An agent-based model driven by tropical rainfall to understand the spatio-temporal heterogeneity of a chikungunya outbreak

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An agent-based model is used to describe the spatio-temporal spread of chikungunya.

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A chikungunya epidemic with symptomatic and asymptomatic classes is described.

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Restricting the movement of symptomatic individuals cannot halt disease spread.

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Probability of symptomatic people moving has minimal impact on disease incidence.

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Identification of asymptomatic people would help control a chikungunya epidemic.

Vector-borne diseases, such as dengue, malaria and chikungunya, are increasing across their traditional ranges and continuing to infiltrate new, previously unaffected, regions. The spatio-temporal evolution of these diseases is determined by the interaction of the host and vector, which is strongly dependent on social structures and mobility patterns. We develop an agent-based model (ABM), in which each individual is explicitly represented and vector populations are linked to precipitation estimates in a tropical setting. The model is implemented on both scale-free and regular networks. The spatio-temporal transmission of chikungunya is analysed and the presence of asymptomatic silent spreaders within the population is investigated in the context of implementing travel restrictions during an outbreak. Preventing the movement of symptomatic individuals is found to be an insufficient mechanism to halt the spread of the disease, which can be readily carried to neighbouring nodes via sub-clinical individuals. Furthermore, the impact of topology structure vs. precipitation levels is assessed and precipitation is found to be the dominant factor driving spatio-temporal transmission.

A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients

Bipolar disorder (BD) is characterized by cognitive deficits that impair patients' functioning and quality of life. Most of the earlier studies assessing changes in BD patients' cognitive functioning over time utilized a cross-sectional research design. The few longitudinal studies that were conducted tended to have methodological limitations such as very short follow-up periods, recruitment of acutely ill patients, and lack of assessment of practice effects. The current study aimed to assess changes over time in the cognitive functioning of typical BD outpatients. For this purpose, asymptomatic and mildly symptomatic BD outpatients were assessed at baseline and after two years (n=31). At baseline, the cognitive functioning of the BD patients was compared to that of gender- and age-matched healthy controls. Practice effects were estimated by re-assessing the controls one week after their first assessment. Compared to the controls, BD patients had deficits in psychomotor speed, sustained attention, and one domain of executive functioning (cognitive planning). No evidence was found of a decline in their cognitive functioning over the two year time interval. These findings support a developmental model of cognitive impairment in BD. Studies using longer follow-up periods and larger sample sizes, however, are needed before these conclusions can be stated confidently.

Detection of Asymptomatic Carriers of Plasmodium vivax among Treated Patients by Nested PCR Method in Minab, Rudan and Bashagard, Iran

BACKGROUND

Plasmodium vivax is the most widespread species of Plasmodium in humans and causing about 80 million clinical cases annually. This study was undertaken to detect P. vivax in asymptomatic treated vivax malaria patients to trace latent/sub-patent malaria infection.

METHOD

The venous blood of all detected cases with P. vivax in Bashagard, Minab and Roodan Districts in Hormozgan Province from 2009 to 2010 was examined by microscopic and nested PCR methods for presence of the parasite.

RESULTS

In microscopic examination of peripheral blood smears, all samples were negative for the presence of the parasites. But, we detected two P. vivax related bands in the electrophoresis of the nested PCR products (120 bp).

CONCLUSION

Following up the malaria cases after treatment by a combination of methods, or new diagnostics such as RDTs can be included in the priorities of malaria elimination program in Iran.

Exploration of the effects of gender and mild esophagitis on esophageal pain thresholds in the normal and sensitized state of asymptomatic young volunteers

BACKGROUND

Clinical data suggest gender differences in gastrointestinal pain, but very little experimental data exist. Esophageal painful thresholds to mechanical, thermal, electric, and chemical stimuli can be measured with the esophageal multimodal pain model. The aim was to measure the effect of gender and mild esophagitis on esophageal pain perception.

METHODS

Thirty-five healthy asymptomatic volunteers [19 men, median age 29 (22-56 years)] underwent upper GI endoscopy, 24 h pH/impedance measurement, and multimodal esophageal pain stimulation before and after sensitization with acid. Stimulus intensities at painful thresholds were recorded.

