Clinical Characteristics Of Young Adults Research Articles

Coronary lesions suggestive of kawasaki disease in young patients presenting with acute myocardial infarction

Abstract Background Approximately 25% of patients with untreated Kawasaki disease (KD) in childhood develop coronary aneurysms, which represent a higher likelihood for the occurrence of acute myocardial infarction (AMI) in young adults. Although the clinical characteristics of young adults with KD and suspected ischemia have been studied, the available data about suggestive lesions of KD in AMI is scarce. Purpose To describe the prevalence, clinical characteristics and in-hospital mortality of young adults with AMI and coronary artery lesions suggestive of KD. Methods We conducted a retrospective study of consecutive ≤40-year old patients hospitalized with AMI and coronary angiography in a coronary care unit of a Mexican teaching hospital between 2006–2020. Patients were classified according to the presence or absence of suggestive lesions of KD sequelae such as proximal aneurysms, larger size and normal distal segments Results There were included 488 patients of 40 years of age and younger, diagnosed with AMI, in whom a coronary angiography was performed. Among them, 44 patients (9%) showed coronary aneurysm or ectasia, within this group, 16 patients (36.3%) had angiographic lesions compatible with KD. The patients were classified according to the type of coronary lesions: Angiographic lesions compatible with KD, 3.3% (n=16); Diffuse coronary artery ectasia (CAE), 5.7% (n=28); and Obstructive coronary disease (OCD), 91% (n=444). The prevalence of smoking, dyslipidemia, and hypertension were similar between the groups, whereas a history of diabetes was absent in KD patients (0%, 10.7%, and 22.1% for KD, CAE and OCD, respectively; P=0.04). At admission, ST-elevation myocardial infarction was more frequent in patients with KD (81.3%, 75%, and 67.1% for KD, CAE and OCD, respectively; P=0.35). More than half of patients with KD had coronary aneurysms in two or more vessels. The right coronary artery was the most commonly affected artery followed by the left anterior descending artery and left circumflex coronary artery (87.5%, 56.3% and 56.3%, respectively). The presence of intracoronary thrombus identified at the time of angiography was more frequent in patients with KD (62.5%, 60.7% and 44.1% for KD, CAE and OCD, respectively; P=0.09). Overall, unadjusted in-hospital mortality was 3.9% and there were no deaths in the KD group (0%, 0% and 4.3% for KD, CAE, and OCD, respectively; P=0.37). Conclusion In young patients with AMI, the sequelae of KD should be considered as a possible etiology, based on their angiographic characteristics. To bear in mind the nature of the pathogenesis is crucial to assess medical and interventional management strategies, which are not well defined yet, in order to evaluate cardiovascular risk and optimize a patient-tailored treatment, which could differ from the treatment of atherosclerotic coronary artery disease Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Cross-sectional Study on MyocardialInfarction in Young Adults in an EmergencyDepartment of a Rural Tertiary Care Hospital, Davanagere,Karnataka, India

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young has been increasing globally. Research in this population has been limited in developed countries or urban areas in developing countries. Identifying the various epidemiologic features in this age group is crucial to understand the disease. Aim: To describe the clinical characteristics of young adults presenting with ACS in a rural tertiary care hospital. Materials and Methods: This cross-sectional study included 50 patients diagnosed with ACS. Data were collected from consecutive patients between the ages of 18 to 45 years diagnosed with ACS between January 2014 to January 2015 in the Emergency Medicine Department of a tertiary care hospital in Davanagere, India. Data were collected on demographic characteristics, risk factors, laboratory tests, and angiographic findings. Range, mean and percentages were calculated for continuous and categorical variables, respectively. A 95% confidence intervals were calculated for all variables. Results: The mean age was 38.1±5.8 years with male preponderance 46 (92%). Risk factors were smoking 36 (72%), diabetes 17 (34%), hypertension 6 (12%) and Body Mass Index (BMI) >23 kg/m2, 36 (72%). Anterior Wall Myocardial Infarction (AWMI) was observed in 35 (70%) of subjects with angiography revealing Single Vessel Disease (SVD) 28 (56%), Double Vessel Disease (DVD) 5 (10%), Triple Vessel Disease (TVD) 3 (6%) and Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) 11 (22%). Three patients died during their course of treatment before initiating an interventional procedure. Conclusion: Smoking, diabetes mellitus and elevated BMI are associated with ACS among young patients. Interventions targeting these risk factors among younger individuals should be developed.

