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Assessing the value of clinical prognosticators of developing relapsing myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
No full textIntroduction 40-60% of people experiencing a first clinical attack of myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) will develop relapsing disease (RMOGAD). The accurate risk prediction of R-MOGAD is challenging. Objective To study the value of a combined predictive model for developing R-MOGAD using clinical features described by prior research studies. Methods A combined multivariate binary logistic regression model was applied on a retrospective clinical dataset of patients with MOGAD from the Nottingham NMOSD/ MOGAD Clinic, with further validation in an independent dataset of MOGAD patients from the NMOSD Specialist Service, Walton Centre Liverpool. Results In the observational dataset (n=34), two MOG-IgG positive tests >= one year apart, age, optic neuritis and early relapses were not significant predictors of developing RMOGAD. Treatment with steroids >=10mg >= three months at disease onset was a significant negative predictor (p=0.006) of R-MOGAD, with 75% sensitivity (95%CI:48%- 93%) and 83% specificity (95%CI:59%-96%). In the independent dataset (n=68) used for validation, this predictor had a sensitivity of 55% (95%CI:36%-72%) and a specificity of 77% (95% CI:60%-90%). Conclusion Our predictive model suggests that the treatment with steroids >=10mg >=three months after the inaugural attack is a significant negative predictor of developing R-MOGAD.https://jnnp.bmj.com/content/95/Suppl_2/A58.
“Rediscovering what I need to do to give myself pleasure.” Trans women’s experiences of their sexualities during gender transition: an interpretative phenomenological analysis
Get PDFOpen Access funding provided by University of Northampton: This work is licensed under a Creative Commons Attribution 4.0 International
License (CC BY 4.0; https://creativecommons.org/licenses/by/4.0).
This license permits copying and redistributing the work in any medium
or format, as well as adapting the material for any purpose, even commercially.Previous research highlights mixed findings regarding how trans people experience sexual satisfaction during and after transition. Qualitative research in particular reflects a process of psychosocial adjustment during and after transition, which reciprocally impacts sex and pleasure. The current research explores trans women’s experiences of their sexualities during gender transition. A phenomenological qualitative methodology was used, and 12 trans women aged 22–67 years old were individually interviewed about their experiences of their sexualities in 2023. Participants had varied sexualities, disabilities, and employment statuses, were mostly White, and had started hormone therapy. Interpretative phenomenological analysis was used to analyze the data. Two group experiential themes were developed, each with two subthemes: transition affords me with the confidence and comfort to explore my sexuality, and doing sexuality differently as a result of transitioning. The results have implications for supporting trans women navigating their identities during the transition by highlighting the psychosocial process of relearning and/or rediscovering their sexualities. Recommendations for future research and practitioners are discussed.https://psycnet.apa.org/fulltext/2024-78565-001.htm
Thyroid dysfunction in early psychosis: improving quality of care
No full textPeople in EIP services are frequently prescribed antipsychotic medication, and often in combination with other psychotropics, all with increased risk of thyroid dysfunction. Undiagnosed and diagnosed thyroid dysfunction can have potential significant implications on both clinical outcomes and treatment for patients with early psychosis. Here, the authors present a clinical practice guideline for the management of thyroid dysfunction in EIP.https://wchh.onlinelibrary.wiley.com/doi/10.1002/psb.216
Efficacy and Safety of Continuous Glucose Monitoring and Intermittently Scanned Continuous Glucose Monitoring in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Interventional Evidence
No full textBackground: Traditional diabetes self-monitoring of blood glucose (SMBG) involves inconvenient finger pricks. Continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems offer CGM, enhancing type 2 diabetes (T2D) management with convenient, comprehensive data. Purpose: To assess the benefits and potential harms of CGM and isCGM compared with usual care or SMBG in individuals with T2D. Data sources: We conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, Web of Science, and bibliographies up to August 2023. Study selection: We analyzed studies meeting these criteria: randomized controlled trials (RCT) with comparison of at least two interventions for ≥8 weeks in T2D patients, including CGM in real-time/retrospective mode, short-/long-term CGM, isCGM, and SMBG, reporting glycemic and relevant data. Data extraction: We used a standardized data collection form, extracting details including author, year, study