The Trunk Appearance Perception Scale (TAPS): a new tool to evaluate subjective impression of trunk deformity in patients with idiopathic scoliosis

<p>Abstract</p> <p>Background</p> <p>Outcome assessment in idiopathic scoliosis should probably include patients' perception of their trunk deformity in addition to self-image. This can be accomplished with the Walter Reed Visual Assessment Scale (WRVAS). Nevertheless, this instrument has some shortcomings: the drawings are abstract and some figures do not relate to the corresponding radiological deformity. These considerations prompted us to design the Trunk Appearance Perception Scale (TAPS).</p> <p>Methods</p> <p>Patients with idiopathic scoliosis and no prior surgical treatment were included. Each patient completed the TAPS and SRS-22 questionnaire and underwent a complete radiographic study of the spine. The magnitude of the upper thoracic, main thoracic, and thoracolumbar/lumbar structural curves were recorded. The TAPS includes 3 sets of figures that depict the trunk from 3 viewpoints: looking toward the back, looking toward the head with the patient bending over and looking toward the front. Drawings are scored from 1 (greatest deformity) to 5 (smallest deformity), and a mean score is obtained.</p> <p>Results</p> <p>A total of 186 patients (86% females), with a mean age of 17.8 years participated. The mean of the largest curve (CMAX) was 40.2°. The median of TAPS sum score was 3.6. The floor effect was 1.6% and ceiling effect 3.8%. Cronbach's alpha coefficient was 0.89; the ICC for the mean sum score was 0.92. Correlation coefficient of the TAPS mean sum and CMAX was -0.55 (<it>P </it>< 0.01). Correlation coefficients between TAPS mean sum score and SRS-22 scales were all statistically significant, ranging from 0.45 to 0.52 (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The TAPS is a valid instrument for evaluating the perception patients have of their trunk deformity. It shows excellent distribution of scores, internal consistency, and test-retest reliability, and has good capacity to differentiate the severity of the disease. It is simple and easy to complete and score, the figures are natural, and a new frontal view is included.</p

Trisomy 8, A Cytogenetic Abnormality In Myelodysplastic Syndromes, Is Constitutional Or Not?

Isolated trisomy 8 is not considered presumptive evidence of myelodysplastic syndrome (MDS) in cases without minimal morphological criteria. One reason given is that trisomy 8 (+8) can be found as a constitutional mosaicism (cT8M). We tried to clarify the incidence of cT8M in myeloid neoplasms, specifically in MDS, and the diagnostic value of isolated +8 in MDS. Twenty-two MDS and 10 other myeloid neoplasms carrying +8 were studied. Trisomy 8 was determined in peripheral blood by conventional cytogenetics (CC) and on granulocytes, CD3+ lymphocytes and oral mucosa cells by fluorescence in situ hybridization (FISH). In peripheral blood CC, +8 was seen in 4/32 patients. By FISH, only one patient with chronic myelomonocytic leukemia showed +8 in all cell samples and was interpreted as a cT8M. In our series +8 was acquired in all MDS. Probably, once discarded cT8M by FISH from CD3+ lymphocytes and non-hematological cells, +8 should be considered with enough evidence to MDS

Connected Insulin Pens and Caps : An Expert's Recommendation from the Area of Diabetes of the Spanish Endocrinology and Nutrition Society (SEEN)

Undoubtedly, technological advances have revolutionised diabetes management in recent years. The development of advanced closed hybrid loop insulin pumps or continuous glucose monitoring (CGM) systems, among others, have increased the quality of life and improved glycaemic control of people with diabetes. However, only some patients have access to such technology, and only some want to use it. CGM has become much more widespread, but in terms of insulin delivery, most people with type 1 diabetes (T1D) and almost all people with type 2 diabetes (T2D) on insulin therapy are treated with multiple-dose insulin injections (MDI) rather than an insulin pump. For these patients, using connected insulin pens or caps has shown benefits in reducing missed insulin injections and promoting correct administration over time. In addition, using these devices improves the quality of life and user satisfaction. The integration of insulin injection and CGM data facilitates both users and the healthcare team to analyse glucose control and implement appropriate therapeutic changes, reducing therapeutic inertia. This expert's recommendation reviews the characteristics of the devices marketed or in the process of being marketed and their available scientific evidence. Finally, it suggests the profile of users and professionals who would benefit most, the barriers to its generalisation and the changes in the care model that implementing these devices can bring with it

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

The Trunk Appearance Perception Scale (TAPS): una nueva herramienta para la evaluación objetiva de la percepción de la deformidad del tronco en pacientes con escoliosis idiopática

