The relationship between white tongue and gastroesophageal reflux disease

Background Signs of gastroesophageal reflux disease (GERD) are limited, therefore, follow up of treatment are mainly based on patients’ symptoms. The aims of study were: 1) to compare the prevalence of white tongue (WT) between individuals with GERD and control group, 2) to evaluate the correlation between WT extension and severity of symptoms in GERD. Materials and methods This case-control study consisted of 100 consecutive individuals with GERD who were referred to the gastroenterology clinic of a referral hospital during 2019-2020. The diagnosis of GERD was made by a gastroenterologist if heart burn or regurgitation existed. The same number of healthy accompanies of patients without GERD participated as the control group. A single examiner defined WT if whitish-gray discoloration of tongue surface existed in two separate sessions [Kappa = 0.93; p < 0.01]. WT extension was estimated based on the approximate white discoloration of the tongue surface. Results All participants with GERD showed white tongue in the first observation and 98% in the second observation, while only 5% of the individuals in the control group revealed WT in both observations (p < 0.001). There was a positive correlation between the WT extension and GERD symptom severity (r: 0.44; p < 0.001). Conclusion It seems that WT might be a reliable sign of GERD. Considering the association between GERD symptoms severity and the extent of WT in this observation, further studies may assess the utility of WT extension as a reasonable objective in monitoring treatment response.

The role of leptin in patients recovering from Anorexia Nervosa

Introduction: Anorexia nervosa (AN) is a mental disorder with the highest death rate. The characteristic feature of AN is endocrine dysregulations, including changes in adipose-tissue secreted hormones, especially adipokines. The most widely studied of them is leptin whose role in the pathophysiology and prognosis of AN is confirmed in more and more studies. The aim of the study was to summarize the role of endocrine disruptions with particular emphasis on leptin in the pathophysiology of AN. Material and methods: For the literature review, the electronic databases PubMed, Cochrane and Google Scholar search were used with the following keywords: eating disorders, adipokines, leptin, metreleptin, satiety, hunger, anorexia, obesity, for studies listed from database inception to October 2021. Results: Leptin, produced mainly by white adipose tissue, inhibits the hunger center in the hypothalamus by negative feedback with ghrelin secreted by the gastrointestinal tract. Leptin is involved in numerous biological functions, including body weight regulation, innate and adaptive immunity regulation, reproduction, and bone formation. Studies confirm decreased leptin levels in AN individuals. In recent years, extensive experience has been gained with leptin as a drug in clinical trials. The studies suggested that treatment can restore menstrual function and bone health and improve mood with unclear body weight effects. Conclusions: Focusing on leptin-related changes is a promising approach to improve AN management. Assessment of leptin levels in AN patients could be a useful tool for therapy monitoring. Treatment with leptin could reverse unfavourable changes induced by diet restriction, including mood symptoms, loss of bone mass and menstrual function. However, the results of these studies need confirmation on larger groups of patients.

Usage of Smartphone Apps in Self-care of Patients Undergoing Hemodialysis: A Scoping Review

Aim: Using smartphone apps can be a valuable tool for self-managing dialysis patients. This study aimed to review the usage of smartphone apps in the self-care of patients undergoing hemodialysis. Method: Resources were searched on three bibliographic databases, including PubMed, Scopus, and CINAHL, investigated from May 2005 through May 2021, using key terms, such as smartphone apps, mobile health, hemodialysis, chronic kidney disease, self-care, and self-management. Selecting articles were based on the PRISMA flow diagram. Results: The smartphone apps used for undergoing hemodialysis patients were categorized into five main categories. These categories included dietary monitoring, treatment adherence, lifestyle management, symptoms monitoring, and patient training. Conclusion: Smartphone apps must be developed by cooperation and supervision of healthcare agencies to improve patient adoption and ensure confidentiality. Further research efforts are needed to assess the impact of apps on quality of life outcomes through randomized controlled trials and cohort studies. In developing apps, the needs and preferences of patients must be considered.

Three-Dimensional Super-Resolved Imaging of Paraffin-Embedded Kidney Samples

Background: Diseases of the glomeruli, the renal filtration units, are a leading cause of progressive kidney disease. Assessment of the ultrastructure of podocytes at the glomerular filtration barrier is essential for diagnosing diverse disease entities, providing insight into the disease pathogenesis as well as monitoring treatment responses. Methods: We here apply previously published sample preparation methods together with STED and confocal microscopy for resolving nanoscale podocyte substructure. The protocols are modified and optimized in order to be applied to samples which have been formalin fixed and paraffin-embedded (FFPE). Results: We successfully modify our protocols to allow for deep three-dimensional STED and confocal imaging of FFPE kidney tissue with similar staining and image quality as compared to our previous approaches. We further show that quantitative analysis can be applied to extract morphometrics of healthy and diseased samples from both mice and humans. Conclusions: The results from this study could increase the feasibility to implement optical kidney imaging protocols in clinical routines, as FFPE is the gold standard method for storage of patient samples.

