Chronic Diseases and Comorbidities In Adults With and Without Intellectual Disabilities

This study identified a younger onset of chronic illness and a higher prevalence of multiple comorbidities among people with ID in general practice than those without ID. This underlines the complexity of people with ID and chronic diseases in general practice.

source: Family Practice

Summary

Comparative Cross-Sectional Study In Dutch General Practice

[Posted 2/Jan/2023]

AUDIENCE: Family Medicine, Neurology

KEY FINDINGS: This study identified a younger onset of chronic illness and a higher prevalence of multiple comorbidities among people with ID in general practice than those without ID. This underlines the complexity of people with ID and chronic diseases in general practice. As this study confirmed the earlier onset of chronic diseases and comorbidities, it is recommended to acknowledge these age differences when following chronic disease guidelines.

BACKGROUND: Chronic disease and comorbidity patterns in people with intellectual disabilities (ID) are more complex than in the general population. However, incomplete understanding of these differences limits care providers in addressing them. Aim of this study is to compare chronic disease and comorbidity patterns in chronically ill patients with and without ID in Dutch general practice.

DETAILS: In this population-based study, a multi-regional primary care database of 2018 was combined with national population data to improve identification of adults with ID. Prevalence was calculated using Poisson regression to estimate prevalence ratios and 95% confidence intervals for the highest-impact chronic diseases (ischemic heart disease (IHD), cerebrovascular disease (CVD), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD)) and comorbidities. Information from 18,114 people with ID and 1,093,995 people without ID was available. When considering age and sex, CVD (PR = 1.1), DM (PR = 1.6), and COPD (PR = 1.5) times more prevalent in people with than without ID. At younger age, people with ID more often had a chronic disease and multiple comorbidities. Males with ID most often had a chronic disease and multiple comorbidities. Comorbidities of circulatory nature were most common.

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Source: van den Bemd, M., Schalk, B. W. M., Bischoff, E. W. M. A., et al. (2022). Chronic Diseases and Comorbidities In Adults With and Without Intellectual Disabilities: Comparative Cross-Sectional Study In Dutch General Practice. Family Practice. 2022; 39 (6): 1056-1062. Published: December, 2022. DOI: 10.1093/fampra/cmac042.



Evaluation and Characterization of Facial Skin Aging Using Optical Coherence Tomography

The results illustrate a decline in skin density with chronological age. It was illustrated that structural change in the epidermis and dermis does occur,

source: Lasers Surg. Med.

Summary

[Posted 1/Feb/2023]

AUDIENCE: General Surgery, Family Medicine

KEY FINDINGS: OCT is an effective method for evaluating changes in aging skin. The results illustrate a decline in skin density with chronological age. Additionally, it was illustrated that structural change in the epidermis and dermis does occur, however on a microscopic scale, there are no significant differences based on laterality. OCT holds promise as a noninvasive technique for characterization of aging skin. Its utility and application in the clinical management and treatment of aged skin requires further research; however, the technology has potential to personalize therapies based on objective findings.

BACKGROUND: The skin aging exposome encompasses internal and external factors that contribute to clinical signs of facial aging. Aging skin can be characterized by distinctive features such as wrinkles, lentigines, elastosis, and roughness. Optical coherence tomography (OCT) is capable of noninvasively measuring skin characteristics. This study aimed to assess bilateral features using OCT to explore temporal skin changes among decades and potential changes in facial skin aging based on laterality.

DETAILS: A total of 97 subjects between 20 and 89 years old with Fitzpatrick skin types I to IV were enrolled. VivoSight, a Multi-Beam OCT system intended to gather topographical and histological images of skin, was used to scan the area inferolateral to the lateral canthus, bilaterally. Investigators compared characteristics of skin roughness, attenuation coefficient and blood flow across age groups and based on laterality to determine any differences. Only data from successful OCT scans were used. Seventy subjects, 10 from each specified decade, had successful bilateral scans and were thus included in the analysis. Chronological aging was characterized by significantly decreased dermal attenuation coefficient with increased age. Skin roughness measurements showed trends of increased roughness with age; however, no statistically significant changes were seen between groups. Qualitative differences amongst scans taken on right and left sides of the face showed no significance regarding roughness, density or blood flow at depths ranging from 0.05 to 0.5 mm.

