Systemic diseases and their association with open-angle glaucoma in the population of Stockholm

Objective We aimed to study open-angle glaucoma in association with somatic comorbidities in the total population of adults in Region Stockholm. Methods The study population included all living persons aged 19 years and above who resided in Stockholm County, Sweden, on 1 January 2017 (N = 1 703 675). Subjects with specified diseases were identified with data from all registered consultations and hospital stays during 2008–2019. As outcome, the risk of being associated with a diagnosis of open-angle glaucoma was identified during 2012–2018. Analyses were performed by gender, controlling for age and socio-economic status. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with open-angle glaucoma, using individuals without this as referents, were calculated. Socio-economic status was assessed based on the neighbourhood the subjects lived in. Results In total, 16,299 cases of open-angle glaucoma were identified during 2012–2018, 9204 women and 7095 men. Higher fully adjusted OR (95% CI) for risk of being associated with open-angle glaucoma was for women and men with diabetes 1.138 (1.074–1.207) and 1.216 (1.148–1.289), cancer 1.175 (1.120–1.233) and 1.106 (1.048–1.166), hypertension 1.372 (1.306–1.440) and 1.243 (1.179–1.311); and for women with thyroid diseases 1.086 (1.030–1.146), chronic lung diseases 1.153 (1.093–1.216), and inflammatory arthropathies 1.132 (1.006–1.275). Higher glaucoma incidence was observed in individuals residing in high socio-economic status neighbourhoods. Conclusion The risk of glaucoma is increased in some somatic diseases, especially in individuals with diabetes, hypertension and cancer; and in higher socio-economic neighbourhoods as compared to lower socio-economic neighbourhoods.

Tryptophan Metabolism in Bipolar Disorder in a Longitudinal Setting

Immune-mediated inflammatory processes and oxidative stress are involved in the aetiopathogenesis of bipolar disorder (BD) and weight-associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found to be more active in BD, and associated with overweight/obesity. This study aimed to investigate tryptophan metabolism in BD compared to controls (C), stratified by weight classes, in a longitudinal setting, dependent on the incidence of BD episodes. Peripheral tryptophan, kynurenine, and neopterin were assessed in the serum of 226 BD individuals and 142 C. Three samples in a longitudinal assessment were used for 75 BD individuals. Results showed a higher kynurenine/tryptophan in both BD compared to C and overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not, or who had an illness episode or had none. Findings indicate that tryptophan, kynurenine, and IDO-1 activity may play a role in pathophysiology in BD but are not necessarily associated with clinical manifestations. Accelerated tryptophan breakdown along the kynurenine axis may be facilitated by being overweight. This may increase the risk of accumulation of neurotoxic metabolites, impacting BD symptomatology, cognition, and somatic comorbidities.

Ceramides: Shared Lipid Biomarkers of Cardiovascular Disease and Schizophrenia

INTRODUCTION: Schizophrenia, although a debilitating mental illness, greatly affects individuals physical health as well. One of the leading somatic comorbidities associated with schizophrenia is cardiovascular disease, which has been estimated to be one of the leading causes of excess mortality in patients diagnosed with schizophrenia. Although the shared susceptibility to schizophrenia and cardiovascular disease is well established, the mechanisms linking these two disorders are not well understood. Genetic studies have hinted toward shared lipid metabolism abnormalities co-occurring in the two disorders, while lipid compounds have emerged as prognostic markers for cardiovascular disease. In particular, three ceramide species in the blood plasma, Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1), have been robustly linked to the latter disorder. AIM: We aimed to assess the differences in abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in the blood plasma of schizophrenia patients compared to healthy controls. METHODS: We measured the abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in a cohort of 82 patients with schizophrenia and 138 controls without a psychiatric diagnosis and validated the results using an independent cohort of 26 patients with schizophrenia, 55 control individuals, and 19 patients experiencing a first psychotic episode. RESULTS: We found significant alterations for all three ceramide species Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) and a particularly strong difference in concentrations between psychiatric patients and controls for the ceramide species Cer(d18:1/18:0). CONCLUSIONS: The alteration of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) levels in the blood plasma might be a manifestation of metabolic abnormalities common to both schizophrenia and cardiovascular disease.

Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden

Introduction Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms. Methods Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment. Results The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses. Conclusions In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity. Policy Implications The study findings underline the need for individualized care and flexible gender affirming treatment options. The role of somatic comorbidities should be further explored, and support should be offered to transgender people in need. There is an unmet need for facial surgery among aM.

Somatic Implications in Hospitalized Patients with Chronic Schizophrenia

Schizophrenic patients have a life expectancy shorter than that of the general population. The multisystemic implication of the psychotic disease is evidenced by the high prevalence of somatic comorbidities associated with the illness. Patients with schizophrenia have a higher risk to develop somatic comorbidities due to their lifestyle changes, medication intake and poor medical assistance. We conducted a retrospective descriptive study in order to determine the prevalence of certain somatic conditions associated with schizophrenia as well as the characteristics of this particular group of patients.

Epilepsy and COVID-19: predictors of a positive outcome in patients with epilepsy (based on analysis of clinical cases)

Background. Many patients with neurological disorders have an increased risk of infection and the severe course of COVID-19. Studies on positive predictors of seizure outcomes with the 2019 novel coronavirus disease remain limited.The objective is to study predictors for positive health outcomes after COVID infection in patients with epilepsy based on analysis of clinical observations.Design and Methods. Study design - the work is a part of a prospective observational study of seizure dynamics after COVID infection in patients with epilepsy.Results. The presented clinical observation demonstrates a positive health outcome after COVID infection in a young patient with the genetic generalized epilepsy with sustained clinical and electroencephalographic seizure remission on the next generation AED monotherapy (brivaracetam).Conclusion. Predictors for positive health outcome after the 2019 novel coronavirus disease in patients with epilepsy include a young age, absence of somatic comorbidities, seizure remission, modern drug use with no interaction among AEDs and antibiotics and antivirals for the coronavirus disease treatment. Despite the encouraging data on the favourable course of epilepsy in cases of developing COVID-19, further research is needed to continue.

How Do Persons with Young and Late Onset Dementia Die?

Background: End of life symptoms and symptom management as well as the quality of dying (QoD) of persons with advanced dementia (PWAD) have not yet been systematically studied in Germany. Objective: 1) To investigate symptoms, treatment and care at the end of life, advance care planning, and circumstances of death of recently deceased PWAD; 2) To determine whether there are differences between young and late onset dementia (YOD and LOD). Methods: The study was performed in the context of the project EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of Young-onset and Late-Onset dementia in Germany). Closest relatives of recently deceased patients with advanced YOD (N = 46) and LOD (N = 54) living at home or in long term care were interviewed. Results: Circumstances of death, symptoms, and treatment appeared to be similar between YOD and LOD, except that persons with LOD had significantly more somatic comorbidities and were admitted to hospital in the last three months of life more often than persons with LOD. At end of life, 60%of PWAD appeared to be “at peace”. Difficulty swallowing, gurgling, shortness of breath, and discomfort were observed most frequently. Large interindividual differences in suffering and QoD were present. Determinants of QoD were not identified. Conclusion: Our findings suggest that low QoD was caused by inadequate recognition and/or insufficient treatment of burdensome physical and emotional symptoms. PWADs’ needs should be assessed regularly, and strategies focusing on treatment and implementing support for both the patient and caregiver must be established.