En la evaluación clínica de la escoliosis idiopática se debería incluir la percepción que tiene el paciente de su deformidad del tronco. Existe el Walter Reed Visual Assessment Scale (WRVAS) pero tiene algunos defectos: los dibujos son poco realistas y no se correlacionan con la deformidad radiológica de la curva. Objetivos: Diseñar una nueva escala visual, el Trunk Appearance Perception Scale (TAPS) para la evaluación de la percepción de la deformidad del tronco. Estudiar las propiedades métricas al añadir el TAPS a la escala especifica para deformidades del raquis de la SRS (SRS-22). Material y Métodos: Se incluyeron pacientes con escoliosis idiopática, edad entre 10 y 40 años, no intervenidos. Se clasificaron según la magnitud de la curva mayor (CMAX): Grupo 0: Cobb de 10º-25º; Grupo 1: 26º- 45º y Grupo 2: Cobb ≥ 46º. Cumplimentaron el cuestionario SRS-22 y el TAPS: incluye tres sets de 5 dibujos correspondiendo a tres puntos de vista del tronco: de espaldas, con el individuo en posición de reverencia de frente y vista de frente: uno para mujeres y otro para hombres. Cada dibujo se puntúa de 1 (mayor deformidad) a 5 (menor deformidad). El resultado total es la suma de los dibujos 1, 2 y 3 dividido por tres. 30 pacientes se llevaron el TAPS a su domicilio y lo contestaron a la semana para el estudio de la fiabilidad test-retest. Resultados: Obtuvimos un total de 186 pacientes (86% mujeres), con media de edad de 17.8 años (DS 17.9). La media de la CMAX fue 40.2° (DS 18.7) . La media de la puntuación del TAPS fue de 3.6. El efecto suelo fue del 1.6% y del techo 3.8%. El coeficiente alpha de Cronbach fue de 0.89; el índice de correlación intraclases (test-retest) para la media del total de la puntuación 0.92. El coeficiente de correlación entre la media del total del TAPS y la CMAX fue -0.55 (P < 0.01) y con las subescalas del SRS-22 fueron significativas entre 0.45 y 0.52. El porcentaje de la varianza para la magnitud de la curva para el SRS-22 es del 14% y aumenta hasta el 34% al añadirle el TAPS, aumentando también la consistencia interna en la escala de imagen corporal (0.75 a 0.85) y en el total (0.87 a 0.89). Conclusiones: El TAPS es un instrumento válido, simple, sencillo de completar y calcular, para evaluar la percepción de la deformidad del tronco y correlacionarse con la gravedad de la enfermedad. Sería útil añadirlo al SRS-22 como instrumento de evaluación de la calidad de vida en pacientes con deformidad del raquis.Background: Outcome assessment in idiopathic scoliosis should probably include patients' perception of their trunk deformity in addition to self-image. This can be accomplished with the Walter Reed Visual Assessment Scale (WRVAS). Nevertheless, this instrument has some shortcomings: the drawings are abstract and some figures do not relate to corresponding radiological deformity. These considerations prompted us to design the Trunk Appearance Perception Scale (TAPS). Methods: Patients with idiopathic scoliosis and no prior surgical treatment were included. Each patient completed the TAPS and SRS-22 questionnaire and underwent a complete radiographic study of the spine. The magnitude of the upper thoracic, main thoracic and thoracolumbar/lumbar structural curves was recorded. The TAPS includes 3 sets of figures that depict the trunk from 3 viewpoints: looking toward the back, looking toward the head with the patient bending over and looking toward the front. Drawings are scored from 1 (greatest deformity) to 5 (smallest deformity), and a mean score is obtained. Results: A total of 186 patients (86% females), with a mean age of 17.8 years participated. The mean of the largest curve (CMAX) was 40.2º. The median of TAPS sum score was 3.6. The floor effect was 1.6% and ceiling effect 3.8%. Cronbach's alpha coefficient was 0.89; the ICC for the mean sum score was 0.92. Correlation coefficient of the TAPS mean sum and CMAX was -0.55 (P0.05).The basic SRS-22 explained 14% of variance (R2=0.14,p<0.5)When the TAPS was added, a variance explaining 34% in regards to the variable Cobb angle was reached. The Internal consistency of image perception subscale and the total of SRS-22 was higger added the TAPS. Conclusions: The TAPS is a valid instrument for evaluating the perception patients have of their trunk deformity. It shows excellent distribution scores, internal consistency, and test-retest reliability, and has good capacity to differenciate the severity of the disease. It is simple and easy to complete score, the figures are natural, and a new frontal view is included

The Trunk Appearance Perception Scale (TAPS) : una nueva herramienta para la evaluación objetiva de la percepción de la deformidad del tronco en pacientes con escoliosis idiopática /

