Predictors of Life Expectancy in Autopsy-Confirmed Alzheimer’s Disease

Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective: No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. Methods: Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer’s Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. Results: Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE variance in 764 total participants. Mini-Mental State Examination (MMSE) score was the strongest predictor of LE, followed by sex, age, race/ethnicity, neuropsychiatric symptoms, abnormal neurological exam results, and functional impairment ratings. Post-hoc analyses revealed correlations of LE were strongest with MMSE ≤12. Conclusion: Global cognitive functioning was the strongest predictor of LE following diagnosis, and AD patients with severe impairment had the shortest LE. AD patients who are older, male, white, and have more motor symptoms, functional impairment, and neuropsychiatric symptoms were also more likely have shorter LE. While this model cannot provide individual prognoses, additional studies may focus on these variables to enhance predictions of LE in patients with AD.

A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression

Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide.Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery–Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide.Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.

Foodborne Toxigenic Agents Investigated in Central Italy: An Overview of a Three-Year Experience (2018–2020)

Foodborne diseases (FBDs) represent a worldwide public health issue, given their spreadability and the difficulty of tracing the sources of contamination. This report summarises the incidence of foodborne pathogens and toxins found in food, environmental and clinical samples collected in relation to diagnosed or suspected FBD cases and submitted between 2018 and 2020 to the Food Microbiology Unit of the Istituto Zooprofilattico Sperimentale del Lazio e della Toscana (IZSLT). Data collected from 70 FBD investigations were analysed: 24.3% of them started with an FBD diagnosis, whereas a further 41.4% involved clinical diagnoses based on general symptomatology. In total, 5.6% of the 340 food samples analysed were positive for the presence of a bacterial pathogen, its toxins or both. Among the positive samples, more than half involved meat-derived products. Our data reveal the probable impact of the COVID-19 pandemic on the number of FBD investigations conducted. In spite of the serious impact of FBDs on human health and the economy, the investigation of many foodborne outbreaks fails to identify the source of infection. This indicates a need for the competent authorities to continue to develop and implement a more fully integrated health network.

Epidemiology and Clinical Features of Anterior Uveitis: a Prospective Study

Purpose: To report the pattern, epidemiology, and clinical features of anterior uveitis (AU) in southern TaiwanMethods: A prospective case series was performed to recruit patients with AU at two medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) in southern Taiwan from December 1, 2018 to March 31, 2020. These patients enrolled were reviewed for clinical diagnoses, ocular presentations, and laboratory data, including aqueous polymerase chain reaction tests.Results: A total of 112 patients were included. The most common clinical diagnoses were idiopathic AU (37.5%), HLA-B27-associated acute AU (25.0%), and herpetic AU (18.8%); among herpetic etiology, cytomegalovirus (CMV) was the most common pathogen. Hypertensive AU was associated with older age, more males, and greater numbers of corneal edema, and fewer iris posterior synechiae. Compared with HLA-B27-associated acute AU, CMV AU was associated with older age, high intraocular pressure, more keratic precipitates, greater iris atrophy, more pseudophakia, and fewer pupil posterior synechiae. Conclusion: This prospective study identified the epidemiological and clinical features of AU in southern Taiwan. The most common etiologies were idiopathic AU, HLA-B27-associated acute AU, and herpetic (most CMV) AU.

Recurrent herpes zoster with IgD deposits, multinucleated keratinocytes and overexpression of galectin and glypican 3 in a patient with SARS-COVID-19 infection

The novel coronavirus disease (COVID-19) that currently plagues the world and caused by SARS-CoV-2, has spread internationally since late 2019. The dermatologic manifestations of this virus are currently being identified. We describe a 73-year-old Caucasian female who presented to many physicians for recurrent Herpes zoster episodes that persisted, despite treatment with multiple antiviral medications. The patient was diagnosed with COVID-19 before an onset of vesicular pustular lesions. The clinical diagnoses were recurrent herpes zoster and recurrent varicella. A skin biopsy was obtained and stained with hematoxylin and eosin to confirm a diagnosis. Immunohistochemical stains for Ki-67, Phospho-Histone H3, galectin 3, glypican and IgD were positive in multinucleated cells of the skin, where the viral lesions were detected. Recidivated herpes zoster and varicella are currently being clinically associated with COVID- 19; the abnormal immune response in patients with COVID-19 may be due to the overexpression of molecules that facilitate the outbreak of these viruses.