Somatic Comorbidities and Cardiovascular Safety in Ketamine Use for Treatment-Resistant Depression

Background and Objectives: There is evidence for ketamine efficacy in treatment-resistant depression (TRD). Several safety and tolerability concerns arise that some psychotropic agents may provide blood pressure or/and heart rate alterations. The aim of this study is to review blood pressure measurements in course of the treatment with ketamine on treatment refractory inpatients with somatic comorbidities in the course of MDD and BP. Materials and Methods: The study population of 49 patients comprised MDD and BP subjects treated with ketamine registered in the naturalistic observational protocol of treatment-resistant mood disorders (NCT04226963). Results: The conducted analysis showed that among people suffering from hypertension there is a higher increase in systolic blood pressure (RR) after infusion 2 (p = 0.004) than among people who do not suffer from hypertension. Patients with hypertension have a higher increase in diastolic RR compared to those not suffering from hypertension (p = 0,038). Among the subjects with diabetes mellitus, significant differences occurred for infusions 2 (p = 0.020), 7 (p = 0.020), and 8 (p = 0.035) for heart rate (HR), compared to subjects without diabetes mellitus. A higher increase in diastolic RR was noted in the group of subjects suffering from diabetes mellitus (p = 0.010) compared to those who did not. In the hyperlipidemic patients studied, a significantly greater decrease in HR after infusion 5 (p = 0.031) and systolic RR after infusion 4 (p = 0.036) was noted compared to nonpatients. People after a stroke had significantly higher increases in diastolic RR after infusions 4 (p = 0.021) and 6 (p = 0.001) than those who did not have a stroke. Patients suffering from epilepsy had a significantly greater decrease in systolic RR after the 8th infusion (p = 0.017) compared to those without epilepsy. Limitations: The study may be underpowered due to the small sample size. The observations apply to inhomogeneous TRD population in a single-site with no blinding and are limited to the acute administration. Conclusions: This study supports evidence for good safety and tolerability profile for short-term IV ketamine use in TRD treatment. However, risk mitigation measures are to be considered in patients with metabolic and cardiovascular comorbidities.

Decades Changes in Prevalence of Disability and Comorbidities’Impact on Elderly with Diabetic in China: Multivariate Decomposition Analysis of Chinese Longitudinal Healthy Longevity Survey Data

Background: In China, the prevalence of diabetes is increasing and the prevalence of disability in the elderly population is decreasing. However, few studies have analyzed the change of ADL or IADL disability and the influence of comorbidity in elderly patients with diabetes in China using national data. Methods: Based on data from Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018, this study not only explored the trend of Chinese elderly prevalence of diabetes and disability but using multivariate decomposition method analyzed the influence of comorbidity in patient’s disability with diabetes between 2008 and 2018. Results: The prevalence of diabetes among the elderly in China increased from 4.2 percent in 2008 to 13.5 percent in 2018, with a larger increase among women, and the prevalence of diabetes in the elderly was lower than that in the younger age group. For older adults with diabetes, the estimated likelihood of ADL having at least one difficulty decreased from 8.3 percent in 2008 to 6.3 percent in 2018. The proportion of women with diabetes with at least one difficulty in IADL increased and decreased in men. The decrease of underweight contributed the most to the decrease of ADL and IADL in men, accounting for 52.8% and 61.4%, respectively. The decrease in the proportion of somatic comorbidities, underweight, and negative emotions was associated with a decrease in the likelihood of having at least one difficulty in ADL in women with diabetes (14.8%, 23.8%, and 30.3%, respectively). Comorbidities had no significant effect on the increased probability of women having at least one difficulty with IADL. Conclusions: Although the prevalence of diabetes in older Chinese adults increased over time, the proportion of male and female adults with at least one difficulty in IADL decreased over time, except for a slight increase in the proportion of female adults in IADL. The proportion of underweight and negative emotion in diabetic patients showed a decreasing trend, which to a certain extent inhibited the negative impact of the increase in the prevalence of somatic comorbidities and elderly disability. The results of this study partially support the "dynamic equilibrium" hypothesis of diabetes incidence. Keywords: Comorbidities in diabetic, Disability, Multivariate decomposition method, Dynamic equilibrium