KEY RESULTS

Men had higher pain thresholds (PT) to mechanical stimulation (mean volume: men 20.9 ± 10 mL vs women 15.2 ± 6.8 mL, P = 0.02) and more men tolerated the maximum acid challenge (58% vs 20%, P = 0.03). There were no differences between genders for PT to (1) thermal stimulation [mean stimulation time (men, women): heat; 20 ± 5 s vs 21 ± 6 s or cold; 33.3 ± 20.1 s vs 20.7 ± 21.4 s, P > 0.2], (2) electrical current (mean current: men 17.6 ± 9.2 mA vs women 12.9 ± 3.7 mA, P = 0.11), or (3) acid volume [median volume: men 200 (20;200) mL vs women 133 (40;200) mL, P = 0.2]. Fifteen asymptomatic subjects had mild esophagitis (10 men, all Los Angeles A). There were no differences in esophageal PT between subjects with normal endoscopy or mild esophagitis (all P > 0.3).

CONCLUSIONS & INFERENCES

The effects of gender and mild esophagitis on esophageal multimodal pain perception have been measured in asymptomatic volunteers. The study suggests that gender, not mild esophagitis, tends to influence mechanical and chemical esophageal pain.

CSF Aβ1-42 combined with neuroimaging biomarkers in the early detection, diagnosis and prediction of Alzheimer's disease

The development of validated, qualified, and standardized biomarkers for Alzheimer's disease (AD) that allow for an early presymptomatic diagnosis and discrimination (classification) from other types of dementia and neurodegenerative diseases is warranted to accelerate the successful development of novel disease-modifying therapies. Here, we focus on the value of the 42-residue-long amyloid β isoform (Aβ1-42) peptide in the cerebrospinal fluid as the core, feasible neurobiochemical marker for the amyloidogenic mechanisms in early-onset familial and late-onset sporadic AD. We discuss the role and use of Aβ1-42 in combination with evolving neuroimaging biomarkers in AD detection and diagnosis. Multimodal neuroimaging techniques, directly providing structural-functional-metabolic aspects of brain pathophysiology, are supportive to predict and monitor the progression of the disease. Advances in multimodal neuroimaging provide new insights into brain organization and enable the detection of specific proteins and/or protein aggregates associated with AD. The combination of biomarkers from different methodologies is believed to be of incrementally added risk-value to accurately identify asymptomatic and prodromal individuals who will likely progress to dementia and represent rational biomarker candidates for preventive and symptomatic pharmacological intervention trials.

Predictors of bone metastasis in pre-treatment staging of asymptomatic treatment-naïve patients with prostate cancer

BACKGROUND

There is no general consensus on the optimal criteria for the application of bone scintigraphy in screening of bone metastasis in patients with prostate cancer. Our study was conducted to assess the value of bone scan for pre-treatment staging of asymptomatic treatment-naïve patients with prostate cancer.

METHODS

A total of 203 consecutive asymptomatic and treatment-naïve patients with prostate cancer (age: 67.6±6.4 years) who were referred to our department for whole body bone scintigraphy were enrolled in the study. Three hours after intravenous injection of 20mCi (99m)Tc-MDP, all patients underwent whole body bone scanning using a single head gamma camera. The planar images were supplemented with SPECT as needed for questionable abnormalities or those having uncertain location on planar images.

RESULTS

The mean serum PSA levels, serum alkaline phosphatase (ALP) and Gleason score (GS) were 42.41±37.1ng/ml, 223.9±129.9IU/L and 6.7±1.1, respectively. A total of 55 cases (27.1%) out of 203 patients had bone metastases. The univariate analysis showed that serum PSA levels, GS and ALP were all significant predictors of bone metastases. However, only serum PSA and ALP levels were found to be independent predictors of bone metastasis in the multivariate logistic regression analysis. The combination of PSA and ALP (in which patients with either elevated PSA [>20ng/ml] or elevated ALP were considered as positive) had the best screening value, with 98.2% sensitivity and 48.6% specificity.

CONCLUSION

Serum ALP screening can be employed as a tool to detect the subgroup of patients who are at high risk of bone metastases, while having a PSA of <20ng/ml. The combination of PSA and ALP can be used to improve predictability of bone metastasis in newly diagnosed patients with prostate cancer, without affecting staging accuracy.

