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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has posed a major challenge to the diagnosis and management of ischemic heart disease (IHD). Myocardial perfusion imaging (MPI) is a non-invasive technique that can assess myocardial ischemia and viability, as well as provide prognostic information for patients with IHD. However, the role of MPI in COVID-19 patients is not well established. Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify relevant studies published until Aprile 24th, 2024. The inclusion criteria were: (1) studies that performed MPI in COVID- 19 patients; (2) studies that reported the results of MPI in terms of ischemia, infarction, or perfusion defects; and (3) studies that compared MPI with other diagnostic modalities or clinical outcomes. The quality of the studies was assessed using the QUADAS-2 tool for diagnostic accuracy studies or the ROBIS tool for systematic reviews. A narrative synthesis was performed to summarize the main findings and recommendations. Results: A total of twenty-two studies met the inclusion criteria. The included study information was categorized into the following aspects: Change in the crude number of MPI scans performed, accidental and definite findings in MPI, and the prognostic outcome of COVID patients who underwent MPI. Conclusion: During Covid-19 pandemic, a reduction in the number of MPI studies was seen. Individuals with a history of COVID-19 infection have higher likelihood of developing ischemic heart disease (IHD). SARS-CoV-2 is an independent risk factor for the development of IHD. [ABSTRACT FROM AUTHOR]

Background: The early diagnosis and treatment of rheumatoid arthritis (RA) are essential to prevent joint damage and enhance patient outcomes. Diagnosing RA in its early stages is challenging due to the nonspecific and variable clinical signs and symptoms. Our study aimed to identify the most predictive features of hand ultrasound (US) for RA development and assess the performance of machine learning models in diagnosing preclinical RA. Methods: We conducted a prospective cohort study with 326 adults who had experienced hand joint pain for less than 12 months and no clinical arthritis. We assessed the participants clinically and via hand US at baseline and followed them for 24 months. Clinical progression to RA was defined according to the ACR/EULAR criteria. Regression modeling and machine learning approaches were used to analyze the predictive US features. Results: Of the 326 participants (45.10 ± 11.37 years/83% female), 123 (37.7%) developed clinical RA during follow-up. At baseline, 84.6% of the progressors had US synovitis, whereas 16.3% of the non-progressors did (p < 0.0001). Only 5.7% of the progressors had positive PD. Multivariate analysis revealed that the radiocarpal synovial thickness (OR = 39.8), PIP/MCP synovitis (OR = 68 and 39), and wrist effusion (OR = 12.56) on US significantly increased the odds of developing RA. ML confirmed these US features, along with the RF and anti-CCP levels, as the most important predictors of RA. Conclusions: Hand US can identify preclinical synovitis and determine the RA risk. The radiocarpal synovial thickness, PIP/MCP synovitis, wrist effusion, and RF and anti-CCP levels are associated with RA development. [ABSTRACT FROM AUTHOR]

Background & Objective: Vaginal birth after Cesarean (VBAC) is often offered as an option after a single cesarean section (CS). To evaluate the success rate of vaginal birth after two cesarean sections (VBAC-2). Materials & Methods: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND ("Vaginal birth after cesar Keywords: Vaginal birth after Cesarean, Cesarean section, Maternal, Fetal outcomesean" OR VBAC) AND (two OR Twice OR second OR multiple). Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis. Results: Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. The mean hysterectomy rate was 0.43% ranging from 0% to 1.7%. Our meta-analysis showed no significant difference between VBAC-2 and CS-3 in the case of hysterectomy, with a pooled odds ratio (OR) of 0.699, but with a wide confidence interval (95% CI was 0.347-1.407). VBAC-2 being associated with 2-fold increased risk of perinatal mortality compared to CS-3. Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections; the outcomes are significantly more favorable for women with a history of vaginal birth. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the clinical profile of patients with seronegative celiac disease (SNCD). Background: Celiac disease (CD) is mainly diagnosed based on positive serology and duodenal mucosal atrophy, but some patients have negative serology. Their diagnosis has some limitations; delays in diagnosis are likely accompanied by a poor prognosis and a high risk of developing complications of CD. Methods: In this retrospective study, 1115 patients were evaluated for CD with mucosal atrophy between 2010 to 2020. SNCD diagnosis requires genetic CD predisposition and improvement of both clinical symptoms and regrowth of duodenal villi after 12 months of a gluten-free diet (GFD) for all patients with IgA deficiency, other IgG-based serology for diagnosis of celiac was done and if these antibodies were negative, consider them as possible SNCD. If they had positive DQ2-DQ8 and improvement of clinical symptoms and mucosal atrophy after 12 months of GFD were confirmed SNCD. Results: Of the 1115 study subjects, 27 had SNCD, 1088 had SPCD with a mean age of 29.7±15.7 years (1 to 76 years) in seropositive celiac disease (SPCD) subjects and 37.1±16.3 years (6 to 63 years) in SNCD participants and 19 female patients with SNCD were presented. The BMI of SNCD and SPCD patients were reported 23.9 and 21.4, respectively. In addition, SPCD subjects were more likely but not statistically significant to have a positive family history. Villous atrophy was shown in 100% SNCD and 95.6% SPCD cases. Scalloping and fissuring in duodenal biopsies were reported in 60% of SNCD and 84.5% of SPCD patients. There was some other cause of seronegative villous atrophy including 3 patients with Crohns disease, 2 with common variable immunodeficiency, 2 drug and one patient with peptic duodenitis. Anemia, neurological symptoms, and liver function tests (LFT) abnormality were common extra intestinal manifestations in SNCD individuals. Levels of Thyroid peroxidase (TPO), TSH were measured, it had been detected that SNCD cases had a higher rate of co-occurrence with thyroid diseases also SPCD cases showed a higher rate of co-occurrence with diabetes. Conclusion: Among patients with celiac disease 2.4% are SNCD. SNCD are older than SPCD at the time of diagnosis and have higher BMI. Most common of cause of seronegative enteropathy also is SNCD followed by inflammatory bowel disease (IBD) common variable immunodeficiency (CVID), medication use, and duodenitis, in this area. [ABSTRACT FROM AUTHOR]

Introduction: Central retinal artery occlusion (CRAO) is a serious ophthalmic disease predominantly affecting older individuals with cardiovascular risk factors. While most cases are attributed to thrombus formation from atheromatous plaques or cardioembolic events, trauma-related CRAO, though rare, presents unique diagnostic and therapeutic challenges. Case Presentation: A 47-year-old woman with multiple controlled comorbidities presented to the emergency department with right eye pain and erythema following a traumatic injury involving a knitting needle. Initial examinations revealed hand motion visual acuity in the right eye, a partial thickness scleral laceration, and conjunctival laceration, which were surgically repaired. Postoperatively, she developed blurred vision, hyphema, and signs of CRAO, prompting anterior chamber paracentesis. OCT imaging revealed marked hyperreflectivity and thickening of the inner retinal layers, indicating significant ischemic damage. Despite normal inflammatory markers, the patient’s visual acuity gradually improved from 2/10 to 5/10 with intervention and eventually reached 10/10 with myopic correction after the hyphema resolved. Conclusion: The case emphasizes the necessity of early recognition and intervention in managing traumatic CRAO to mitigate irreversible retinal damage. It underscores the need for enhanced diagnostic and therapeutic strategies as understanding the condition’s pathophysiology advances. [ABSTRACT FROM AUTHOR]