Diagnosis Of People Research Articles

Is alcohol use disorder associated with higher rates of depression and anxiety among people with new onset type 2 diabetes? A cohort study using linked primary care data in England

IntroductionDepression and alcohol use disorder (AUD) in people living with Type 2 diabetes mellitus (T2DM) are associated with worse health outcomes. AUD is strongly associated with depression and anxiety, but it is not known how these conditions cluster in people with T2DM. We investigated rates of new episodes of depression and anxiety following T2DM diagnosis in people with and without prior AUD among an English primary care population.MethodsThe study population was people diagnosed with T2DM between 2004 and 2019. We used the Clinical Practice Research Datalink (CPRD) Aurum database and linked Hospital Episode Statistics Admitted Patient Care (HES APC) and Office for National Statistics (ONS) mortality data. We examined incidence of new episodes of anxiety or depression in people with T2DM with and without AUD. AUD was defined as any of i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm (physical or mental) using SNOMED-CT or ICD-10 codes. People were excluded if they had codes for depression/anxiety 12 months prior to T2DM diagnosis. Poisson regression models were fitted adjusting sequentially for a) age, gender, calendar time; b) region, Index of Multiple Deprivation, ethnicity, body mass index, smoking status, Charlson co-morbidity index; and c) history of a mental health condition.ResultsOur study population was 479,447 people of whom 10,983 (2.3%) had an AUD code prior to T2DM diagnosis.After adjusting for all measured confounders except history of a mental health condition, IRR for depression was 2.00 (95% CI 1.93, 2.06) for people with AUD compared to without AUD. This reduced to 1.45 (95% CI 1.41, 1.50) after further adjustment for history of a mental health condition.Findings for anxiety were substantially similar to those for depression (adjusted for all measured confounders except history of a mental health condition, IRR 2.08 95% CI 1.99, 2.18 fully adjusted IRR 1.48 95% CI 1.41, 1.55).ConclusionsPeople with AUD have over double the rates of depression and anxiety following T2DM diagnosis than those without AUD. This was only partially explained by pre-existing diagnoses of mental health conditions. A holistic approach incorporating mental health support is needed to improve health outcomes for people with AUD who develop T2DM.Trial registrationNot applicable.

Nutritional diagnoses in people with type 2 diabetes: association with metabolic, anthropometric, and dietary parameters.

Nutritional diagnosis involves identifying a nutritional problem, its cause, and the signs that indicate it to guide appropriate treatment. Few studies report on the most prevalent nutritional diagnoses in people living with type 2 diabetes (T2D). To define nutritional diagnoses across different domains and their association with metabolic, anthropometric, and dietary parameters in individuals with T2D. A personalized nutritional intervention was conducted using the Nutrition Care Process (NCP) model, which encompasses assessment, diagnosis, intervention, and evaluation, utilizing standardized terminology from the Nutrition Care Process Terminology (NCPT). Two dietitians, trained and standardized in applying the NCP and NCPT, performed patient assessments and established the diagnoses. Patients over 18 years old with a diagnosis of T2D for less than 5 years were included. Data from 2,050 patients were analyzed, of whom 55.3% were women, and 44.7% were men, with a median age of 57 and 54 years, respectively. The most prevalent nutritional diagnosis was excessive energy and carbohydrate intake. Diagnoses were distributed across domains: Intake (55.9%), Behavioral/Environmental (32.7%), Clinical (10.2%), and 1.2% without nutritional diagnosis. Significant intergroup differences were observed in anthropometric variables such as BMI, waist circumference, and body fat percentage (p < 0.05). HbA1c and glucose levels were significantly higher in the Intake and Behavioral groups (p < 0.001). Albumin/creatinine ratio (ACR) was higher in the ingestion group (p = 0.007). Caloric and carbohydrate intake were higher in the ingestion group, while protein and fat intake were higher in the clinical and behavioral groups (p < 0.001). Nutritional diagnoses in the intake domain, followed by behavioral/ environmental and clinical domains, are highly prevalent in people with T2D and are associated with worse metabolic control, higher BMI, and increased energy and carbohydrate intake. Timely identification of issues in these domains can support targeted nutritional therapy to improve disease management and promote a healthy lifestyle. https://clinicaltrials.gov/study/NCT02836808?term=caipadi&rank=2, Identifier (NCT02836808).