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Copyright © Wiley Periodicals LLC. All rights reserved.

Source: Vingan, N. R., Parsa, S., Barillas, J., et al. (2023). Evaluation and Characterization of Facial Skin Aging Using Optical Coherence Tomography. Lasers Surg. Med.. 2023; 55(1): 23-24. Published: January, 2023. DOI: 10.1002/lsm.23611.



Sentinel Lymph Node Biopsy In Patients with T1A Cutaneous Malignant Melanoma

SLN+ is low in patients with T1a melanomas, but younger age, lymphovascular invasion, mitogenicity, and head/neck primary site appear to confer a higher risk of SLN+.

source: JAAD

Summary

A Multicenter Cohort Study

[Posted 31/Jan/2023]

AUDIENCE: Dermatology, Oncology

KEY FINDINGS: SLN+ is low in patients with T1a melanomas, but younger age, lymphovascular invasion, mitogenicity, and head/neck primary site appear to confer a higher risk of SLN+.

BACKGROUND: Sentinel lymph node biopsy is not routinely recommended for T1a cutaneous melanoma due to the overall low risk of positivity. Prognostic factors for positive sentinel lymph node (SLN+) in this population are poorly characterized. Aim of this study was to determine factors associated with SLN+ in patients with T1a melanoma

DETAILS: Patients with pathologic T1a (<0.80 mm, nonulcerated) cutaneous melanoma from 5 high-volume melanoma centers from 2001 to 2020 who underwent wide local excision with sentinel lymph node biopsy were included in the study. Patient and tumor characteristics associated with SLN+ were analyzed by univariate and multivariable logistic regression analyses. Age was dichotomized into <=42 (25% quartile cutoff) and >42 years. Of the 965 patients identified, the overall SLN+ was 4.4% (N = 43). Factors associated with SLN+ were age <=42 years (7.5% vs 3.7%; odds ratio [OR], 2.14; P = .03), head/neck primary tumor location (9.2% vs 4%; OR, 2.75; P = .04), lymphovascular invasion (21.4% vs 4.2%; OR, 5.64; P = .01), and >=2 mitoses/mm2 (8.2% vs 3.4%; OR, 2.31; P = .03). Patients <42 years with >=2 mitoses/mm2 (N = 38) had a SLN+ rate of 18.4%.

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Copyright © Elsevier Ltd. All rights reserved.

Source: Shannon, A. B., Sharon, C. E., Straker III, R. J., et al. (2023). Sentinel Lymph Node Biopsy In Patients With T1A Cutaneous Malignant Melanoma: A Multicenter Cohort Study. JAAD. 2023; 88(1): 52-59. Published: January, 2023. DOI: 10.1016/j.jaad.2022.09.040.



Clinical Prediction Models for Pancreatic Cancer in General and At-Risk Populations

Identifying high-risk individuals using a risk prediction model could be a crucial first stage of screening pathways to improve the early detection of pancreatic cancer.

source: Am J Gastro.

Summary

A Systematic Review

[Posted 30/Jan/2023]

AUDIENCE: Gastroenterology, Internal Medicine

KEY FINDINGS: Many clinical risk prediction models for pancreatic cancer had been developed for different target populations. Although low risk-of-bias studies were identified, these require external validation and implementation studies to ensure that these will benefit clinical decision making.

BACKGROUND: Identifying high-risk individuals using a risk prediction model could be a crucial first stage of screening pathways to improve the early detection of pancreatic cancer. A systematic review was conducted to critically evaluate the published primary literature on the development or validation of clinical risk prediction models for pancreatic cancer risk.

