Carotid plaque detection improves the predictive value of CHA2DS2-VASc score in patients with non-valvular atrial fibrillation::The ARAPACIS Study

BACKGROUND AND AIMS: Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA2DS2-VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA2DS2-VASc score. METHODS: We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. RESULTS: VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Adding CP to the VD definition leaded to higher VD prevalence (30.9%). During a median [IQR] follow-up time of 36months, 56 (2.8%) stroke/TIA events were recorded. Survival analysis showed that conventional VD alone did not increase the risk of stroke (Log-Rank: 0.009, p=0.924), while addition of CP to conventional VD was significantly associated to an increased risk of stroke (LR: 5.730, p=0.017). Cox regression analysis showed that VD+CP was independently associated with stroke (HR: 1.78, 95% CI: 1.05-3.01, p=0.0318). Reclassification analysis showed that VD+CP allowed a significant risk reclassification when compared to VD alone in predicting stroke at 36months (NRI: 0.192, 95% CI: 0.028-0.323, p=0.032). CONCLUSIONS: In non-valvular AF patients the addition of ultrasound detection of carotid plaque to conventional VD significantly increases the predictive value of CHA2DS2-VASc score for stroke

The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain

<p>Abstract</p> <p>Background</p> <p>This study was aimed at evaluating whether or not patients with chronic type III acromioclavicular dislocation develop cervical spine pain and degenerative changes more frequently than normal subjects.</p> <p>Methods</p> <p>The cervical spine of 34 patients with chronic type III AC dislocation was radiographically evaluated. Osteophytosis presence was registered and the narrowing of the intervertebral disc and cervical lordosis were evaluated. Subjective cervical symptoms were investigated using the Northwick Park Neck Pain Questionnaire (NPQ). One-hundred healthy volunteers were recruited as a control group.</p> <p>Results</p> <p>The rate and distribution of osteophytosis and narrowed intervertebral disc were similar in both of the groups. Patients with chronic AC dislocation had a lower value of cervical lordosis. NPQ score was 17.3% in patients with AC separation (100% = the worst result) and 2.2% in the control group (p < 0.05). An inverse significant nonparametric correlation was found between the NPQ value and the lordosis degree in the AC dislocation group (p = 0.001) wheras results were not correlated (p = 0.27) in the control group.</p> <p>Conclusions</p> <p>Our study shows that chronic type III AC dislocation does not interfere with osteophytes formation or intervertebral disc narrowing, but that it may predispose cervical hypolordosis. The higher average NPQ values were observed in patients with chronic AC dislocation, especially in those that developed cervical hypolordosis.</p

Epidemiological aspects of olfactory dysfunction.

PURPOSE: This study aimed at assessing the most common aetiological factors causing total or partial olfactory deficit and the statistical analysis of some clinical aspects. MATERIALS AND METHODS: 243 patients reporting alfactory dysfunction were enrolled in this STUDY: A case history was drawn up for each patient, and all of them underwent otolaryngology objective examination, including nasal endoscopy, paranasal sinuses CT-scan, and Utrecht method (GITU) based smell indentification test. RESULTS: Upper respiratory viral infections (40.2%), ceanial-facial traumas (39.3%), and rhinosinusal pathologies (6.3%) were the main aetiopathological factors indentified. A relevant number of case were recorded with unknown aetiology (14.2%). In 2 cases, olfactory dysfunction was due to neurological diseases, in 1 case it was due to intoxication and, in another case, it was congenital. The correlation between aetiology, gender, age, symptoms duration and deficit severity was studied. CONCLUSIONS: many different aetiological factors caused the loss or weakening of the sense of smell. They mainly affected olfactory neurosensorial structures and odorant conduction. However, there were many cases of unknown aetiology. Women, over 40 in particular, were the most affected. Anosmia and severe hyposmia were mainly correlated with traumas and viral pathologies

GENETIC POLYMORPHISM OF ANGIOTENSIN-CONVERTING ENZYME IS NOT ASSOCIATED WITH THE DEVELOPMENT OF PARKINSON’S DISEASE AND OF L-DOPA INDUCED ADVERSE EFFECTS

Sporadic Parkinson's disease (PD) is a frequent neurodegenerative movement disorder. Both environmental and genetic factors have been studied in the etiology of PD. Among genetic factors, increasing evidences suggest that deletion/insertion (D/I) gene polymorphism of the angiotensin I-converting enzyme (ACE) may be involved in the pathogenesis of PD and in the occurrence of the adverse effects of chronic L-dopa therapy. We investigated this hypothesis by evaluating the frequency of the ACE gene D/I polymorphism in 120 Italian PD patients and 132 controls. Out of the 120 PD patients, 91 were under chronic L-dopa treatment. Our results revealed no difference in ACE I/D genotype (?2=0.79, p=0.66) and allele (?2=0.34, p=0.56) frequencies between PD and controls. We also failed to observe any significant association with the occurrence of L-dopa-induced adverse effects in long-term treated PD patients, thereby excluding the presence of an association between ACE I/D genotypes and the genetic susceptibility to PD and the development of adverse effect of chronic L-dopa therapy