Descripció del recurs: el 01 setembre 2012En la evaluación clínica de la escoliosis idiopática se debería incluir la percepción que tiene el paciente de su deformidad del tronco. Existe el Walter Reed Visual Assessment Scale (WRVAS) pero tiene algunos defectos: los dibujos son poco realistas y no se correlacionan con la deformidad radiológica de la curva. Objetivos: Diseñar una nueva escala visual, el Trunk Appearance Perception Scale (TAPS) para la evaluación de la percepción de la deformidad del tronco. Estudiar las propiedades métricas al añadir el TAPS a la escala especifica para deformidades del raquis de la SRS (SRS-22). Material y Métodos: Se incluyeron pacientes con escoliosis idiopática, edad entre 10 y 40 años, no intervenidos. Se clasificaron según la magnitud de la curva mayor (CMAX): Grupo 0: Cobb de 10º-25º; Grupo 1: 26º- 45º y Grupo 2: Cobb ≥ 46º. Cumplimentaron el cuestionario SRS-22 y el TAPS: incluye tres sets de 5 dibujos correspondiendo a tres puntos de vista del tronco: de espaldas, con el individuo en posición de reverencia de frente y vista de frente: uno para mujeres y otro para hombres. Cada dibujo se puntúa de 1 (mayor deformidad) a 5 (menor deformidad). El resultado total es la suma de los dibujos 1, 2 y 3 dividido por tres. 30 pacientes se llevaron el TAPS a su domicilio y lo contestaron a la semana para el estudio de la fiabilidad test-retest. Resultados: Obtuvimos un total de 186 pacientes (86% mujeres), con media de edad de 17.8 años (DS 17.9). La media de la CMAX fue 40.2° (DS 18.7) . La media de la puntuación del TAPS fue de 3.6. El efecto suelo fue del 1.6% y del techo 3.8%. El coeficiente alpha de Cronbach fue de 0.89; el índice de correlación intraclases (test-retest) para la media del total de la puntuación 0.92. El coeficiente de correlación entre la media del total del TAPS y la CMAX fue -0.55 (P 0.01) y con las subescalas del SRS-22 fueron significativas entre 0.45 y 0.52. El porcentaje de la varianza para la magnitud de la curva para el SRS-22 es del 14% y aumenta hasta el 34% al añadirle el TAPS, aumentando también la consistencia interna en la escala de imagen corporal (0.75 a 0.85) y en el total (0.87 a 0.89). Conclusiones: El TAPS es un instrumento válido, simple, sencillo de completar y calcular, para evaluar la percepción de la deformidad del tronco y correlacionarse con la gravedad de la enfermedad. Sería útil añadirlo al SRS-22 como instrumento de evaluación de la calidad de vida en pacientes con deformidad del raquis.Background: Outcome assessment in idiopathic scoliosis should probably include patients' perception of their trunk deformity in addition to self-image. This can be accomplished with the Walter Reed Visual Assessment Scale (WRVAS). Nevertheless, this instrument has some shortcomings: the drawings are abstract and some figures do not relate to corresponding radiological deformity. These considerations prompted us to design the Trunk Appearance Perception Scale (TAPS). Methods: Patients with idiopathic scoliosis and no prior surgical treatment were included. Each patient completed the TAPS and SRS-22 questionnaire and underwent a complete radiographic study of the spine. The magnitude of the upper thoracic, main thoracic and thoracolumbar/lumbar structural curves was recorded. The TAPS includes 3 sets of figures that depict the trunk from 3 viewpoints: looking toward the back, looking toward the head with the patient bending over and looking toward the front. Drawings are scored from 1 (greatest deformity) to 5 (smallest deformity), and a mean score is obtained. Results: A total of 186 patients (86% females), with a mean age of 17.8 years participated. The mean of the largest curve (CMAX) was 40.2º. The median of TAPS sum score was 3.6. The floor effect was 1.6% and ceiling effect 3.8%. Cronbach's alpha coefficient was 0.89; the ICC for the mean sum score was 0.92. Correlation coefficient of the TAPS mean sum and CMAX was -0.55 (P 0.05).The basic SRS-22 explained 14% of variance (R2=0.14,p 0.5)When the TAPS was added, a variance explaining 34% in regards to the variable Cobb angle was reached. The Internal consistency of image perception subscale and the total of SRS-22 was higger added the TAPS. Conclusions: The TAPS is a valid instrument for evaluating the perception patients have of their trunk deformity. It shows excellent distribution scores, internal consistency, and test-retest reliability, and has good capacity to differenciate the severity of the disease. It is simple and easy to complete score, the figures are natural, and a new frontal view is included

Palmar fascitis and polyarthritis as a paraneoplastic syndrome associated with ovarian carcinoma: a case report

This case report concerns a 49-year-old woman whose physical examination was remarkable for symmetrical swollen hands, fingers and palmar fascial thickening with erythema. The fingers showed flexion contractures. Examination also revealed markedly limited bilateral shoulder and limited knee flexion