Estimated glucose disposal rate demographics and clinical characteristics of young adults with type 1 diabetes mellitus: A cross-sectional pilot study.

Background:Estimated glucose disposal rate (eGDR) is a practical measure of Insulin Resistance (IR) which can be easily incorporated into clinical practice. We profiled eGDR in younger adults with type 1 diabetes mellitus (T1DM) by their demographic and clinical characteristics.Methods:In this single centre study, medical records of TIDM were assessed and eGDR tertiles correlated with demographic and clinical variables.Results:Of 175 T1DM individuals, 108 (61.7%) were males. Mean age (±SD) was 22.0 ± 1.6 years and median time from diagnosis 11.0 years (range 1–23). Individuals were predominantly Caucasian (81.7%), with 27.4% being overweight (BMI: 25–30 kg/m2) and 13.7% obese (BMI > 30 kg/m2). Mean total cholesterol (TC) levels were significantly lower in high and middle eGDR tertiles (4.4 ± 1 and 4.3 ± 0.8 mmol/l, respectively) compared with low eGDR tertile (4.8 ± 1, p < 0.05 for both). Triglyceride (TG) levels showed a similar trend at 1.1 ± 0.5 and 1.1 ± 0.5 mmol/l for high and middle eGDR tertile compared to low eGDR tertile (1.5 ± 1 mmol/l, p < 0.05 for both). Renal function was similar across eGDR tertiles and no difference in retinopathy was detected.Conclusion:TC and TG are altered in individuals with T1DM and low eGDR, suggesting that this subgroup requires optimal lipid management to ameliorate their vascular risk.

The effect of base‐in prism on vision‐related symptoms and clinical characteristics of young adults with convergence insufficiency; a placebo‐controlled randomised clinical trial

The aim of the present study was to evaluate the effect of base-in prism on symptoms and clinical characteristics of young adults with convergence insufficiency. In this randomised clinical trial, 64 CI patients aged 18-38years who presented to Bina Eye Hospital, Tehran, Iran between November 2018 and April 2019 were selected and randomly assigned to either prism or placebo groups. All participants underwent complete optometric examinations, including the measurement of visual acuity, objective and subjective refraction, and complete accommodative and binocular vision examinations. Clinical examinations were repeated after three months. The overall score of the Convergence Insufficiency Symptom Survey (CISS) was considered as the primary outcome measure. Secondary outcome measures included near exophoria, positive fusional vergence at near, near point of convergence, vergence facility, monocular accommodative facility, accommodative response, negative relative accommodation and accommodative convergence/accommodation (AC/A) ratio. The mean (S.D.) age of the participants was 25.5 (5.5) years and 44% of them were male. The mean CISS score was significantly lower in the prism group compared to the placebo group in the outcome examination (p<0.001). Moreover, the values of monocular accommodative facility, accommodative response, and negative relative accommodation were significantly higher in the prism group versus the placebo group (p<0.001). There was no significant difference in other parameters, including near positive fusional vergence, near point of convergence, vergence facility, and AC/A ratio between the two groups in the outcome examination (p>0.10). The base-in prism reduced symptoms in young adults with convergence insufficiency, while it had no significant effect on the near point of convergence, near positive fusional vergence, vergence facility and AC/A ratio. However, the results of this study only supports the symptomatic effectiveness of prism in the short term and further studies are needed to assess the long-term effect of prism.

Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe

BackgroundFetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.ObjectiveTo describe the clinical characteristics of young adults with...