VEGFA rs3025039 and biliary atresia susceptibility in Chinese population: a systematic review and meta-analysis

BackgroundPrevious studies have suggested an association between vascular endothelial growth factor A (VEGFA) rs3025039 polymorphism and biliary atresia (BA). However, this conclusion is controversial and there is no published pooled evidence of this association.MethodsThis study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews). A thorough search was performed on databases including PubMed, Embase, and Chinese Biomedical Database up to August 2020. This study included 846 cases of BA and 2821 controls concerning VEGFA rs3025039 polymorphism. We selected relevant studies based on the following inclusion criteria: (1) the study design was case–control and cohort and (2) the patients carried standard clinical diagnoses of BA, etc. The exclusion criteria were as follows: (1) patients with other related diseases, (2) lack of requisite information and (3) duplicate data. The OR (odd ratio) and the corresponding 95% CI (confidence interval) were calculated to estimate the association.ResultsThis study on VEGFA rs3025039 polymorphism in the Chinese population included 846 cases and 2821 controls. The results showed that there was no significant association between rs3025039 and susceptibility to BA under four genetic models. The results of the subgroup analysis were similar to the overall results.ConclusionsThis meta-analysis shows that rs3025039 was not associated with susceptibility to BA in the Chinese population. Further validation may entail additional research.PROSPERO registration numberCRD42020203812.

Spectrum of Oral Cavity Lesions and its Clinico-Histopathological Correlation

Introduction: Oral cavity lesions comprise a wide spectrum of diseases that varies from non-neoplastic to neoplastic. The clinical evaluation alone is insufficient for proper diagnosis in most cases. So, histopathological examination is the gold standard method for diagnosis and management of patients accordingly. Objective: The present study was done to evaluate the histopathological spectrum of oral cavity lesions and compare them in relation to age, sex, site, clinical features, risk factors, and clinical diagnoses. Methods: This prospective cross-sectional study enrolled 127 cases of oral biopsies which were received at the Department of Pathology, Tribhuvan University and Teaching Hospital, Kathmandu Nepal, from May 2018 to April 2019 for histopathological examination. Specimens were fixed in 10% formalin and subjected for tissue processing and Hematoxylin and Eosin stained sections. Data entry and analysis were done by using SPSS 24 version where frequency and percentile were calculated. Results: Total cases were 127 with slight female predilection and the age group of 50-60 years (mean age of 44.24 years) were commonly affected. The tongue being the most common site, frequently lesions presented as swelling. Most of the lesions were non-neoplastic comprising 45% whereas malignant lesions comprised 23.6%. Smoking increased the risk of malignancy by 2 fold. The most common benign lesions were squamous papilloma & fibroepithelial polyp whereas the malignant lesion was squamous cell carcinoma. Sixty percent of clinical diagnoses didn’t show correlation. Conclusions: Oral cavity lesions have a wide spectrum of distribution in age, sex, site, and clinical presentation. Initially, oral lesions may present with subtle symptoms which may cause underdiagnosis. Thus, histopathological diagnosis is a must to rule out malignancy. Keywords: Clinical presentation; correlation; oral cavity; risk factors.

Rest-Activity Pattern and Circadian Phase Alterations Across the Alzheimer’s Disease Clinical Spectrum

Actigraphy-derived locomotor activity recordings are novel and critical tools for evaluating rest-activity pattern and circadian phase in humans. We conducted a narrative review assessing rest-activity pattern and circadian phase alterations within various stages of Alzheimer’s disease, in consideration of the reciprocal associations between neurodegeneration and circadian rhythm disruption in patients with Alzheimer’s disease. The goal of this review was to characterize possible associations between circadian rhythm disruption and neurodegeneration in Alzheimer’s disease. To the best of our knowledge, only two studies have assessed rest-activity pattern and circadian phase alterations in the preclinical Alzheimer’s disease stage and the results of the studies were inconsistent. Several studies have evaluated rest-activity pattern and circadian phase alterations in patients with Alzheimer’s dementia. The most replicated findings were delayed phase and increased activity fragmentation, represented as increased intra-daily variability. Unfortunately, many studies performed in dementia patients have not examined neuroimaging biomarkers or structured neuropsychological tests, thus limiting the specification of dementia clinical diagnoses. Future studies should consider a more comprehensive evaluation of various clinical and biomarker characteristics in patients with dementia or Alzheimer’s disease.

