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Journal of Diabetes Jul 2024We studied the prevalence and incidence of type 2 diabetes (T2DM) and its associated risk factors in younger (20 and 39 years) and older individuals (≥40 years)...
BACKGROUND
We studied the prevalence and incidence of type 2 diabetes (T2DM) and its associated risk factors in younger (20 and 39 years) and older individuals (≥40 years) over a 10-year period.
METHODS
Epidemiological surveys in 2006 (n = 7066) and 2016 (n = 9848) were conducted in similar urban and rural locations of southern India among people aged ≥20 years. Diagnosis of T2DM was made using World Health Organization criteria. Self-reported diabetes was verified from medical records. Age and gender standardized prevalence and incidence rates, percentage change in obesity, hypertension, and dyslipidemia were calculated. Prevalence ratios (PR) were calculated using Poisson regression analyses. Primary study was registered on www.
CLINICALTRIALS
gov. Identifier: NCT03490136.
RESULTS
In 10 years, the prevalence of T2DM increased in younger (7.8% vs. 4.5%, p < 0.0001) and older individuals (34% vs. 28.4%, p < 0.0001). After adjusting for age, family history of diabetes, and waist circumference, younger individuals showed a higher percentage increase in prevalence than the older group (PR = 1.36 [95% confidence interval [CI], 1.14-1.62], p = 0.001) versus (PR = 1.11 [95% CI, 1.02-1.20], p = 0.02). Increase in rates of obesity and dyslipidemia was also higher in the younger than in the older individuals. In 10 years, incidence of T2DM increased by 120% (1.1% vs. 0.5%, p < 0.0001) and 150% (5% vs. 2%, p < 0.0001) in the younger and older individuals, respectively.
CONCLUSIONS
Higher percentage increase in prevalence of T2DM was seen among younger individuals over a 10-year period. Obesity and family history of diabetes were shown to be the primary contributing factors for the rise in prevalence.
Topics: Adult; Female; Humans; Male; Middle Aged; Young Adult; Age Factors; Diabetes Mellitus, Type 2; Dyslipidemias; Incidence; India; Obesity; Prevalence; Risk Factors
PubMed: 38923743
DOI: 10.1111/1753-0407.13576 -
Current Opinion in Ophthalmology Jun 2024This review aims to enhance understanding of juvenile Sjögren's disease (jSjD) by exploring diagnostic criteria, ocular clinical features, ancillary ophthalmic testing,...
PURPOSE OF REVIEW
This review aims to enhance understanding of juvenile Sjögren's disease (jSjD) by exploring diagnostic criteria, ocular clinical features, ancillary ophthalmic testing, and management strategies specific to this rare pediatric condition.
RECENT FINDINGS
Unlike adults, children with jSjD often present with recurrent parotitis and extra-glandular symptoms before developing sicca symptoms. Adult SjD classification criteria do not consider pediatric-specific symptoms and physiological differences. Underutilization of diagnostic tests such as the ocular staining score (OSS) and Schirmer I may result in an incomplete understanding of the prevalence of keratoconjunctivitis sicca in jSjD.
SUMMARY
Timely referral to an ophthalmologist can address perceived feasibility issues with respect to ocular features in jSjD. Management of keratoconjunctivitis sicca in jSjD includes improving ocular surface lubrication and decreasing inflammation. Recognition of pediatric-specific clinical features and development of universally accepted jSjD classification criteria will allow for better identification of potential participants for future jSjD studies.