DETAILS: MEDLINE, Embase, and Web of Science were searched for relevant articles from the inception of each database up to November 2021. Study selection and data extraction were conducted by 2 independent reviewers. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was applied to assess risk of bias. In total, 33 studies were included, describing 38 risk prediction models. Excluding studies with an overlapping population, this study consist of 15,848,100 participants, of which 58,313 were diagnosed with pancreatic cancer. Eight studies externally validated their model, and 13 performed internal validation. The studies described risk prediction models for pancreatic cancer in the general population (n = 14), patients with diabetes (n = 8), and individuals with gastrointestinal (and other) symptoms (symptoms included abdominal pain, unexplained weight loss, jaundice, and change in bowel habits and indigestion; n = 11). The commonly used clinical risk factors in the model were cigarette smoking (n = 27), age (n = 25), diabetes history (n = 22), chronic pancreatitis (n = 18), and body mass index (n = 14). In the 25 studies that assessed model performance, C-statistics ranged from 0.61 to 0.98. Of the 33 studies included, 6 were rated as being at a low risk of bias based on PROBAST.

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Copyright © The American College of Gastroenterology. All rights reserved.

Source: Santos, R., Coleman, H. G., Cairnduff, V., et al. (2022). Clinical Prediction Models for Pancreatic Cancer in General and At-Risk Populations: A Systematic Review. American Journal of Gastroenterology. 2023; 118(1): 26-40. Published: January, 2023. DOI: 10.14309/ajg.0000000000002022.



Effect of Preoperative Low-Normal Cervical Length on Perinatal Outcome After Laparotomy-Assisted Fetoscopic Spina Bifida Repair

Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications.

source: Ultrasound Obstet Gynecol

Summary

[Posted 27/Jan/2023]

AUDIENCE: Ob/Gyn, Neurology, Family Medicine

KEY FINDINGS: Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications. These data warrant further research and are of critical relevance for clinical teams considering the eligibility of patients for in-utero spina bifida repair. Based on this evidence, patients with a low-normal cervical length should be aware of their increased risk for adverse perinatal outcome.

BACKGROUND: Aim of this study i to determine if preoperative cervical length in the low-normal range increases the risk of adverse perinatal outcome in patients undergoing fetoscopic spina bifida repair.

DETAILS: This was a retrospective cohort study of patients who underwent fetal spina bifida repair between September 2014 and May 2022 at a single center. Cervical length was measured on transvaginal ultrasound during the week before surgery. Eligibility for laparotomy-assisted fetoscopic spina bifida repair was as per the criteria of the Management of Myelomeningocele Study, although maternal body mass index (BMI) up to 40 kg/m2 was allowed. Laparotomy-assisted fetoscopic spina bifida repair was performed, with carbon dioxide insufflation via two 12-French ports in the exteriorized uterus. All patients received the same peri- and postoperative tocolysis regimen, including magnesium sulfate, nifedipine and indomethacin. Postoperative follow-up ultrasound scans were performed either weekly ( 32 weeks' gestation) or twice a week (< 32 weeks). Perinatal outcome was compared between patients with a preoperative cervical length of 25-30 mm vs those with a cervical length > 30 mm. Logistic regression analyses and generalized linear mixed regression analyses were used to predict delivery at less than 30, 34 and 37 weeks' gestation. The study included 99 patients with a preoperative cervical length > 30 mm and 12 patients with a cervix 25-30 mm in length. One further case which underwent spina bifida repair was excluded because cervical length was measured > 1 week before surgery. No differences in maternal demographics, gestational age (GA) at surgery, duration of surgery or duration of carbon dioxide uterine insufflation were observed between groups. Cases with low-normal cervical length had an earlier GA at delivery (median (range), 35.2 (25.1-39.7) weeks vs 38.2 (26.0-40.9) weeks; P = 0.01), higher rates of delivery at < 34 weeks (41.7% vs 10.2%; P = 0.01) and < 30 weeks (25.0% vs 1.0%; P < 0.01) and a higher rate of preterm prelabor rupture of membranes (PPROM) (58.3% vs 26.3%; P = 0.04) at an earlier GA (mean ± SD, 29.3 ± 4.0 weeks vs 33.0 ± 2.4 weeks; P = 0.05) compared to those with a normal cervical length. Neonates of cases with low-normal cervical length had a longer stay in the neonatal intensive care unit (20 (7-162) days vs 9 (3-253) days; P = 0.02) and higher rates of respiratory distress syndrome (50.0% vs 14.4%; P < 0.01), sepsis (16.7% vs 1.0%; P = 0.03), necrotizing enterocolitis (16.7% vs 0%; P = 0.01) and retinopathy (33.3% vs 1.0%; P < 0.01). There was an association between preoperative cervical length and risk of delivery at < 30 weeks which was significant only for patients with a maternal BMI < 25 kg/m2 (odds ratio, 0.37 (95% CI, 0.07-0.81); P = 0.02).