design, baseline characteristics, intervention, and outcomes. Data synthesis: We included 26 RCTs (17 CGM and 9 isCGM) involving 2,783 patients with T2D (CGM 632 vs. usual care/SMBG 514 and isCGM 871 vs. usual care/SMBG 766). CGM reduced HbA1c (mean difference -0.19% [95% CI -0.34, -0.04]) and glycemic medication effect score (-0.67 [-1.20 to -0.13]), reduced user satisfaction (-0.54 [-0.98, -0.11]), and increased the risk of adverse events (relative risk [RR] 1.22 [95% CI 1.01, 1.47]). isCGM reduced HbA1c by -0.31% (-0.46, -0.17), increased user satisfaction (0.44 [0.29, 0.59]), improved CGM metrics, and increased the risk of adverse events (RR 1.30 [0.05, 1.62]). Neither CGM nor isCGM had a significant impact on body composition, blood pressure, or lipid levels. Limitations: Limitations include small samples, single-study outcomes, population variations, and uncertainty for younger adults. Additionally, inclusion of <10 studies for most end points restricted comprehensive analysis, and technological advancements over time need to be considered. Conclusions: Both CGM and isCGM demonstrated a reduction in HbA1c levels in individuals with T2D, and unlike CGM, isCGM use was associated with improved user satisfaction. The impact of these devices on body composition, blood pressure, and lipid levels remains unclear, while both CGM and isCGM use were associated with increased risk of adverse events.https://diabetesjournals.org/care/article-abstract/47/1/169/154009/Efficacy-and-Safety-of-Continuous-Glucose?redirectedFrom=fulltex
Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD
No full textRationale: As the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy. Objectives: To assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality. Methods: Twelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters. Measurements and main results: In 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09-12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17-13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11-3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation. Conclusions: Despite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.https://www.resmedjournal.com/article/S0954-6111(23)00413-4/fulltex
POP culture: the increasing perils of publish or perish. A farewell from the Editors in Chief.
No full textNone available
Identifying clusters of objective functional impairment in patients with degenerative lumbar spinal disease using unsupervised learning.
Get PDFOBJECTIVES: The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and thus provides an adjunctive dimension in patient assessment. It is conceivable that there are different subsets of patients with OFI and degenerative lumbar disease. We aim to identify clusters of objectively functionally impaired individuals based on 5R-STS and unsupervised machine learning (ML). METHODS: Data from two prospective cohort studies on patients with surgery for degenerative lumbar disease and 5R-STS times of ≥ 10.5 s-indicating presence of OFI. K-means clustering-an unsupervised ML algorithm-was applied to identify clusters of OFI. Cluster hallmarks were then identified using descriptive and inferential statistical analyses. RESULTS: We included 173 patients (mean age [standard deviation]: 46.7 [12.7] years, 45% male) and identified three types of OFI. OFI Type 1 (57 pts., 32.9%), Type 2 (81 pts., 46.8%), and Type 3 (35 pts., 20.2%) exhibited mean 5R-STS test times of 14.0 (3.2), 14.5 (3.3), and 27.1 (4.4) seconds, respectively. The grades of OFI according to the validated baseline severity stratification of the 5R-STS increased significantly with each OFI type, as did extreme anxiety and depression symptoms, issues with mobility and daily activities. Types 1 and 2 are characterized by mild to moderate OFI-with female gender, lower body mass index, and less smokers as Type I hallmarks. CONCLUSIONS: Unsupervised learning techniques identified three distinct clusters of patients with OFI that may represent a more holistic clinical classification of patients with OFI than test-time stratifications alone, by accounting for individual patient characteristics
Twenty-four-hour physical behaviour profiles across type 2 diabetes mellitus subtypes
No full textAim: To investigate how 24-h physical behaviours differ across type 2 diabetes (T2DM) subtypes. Materials and methods: We included participants living with T2DM, enrolled as part of an ongoing observational study. Participants wore an accelerometer for 7 days to quantify physical behaviours across 24 h. We used routinely collected clinical data (age at onset of diabetes, glycated haemoglobin level, homeostatic model assessment index of beta-cell function, homeostatic model assessment index of insulin resistance, body mass index) to replicate four previously identified subtypes (insulin-deficient diabetes [INS-D], insulin-resistant diabetes [INS-R], obesity-related diabetes [OB] and age-related diabetes [AGE]), via k-means clustering. Differences in physical behaviours across the diabetes subtypes were assessed using generalized linear models, with the AGE cluster