Background. Patients with inflammatory joint diseases (IJD) are more likely to develop cardiovascular disease compared with the general population. We hypothesized that cardiovascular magnetic resonance (CMR) could identify cardiac abnormalities in patients with IJD and atypical symptoms unexplained by routine clinical evaluation. Patients-Methods. A total of 51 consecutive patients with IJD (32 with rheumatoid arthritis, 10 with ankylosing spondylitis, and 9 with psoriatic arthritis) and normal clinical, electrocardiographic and echocardiographic workups, were referred for CMR evaluation due to atypical chest pain, shortness of breath, and/or palpitations. Their CMR findings were compared with those of 40 non-IJD controls who were referred for the same reason. All participants were examined using either a 1.5 T or 3.0 T CMR system. For T1/T2 mapping, comparisons were performed separately for each field strength. Results. Biventricular systolic function was similar between groups. In total, 25 (49%) patients with IJD vs. 0 (0%) controls had replacement-type myocardial fibrosis (p < 0.001). The T2 signal ratio, early/late gadolinium enhancement, and extracellular volume fraction were significantly higher in the IJD group. Native T1 mapping was significantly higher in patients with IJD independent of the MRI field strength (p < 0.001 for both). T2 mapping was significantly higher in patients with IJD compared with controls only in those examined using a 1.5 T MR system—52.0 (50.0, 55.0) vs. 37.0 (33.5, 39.5), p < 0.001. Conclusions. In patients with IJD and a mismatch between cardiac symptoms and routine non-invasive evaluation, CMR uniquely identified a significant proportion of patients with myocardial inflammation. A CMR examination should be considered in patients with IJD in similar clinical settings.
Background Can learning outcomes be transformed in useful tools revealing strong and weak learning outcomes, learners, teachers; reporting student self-assessment overestimation; informing formative feedback and summative examinations? Methods Based on the ESMO / ASCO global curriculum, 66 level-two learning outcomes were identified and transformed in the iCAN!-Oncology and theyCAN!-Oncology questionnaires, anonymously completed online, before and after teaching, by trainees and trainers respectively, in a five-day fulltime undergraduate oncology course. Results In total, students assessed themselves (iCAN!) with 55% before and 70% after the course (27% improvement); teachers assessed students (theyCAN!) with 43% before and 69% after (60% improvement). Twenty level-two learning outcomes (30%) were scored below the pass / fail cut-point by students while 46 (70%) by teachers, before the course; none after the course. Students assessed themselves the highest in “TNM system” before (81%) and after (82%), while the teachers assessed students so in “Normal cell biology” before (72%) and “Moral / ethical issues in clinical research” after (83%). The lowest assessed outcome was the “Research protocol” by students (28%) and teachers (18%) before, and the “Anticancer agents” after (54% by both). Individual students self-assessed themselves from 31% to 88% before, and from 54% to 88% after; individual teachers assessed students from 29% to 66% before, and from 55% to 94% after. The iCAN! / theyCAN! provided detailed individual student or teacher profile, tightfisted or generous. Conclusions The iCAN! / theyCAN! differentiate strong and weak learning outcomes, learners, teachers; reveal no student self-assessment overestimation; inform formative feedback and summative exams at a metacognitive level; generalize to any course and assessor; support evidence-based teaching and learning SWOT policy.
Backgroundtraditionally, the diagnosis of inflammatory myopathies has been based on clinical signs and symptoms (muscle weakness and characteristic skin involvement, especially in dermatomyositis), increased muscle enzymes, electromyographic findings, skin or muscle biopsy, as well as anti-Jo1 antibodies (antisynthetase syndrome). However, this approach has led to significant diagnostic gaps in atypical cases such as in those of pure lung involvement.Objectivesto evaluate the diagnostic yield of each procedure in a sample of 61 patients who were diagnosed, followed-up and treated in two tertiary university rheumatology clinics in Greece.Methodsserum samples tested using a myositis panel (Mi-2α, Mi-2β, Ku, PM-Scl100, PM-Scl 75, SRP, Jo-1, PL-7, PL-12, OJ, EJ, Ro-52, TIF1γ, MDA5, NXP2, SAE1) and muscle enzymes (CK, aldolase, LDH, SGOT, SGPT). Electromyography has been carried out in all patients, whereas in 27 with elevated muscle enzymes or muscle weakness an MRI-guided muscle biopsy has been done. In addition, in 8 patients, a skin biopsy has been performed and in all patients a detailed examination (determination of muscle strength) has been performed in all muscle groups.Resultsin 42 cases the diagnosis has been made after a positive myositis panel, while in 20 cases there was also a histological confirmation. In 8 cases, the diagnosis has been made on the grounds of positive clinical features and characteristic findings on the electromyogram. Only 4 patients have been diagnosed on the basis of histological findings in the absence of other laboratory and clinical findings(table 1). The most common autoantibodies in patients with lung involvement were Jo-1, PL-12 and PL-7.Conclusionbased on the aforementioned results, a myositis panel seems a reasonable and reliable diagnostic strategy as it improves significantly the diagnostic yield of an inflammatory myopathy. In addition, it gives a diagnostic “alibi” for the therapeutic approaches that otherwise can be administered only by histological confirmation. Finally, in patients with atypical signs and symptoms such as lung fibrosis that cannot be attributed elsewhere, a myositis panel should be performed.Reference[1]Tsamis KI, Boutsoras C, Kaltsonoudis E, Pelechas E, Nikas IP, Simos YV, et al. Clinical features and diagnostic tools in idiopathic inflammatory myopathies. Crit Rev Clin Lab Sci. 2022;59:219-240. Doi: 10.1080/10408363.2021.2000584Table 1.Positive MPPositive EMGPositive histologyMuscle biopsySkin biopsyNumber of patients42/618/6120/6127/618/61MP: myositis panel; EMG: electromyography; ME: muscle enzymesAcknowledgements:NIL.Disclosure of InterestsNone Declared.
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