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Copyright © International Society of Ultrasound in Obstetrics and Gynecology. All rights reserved.

Source: Corets, M. S., Corroenne, R., Johnson, B., et al. (2022). Effect of Preoperative Low-Normal Cervical Length on Perinatal Outcome After Laparotomy-Assisted Fetoscopic Spina Bifida Repair. Ultrasound Obstet Gynecol. 2023; 61(1): 74-80. Published: January, 2023. DOI: 10.1002/uog.26070.



The Link Between Autism and Sex-Related Neuroanatomy, and Associated Cognition and Gene Expression

The results demonstrate an increased resemblance in both autistic male and female individuals' neuroanatomy with male-characteristic patterns associated with typically sex-differential social cognitive features and related gene expression patterns.

source: Am J Psychiatry

Summary

[Posted 26/Jan/2023]

AUDIENCE: Psychiatry, Family Medicine

KEY FINDINGS: The results demonstrate an increased resemblance in both autistic male and female individuals' neuroanatomy with male-characteristic patterns associated with typically sex-differential social cognitive features and related gene expression patterns. The findings hold promise for future research aimed at refining the quest for biological mechanisms underpinning the etiology of autism.

BACKGROUND: The male preponderance in prevalence of autism is among the most pronounced sex ratios across neurodevelopmental conditions. The authors sought to elucidate the relationship between autism and typical sex-differential neuroanatomy, cognition, and related gene expression.

DETAILS: Using a novel deep learning framework trained to predict biological sex based on T1-weighted structural brain images, the authors compared sex prediction model performance across neurotypical and autistic males and females. Multiple large-scale data sets comprising T1-weighted MRI data were employed at four stages of the analysis pipeline: 1) pretraining, with the UK Biobank sample (>10,000 individuals); 2) transfer learning and validation, with the ABIDE data sets (1,412 individuals, 5-56 years of age); 3) test and discovery, with the EU-AIMS/AIMS-2-TRIALS LEAP data set (681 individuals, 6-30 years of age); and 4) specificity, with the NeuroIMAGE and ADHD200 data sets (887 individuals, 7-26 years of age). Across both ABIDE and LEAP, features positively predictive of neurotypical males were on average significantly more predictive of autistic males (ABIDE: Cohen's d=0.48; LEAP: Cohen's d=1.34). Features positively predictive of neurotypical females were on average significantly less predictive of autistic females (ABIDE: Cohen's d=1.25; LEAP: Cohen's d=1.29). These differences in sex prediction accuracy in autism were not observed in individuals with ADHD. In autistic females, the male-shifted neurophenotype was further associated with poorer social sensitivity and emotional face processing while also associated with gene expression patterns of midgestational cell types.

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Copyright © American Psychiatric Association. All rights reserved.

Source: Floris, D. L., Peng, H., Warrier, V., et al. (2022). The Link Between Autism and Sex-Related Neuroanatomy, and Associated Cognition and Gene Expression. Am J Psychiatry. Published: January, 2023. DOI: 10.1176/appi.ajp.20220194.



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