Violent behavior patterns: possible homeopathic remedies

The authors discuss violence as a current epidemics and violent behavior in children and adolescents. They present a repertory study including the characteristic and peculiar symptoms of 12 patients, with clinical diagnoses of Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder and Oppositional Defiant Disorder, and the symptoms corresponding to the diagnostic criteria in the DSM-IV transcribed in repertory language. The result is a materia medica for patterns of violent behavior. Keywords: Violent behavior, homeopathy, children and adolescents, ADHD, Conduct Disorder, Oppositional Defiant Disorder.  Padrões de conduta violenta: possíveis medicamentos homeopáticos Resumo Os autores abordam a violéncia como epidemia contemporânea e estudam a conduta violenta em crianças e adolescentes. Apresenta-se uma análise repertorial, incluindo os sintomas característicos e peculiares de 12 pacientes com diagnóstico clínico de Transtorno de Déficit de Atenção com Hiperatividade (TDAHI), Transtorno de Conduta e Oposicional Desafiador, e os sintomas correspondentes aos critérios diagnósticos no DSM-IV transcritos em línguagem repertorial. O resultado é uma matéria médica para padrões de conduta violenta. Palavras-chave: Comportamento violento, homeopatia, crianças e adolescentes, TDAH, Desordem de conduta, Transtorno Oposicional Desafiador.  Modelos de conducta violenta: posibles remedios homeopáticos Resumen Los autores abordan la violencia como epidemia contemporánea y estudian la conducta violenta en niños y adolescentes. Se presenta un análisis repertorial, incluyendo los síntomas característicos y peculiares de 12 pacientes con diagnóstico clínico de Trastorno de Déficit de Atención con Hiperactividad (TDAHI), Trastorno de Conducta y Oposicional Desafiador, y los síntomas correspondientes a los criterios diagnósticos en el DSM-IV transcriptos en lenguaje repertorial. El resultado es una materia médica para modelos de conducta violenta. Palabras-clave: Comportamiento violento, homeopatía, niños, niñas y adolescentes, TDAH, trastorno de conducta, trastorno de oposición desafiante.  Correspondence author: Célia R. Barollo, [email protected]; http://www.nephsp.org How to cite this article: Barollo CR, Bignardi FAC, Osielski JM, Pedalino CMV.Violent behavior patterns: possible homeopathic remedies. Int J High Dilution Res [online]. 2008 [cited YYYY Mmm DD]; 7(22):7-21. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/257/341. ÂÂÂ

Associations of Social Vulnerability Index With Pathologic Myocardial Findings at Autopsy

Background: Social vulnerability is an important determinant of cardiovascular health. Prior investigations have shown strong associations of social determinants of health with cardiovascular risk factors, imaging findings, and clinical events. However, limited data exist regarding the potential role of social vulnerability and related physiologic stressors on tissue-level pathology.Methods: We analyzed clinical data and linked autopsy reports from 853 decedent individuals who underwent autopsy from 4/6/2002 to 4/1/2021 at a large urban medical center. The mean age at death was 62.9 (SD = 15.6) and 49% of decedent individuals were men. The primary exposure was census-tract level composite social vulnerability index based on the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Individuals were geocoded to census tracts and assigned SVI accordingly. Four myocardial tissue-level outcomes from autopsy were recorded as present or absent: any coronary atherosclerosis, severe/obstructive coronary atherosclerosis, myocardial fibrosis, and/or myopericardial inflammation. Multivariable-adjusted logistic regression models were constructed with SVI as the primary exposure and covariates including age, sex, race, body mass index (BMI), diabetes, and hypertension. Additional analyses were performed stratified by clinical diagnoses of heart failure (HF) and coronary artery disease (CAD).Results: In the overall cohort, SVI was not associated with outcomes on cardiac pathology in multivariable-adjusted models. However, in stratified multivariable-adjusted analyses, higher SVI (higher social vulnerability) was associated with a higher odds of myocardial fibrosis among individuals without clinical diagnoses of HF.Conclusions: Higher indices of social vulnerability are associated with a higher odds of myocardial fibrosis at autopsy among individuals without known clinical diagnoses of HF. Potential pathophysiological mechanisms and implications for prevention/treatment of myocardial dysfunction require further study.