Biopsychosocial model of resilience in young adults with multiple sclerosis (BPS-ARMS): an observational study protocol exploring psychological reactions early after diagnosis

IntroductionMultiple sclerosis (MS), the most common neurological disease causing disability in young adults, is widely recognised as a major stress factor. Studies have shown that the first years after the...

Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention

BackgroundLimited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Methods and resultsBetween 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m2. The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08–19.1, p=0.04) for young adults. ConclusionCurrent smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese.

EPA-1693 – Childhood maltreatment and young adult psychopathology: is gender relevant?

Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for multiple psychiatric diagnoses. This may mean that childhood maltreatment increases vulnerability to a great number of specific psychiatric disorders through diverse and specific mechanisms or that childhood maltreatment engenders a generalised liability to dimensions of psychopathology. Gender differences have been suggested to play a role in this associations. To compare demographic and clinical characteristics of young adults with history of childhood maltreatment admitted to a psychiatric unit, according to gender. To delineate the impact of gender on the psychopathology of young adults submitted to childhood maltreatment. Retrospective data of patients aged 15 and 23 and admitted to a psychiatric outpatient unit, from December 2010 and December 2013, were reviewed. The demographic and clinical characteristics of the two genders were compared. Childhood maltreatment was associated with elevated odds of mood, anxiety and drug disorders in both genders, but gender differences emerged with physical abuse associated only with externalising liability in men, and only with internalising liability in women. There were no gender differences in age of onset. C hildhood maltreatment have gender-specific consequences for the expression of psychopathology, suggesting gender-specific aetiological pathways between maltreatment and psychopathology.

Diastolic blood pressure is the first to rise in association with early subclinical obstructive sleep apnea: lessons from periodic examination screening

Background Obstructive sleep apnea syndrome (OSAS) is associated with long-term cardiovascular morbidity. Little is known about these relations at early stages. We conducted a case-control study in which we analyzed the clinical characteristics of young adults who underwent a periodic health examination and were screened for, and eventually found to experience, OSAS. Methods We identified 121 subjects newly diagnosed in a sleep study as having OSAS, and 229 matched control subjects in which screening for OSAS was negative. All had a medical interview, physical examination, and routine laboratory tests. Results Subjects who had OSAS had a higher, body mass index (3-kg/m 2 difference) and a higher diastolic blood pressure (4–mm Hg difference) value, without elevation in systolic blood pressure. There was no metabolic difference (lipids profile and fasting glucose levels) between groups. Conclusions Diastolic blood pressure is higher early in the course of OSAS. Long term follow-up may determine effects of prevention and early intervention in OSAS and associated hypertension.

Substance Abuse Treatment Characteristics of Probation‐Referred Young Adults in a Community‐Based Outpatient Program

Although rates of substance abuse continue to rise among young adults ages 18–25, there is little information on the clinical characteristics of young adults referred to treatment, their readiness to change substance use behaviors, and treatment outcomes. These aspects were examined in young (18–25 years old) and older adult (26–45 years old) substance abusers entering treatment at a large, urban, outpatient substance abuse treatment facility. All clients were referred for outpatient treatment by the local Offices of Adult Probation during 1998–1999. The demographic and substance use characteristics, motivation level/readiness to change substance use behaviors, treatment attendance, completion, and “drug‐free” status based on patient self‐report and urine/breathalyzer data were assessed. Results. Substance‐abusing young adult probationers were more likely to be African‐American, with a significantly earlier age of onset of primary substance use. They were more likely to have a marijuana use disorder as compared with older adults, who in turn, were more likely to meet criteria for alcohol use disorders. Furthermore, as compared with older adults, young adults had significantly higher scores on precontemplation, and significantly lower scores on contemplation, determination, action, and maintenance subscales of motivation/change readiness. A significantly higher number of young adults did not complete outpatient treatment and were “drug‐positive” at discharge, as compared with older adults. Conclusions. Young adult probationers referred to substance abuse treatment show significantly different substance abuse and treatment characteristics as compared with their older adult counterparts. The findings suggest that specialized treatment approaches that focus on enhancing treatment readiness and motivation to change substance use behaviors may be of particular benefit to substance abusing young adults.