8486 Age at diagnosis in Prader Willi Syndrome (PWS)

Abstract Disclosure: R. Sritharan: None. J. Lodge: None. S. Tadros: None. L. Menzies: None. E.F. Gevers: None. PWS is a complex neurodevelopmental disorder characterised by neonatal hypotonia,failure to thrive, hypothalamic and endocrine dysfunction, behavioural and learning difficulties and hyperphagia. It is caused by absence of expression of paternally imprinted genes on chromosome 15q11-q13. PWS is confirmed by genetic methylation analysis of this region. Most patients with PWS are referred for genetic investigations in the first months of life due to severe hypotonia and/or failure to thrive. However, it is known that some patients are still only diagnosed in adulthood, with resulting missed opportunities for prompt early treatments for PWS, such as growth hormone therapy. Little information is available on age of diagnosis of PWS, and whether opportunities to request genetic investigation are missed in childhood. We therefore aimed to study age at diagnosis of PWS in the UK. To do so, we assessed data as reported to the UK patient association PWSA-UK from 1968-2023, and additionally audited PWS genetic testing by the North Thames Genomics Laboratory Hub from 2019-22. Of 1145 people registered at PWSA as having PWS, 945 had an age of diagnosis recorded. Of these, 254 (28%) were diagnosed over 1 year of age. From March 2021 to Sept 2023, 13 were diagnosed over 1 year of age with a mean age at diagnosis of 9.27 yr (95% CI 4.15 to 14.4) and with 8 patients below 5 years of age. We assessed PWS diagnoses made in blocks of 4 years from 1968, and the number of PWS diagnoses in people over age 1 year in those time blocks. The number of diagnoses in people over 1 year of age appeared to decrease since 1996 to 7 but from 2015 this has been fluctuating. North Thames Genomics Laboratory Hub provides testing for around 10 million people in and around London. Over a 3-year period between 2019-2022, there were 59 requests for PWS testing. 28 of these were positive (a 47% diagnostic yield). 20/28 (71%) of patients were diagnosed under 1 month of age, 7% were diagnosed at 1-24 months of age, 3.5% at 2-5 yrs and 18% at &amp;gt;5 yrs of age (one at age 9, two at age 18, one at age 29 and one at 33 yrs of age). Most tests were performed in children under1 month of age (91% yield), followed by those over 5 yrs of age (30% yield). For 10 individuals, microarray was requested, however methylation studies would have been more appropriate. All patients diagnosed over 5 years of age had hypotonia and were described as hyperphagic and having intellectual disability, and 75% were obese. Patients diagnosed after age 8were described as having neonatal hypotonia and may have been eligible for genetic testing soon after birth. These data suggest that a considerable percentage of patients are diagnosed with PWS after the first year of life in the UK. Further root analysis, interventions, and education is required to reduce age at diagnosis in patients with PWS to allow for optimal management starting in the first few months of life. Presentation: 6/1/2024

Sleep duration in middle-aged years of life predicts the age of diagnosis of Parkinson's disease

IntroductionChronic short sleep duration (i.e., <7 h sleep daily) could reduce the brain's ability to attenuate toxin and protein accumulation, which may contribute to Parkinson's disease (PD). The purpose of this study was to characterize the relationship between self-reported sleep duration from adolescence to adulthood and the age of diagnosis in people with PD. A secondary purpose was to characterize the interaction between sleep duration and physical activity through the lifespan on the age of PD diagnosis. MethodsA secondary data analysis was performed using the Fox Insight data set. Multiple regression analysis was used to determine the age range that sleep duration best predicted the age of diagnosis of PD. Hierarchical linear multiple regression was performed to assess if self-reported sleep duration, physical activity, and their interaction predicted the age of diagnosis for PD, after accounting for sociodemographic factors. ResultsBoth sleep (p < 0.001) and physical activity time (p = 0.013) significantly predicted the of age of onset of PD. In contrast, there was no evidence to support an interaction of sleep by physical activity on the age of diagnosis of PD. Sleep duration at 46–55 years maintained significance after controlling for education, income, race, ethnicity, and sex (p < 0.001). Weekly duration of time spent performing moderate-intensity physical activity was added as an input variable. ConclusionSleep duration significantly predicts the age of diagnosis of PD, with shorter sleep duration associated with a younger age of diagnosis of PD.

