Epilepsy in NF1: Epidemiologic, Genetic, and Clinical Features. A Monocentric Retrospective Study in a Cohort of 784 Patients

An increased lifetime risk of epilepsy has been reported in neurofibromatosis type 1 (NF1) patients, ranging between 4% and 14%. To further analyze the correlation between NF1 and epilepsy, we retrospectively reviewed the epidemiologic, clinical, radiological, and molecular data of 784 unselected patients diagnosed with NF1 and referred to the neurofibromatosis outpatient clinics at the University Hospital of Padua. A crude prevalence of epilepsy of 4.7% was observed. In about 70% of cases, seizures arose in the context of neuroradiological findings, with the main predisposing factors being cerebral vasculopathies and hydrocephalus. In the absence of structural abnormalities, the prevalence of epilepsy was found to be 1.27%, which is approximately equal to the total prevalence in the general population. NF1 patients with seizures exhibit a higher incidence of intellectual disability and/or developmental delay, as well as of isolated learning disabilities. The comparison of causative NF1 mutations between the two groups did not reveal a specific genotype–phenotype correlation. Our data refine the current knowledge on epileptological manifestations in NF1 patients, arguing against the hypothesis that specific mechanisms, inherent to neurofibromin cellular function, might determine an increased risk of epilepsy in this condition.

Changing the landscape of stroke in Egypt

Egypt, a low–middle-income country, is the most populated nation in the Middle East. In Egypt, the overall crude prevalence rate of stroke is high (963/100,000 inhabitants), and the incidence of stroke annually is approximately 150 000 to 210 000. The official national statistics indicate that diseases of the circulatory system, including stroke, are the primary cause of death in Egypt, where stroke accounts for 6.4% of all deaths and ranks third after cardiovascular and gastrointestinal diseases. Although the number of deaths attributed to stroke have declined in many countries, in Egypt, it was relatively unchanged in the past 10 years.

Seroconversion following the first, second, and third dose of SARS-CoV-2 vaccines in immunocompromised population; A systematic review and meta-analysis

Background: Immunocompromised (IC) patients are at higher risk of more severe COVID-19 infections than the general population. Special considerations should be dedicated to such patients. We aimed to investigate the efficacy of COVID-19 vaccines based on the vaccine type and etiology as well as necessity of booster dose in this high-risk population.Materials and methods: We searched PubMed, Web of Science, and Scopus databases for observational studies published between June 1st, 2020, and September 1st, 2021, which investigated the seroconversion after COVID-19 vaccine administration in adult patients with IC conditions. For investigation of sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. Statistical analysis was performed using R software.Results: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 81 articles in the meta-analysis. The overall crude prevalence of seroconversion after the first (n: 7,460), second (n: 13,181), and third (n: 909, all population were transplant patients with mRNA vaccine administration) dose administration was 26.17% (95% CI: 19.01%, 33.99%, I2= 97.1%), 57.11% (95% CI: 49.22%, 64.83%, I2= 98.4%), and 48.65% (95% CI: 34.63%, 62.79%, I2= 94.4%). Despite the relatively same immunogenicity of mRNA and vector-based vaccines after the first dose, the mRNA vaccines induced higher immunity after the second dose. Regarding the etiologic factor, transplant patients were less likely to develop immunity after both first and second dose rather than patients with malignancy (17.0% vs 37.0% after first dose, P=0.02; 38.3% vs 72.1% after second dose, P<0.001) or autoimmune disease (17.0% vs 36.4%, P=0.04; 38.3% vs 80.2%, P<0.001). To evaluate the efficacy of the third dose, we observed an increasing trend in transplant patients after the first (17.0%), second (38.3%), and third (48.6%) dose.Conclusion: The rising pattern of seroconversion after boosting tends to be promising. In this case, more attention should be devoted to transplant patients who possess the lowest response rate.

795. A Bayesian Spatial-temporal Modelling Approach for Prevalence Estimation of a VRE Outbreak in a Tertiary Care Hospital