PubMed: 38923442
DOI: 10.1097/ICU.0000000000001069 -
Scientific Reports Jun 2024Studies in Western populations have shown that Black and Hispanic patients have an earlier age of Multiple Sclerosis (MS) onset and a more severe disease course... (Comparative Study)
Comparative Study Observational Study
Studies in Western populations have shown that Black and Hispanic patients have an earlier age of Multiple Sclerosis (MS) onset and a more severe disease course characterised by faster disability accrual compared to Whites. It is yet unclear whether MS disease characteristics and clinical course differ amongst Asian racial groups. Singapore is uniquely poised to investigate this as its multi-racial population comprises three genetically diverse Asian racial groups-Chinese, Malay and South Asian. Herein, we sought to elucidate differences in the clinical phenotypes, disease-modifying therapy (DMT) usage, and disease course amongst these three Asian racial groups by performinga retrospective observational study on MS patients seen at the National Neuroscience Institute, Singapore. Data on demographics, disease characteristics, ancillary investigations, and DMT usage were collected. One hundred and eighty-eight patients were included (90 Chinese, 32 Malay, and 66 South Asian). Our findings showed that MS prevalence was the highest in South Asians followed by Malays and Chinese, while demographics, healthcare access, and longer-term disease course were identical across the racial groups. However, several differences and trends were elucidated: (1) South Asian patients had milder sentinel attacks (p = 0.006), (2) a higher proportion of Malay patients had enhancing lesions on their initial MRI (p = 0.057) and the lesion topography differed across the races (p = 0.034), and (3) more Malay patients switched out of their initial DMT (p = 0.051). In conclusion, MS disease characteristics were largely similar across these three Asian racial groups, and while there were some clinical and radiological differences at presentation, these did not influence longer-term outcomes.
Topics: Humans; Singapore; Male; Female; Multiple Sclerosis; Adult; Retrospective Studies; Asian People; Middle Aged; Prevalence; Magnetic Resonance Imaging
PubMed: 38918591
DOI: 10.1038/s41598-024-65575-3 -
Cureus May 2024Artificial intelligence (AI) is a suite of technologies that enables computers to learn and interpret information like human cognition. It has found applications across...
Artificial intelligence (AI) is a suite of technologies that enables computers to learn and interpret information like human cognition. It has found applications across various fields, including healthcare, agriculture, astronomy, navigation, and robotics. Within healthcare, AI has the potential to enhance diagnostic accuracy, facilitate drug research, and automate patient experiences. This comparative study focuses on the proficiency of AI in generating accurate differential diagnoses in the field of pathology. Six medical vignettes were crafted, and each scenario was then input into three different AI platforms. The pathologist reviewed and determined the most accurate AI model.
PubMed: 38915984
DOI: 10.7759/cureus.61075 -
European Stroke Journal Jun 2024Atrial fibrillation (AF) and cancer are each associated with worse outcomes in patients with acute ischemic stroke (AIS). Few studies have evaluated the impact of AF on...
INTRODUCTION
Atrial fibrillation (AF) and cancer are each associated with worse outcomes in patients with acute ischemic stroke (AIS). Few studies have evaluated the impact of AF on outcomes of cancer-related stroke.
PATIENTS AND METHODS
We conducted a retrospective cross-sectional study using the 2016-2019 National Inpatient Sample, identifying all hospitalizations with diagnosis codes for cancer and AIS. The primary exposure was a diagnosis of AF. The primary outcome was in-hospital mortality. The secondary outcomes were length-of-stay and discharge to non-home locations. We used multiple logistic and linear regression models, adjusted for age, gender, race-ethnicity, and the Charlson Comorbidity Index, to examine the association between AF and study outcomes.
RESULTS
Among 150,200 hospitalizations with diagnoses of cancer and AIS (mean age 72 years, 53% male), 40,084 (26.7%) included comorbid AF. Compared to hospitalizations without AF, hospitalizations with AF had higher rates of in-hospital mortality (14.8% [95% CI, 14.0%-15.6%] vs 12.1% [95% CI, 11.6%-12.5%]) and non-home discharge disposition (83.5% [95% CI, 82.7%-84.3%] vs 75.1% [95% CI, 74.5%-75.7%]) as well as longer mean length-of-stay (8.4 days [95% CI, 8.2-8.6 days] vs 8.2 days [95% CI, 8.0-8.3 days]). In multivariable analyses, AF remained independently associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR], 1.34; 95% CI, 1.24-1.46), non-home discharge disposition (aOR, 1.32; 95% CI, 1.23-1.42), and longer length-of-stay (adjusted mean difference, 13.7%; 95% CI, 10.9%-16.7%).
DISCUSSION AND CONCLUSION
In cancer-related AIS, comorbid AF is associated with worse short-term outcomes, including higher odds for in-hospital mortality, poor discharge disposition, and longer hospital stays.
PubMed: 38915252
DOI: 10.1177/23969873241263402 -
Human Pathology Jun 2024Multiple myeloma (MM) is an incurable malignant plasma cell neoplasm, representing the second most common hematopoietic cancer. As plasma cell neoplasms are clonal and...