Prevalence of sarcopenia among people living with HIV defined by the revised European working group on sarcopenia in older people.

Sarcopenia is a progressive and systemic skeletal muscle disorder associated with an increased risk of hospitalization and adverse effects on survival. This study aims to investigate the prevalence and related risk factors of sarcopenia in people living with HIV using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition. This cross-sectional study comprising 379 patients with confirmed HIV infection evaluated the appendicular skeletal muscle mass by employing the bioelectrical impedance analysis method. Muscle strength and functional mobility were analyzed using the five-time sit-to-stand test and the timed "Up and Go" test. The prevalence rates of pre-sarcopenia and sarcopenia among people living with HIV were 3.4 % and 2.1 % according to the revised EWGSOP2 definition. Advanced age (Odds Ratio 1.07, p = .03), lower body mass index (Odds Ratio 0.79, p = .012) and CD4+ T-cell count below 500/μl (Odds Ratio 2.22, p = .007) were identified as significant factors associated with sarcopenia. Sarcopenia was also identified as a significant correlate of frailty (p < .001). This is the first study examining the prevalence of sarcopenia in people living with HIV according to the revised EWGSOP2 clinical algorithm. Advanced age, lower body mass index and a poor immune status are determined as promoting factors of sarcopenia. Sarcopenia significantly correlates with frailty. Standardized clinical algorithms are essential for reliable sarcopenia diagnosis in people living with HIV in order to promote intervention strategies and to prevent adverse health outcomes.

Reasons for diagnostic delays in Bipolar Disorder: Systematic review and narrative synthesis

BACKGROUND: Bipolar disorder is common, affecting 1% of people. The diagnosis of bipolar disorder is often delayed, which limits access to effective treatment and increases the burden of disease on individuals, families, and society. AIM: This paper investigates the individual, social, and clinical factors that contribute to delays in diagnosis for people with bipolar disorder, including delays that occur before and after a person presents to a primary care clinician. DESIGN AND SETTING: Systematic review and narrative synthesis. METHOD: Four electronic databases - Embase, Medline, PsychInfo, and Global Health - were systematically searched. This search yielded 3078 studies, 21 of which met the inclusion criteria. The data retrieved were analysed using Braun and Clarke’s Thematic Analysis to report a summary of recent research on the delays in the diagnosis of bipolar disorder. RESULTS: Analysis of the data from the 21 studies identified five main themes as reasons for delays in diagnosis: (1) misdiagnosis, (2) healthcare challenges, (3) mental health stigma, (4) the complex nature of bipolar disorder, and (5) individual factors. CONCLUSIONS: The review demonstrates the importance of educating individuals, families, and clinicians on the symptomology of bipolar disorder to avoid misdiagnosis. Furthermore, changes in the accessibility and delivery of mental health services are essential to ensure that people with bipolar disorder are diagnosed and treated in a timely manner. In addition, mental health stigma among individuals, families, and clinicians must be addressed to reduce diagnostic delays.

Accuracy of nine-item Patient Health Questionnaire against psychiatric diagnosis for depression among people with HIV.