Background There was a nosocomial outbreak of vancomycin-resistant enterococci (VRE) in our hospital group from 2018-19. The goals of the study were to describe the prevalence trajectory and explore risk factors associated with putative room colonization during the outbreak. Methods We performed a room centric analysis of 12 floors (floors F to R, 264 rooms) of the main bed tower of the hospital, including data on 37’458 patients (23’050 person weeks) over the 104 week period. Patients were assumed to be colonized in the week prior to their first positive test, and thereafter throughout the remainder of their stay until discharge. Poisson Bayesian Hierarchical models were fitted to estimate prevalence per room, including both spatial (conditional autoregressive) and temporal (random walk) random effects terms. Model M1 estimated prevalence for each floor and then used meta-analysis to combine the estimates, whereas model M2 estimated prevalence for “all-floors” simultaneously. Results The oncology department, where the outbreak was thought to have started, experienced slightly higher prevalence (floors O and R; adjusted incidence rate ratio (aIRR) 4.8 [2.6, 8.9], p&lt; 0.001; reference is general medicine; see Figure Panel A), as did both the cardiac surgery (floors G, N, O; aIRR 3.8 [2.0, 7.3], p&lt; 0.001) and abdominal surgery departments (floors H and Q; 3.7 [1.8, 7.6], p&lt; 0.001). There was no discernible difference in prevalence between floors with single and multiple department occupancy. Furthermore, departments spread across multiple floors had similar prevalence on all constituent floors – perhaps indicating transmission by people or devices moving between floors. The “single floor meta-analysis” model (M1) more closely followed the estimated trajectory for the crude prevalence, whereas the “all floors” model (M2) dampened the amplitude of the peaks somewhat, but better estimated periods of low prevalence (Figure Panel B). Figure: Estimates from the Bayesian Hierarchical Models Panel A. Random effect prevalence estimates for each floor (from model M2). Panel B. Crude prevalence (black) and estimates from the “single floor meta-analysis” approach (M1, dashed red) with 95% credible intervals shaded (shaded red), and “all-floors” model (M2, blue ). Conclusion We applied a room centric approach that took into account spatial and temporal dependencies apparent in the nosocomial VRE outbreak. Despite additional complexity, Bayesian Hierarchical Models provide a more flexible platform for studying transmission dynamics and performing hypothesis testing, compared to more traditional methods. Disclosures All Authors: No reported disclosures

Prevalence of type 2 diabetes by age, sex and geographical area among two million public assistance recipients in Japan: a cross-sectional study using a nationally representative claims database

BackgroundRecognising the importance of the social determinants of health, the Japanese government introduced a health management support programme targeted at type 2 diabetes (T2D) for public assistance recipients (PAR) in 2018. However, evidence of the T2D prevalence among PAR is lacking. We aimed to estimate T2D prevalence by age and sex among PAR, compared with the prevalence among health insurance enrollees (HIE). Additionally, regional differences in T2D prevalence among PAR were examined.MethodsThis was a cross-sectional study using 1-month health insurance claims of both PAR and HIE. The Fact-finding Survey data on Medical Assistance and the National Database of Health Insurance Claims data were used. T2D prevalence among PAR and HIE were assessed by age and sex, respectively. Moreover, to examine regional differences in T2D prevalence of inpatients and outpatients among PAR, T2D crude prevalence and age-standardised prevalence were calculated by prefecture. Multilevel logistic regression analysis was also conducted at the city level.ResultsT2D crude prevalence was 7.7% in PAR (inpatients and outpatients). Among outpatients, the prevalence was 7.5% in PAR and 4.1% in HIE, respectively. The mean crude prevalence and age-standardised prevalence of T2D (inpatients and outpatients) among 47 prefectures were 7.8% and 3.9%, respectively. In the city-level analysis, the OR for the prevalence of T2D by region ranged from 0.31 to 1.51.ConclusionThe prevalence of T2D among PAR was higher than HIE and there were regional differences in the prevalence of PAR. Measures to prevent the progression of diabetes among PAR by region are needed.

1325Longitudinal epidemiology of MS in the Greater Hobart region, 1961 to 2019

Background The Greater Hobart region (42.3°S) of Tasmania has the highest frequencies of MS in Australia, this consistent across studies conducted over the last half century. However, the degree of excess compared to mainland sites like Newcastle (32.5°S) has declined over time. Methods Cases were recruited from clinic-based samples and other multiple other data sources. Prevalence date was 1 June 2019. 2019 prevalence and 2009-19 incidence and mortality rates were estimated. Prevalence and incidence and mortality rates were age/sex-standardised to the 1961 and 1954 Hobart populations, respectively, to allow longitudinal comparisons. Female:male prevalence and incidence sex-ratios were also assessed. Differences between timepoints were assessed using Poisson regression. Results 472 MS cases (female:71.4%) resident on prevalence day were identified, a crude prevalence=212.3/100,000 (155.8 age/sex-standardised), 57% increase vs 2009 and 388.0% vs 1961. The 2009-19 incidence rate=7.56/100,000 person-years (7.03 age/sex-standardised), 91% increase vs 2001-9 and 218.1% vs 1951-61. The 2009-19 mortality rate was 2.25/100,000 person-years (1.12 age/sex-standardised), comparable to 2001-9 (1.00). The age/sex-standardised prevalence-sex-ratio was 2.61, comparable to 2009 (2.65), but the incidence-sex-ratio was 2.68, 31% increase vs 2001-9 (2.05). Conclusions Prevalence and incidence continue to be high in Hobart, although the differences compared to lower-latitude Newcastle have attenuated significantly. Changes in lifestyle may underlie the deterioration of the latitudinal gradient of MS in Australia. Further investigation is required to define the factors that drive these associations. Key messages MS prevalence and incidence are still highest in Australia in southern Tasmania but the latitudinal variation is declining.