Multiple myeloma (MM) is an incurable malignant plasma cell neoplasm, representing the second most common hematopoietic cancer. As plasma cell neoplasms are clonal and often secrete a monoclonal protein (M-spike), laboratory diagnosis is usually straightforward, especially when ancillary studies such as immunohistochemistry, flow cytometry, and protein electrophoresis are available in addition to microscopic examination. Despite the repertoire of diagnostic tools, rare cases pose diagnostic dilemmas, especially when reagent antibodies do not react as expected, extent of disease is patchy, or when disease occurs in unique age groups. In this retrospective study, we report a series of challenging diagnostic cases, discussing aberrant findings and comparing them to more classic counterparts. Twelve cases collected during routine clinical sign-out were reanalyzed and include examples of MGUS, classic multiple myeloma, t(11;14) rearranged myeloma, minimal residual disease, AA and AL amyloidosis, truncated light chain, non-secretory and non-producer myeloma, biphenotypic myeloma, oligoclonal expansion after bone marrow transplant, and plasma cell leukemia in a young adult. This cohort showcases the diversity of atypical presentations of plasma cell neoplasms, and we highlight standardized approaches to workup to avoid diagnostic pitfalls.
PubMed: 38909710
DOI: 10.1016/j.humpath.2024.06.012 -
Sleep Health Jun 2024To examine the association of biopsychosocial stress indicators (perceived stress, perceived discrimination, stressful life events, and allostatic load) with sleep...
OBJECTIVES
To examine the association of biopsychosocial stress indicators (perceived stress, perceived discrimination, stressful life events, and allostatic load) with sleep outcomes (sleep duration and insomnia symptoms) and to examine sex and age interactions for associations between stress and sleep in older Puerto Rican adults.
METHODS
Secondary analyses were performed with 830 participants (72% female) from wave 2 (2006-2011) of the Boston Puerto Rican Health Study (BPRHS), a prospective population-based cohort study (45-75years at baseline) and Boston Puerto Rican Osteoporosis Study (BPROS) (2007-2012), an ancillary study of the BPRHS. Recruitment occurred in randomly selected census blocks using door-to-door and community-based activities. In-home data collection visits included a baseline assessment and follow-up interviews. Questionnaires assessed perceived stress, discrimination, stressful life events, and sleep. Allostatic load indicators were measured objectively. Regression models controlled for sociodemographic, behavioral, and health factors, with interaction analyses, followed by sex- and sex-by-age-stratified analyses.
RESULTS
In the prior 2years, participants with chronic stress had 50% greater odds of reporting nonoptimal sleep duration (<7 or >9 hours). Life events trajectories were significantly related to insomnia symptoms. Men ≥65years who experienced chronic stress had greater insomnia symptoms than women, or than men with low stress or acute stress.
CONCLUSIONS
Stressful life events may affect sleep duration and insomnia symptoms among older Puerto Rican adults, particularly men 65 years and older who experienced chronic stress. Given the differences in sleep patterns experienced by older adults and their relationships with health outcomes, identifying methods to support sleep health among those with chronic stress is important.
PubMed: 38908940
DOI: 10.1016/j.sleh.2024.04.001 -
Indian Journal of Pathology &... Jun 2024An extremely rare benign lesion of the scalp is reported in a 2-month-old infant. The lesion had been present since birth. On examination, a 3 × 4 cm skin-colored soft...
An extremely rare benign lesion of the scalp is reported in a 2-month-old infant. The lesion had been present since birth. On examination, a 3 × 4 cm skin-colored soft mass over the occipital midline area was observed. On ultrasound, a diagnosis of occipital encephalocele was suggested. A complete excision of the mass was performed. Histological examination showed a subcutaneous lesion, which showed haphazardly arranged epithelioid cell nests admixed with connective tissue components, adipose tissues, and pseudovascular patterns within the deep dermis. Immunohistochemistry showed positive expression of Epithelial membrane antigen (EMA) and Vimentin. Tumor cells showed negative expression for Glial Fibrillary acidic protein (GFAP), chromogranin, S-100, Smooth muscle actin (SMA), and CD 34. Based on the clinical presentation, histologic features, and results of ancillary studies, a diagnosis of meningothelial hamartoma of the scalp was given. The clinical behavior of this lesion is benign but it often causes diagnostic confusion and may mimic malignant tumors. It is crucial to recognize the main features of this lesion.