Asymptomatic bacteriuria in Nigerian children with sickle cell anemia

Urinary tract infections (UTI) in children with sickle cell anemia (SCA) may result in long term renal dysfunction. The prevalence, potential risk factors, and clinical significance of asymptomatic bacteriuria (ASB) were investigated in 196 Nigerian children with SCA in stable state. These children had clinical evaluation and assessment of their mid-stream urine (MSU) for pyuria, culture, and sensitivity tests; urinalysis for proteinuria, and estimated glomerular filtration rate (eGFR), hematocrit, serum creatinine and uric acid estimation. Children with confirmed ASB were compared with those without ASB. Those with confirmed ASB were monitored for 6 months for persistence of significant growth, development of symptomatic UTI, and evaluation of renal functions. The prevalence of probable and confirmed ASB in this cohort of SCA children were 12.2% and 6.6%, respectively. Confirmed ASB was more prevalent among older (P = 0.046) and female (P = 0.003) SCA children, particularly those with pyuria (odd Ratio, OR = 5.4, 95% confidence interval, CI = 2.7-11.0, P < 0.001) and proteinuria (OR = 1.4, 95% CI = 3.9-8.7, P = 0.006). Previous symptomatic UTI was not associated with ASB. Also, the mean eGFR, serum creatinine, and uric acid were not different in the group with ASB and those without ASB (P > 0.05). At the end of 6 month follow-up, two (15.4%) of the 13 children with ASB had persistence of significant growth, but none develop symptomatic UTI. Also, none of the two with persistent ASB had hypertension or deranged renal function. ASB is a significant problem in older age female SCA children, although renal functions were not different among those with and without ASB. A large scale randomized placebo-controlled trial of conventional treatment for ASB in SCA is advocated to define its long-term clinical significance.

Single-centre experience with mitral valve repair in asymptomatic patients with severe mitral valve regurgitation

OBJECTIVES

Guidelines recommend surgical mitral valve repair in selected patients with asymptomatic severe mitral valve regurgitation (MR), but the role of repair remains a matter of debate. Survival analyses of operated asymptomatic patients have been reported, but long-term haemodynamics and quality of life are not well defined. The aim of this study was to report the long-term follow-up focusing on these aspects.

METHODS

Our database identified patients who underwent primary isolated mitral valve repair for severe MR and were asymptomatic by New York Heart Association Class I and in sinus rhythm. To obtain sufficient length of follow-up, only patients operated on before 2006 returned for an echocardiogram and quality-of-life assessment (SF-36).

RESULTS

Between May 1991 and December 2005, 46 asymptomatic patients with severe MR and a normal left ventricular function (ejection fraction >60%) were operated on. Mean age was 50.2 ± 13.2 years and 89% of patients were male. There were no operative deaths. Mean follow-up was 8.4 ± 3.9 years with 386 patient-years, survival was 93.3% at 12 years and comparable with the general age-matched Dutch population. Follow-up echocardiography showed that 92% had no to mild MR, and 3 patients had moderate MR. Left ventricular function was good/impaired/moderate in 66/29/5% of patients. Quality-of-life SF-36 assessment showed that mean physical and mental health components were 83 ± 17 and 79 ± 17, which was comparable with that of the general age- and gender-matched Dutch population.

CONCLUSIONS

Our experience shows that mitral valve repair for severe MR in asymptomatic patients is safe, and has satisfactory long-term survival with a low recurrence rate of MR, good left ventricular function, and excellent quality of life that is comparable with the general Dutch population.

Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village

PURPOSE

Rotator cuff tear is the most common shoulder disease in patients with shoulder problems, but its prevalence is not well known.

METHODS

We performed a health care check-up of locomotive organs in 664 residents (21.3% of the population) in one village. Ultrasonography on bilateral shoulders was performed in all the participants.

