemorrhagic stroke. Aspirin and atorvastatin were continued, a neuropsychological evaluation was ordered, and CADASIL genetic counseling and testing were offered to him and his children. Over several years, patients developed several strokes and seizures due to infarcts. He also developed intraparenchymal hemorrhage complicated by dysphagia, requiring a feeding tube. Due to his severe physical debility, he was discharged to a nursing home for rehabilitation, where he did not improve with therapy and remained bedbound.He was discharged and sent home with his family. CADASIL can present as a diagnostic challenge due to its common presentation with migraines, transient ischemic attacks, and strokes, with or without risk factors. This unique presentation of CADASIL with facial palsy highlights the importance of emerging atypical presentations and the need for a detailed history of neuroimaging, family history, and personal history of neurovascular events. By accurately diagnosing the condition, patients and families can be counseled on the disease course and genetics. Management requires a multidisciplinary approach with neurology, genetic counseling, physical therapy, psychology, and psychiatry if depression or anxiety is present, with the aim of improving the patient's quality of life.

The performance of an implant-supported prosthesis depends on the implant type, number, implant location, and prosthesis design which is directly associated with the distribution of the occlusal forces during mastication. Thepurpose of the present study is to analyze with three-dimensional (3D) finite element comparative analysis, the influence of implant location, number, and prosthesis design in the mandibular posterior region where multiple posterior teeth replacement is indicated, which in turn is associated with the longevity or Implant success rate. Mandibular posterior section, where 4 teeth are missing, based on the space available for implants and following the surgical guide instructions, a standard make four implants (1st and 2nd premolars {3.8 mm × 11.5 mm}, 1st and 2nd molar {5.1 mm × 11.5 mm}) were selected and with standardization for placement, 4 groups were created with different implant location, number and prosthesis design from the selected implants as model FM1, FM2, FM3, FM4. Finite element analysis was carried out usingANSYS software, version 14.5 (ANSYS Inc.,Canonsburg, PA, USA) for assessment of stress, strain, and deformation around implant and bone. Maximum von Mises stress on vertical loading was highest for FM4 (139.55MPa) model (center of prosthesis on premolar and molar pontics) and lowest for FM3 (53.65MPa) model (on 2ndpremolar pontic) with values in decreasing order as FM4 ˃ FM2 ˃ FM1 ˃ FM3. Maximum von Mises stress on oblique loading was highest at the distal of 1stmolar implant pontic for FM2 (539.81MPa) and lowest at the 2ndpremolar pontic for FM3 (352.48MPa) model with values as FM2˃FM1˃FM4˃FM3. Deformation for vertical and oblique loading was observed minimum at the buccal cusp and buccal crestal bone of 2ndpremolar, 1stmolaron FM3 model against highest deformation on buccal and lingual crestal bone, cuspal area of 2ndpremolar, 1stmolar implants. For oblique loading minimum deformation was seenfor the 2ndpremolar, 1stmolar cuspal area in FM3,and maximum at the 2ndpremolar region in FM1. Four single implants may be chosen if there is enough mesiodistal and buccolingual space to allow for a minimum inter-implant and inter-implant-tooth distance that can be maintained while putting the least amount of stress on the implants and bone. To reduce stress on the bone and implants, it is best to avoid long-span implant-supported prostheses when using fixed implant-supported prostheses.

Objective:Community of Hope Health Clinic (CHHC), a free and charitable clinic inShelby County, Alabama, developed a screening protocol to identify patientswith asymptomatic COVID-19 with the goal of minimizing infection risk forother patients, health care providers, and staff. We sought to determinewhether the use of the CHHC screening protocol identified asymptomaticcarriers of SARS-CoV-2 before their scheduled clinic visits.Methods:The CHHC screening protocol included the use of an adapted Centers forDisease Control and Prevention questionnaire via telephone 48-72 hoursbefore a scheduled clinic appointment, coupled with a second administrationof the questionnaire and a temperature check immediately before thepatient’s scheduled visit. Patients with positive responses to any questionsor whose temperatures were greater than 100.4 °F were refused entry to theclinic, their appointments were rescheduled, and a SARS-CoV-2 test wasrecommended. SARS-CoV-2 laboratory testing was conducted on all patientswith an appointment from October 26, 2020, through February 18, 2021, toverify whether the screening protocol was effective.Results:Of 298 patient encounters, 20 patients screened positive on the SARS-CoV-2patient screen. Another 278 patients screened negative, were seen forpatient care, and received a SARS-CoV-2 test via nasal swab; 274 (98.6%)patients received a negative test result, and 4 (1.4%) patients received apositive test result.Conclusions:The CHHC SARS-CoV-2 screening protocol, as validated by SARS-CoV-2 assay, waseffective in screening out asymptomatic patients infected with SARS-CoV-2before they were seen in clinic. As clinics and office practices return toprepandemic volumes, the use of such a screening protocol can help mitigatethe risk of serious COVID-19 infection, especially for unvaccinatedpatients, health care providers, and staff.

SummaryThis study reviews publications to describe the signs, symptoms and impact of tumour-induced osteomalacia (TIO) on patients’ burden of disease. TIO is associated with a spectrum of signs and symptoms imposing a significant clinical burden, but the psychosocial impact of this rare disease has been poorly researched so far.IntroductionTo describe the signs, symptoms and impacts of tumour-induced osteomalacia (TIO) and summarise the state of research on the burden of disease of this ultra-rare condition.MethodsA targeted literature review was conducted in PubMed using pre-defined search terms. Relevant articles published between 1980 and 2021 were screened for inclusion. Seventy records were selected for analysis. Data were extracted and grouped into categories and sub-categories to identify recurrent signs, symptoms and impacts of TIO and describe the burden on patients. Chord diagrams were created to analyse the relationships between different TIO outcomes and characterise the presentation of TIO.ResultsAlthough the number of articles on TIO published have been increasing over the past 20 years, most studies were case reports and case series (n = 65/70) and only few were studies with higher quality of evidence (n = 5/70). Most articles were based on data reported by clinicians (n = 67/70). Patients with TIO experienced a combination of outcomes including chronic pain, weakness, skeletal-related manifestations and limitations in mobility. Only a few studies (n = 2/70) analysed the burden of TIO on the emotional wellbeing and on the work life of the patient.ConclusionPatients with TIO present with a spectrum of signs and symptoms that impose a significant burden. The impact on the psychosocial wellbeing of patients should be further investigated, as this has been poorly researched so far. Studies with high quality of evidence should be designed to further the understanding of the burden of disease of TIO from the patient’s perspective.

Abstract Background: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017–2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness.Methods: The study enrolled patients hospitalized in a GIHSN hospital in the previous 48 h with acute respiratory symptoms and who had symptoms consistent with influenza within the 7 days before admission. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. “Complicated hospitalization” was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of four age strata (<15, 15–<50, 50–<65, and ≥65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model.Results: The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4,306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15–<50 years and ≥65 years), diabetes (15–<50 years), male sex (50–<65 years), hospitalization during the last 12 months (50–<65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (50–<65 years), other chronic conditions (15–<50 years), influenza A (50–<65 years), and hospitalization during the last 12 months (<15 years) were associated with a longer hospital stay. The proportion of patients with complicated influenza did not differ between influenza A and B.Conclusions: Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included chronic obstructive pulmonary disease, diabetes, and hospitalization during the last 12 months.

Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 2.90. Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included "Local evidence and strategies in addressing NCDs Non-Communicable Diseases in Tanzania", "Universal Health Coverage through Integrated Care", and "The Minderoo-Monaco Commission on Plastics and Human Health". Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.