The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH). Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d'Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days. Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d'Ivoire, 98 (12.6%) in Kenya, and 103 (13.2%) in Senegal. The area under the curve for PHQ-9 score was generally high ranging from 0.935 [95% confidence interval (CI): 0.893, 0.977] in Cote d'Ivoire to 0.768 (95% CI: 0.589, 0.947) in Congo. However, for the common cut-off score ≥10, sensitivity was low: 50% or lower in Cameroon, Congo and Senegal, 66.7% in Kenya and 70.6% in Cote d'Ivoire. But negative predictive values (NPV) were high: 98.9% (95% CI: 96.9%, 99.8%) in Cameroon, 96.1 (95% CI: 91.1, 98.7) in Cote d'Ivoire, 96.3% (95% CI: 89.7%, 99.2%) in Kenya, 95.7% (95% CI: 90.2%, 98.6%) in Congo, and 89.0% (95% CI: 81.2%, 94.4%) in Senegal. Across all countries, PHQ-9 score ≥10 performed very poorly (low sensitivity) as a tool to identify psychiatrist diagnosed depression. However, the observed high NPV suggests it can be used to rule out depression.

Operational indicators for pulmonary tuberculosis diagnosis in people living with HIV before and after Xpert MTB/RIF implementation in the state of São Paulo, Brazil

Operational indicators for pulmonary tuberculosis diagnosis in people living with HIV before and after Xpert MTB/RIF implementation in the state of São Paulo, Brazil

Progress in lipoarabinomannan antigen detection for tuberculosis diagnosis in people living with HIV/AIDS

Tuberculosis (TB) is the leading cause of death among people living with HIV/AIDS (PLWHA), posing a significant disease burden. Early TB screening in PLWHA is a key intervention to reduce transmission and control disease progression. ​Lipoarabinomannan (LAM) is a glycolipid of Mycobacterium tuberculosis (MTB) that can be detected in the urine of tuberculosis patients. LAM is useful for the rapid and accurate diagnosis of tuberculosis. This article reviews LAM and its application and limitations in the diagnosis of PLWHA, hoping to provide a reference for the diagnosis of tuberculosis in PLWHA.

Age of Alzheimer's disease diagnosis in people with Down syndrome and associated factors: Results from the Horizon 21 European Down syndrome consortium.

People with Down syndrome (DS) have high risk of developing Alzheimer's disease (AD). This study examined mean ages of AD diagnosis and associations with co-occurring conditions among adults with DS from five European countries. Data from 1335 people with DS from the Horizon 21 European DS Consortium were used for the analysis. Mean ages of AD diagnosis ranged between 51.4 (SD 7.0) years (United Kingdom) and 55.6 (SD 6.8) years (France). Sleep-related and mental health problems were associated with earlier age of AD diagnosis. The higher number of co-occurring conditions the more likely the person with DS is diagnosed with AD at an earlier age. Mean age of AD diagnosis in DS was relatively consistent across countries. However, co-occurring conditions varied and impacted on age of diagnosis, suggesting that improvements can be made in diagnosing and managing these conditions to delay onset of AD in DS. Mean age of AD diagnosis was relatively consistent between countries Sleep problems and mental health problems were associated with earlier age of AD diagnosis APOE ε4 carriers were diagnosed with AD at an earlier age compared to non-carriers Number of co-occurring conditions was associated with earlier age of AD diagnosis No differences between level of intellectual disability and mean age of AD diagnosis.

Reasons for diagnostic delays in Bipolar Disorder: Systematic review and narrative synthesis

BACKGROUND: Bipolar disorder is common, affecting 1% of people. The diagnosis of bipolar disorder is often delayed, which limits access to effective treatment and increases the burden of disease on individuals, families, and society. AIM: This paper investigates the individual, social, and clinical factors that contribute to delays in diagnosis for people with bipolar disorder, including delays that occur before and after a person presents to a primary care clinician. DESIGN AND SETTING: Systematic review and narrative synthesis. METHOD: Four electronic databases - Embase, Medline, PsychInfo, and Global Health - were systematically searched. This search yielded 3078 studies, 21 of which met the inclusion criteria. The data retrieved were analysed using Braun and Clarke’s Thematic Analysis to report a summary of recent research on the delays in the diagnosis of bipolar disorder. RESULTS: Analysis of the data from the 21 studies identified five main themes as reasons for delays in diagnosis: (1) misdiagnosis, (2) healthcare challenges, (3) mental health stigma, (4) the complex nature of bipolar disorder, and (5) individual factors. CONCLUSIONS: The review demonstrates the importance of educating individuals, families, and clinicians on the symptomology of bipolar disorder to avoid misdiagnosis. Furthermore, changes in the accessibility and delivery of mental health services are essential to ensure that people with bipolar disorder are diagnosed and treated in a timely manner. In addition, mental health stigma among individuals, families, and clinicians must be addressed to reduce diagnostic delays.

Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Exams for Medical Diagnosis in People With Skin, Neurological, and Pulmonary Diseases: Protocol for a Systematic Review.

Traditional health care systems face long-standing challenges, including patient diversity, geographical disparities, and financial constraints. The emergence of artificial intelligence (AI) in health care offers solutions to these challenges. AI, a multidisciplinary field, enhances clinical decision-making. However, imbalanced AI models may enhance health disparities. This systematic review aims to investigate the economic performance and equity impact of AI in diagnostic imaging for skin, neurological, and pulmonary diseases. The research question is "To what extent does the use of AI in imaging exams for diagnosing skin, neurological, and pulmonary diseases result in improved economic outcomes, and does it promote equity in health care systems?" The study is a systematic review of economic and equity evaluations following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Eligibility criteria include articles reporting on economic evaluations or equity considerations related to AI-based diagnostic imaging for specified diseases. Data will be collected from PubMed, Embase, Scopus, Web of Science, and reference lists. Data quality and transferability will be assessed according to CHEC (Consensus on Health Economic Criteria), EPHPP (Effective Public Health Practice Project), and Welte checklists. This systematic review began in March 2023. The literature search identified 9,526 publications and, after full-text screening, 9 publications were included in the study. We plan to submit a manuscript to a peer-reviewed journal once it is finalized, with an expected completion date in January 2024. AI in diagnostic imaging offers potential benefits but also raises concerns about equity and economic impact. Bias in algorithms and disparities in access may hinder equitable outcomes. Evaluating the economic viability of AI applications is essential for resource allocation and affordability. Policy makers and health care stakeholders can benefit from this review's insights to make informed decisions. Limitations, including study variability and publication bias, will be considered in the analysis. This systematic review will provide valuable insights into the economic and equity implications of AI in diagnostic imaging. It aims to inform evidence-based decision-making and contribute to more efficient and equitable health care systems. DERR1-10.2196/48544.

Exercise and physical activity promotion for people newly diagnosed with Parkinson’s disease: a UK survey exploring current practice and the views of healthcare professionals

ObjectivesExercise and physical activity (PA) are increasingly recognized as important components in the management of Parkinson’s disease (PD). Their promotion at diagnosis is essential for better management of symptoms and overall well-being. Healthcare professionals (HCPs) are pivotal to the promotion of exercise and PA, but there is limited guidance on the content of such interventions. This study describes current practice, and explores views of HCPs around PA and exercise promotion at diagnosis for people with PD (PwP) DesignA cross-sectional study using an anonymous online survey. ParticipantsHCPs working with PwP in the UK. ResultsTwenty-nine doctors, 17 nurses and 106 physiotherapists completed the survey. All nurses, 99% of physiotherapists and 72% of doctors reported that they always promote exercise and PA during clinic appointments. HCPs identified how PA impacts PD symptoms, evidence on the role of exercise, and signposting to support groups as core topics in PA promotion for PwP. However, these topics are mainly addressed during physiotherapy appointments. Referrals to physiotherapy occur most frequently when PwP experience falls or mobility issues, rather than at diagnosis. HCPs (52% doctors and 41% of nurses) identified lack of confidence as a barrier to prescribing exercise to PwP. ConclusionThe importance of promoting PA at diagnosis is widely acknowledged by HCPs. There are variations between disciplines in terms of the tools used, and the timing and duration of interventions. Previously identified barriers to exercise promotion were also found in this study, and should be explored further in order to aid the implementation of effective interventions.