RESULTS

One hundred and forty seven out of 664 subjects (22.1%) had full-thickness rotator cuff tears. The prevalence of tear in each decade was 0% in the 20s to 40s, 10.7% in the 50s, 15.2% in the 60s, 26.5% in the 70s, and 36.6% in the 80s. Symptomatic rotator cuff tears accounted for 34.7% of all tears and asymptomatic tears for 65.3%. The prevalence of asymptomatic rotator cuff tears was one-half of all tears in the 50s, whereas it accounted for two-thirds of those over the age of 60. The prevalence of tear was significantly greater in male than in female in the 50s and 60s, but not in the 70s and 80s.

CONCLUSION

The prevalence of rotator cuff tear in the general population was 22.1%, which increased with age. Asymptomatic tear was twice as common as symptomatic tear.

Evaluation of asymptomatic peripheral arterial disease by ankle- brachial index in patients with concomitant coronary arterial disease

BACKGROUND

Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD) improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary.

OBJECTIVES

The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease.

METHODS

Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3) with a documented coronary arterial disease.

RESULTS

Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9.

CONCLUSIONS

It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

Peritoneal dissemination of prostate cancer with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted radical prostatectomy

Peritoneal dissemination of prostate cancer (PCa) with the absence of other metastases is extremely rare. Atypical sites of metastatic disease, for example the peritoneum, are only a recognized finding at autopsy. Herein, we report a case of peritoneal dissemination of a PCa, with the absence of lymph node, skeletal, or visceral metastases in a patient scheduled to undergo robot-assisted laparoscopic prostatectomy.

Prevalence of cases of Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum and Chlamydia trachomatis in women with no gynecologic complaints

Purpose

To evaluate the prevalence of Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae in women with no gynecologic complaints screened in the Human Reproduction outpatient clinic of Faculdade de Medicina of ABC, Brazil.

Methods

A total of 106 women without gynecologic complaints and in reproductive age were evaluated. DNA was extracted from cells of the genitourinary tract with bacteria for the detection of six types of bacteria by polymerase chain reaction.

Results

We found that 11.3 % of women had infection with M. hominis and 2.83 % for C. trachomatis. The other bacteria investigated occurred in 2.83 % of women. The percentage of infections identified was 15 %.

Conclusion

The data showed a low percentage of women with genitourinary tract bacteria without symptoms. However, these infections can be sexually transmitted, and relate to infertility and other serious illnesses. The identification and treatment of infection in asymptomatic woman can avoid transmission and future genitourinary trait complications.

Perspectives on Quality of Life in Glaucoma

Chronic diseases are invariably associated with decreased functioning ability of the individual in one form or the other depending upon the system/organ involved. Disability consequent to the disease is the major factor affecting the patient's physical and psychosocial well-being; in other words, the 'Quality of Life (QOL)'. Besides the disease itself, the treatment and its consequences are also major determinants of QOL of the patients. Globally, glaucoma, which is emerging as one of the leading causes of blindness, is one such chronic ophthalmic disease characterized by a progressive loss of visual function and a potential to cause irreversible blindness, if not treated at an early stage. Patients of glaucoma need to take lifelong medications in order to keep their intraocular pressure within limits. It's impact on the daily life of patients cannot be overexpressed and compounded by the fact that it remains asymptomatic for a considerable time after the disease has set in; has led to new imperatives in diagnosis, treatment and epidemiological and outcome studies. Assessment of the debilitating effect of glaucoma and side effects of its treatment on the emotional and physical QOL of the patient is therefore an important criterion for arriving at the treatment regimen. An extensive literature search was done on Pubmed Central, Pubmed and Google Scholar using the keywords 'glaucoma', 'quality of life in glaucoma', 'management in POAG' and 'QOL assessment tools'. Various tools available for the assessment of QOL, and their advantages and limitations have been reviewed in this article.

Current Chlamydia trachomatis Infection, A Major Cause of Infertility

BACKGROUND

In India, the impact of current Chlamydia trachomatis (C. trachomatis) in reproductive health remains a neglected area of investigation. The present study evaluates if current Chlamydia infection is associated with any clinical complication that needs the attention of clinical investigators.

METHODS

In this cross-sectional study, we enrolled 896 women attending the Gynecology Out Patient for the detection of C. trachomatis infection. Polymerase chain reaction was used to diagnose current C. trachomatis infection and ELISA for past infections. Bacterial vaginosis, Candida and Trichomonas were screened. The results of symptomatic and asymptomatic groups were compared. The data was analyzed using Epi Info version 6 and "Z" test. A probability value of p≤0.05 was considered as significant..