PubMed: 38904440
DOI: 10.4103/ijpm.ijpm_533_23 -
Indian Journal of Pathology &... Jun 2024Myeloid sarcoma (MS) is a tumor mass comprising myeloid blasts with or without maturation occurring in any site other than bone marrow. It is a rare and distinct...
BACKGROUND
Myeloid sarcoma (MS) is a tumor mass comprising myeloid blasts with or without maturation occurring in any site other than bone marrow. It is a rare and distinct clinical presentation of myeloid neoplasm.
MATERIALS AND METHODS
This is a retrospective study over 7 years (2015-2022) comprising a series of eight cases, which includes clinical details, morphology, immunohistochemistry (IHC) markers, cytogenetics, and molecular details.
RESULTS
These cases showed up as an isolated MS (3/8), as an initial clinical presentation in acute myeloid leukemia (1/8), as acute myeloid leukemia (1/8), as a disease progression in primary myelofibrosis (1/8), as chronic myeloid leukemia (1/8), and as BCR-ABL-negative myelodysplastic syndrome/myeloproliferative neoplasm (1/8). One of the three isolated MS was incorrectly identified as having Ewing's sarcoma. One case each presented at the cervical lymph node, mediastinum, skin, sacral soft tissue, maxillary sinus, and perinephric fat, and two cases presented at the hard palate.
CONCLUSION
Four of the cases in our study were clinically thought of as lymphoma/sarcoma, which was a major diagnostic challenge. All but one case succumbed to their disease. Without adequate clinical history and appropriate use of ancillary techniques such as IHC in tissue biopsies, flow cytometry, cytogenetics, and molecular studies, these cases have a high chance of being misdiagnosed as non-Hodgkin lymphoma, small round blue cell tumor, or undifferentiated carcinomas, which can complicate patient management and prognosis.
PubMed: 38904435
DOI: 10.4103/ijpm.ijpm_474_23 -
Frontiers in Aging Neuroscience 2024Sleep-related disorders have been associated with cognitive decline and neurodegeneration. American Indians are at increased risk for dementia. Here, we aim to...
BACKGROUND
Sleep-related disorders have been associated with cognitive decline and neurodegeneration. American Indians are at increased risk for dementia. Here, we aim to characterize, for the first time, the associations between sleep characteristics and subsequent cognitive performance in a sample of aging American Indians.
METHODS
We performed analyses on data collected in two ancillary studies from the Strong Heart Study, which occurred approximately 10 years apart with an overlapping sample of 160 American Indians (mean age at follow-up 73.1, standard deviation 5.6; 69.3% female and 80% with high school completion). Sleep measures were derived by polysomnography and self-reported questionnaires, including sleep timing and duration, sleep latency, sleep stages, indices of sleep-disordered breathing, and self-report assessments of poor sleep and daytime sleepiness. Cognitive assessment included measures of general cognition, processing speed, episodic verbal learning, short and long-delay recall, recognition, and phonemic fluency. We performed correlation analyses between sleep and cognitive measures. For correlated variables, we conducted separate linear regressions. We analyzed the degree to which cognitive impairment, defined as more than 1.5 standard deviations below the average Modified Mini Mental State Test score, is predicted by sleep characteristics. All regression analyses were adjusted for age, sex, years of education, body mass index, study site, depressive symptoms score, difference in age from baseline to follow-up, alcohol use, and presence of allele.
RESULTS
We found that objective sleep characteristics measured by polysomnography, but not subjective sleep characteristics, were associated with cognitive performance approximately 10 years later. Longer sleep latency was associated with worse phonemic fluency ( = -0.069, = 0.019) and increased likelihood of being classified in the cognitive impairment group later in life (odds ratio 1.037, = 0.004). Longer duration with oxygen saturation < 90% was associated with better immediate verbal memory, and higher oxygen saturation with worse total learning, short and long-delay recall, and processing speed.
CONCLUSION
In a sample of American Indians, sleep characteristics in midlife were correlated with cognitive performance a decade later. Sleep disorders may be modifiable risk factors for cognitive impairment and dementia later in life, and suitable candidates for interventions aimed at preventing neurodegenerative disease development and progression.
PubMed: 38903901
DOI: 10.3389/fnagi.2024.1346807