Age and cancer type: associations with increased odds of receiving a late diagnosis in people with advanced cancer

PurposeIn order to deliver appropriate and timely care planning and minimise avoidable late diagnoses, clinicians need to be aware of which patients are at higher risk of receiving a late cancer diagnosis. We aimed to determine which demographic and clinical factors are associated with receiving a ‘late’ cancer diagnosis (within the last 12 weeks of life).MethodRetrospective cohort study of 2,443 people who died from cancer (‘cancer decedents’) in 2013–2015. Demographic and cancer registry datasets linked using patient-identifying Community Health Index numbers. Analysis used binary logistic regression, with univariate and adjusted odds ratios (SPSS v25).ResultsOne third (n = 831,34.0%) received a late diagnosis. Age and cancer type were significantly associated with late cancer diagnosis (p < 0.001). Other demographic factors were not associated with receiving a late diagnosis. Cancer decedents with lung cancer (Odds Ratios presented in abstract are the inverse of those presented in the main text, where lung cancer is the reference category. Presented as 1/(OR multivariate)) were more likely to have late diagnosis than those with bowel (95% Confidence Interval [95%CI] Odds Ratio (OR)1.52 (OR1.12 to 2.04)), breast or ovarian (95%CI OR3.33 (OR2.27 to 5.0) or prostate (95%CI OR9.09 (OR4.0 to 20.0)) cancers. Cancer decedents aged > 85 years had higher odds of late diagnosis (95%CI OR3.45 (OR2.63 to 4.55)), compared to those aged < 65 years.ConclusionsCancer decedents who were older and those with lung cancer were significantly more likely to receive late cancer diagnoses than those who were younger or who had other cancer types.

Association between Physical Activity and Reduced Mortality in Inoperable Lung Cancer

We examined device-measured physical activity (PA) and sedentary behaviour at the time of diagnosis in people with inoperable lung cancer and investigated their associations with 12-month mortality. The people with inoperable lung cancer wore an accelerometer for seven days prior to the treatment commencement. The analysed PA/sedentary behaviour variables included light-intensity PA, moderate-to-vigorous-intensity PA (MVPA), step count, the total time spent sedentary, and the usual sedentary bout duration. The data on the disease stage, clinical covariates and 12-month mortality were extracted from medical records. Cox regression models were used to estimate the association between the PA measures and 12-month mortality, and the sedentary behaviour measures and 12-month mortality. The models were adjusted for the stage and neutrophil-to-lymphocyte ratio. All the PA and sedentary behaviour variables were dichotomised at their medians for analysis. Eighty-nine participants (70 ± 10 years; 55 [62%] males) contributed valid data. The twelve-month mortality was 30% (n = 27). Compared to the participants who spent ≤4.6 min/day in MVPA (n = 45), those who spent &gt;4.6 min/day (n = 44) had a relative risk of 12-month mortality reduced by 60% (hazard ratio, 0.40; 95% CI, 0.16 to 0.96; 18 versus nine deaths, respectively). The other variables of PA/sedentary behaviour were not associated with 12-month mortality. Higher device-measured MVPA was associated with reduced 12-month mortality in people who were newly diagnosed with inoperable lung cancer.

Epidemiology of Sjögren's: A Systematic Literature Review.

Primary Sjögren's is a multi-system autoimmune disease affecting patients' physical, mental, and emotional wellbeing. The epidemiology of Sjögren's is not well understood, and up-to-date epidemiological evidence is needed to improve knowledge and awareness of Sjögren's among patients and healthcare professionals, and to ascertain the global burden of disease. The objective of this research was to conduct a de novo systematic literature review (SLR) to identify and synthesise evidence on global epidemiology of primary Sjögren's. This SLR was conducted in May 2021 by searching MEDLINE and Embase databases, relevant conference proceedings, websites of registries, and health technology assessment agencies and databases. Publications were systematically screened for English language articles reporting on the incidence, prevalence, age at symptom onset, and age at diagnosis for people with primary Sjögren's. Of 3510 records identified, 68 publications were included, representing 62 unique studies. Studies reported on age at symptom onset (16/62; 25.8%) and age at diagnosis (43/62; 69.4%) more frequently than incidence (7/62; 11.3%) and prevalence (9/62; 14.5%). Primary Sjögren's was found to have the highest incidence and prevalence in females and in older age groups (incidence: ≥65years; prevalence: ≥75years). Average age at onset and diagnosis of primary Sjögren's ranged between 34-57years and 40-67 years, respectively. This SLR identified a paucity of incidence and prevalence data for primary Sjögren's, highlighting a need for further epidemiological studies. The global Sjögren's community must work together to follow the defined classification criteria of primary Sjögren's and reporting guidelines for incidence and prevalence data to allow for meaningful epidemiological comparisons across studies, settings, and countries.