RESULTS

Statistical analysis revealed significant association between current C. trachomatis infection with infertility when comparing infected fertile (18.6% vs. 9.4%, odds ratio: 2.19, p<0.0005) and uninfected infertile women (45.6% vs. 27.3%, odds ratio: 2.24, p<0.0001). Average infection rate was 12.1%, highest in women with infertility (18.6%) or with ectopic pregnancy (25%). Significant proportions of infected women with infertility (p<0.01) or with recent pregnancy (p<0.001) were asymptomatic. Follow up of infected women who became negative after treatment [28 women from infertility group and 9 women with recurrent spontaneous abortion (RSA)] revealed live birth in 8 (21.6%) women within one year, 4 with infertility and 4 with RSA.

CONCLUSION

Study findings suggest association between current C. trachomatis infection and infertility. Absence of signs and symptoms associated with this infection highlights its diagnosis in women with a history of infertility and RSA for their better management, as revealed by live births with one year of follow up.

Asymptomatic anisakiasis of the colon incidentally found by colonoscopy

Asymptomatic anisakiasis of the colon is a rare condition that is difficult to diagnose. A 42-year-old man with no symptoms was referred to our department because of elevated serum carcinoembryonic antigen (CEA) levels detected previously at another hospital. A colonoscopy was performed to find the reason for these elevated CEA levels, and Anisakis larvae were identified by chance in the ascending colon wall. This is only the fourth case of asymptomatic anisakiasis of the colon to be reported worldwide.

Significant bacteriuria among asymptomatic antenatal clinic attendees in ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria.

All consenting ANC attendees without UTI were enrolled in the study. Urine specimens of 5 to 10 ml collected from each subject were examined microscopically for white blood cells, red blood cells and bacteria. The specimens were further cultured on MacConkey agar using a sterile bacteriological loop that delivered 0.002 ml of urine. Colony counts yielding bacterial growth of more than 10⁵/ml of pure isolates were considered significant.

Of the 473 subjects studied, 136 had significant bacteriuria, giving a prevalence rate of 28.8%. The highest age specific prevalence (47.8%) was found in the 25–29 year olds while only one (0.7%) was found in the teenage group. A large percentage (64.0%) of subjects with significant bacteriuria had tertiary education, compared with 4.4% who had no formal education but the association was not statistically significant (X² = 0.47, p = 0.79). The majority (75.8%) of subjects with significant bacteriuria had no previous history of abortion, while 20 (14.7%) had one previous abortion and only three (2.1%) admitted to three previous abortions (X² = 5.16, p = 0.16). The majority (69.8%) of those with significant bacteriuria presented at second trimester while 38 (28.0%) presented at third trimester (X² = 6.5, p = 37).

Only 22 (4.6%) of the studied subjects presented at first trimester, and 3 (13.7%) of these had significant bacteriuria.

The prevalence of asymptomatic bacteriuria is high among this study population. Hence we suggest that advocacy programs be initiated to urge pregnant women to access ANC services early in pregnancy.

Hyperbilirubinemia in normal healthy donors

The present study was carried out in B.A.R.C. Hospital Blood Bank over a span of five years, and includes 2734 donors. All the bags were screened for HIV, HBsAg, HCV and VDRL and the plasma in the pilot tubes of the blood bags was observed to detect any abnormality in color. In 27 cases plasma was found to be icteric and liver function tests were carried out on these samples. Two donors showed higher SGPT level, and were excluded. No significant increases in liver enzymes were recorded in the others. Causes of icteric plasma in these apparently healthy donors are discussed. Differential diagnosis includes Gilbert’s disease, hemolytic anemia, drug-induced anemia and other hepatic causes of hyperbilirubinemia, of which Gilbert’s disease is most probable cause with a prevalence of 0.91% in our population. As there are no studies to document the safety of the recipients receiving such abnormal colored plasma as well as to document the hazards in its transfusion, the question arises whether to transfuse such units or not. This study highlights this dilemma. A reassessment of existing policies and regulations is merited.