Open Issues and Practical Suggestions for Telemedicine in Chronic Pain

Telemedicine represents a major opportunity to facilitate continued assistance for patients with chronic pain and improve their access to care. Preliminary data show that an improvement can be expected of the monitoring, treatment adherence, assessment of treatment effect including the emotional distress associated with pain. Moreover, this approach seems to be convenient and cost-effective, and particularly suitable for personalized treatment. Nevertheless, several open issues must be highlighted such as identification of assessment tools, implementation of monitoring instruments, and ability to evaluate personal needs and expectations. Open questions exist, such as how to evaluate the need for medical intervention and interventional procedures, and how to define when a clinical examination is required for certain conditions. In this context, it is necessary to establish dynamic protocols that provide the right balance between face-to-face visits and telemedicine. Useful tips are provided to start an efficient experience. More data are needed to develop precise operating procedures. In the meantime, the first experiences from such settings can pave the way to initiate effective care pathways in chronic pain.

Patient satisfaction with tele-advice during the COVID-19 pandemic

Introduction: The coronavirus pandemic has shed a whole new light on telehealth, which has become an alternative for diagnosis, monitoring, treatment and support without physical contact between patient and healthcare professional. The aim of this study was to examine patient satisfaction with medical services provided with tele-advice during the Covid-19 pandemic. Material and methods: The study was conducted using our own questionnaire via Google Form that was correctly completed by 133 individuals between the ages of 18 and 76 years (mean 33.1 ± 13.1 years) who received medical services via tele-advice. Results: Patients with chronic conditions were statistically more likely to seek specialist services via tele-advice (p = 0.003). Slightly less than one-third of respondents (n = 39; 29.3%) were asked during the tele-advice to attend the clinic / office in person to complete the visit with a physical examination. The vast majority of subjects (n = 95; 71.4%) responded that their health status had not changed since the pandemic and the introduction of tele-advice. Nearly half (n = 64; 48.1%) believed that their health problem had been solved via tele-advice. Only 4.5% of the respondents (n = 6) strongly agreed with the statement that “tele-advice enables proper diagnosis and matching of effective treatment”, 18.0% (n = 24) tended to agree. The vast majority of respondents believed that everyone should be able to choose between tele-advice and a traditional medical visit (n = 121; 91.0%). Conclusions: The majority of people surveyed did not perceive a difference in their health since the pandemic and the introduction of tele-advice. Nearly half of respondents believed that their health problem had been resolved with a telemedicine consultation, with even fewer people convinced that “tele-advice allows for proper diagnosis and matching of effective treatment.” Patients would mostly like to have a choice between tele-visit and in-person visits, with no clear indication of the superiority of one or the other. Continuous improvement of current solutions will certainly contribute to increased patient satisfaction with the medical services provided.

A non-cardiac applications of T1-mapping

T1-mapping has proven to be a valuable tool in cardiac imaging. While mainly used in cardiac MRI, it is investigated for usage and application of T1-mapping to imaging of other organs and systems, including abdominal imaging, musculoskeletal imaging or neuroradiology, resulting in potential new prospects for medical imaging. T1-mapping provides numerical data on an inherent, physical property of imaged tissue – enabling quantitative and comparative assessment of tissue characterization f.ex. fibrosis, amyloid contents, fatty transformation, myelinization or contrast enhancement as well as lesion characterization. Reports of application of T1-mapping in assessment of liver, kidney or pancreas fibrosis create perspectives of reducing the number of invasive diagnostic procedures, such as biopsies, as well as monitoring treatment response or disease progression. Furthermore T1-mapping can potentially replace MR elastography in assessment of liver fibrosis or used in thyroid fibrosis to define degree of destruction in AIT or other thyroid diseases. In neuroradiology T1-mapping is promising in the spine imaging, enabling better characterization of spinal cord lesions also has a potential to evaluate effectiveness of conservative or operative treatment. There are also successful reports of employing T1-mapping in orbital imaging, such as in predicting steroid resistant diplopia in Graves’ disease or in evaluation of diabetic cataracts. In musculoskeletal imaging, T1-relaxation could be a possible biomarker of bone quality that could play a role in osteoporotic fracture risk assessment. In conclusion, T1-mapping shows promise as a quantitative method complementary to standard MR imaging beyond cardiac MRI, and needs further research and validation efforts to establish its place in standard diagnostic protocols.

P.048 International MAGNIMS-CMSC-NAIMS consensus recommendations on the use of standardized MRI in MS

Background: Standardized magnetic resonance imaging (MRI) guidelines published in 2015 by the Europoean MAGNIMS group and in 2016 by the CMSC are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and for the appropriate use of MRI in routine clinical practice. Methods: Two panels of experts convened to update existing guidelines for a standardized MRI protocol. The MAGNIMS panel convened in Graz, Austria in April 2019. The CMSC NAIMS panel met separately and independently in Newark, USA in October 2019. Subsequently, the MAGNIMS, NAIMS, and CMSC working groups combined their efforts to reach an international consensus Results: The revised guidelines on MRI in MS merges recommendations from MAGNIMS, CMSC, and NAIMS to improve the use of MRI for diagnosis, prognosis and monitoring of individuals with MS. 3D acquisitions are emphasized for optimal comparison over time. Core brain sequences include a 3D-T2wFLAIR for lesion identification and monitoring treatment effectiveness. Gadolinium-based contrast is recommended for diagnostic studies and judicious use for routine monitoring of MS patients. DWI sequences are recommended for PML safety monitoring. Conclusions: The international consensus guidelines strive for global acceptance of a useful and usable standard of care for patients with MS.