Research and Evaluation of the Diagnostic Precision of an Artificial Intelligence Algorithm Using Ultrasound Images for Early Diagnosis of Arthropathy in People with Hemophilia

Background: Frequent joint bleeding in people with hemophilia can cause synovitis and progressive joint damage, leading to reduced quality of life over the long term. Despite widespread use of prophylactic treatment, frequent joint bleeding is still prevalent. Early diagnosis of symptomatic/asymptomatic hemarthrosis and synovitis is required through regular assessment to ensure appropriate therapeutic intervention. Ultrasonography is a convenient diagnostic tool, but accurate diagnosis of hemarthrosis and synovitis requires specialist skills and experience, and so its implementation in daily clinical practice is not currently widespread. By constructing an artificial intelligence (AI) algorithm to support diagnosis of hemarthrosis and synovitis using ultrasonography, increased uptake of joint ultrasonography is expected. This study researches and evaluates an AI algorithm for detecting the presence or absence of hemarthrosis and synovitis using ultrasound images obtained in people with hemophilia. Methods: This study evaluated the diagnostic precision of AI model-based diagnoses in people with congenital hemophilia A or B. Ankle, elbow, and knee joint ultrasound images obtained at study sites between January 1, 2010 and March 31, 2022 were used to train and test six AI models for each joint to estimate the presence or absence of hemarthrosis and synovitis. The ultrasound images were stratified by presence or absence of hemarthrosis and synovitis, as determined by an Executive Committee consisting of a physician and two orthopedists who are experts in hemophilia care. Images were then randomly divided, with 70% used to train the AI models and 30% used to test their diagnostic precision. The AI algorithm used various image pre-processing methods and the convolutional neural network-based AI model. The primary endpoint was the area under the receiver operating characteristic curve (AUC) for the diagnostic precision of the AI model to diagnose hemarthrosis and synovitis. The other endpoints were examined using parameters such as the rate of accuracy, precision, recall, and specificity. In addition, to evaluate whether the lesion area was detected correctly or not by visualization techniques, we displayed the lesion area with region of interest and expressed the discrimination basis using a heat map ( Figure 1). Results: A total of 5649 images were collected from five study sites. Following assessment by the Study Executive Committee,3435 images were used in this analysis. The AUC for hemarthrosis detection for the ankle, elbow, and knee joints was 0.87, 0.91, and 0.91, respectively, while for synovitis detection it was 0.90, 0.97, and 0.91, respectively ( Table 1). When evaluated in subgroups according to age, AUCs for hemarthrosis detection for at the ankle, elbow, and knee joints, respectively, were: 0.85, 0.94, and 0.98 at 10-19 years old; 0.82, 0.91, and 0.84 at 20-29 years old; 0.91, 0.90, and 0.89 at 30-39 years old; 0.90, 0.93, and 0.93 at 40-49 years old; and 0.91, 0.93, and 0.95 at 50-59 years old. AUCs for synovitis detection for the ankle, elbow, and knee joints, respectively, for different age groups were 0.95, 0.92, and 0.94 at 10-19 years old; 0.89, 0.97, and 0.95 at 20-29 years old; 0.94, 1.00, and 0.91 at 30-39 years old; 0.84, 0.96, and 0.91 at 40-49 years old; and 0.90, 0.98, and 0.91 at 50-59 years old. The analysis of the hemarthrosis and synovitis algorithms by joint site indicated high accuracy, precision, recall, and specificity ( Table 1). Conclusions: Although the AI model produced high AUC values for detecting hemarthrosis and synovitis, further refinement is needed before it can be used in diagnosis. Additional research should determine why the AI model and physician results differed. This may be due to image brightness or AI training data quality/quantity. As joint shape changes greatly with growth, and the AI model uses the bone surface as a landmark, pediatric (&amp;lt;10 years old) images were excluded; the model has low discrimination accuracy if a bone surface cannot be detected. In future, features associated with joint growth should be incorporated into the algorithm to allow more accurate pediatric diagnosis. The future ability of an AI model to diagnose hemarthrosis and synovitis in clinical practice would support appropriate therapeutic intervention. This would be expected to help with the achievement of a healthy and active life for people with hemophilia.