An evaluation of the management of asymptomatic catheter-associated bacteriuria and candiduria at The Ottawa Hospital

BACKGROUND

Asymptomatic catheter-associated urinary tract infections (CAUTIs) are common in hospitalized patients. They are associated with a low incidence of sequelae and morbidity, and in most patients resolve spontaneously on removal of the catheter. As a result, it is not recommended that asymptomatic catheter-associated bacteriuria or candiduria be treated with antimicrobial agents while the catheter remains in place because it may lead to the evolution of resistant flora.

OBJECTIVE

To assess the current management of patients with CAUTIs with respect to antimicrobial therapy at The Ottawa Hospital and the University of Ottawa Heart Institute, Ottawa, Ontario.

METHODS

A prospective observational study over a period of 26 consecutive days was conducted at The Ottawa Hospital (General and Civic campuses) and the University of Ottawa Heart Institute. Inpatients with an indwelling catheter, a positive urine culture and the absence of UTI signs or symptoms were assessed. Patients were followed for five days to determine whether antimicrobials were prescribed.

RESULTS

From March 3 to March 28, 2003, 29 of 119 patients screened met inclusion criteria. Of these 29 patients, 15 (52%) were prescribed antimicrobials and were therefore considered to be inappropriately managed. Differences were observed between the appropriate and inappropriate management groups in terms of duration of stay to positive urine culture and whether yeast or bacteria were isolated from the culture.

CONCLUSION

Antimicrobial agents were prescribed in over one-half of CAUTI cases, contrary to recommendations from the literature. Education is required to bring this strongly supported recommendation into clinical practice.

Unusual presentation of adult Gaucher's disease: A long and difficult road to diagnosis

Gaucher's disease is the most frequent sphingolipid storage disease. We present a case of type 1 non-neuropathic type of adult Gaucher's disease patient with atypical presentation.

Intrathyroidal Parathyroid Carcinoma Presenting as Asymptomatic High Normal Serum Calcium and Slightly Elevated Intact Parathyroid Hormone: A Case Report and Review of Literature

Parathyroid carcinoma is an uncommon endocrine malignancy and the probability of an intrathyroidal location is low. We report a case of intrathyroidal parathyroid carcinoma presenting as asymptomatic high normal serum calcium and slightly elevated intact parathyroid hormone (iPTH) making preoperative suspicion and diagnosis extremely difficult.

Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

AIM: To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease (PUD) in a general Taiwanese population.

METHODS: From January to August 2008, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy. Gastroduodenal mucosal breaks were carefully assessed, and a complete medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to identify independent risk factors for asymptomatic PUD.

RESULTS: Of the 572 asymptomatic subjects, 54 (9.4%) were diagnosed as having PUD. The prevalence of gastric ulcer, duodenal ulcer and both gastric and duodenal ulcers were 4.7%, 3.9%, and 0.9%, respectively. Multivariate analysis revealed that prior history of PUD [odds ratio (OR), 2.0, 95% CI: 1.3-2.9], high body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m²: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) were independent predictors of asymptomatic PUD. In contrast, high education level was a negative predictor of PUD (years of education 10-12: OR, 0.5, 95% CI: 0.3-0.8; years of education > 12: OR, 0.6, 95% CI: 0.3-0.9).

CONCLUSION: The prevalence of PUD in asymptomatic subjects is 9.4% in Taiwan. Prior history of PUD, low education level, a high BMI and current smoker are independent risk factors for developing asymptomatic PUD.

Isolated true parachute mitral valve in an asymptomatic elderly patient

We report the extremely rare case of a 73-year-old asymptomatic patient who has an isolated true parachute mitral valve (PMV). In the echocardiographic examination, the parasternal long-axis view showed a single papillary muscle. The short-axis view revealed the presence of a symmetric mitral valve orifice with all chordae attaching to a large anterolateral papillary muscle. Because detailed examination did not reveal the presence of other complications, this patient was diagnosed as an isolated true PMV.

Asymptomatic Cervical or Thoracic Lesions in Elderly Patients who Have Undergone Decompressive Lumbar Surgery for Stenosis

Study Design

A retrospective study.

Purpose

To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis.

Overview of Literature

Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated.

Methods

A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually.

Results

Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions.

Conclusions

The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.