as the reference. Results: A total of 564 participants were included in this analysis (mean age 63.6 ± 8.4 years, 37.6% female, mean age at diagnosis 53.1 ± 10.0 years). The proportions in each cluster were as follows: INS-D: n = 35, 6.2%; INS-R: n = 88, 15.6%; OB: n = 166, 29.4%; and AGE: n = 275, 48.8%. Compared to the AGE cluster, the OB cluster had a shorter sleep duration (-0.3 h; 95% confidence interval [CI] -0.5, -0.1), lower sleep efficiency (-2%; 95% CI -3, -1), lower total physical activity (-2.9 mg; 95% CI -4.3, -1.6) and less time in moderate-to-vigorous physical activity (-6.6 min; 95% CI -11.4, -1.7), alongside greater sleep variability (17.9 min; 95% CI 8.2, 27.7) and longer sedentary time (31.9 min; 95% CI 10.5, 53.2). Movement intensity during the most active continuous 10 and 30 min of the day was also lower in the OB cluster. Conclusions: In individuals living with T2DM, the OB subtype had the lowest levels of physical activity and least favourable sleep profiles. Such behaviours may be suitable targets for personalized therapeutic lifestyle interventions.https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.1543
Natural history and outcomes in paediatric RASopathy-associated hypertrophic cardiomyopathy
No full textAims: This study aimed to describe the natural history and predictors of all-cause mortality and sudden cardiac death (SCD)/equivalent events in children with a RASopathy syndrome and hypertrophic cardiomyopathy (HCM). Methods and results: This is a retrospective cohort study from 14 paediatric cardiology centres in the United Kingdom and Ireland. We included children <18 years with HCM and a clinical and/or genetic diagnosis of a RASopathy syndrome [Noonan syndrome (NS), NS with multiple lentigines (NSML), Costello syndrome (CS), cardiofaciocutaneous syndrome (CFCS), and NS with loose anagen hair (NS-LAH)]. One hundred forty-nine patients were recruited [111 (74.5%) NS, 12 (8.05%) NSML, 6 (4.03%) CS, 6 (4.03%) CFCS, 11 (7.4%) Noonan-like syndrome, and 3 (2%) NS-LAH]. NSML patients had higher left ventricular outflow tract (LVOT) gradient values [60 (36-80) mmHg, P = 0.004]. Over a median follow-up of 197.5 [inter-quartile range (IQR) 93.58-370] months, 23 patients (15.43%) died at a median age of 24.1 (IQR 5.6-175.9) months. Survival was 96.45% [95% confidence interval (CI) 91.69-98.51], 90.42% (95% CI 84.04-94.33), and 84.12% (95% CI 75.42-89.94) at 1, 5, and 10 years, respectively, but this varied by RASopathy syndrome. RASopathy syndrome, symptoms at baseline, congestive cardiac failure (CCF), non-sustained ventricular tachycardia (NSVT), and maximal left ventricular wall thickness were identified as predictors of all-cause mortality on univariate analysis, and CCF, NSVT, and LVOT gradient were predictors for SCD or equivalent event. Conclusions: These findings highlight a distinct category of patients with Noonan-like syndrome with a milder HCM phenotype but significantly worse survival and identify potential predictors of adverse outcome in patients with RASopathy-related HCM.https://onlinelibrary.wiley.com/doi/10.1002/ehf2.1463
Ethnic differences in cardiac structure and function assessed by MRI in healthy South Asian and White European people: a UK Biobank Study
No full textBackground: Echocardiographic studies indicate South Asian people have smaller ventricular volumes, lower mass and more concentric remodelling than White European people, but there are no data using cardiac MRI (CMR). We aimed to compare CMR quantified cardiac structure and function in White European and South Asian people. Methods: Healthy White European and South Asian participants in the UK Biobank Imaging CMR sub-study were identified by excluding those with a history of cardiovascular disease, hypertension, obesity or diabetes. Ethnic groups were matched by age and sex. Cardiac volumes, mass and feature tracking strain were compared. Results: 121 matched pairs (77 male/44 female, mean age 58±8 years) of South Asian and White European participants were included. South Asian males and females had smaller absolute but not indexed left ventricular (LV) volumes, and smaller absolute and indexed right ventricular volumes, with lower absolute and indexed LV mass and lower LV mass:volume than White European participants. Although there were no differences in ventricular or atrial ejection fractions, LV global longitudinal strain was higher in South Asian females than White European females but not males, and global circumferential strain was higher in both male and South Asian females than White European females. Peak early diastolic strain rates were higher in South Asian versus White European males, but not different between South Asian and White European females. Conclusions: Contrary to echocardiographic studies, South Asian participants in the UK Biobank study had less concentric remodelling and higher global circumferential strain than White European subjects. These findings emphasise the importance of sex- and ethnic- specific normal ranges for cardiac volumes and function.https://www.sciencedirect.com/science/article/pii/S1097664723001667?via%3Dihu