Literatur Review Potensi Kandungan Antioksidan Buah Tin dalam Pencegahan Penyakit Stroke

According to the World Health Organization (WHO), 15 million people suffer from stroke worldwide every year. Of this number, 5 million died and another 5 million were permanently disabled. The prevalence of stroke in Indonesia based on the diagnosis of people who had a stroke increased in 2018, there were 7% of the population who had a stroke in 2013 and became 10.9% in 2018. Figs contain good nutrition and can be used as a source of minerals and vitamin. Fresh or dried figs contain high levels of fiber and polyphenols. Apart from that, the antioxidant content in figs can protect lipoproteins in plasma from oxidation, resulting in an increase in the amount of plasma antioxidants which improves. Objective: This study aims to determine the potential antioxidant content of figs in preventing stroke. Method: This article was prepared using a literature review method by referring to national and international literature that is considered relevant to the keywords used. There were 12 articles obtained through the Google Scholar, Pubmed, Elsevier, NCBI, and Clinical Key databases. Results: The results of the article review carried out can be concluded that the antioxidant content of figs is flavonoids, polyphenols and etonal which have the potential to prevent stroke.

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

ObjectiveAlcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The...

1251-P: Glycaemic Trajectory before Diabetes Diagnosis in People with Young-Onset and Usual-Onset Type 2 Diabetes—A Population-Based Retrospective Study in Hong Kong

Objectives: To identify distinct glycaemic trajectories before diabetes diagnosis in people with young-onset (&amp;lt;40 years) and usual-onset type 2 diabetes (≥40 years). Methods: Adult patients with incident type 2 diabetes diagnosed between 2002 and 2019 who had at least three HbA1c measurements before diabetes diagnosis in Hong Kong Hospital Authority electronic medical record system were included in this study. Latent class trajectory modelling was applied to identify distinct HbA1c trajectories before diabetes diagnosis, adjusted for sex and age. The shape and number of trajectory classes (one to five) were selected based on a combination of Bayesian Inclusion Criteria, model adequacy and proportion of people in each trajectory class (no less than 2% required). Results: A total of 2,252 people with young-onset type 2 diabetes (age [mean ± SD]: 34.1 ± 4.9 years; 40.0% male) and 77,892 people with usual-onset type 2 diabetes (age [mean ± SD]: 64.9 ± 11.0 years; 51.4% male) were included in this analysis. The 2-class solution and 1-class solution were chosen as the most appropriate models for young-onset and usual-onset type 2 diabetes respectively. A stable-increase trajectory with HbA1c rising gradually before diabetes diagnosis was identified in 96% of people with young-onset type 2 diabetes, while the other 4% had an accelerated-increase trajectory with HbA1c increasing rapidly within one year before diagnosis. People with usual-onset type 2 diabetes had HbA1c value increasing gradually before diabetes diagnosis. Conclusion: Blood glucose climbed gradually at a steady rate before diabetes diagnosis in most people with type 2 diabetes, while a small proportion of people with young-onset type 2 diabetes showed a rapid deterioration within a short period before disease onset. Disclosure Y.Fan: None. H.Wu: None. E.S.H.Lau: None. A.Yang: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. R.C.Ma: Advisory Panel; AstraZeneca, Merck &amp; Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company.