Trends and Patterns of Knee Osteoarthritis in China: A Longitudinal Study of 17.7 Million Adults from 2008 to 2017

Background: Knee osteoarthritis (KOA) provides many challenges on the healthcare system. However, few studies have reported the epidemiology, particularly in a large population. Our study aimed to estimate the prevalence, incidence, trends, and patterns of diagnosed KOA in China. Methods: This was a longitudinal study. We used health insurance claims of 17.7 million adults from 2008–2017 to identify people with KOA. Trends in prevalence and incidence were analyzed using joinpoint regression. Results: We identified 2,447,990 people with KOA in Beijing, 60% of which were women. The 10-year average age-standardized prevalence and incidence of KOA was, respectively, 4.6% and 25.2 per 1000 person-years. Prevalence increased with age, surging after 55 years old. The average crude prevalence was 13.2% for people over 55 years old. The prevalence showed an increasing trend from 2008 to 2017, including a period of rapid rise from 2008 to 2011 (p < 0.05); the increase in prevalence was greatest in people under 35 years old (p < 0.05). Conclusion: Our analyses showed that the annual prevalence rate of KOA increased significantly from 2008 to 2017 in China. We need to increase our attention to women and the elderly over 55 years old, and also be alert to the younger trend of incidence of KOA.

Epidemiology of Parkinson’s Disease in Chile

<b><i>Introduction:</i></b> Parkinson’s disease (PD) is one of the most common neurodegenerative disorders. There is no epidemiological description of PD in Chile and not many descriptions in Latin America. This study aims to describe the incidence and prevalence of PD in Chile. <b><i>Methods:</i></b> The study group was the population on the public health system in Chile between 2010 and 2018 that were registered in the GES system as having PD. Crude and standardized prevalence and incidence were calculated with a 95% confidence interval. <b><i>Results:</i></b> 33,345 patients were found in the register as confirmed cases with PD. The crude incidence in 2018 was 23.7/100,000; the crude prevalence in 2018 was 160.7/100,000. The male-to-female ratio was 1.03. <b><i>Conclusion:</i></b> The prevalence and incidence observed in the Chilean population are consistent with studies from other countries.

Ethnic differences in prevalence of actionable HbA1c levels in UK Biobank: implications for screening

IntroductionEarly detection and treatment of diabetes as well as its prevention help lessen longer-term complications. We determined the prevalence of pre-diabetes and undiagnosed diabetes in the UK Biobank and standardized the results to the UK general population.Research design and methodsThis cross-sectional study analyzed baseline UK Biobank data on plasma glycated hemoglobin (HbA1c) to compare the prevalence of pre-diabetes and undiagnosed diabetes mellitus in white, South Asian, black, and Chinese participants. The overall and ethnic-specific results were standardized to the UK general population aged 40–70 years of age.ResultsWithin the UK Biobank, the overall crude prevalence was 3.6% for pre-diabetes, 0.8% for undiagnosed diabetes, and 4.4% for either. Following standardization to the UK general population, the results were similar at 3.8%, 0.8%, and 4.7%, respectively. Crude prevalence was much higher in South Asian (11.0% pre-diabetes; 3.6% undiagnosed diabetes; 14.6% either) or black (13.8% pre-diabetes; 3.0% undiagnosed diabetes; 16.8% either) participants. Only six middle-aged or old-aged South Asian individuals or seven black would need to be tested to identify an HbA1c result that merits action.ConclusionsSingle-stage population screening for pre-diabetes or undiagnosed diabetes in middle-old or old-aged South Asian and black individuals using HbA1c could be efficient and should be considered.

Prevalence and causes of vision impairment in Norwest Portugal: a capture and recapture study

Aim: The aim of this study was to estimate the prevalence and causes of vision impairment (VI) in the Norwest of Portugal. Methods: Information about people with VI was obtained from different sources in the Norwest of Portugal during a period spanning years 2014-2015. Log-linear models were applied to estimate the number of individuals missing from lists of cases obtained from Primary Care Centres, blind association (ACAPO) and from hospitals (the PCVIP-study). Log-linear models were used to estimate the crude prevalence and the category specific prevalence of VI. Causes of VI were obtained from the PCVIP-study. Results: Crude prevalence of VI was 1.97% (95%CI=1.56-2.54), and normalized prevalence was 1% (95%CI=0.78-1.27). The age-specific prevalence was 3.27% (95% CI,=2.36-4.90), older than 64 years, 0.64% (95%CI=0.49-0.88), aged 25-64 years, and 0.07% (95%CI=0.045-0.13), aged less than 25 years. Prevalence amongst females was 1.3x higher than amongst males. The five leading causes of VI were Diabetic Retinopathy, Cataract, Age-related Macular Degeneration, Glaucoma and Disorders of the Globe. Conclusion: The prevalence of VI in Portugal was within the expected range and in line with other European countries. A significant number of cases of VI might be due to preventable cases and, therefore, a reduction of the prevalence of VI in Portugal seems possible. Women and old people were more likely to have VI and, therefore, these groups require extra attention. Future studies are necessary to characterize temporal changes in prevalence of VI in Portugal.