Disease Patterns Research Articles

Pattern of kidney diseases admission and outcome in Bauchi, Northeast Nigeria: a 2 year review

Background Kidney diseases are a heterogeneous group of disorders which if left untreated could lead to chronic kidney disease (CKD) which inadvertently progress to end-stage kidney disease. Renal replacement therapy for end-stage kidney disease is unaffordable, not widely available and require huge financial resources. Knowledge of the prevailing type of kidney disease will help to develop measures of prevention of the disease. This study aims to evaluate the burden and pattern of kidney disease and to determine its outcome over a 2 year period. Patients and methods This is a retrospective study of kidney diseases admission and outcome at Abubakar Tafawa Balewa university teaching hospital over a 2 year period. All case files of patients admitted were retrieved and those with diagnosis of kidney disease were evaluated. Results One thousand and nineteen patients were admitted during the period, 98 of which had kidney disease diagnosis, with 10.4% disease burden. The mean age of the patients was 48.71 ± 12.2 years. CKD accounted for 51% of the total admission, followed by urinary tract infection, acute Kidney injury, Nephrotic syndrome, and Nephritic syndrome each accounting for 19.3, 15.4, 9.2, and 5.1%, respectively. Overall six (10.5%) patients died on admission. Conclusion The burden of kidney disease is high in our study and is mainly due to high prevalence of CKD that affects younger age group.

Spatial Analysis of Chronic Kidney Disease of Unknown Aetiology (CKDu) Prevalence in Badulupura Village, Sri Lanka

This study investigated spatial patterns of chronic kidney disease of unknown aetiology (CKDu) patients in Badulupura village. The analysis utilized published locational data for all households, including households affected by CKDu, and all wells used by CKDu-affected patients (CPA wells). The study employed Average Nearest Neighbour (ANN) and Hot Spot Analysis (Getis-Ord Gi*) tools to assess the spatial clustering of CKDu households and CPA wells. The study also explored the impact of topographical factors such as elevation, slope, and distance to watershed boundaries on the spatial distribution of CKDu patients. The ANN analysis revealed a dispersed pattern for all wells, and a random distribution for all households. However, both CKDu households and CPI wells exhibited a clustered pattern, suggesting a location-specific cause for the spatial distribution of the disease. Additionally, overlaying CKDu-affected households on the digital elevation model revealed a concentration of CKDu hot spots in high-elevation areas, while cold spots were observed in low-elevation regions. Furthermore, the t-test was employed to investigate the significance of elevation, slope, and distance to the watershed boundaries in relation to CKDu distribution. The results indicated a significant (p<0.05) prevalence of CKDu in high-elevation areas, while no significant association was found with slope or distance to watershed boundaries. The study revealed the presence of localized CKDu hot spots and cold spots within a small geographical area, highlighting the importance of considering topographical factors and conducting comprehensive hydrogeological and geological studies to gain valuable insights into the spatial distribution of CKDu.

TCT-257 Impact of Diabetes on Coronary Artery Disease Patterns and PCI Outcomes

TCT-257 Impact of Diabetes on Coronary Artery Disease Patterns and PCI Outcomes

Endovascular and Hybrid Interventions for Aortoiliac Occlusive Disease in Patients with Intermittent Claudication

IntroductionSignificant practice variability exists regarding the management of intermittent claudication (IC) across anatomic segments. We sought to answer the question of whether the safety, efficacy, and durability outcomes of an endovascular approach with or without common femoral endarterectomy for complex aortoiliac occlusive disease (AIOD) justify a surgical approach in patients presenting with IC. MethodsA retrospective single-center review of all patients who were treated using an endovascular approach for AIOD with or without CFE from 2010 to 2020 was conducted. The review was limited to those with symptoms of IC. Patient- and limb-level preoperative presentations were reviewed. The outcomes were postoperative complications and patency rates in addition to freedom from re-intervention. Subgroup analyses were conducted to compare patients who underwent endovascular and hybrid procedures. ResultsA total of 245 limbs in 180 consecutive patients were analyzed. The mean age was 65 years and 61% were males. Of 176 patients, 101 (57%) had TASC class D and 18 (10%) had Class C. Eleven limbs (7.4%) had access site complications, 12 (7.9%) had surgical wound complications, and below-the-knee amputation was observed in 2 limbs (0.82%) (2 patients). Two (1.0%) patients had perioperative MI, 1(0.5%) stroke, 1(0.5%) AKI that progressed to dialysis, and no 30-day mortality. Rutherford’s classification was improved during the follow-up period. The 1-, 2- and 5-year primary patency rates were 94%, 77%, and 58%; primary-assisted patency rates were 98%,91%, and 79%, respectively; and secondary patency rates were 100% for all follow-up periods. Patients who had concurrent CFE were likely to have hypertension, hyperlipidemia, and anatomically more diffuse disease. No significant differences in patency or reintervention-free survival were observed, though event rates were low in both outcomes and trended toward a protective effect with CFE. ConclusionEndovascular management for complex AIOD with or without CFE for IC patients is safe, effective, and durable. These results justify an active, patient-centered approach for this advanced anatomic disease pattern. The morbidity of a hybrid approach in the CFE subset is low and treatment vessel patency is excellent. The presence of anatomically advanced AIOD is not prohibitive for the treatment of patients with IC, however careful patient selection is essential.

Clinical Profiles and Risk Factors of Acute Myocardial Infarction in Young Adults: A Cross-Sectional Study in Myanmar.

Introduction Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with an increasing prevalence of acute myocardial infarction (AMI) among younger populations. Despite this rising trend, there are limited data from Myanmar on the clinical profile and associated risk factors for premature CAD in young adults. This study aims to investigate the clinical characteristics and predisposing risk factors for AMI in individuals aged 40 years and below, contributing to a better understanding of disease patterns in this population. Methods A cross-sectional descriptive study was conducted at the coronary care unit of Yangon General Hospital over a 12-month period from January 1, 2019, to December 31, 2019. A total of 59 young adults, diagnosed with AMI based on the Fourth Universal Definition of Myocardial Infarction, were included. Clinical data, laboratory investigations, and demographic characteristics were collected and analyzed. Results Among the 59 participants, 46 (78%) were male, and smoking was prevalent in 45 (76.3%) cases. Dyslipidemia was common, with 46 (77.9%) exhibiting low high-density lipoprotein (HDL) cholesterol levels and 27 (45.8%) having elevated total cholesterol. Hypertension was observed in 31 (52.5%) patients, and 32 (54.2%) reported a family history of premature atherosclerotic cardiovascular disease. Furthermore, 28 (47.5%) of the cohort were classified as overweight, and 26 (44.1%) demonstrated low levels of physical activity. Chest pain was universally reported by all 59 (100%) patients as the presenting symptom. ST-segment elevation myocardial infarction (STEMI) was the predominant type, affecting 47 (79.6%) patients, with anterior wall involvement in 36 (61%) cases. Conclusion The findings of this study reveal that AMI in young adults is more prevalent among males, with smoking and dyslipidemia being the most significant risk factors. The high prevalence of low physical activity, hypertension, and overweight status further underscores the need for early lifestyle interventions. These results can be directly applied to clinical practice and public health policy in Myanmar by prioritizing smoking cessation programs, improving dyslipidemia management, and promoting physical activity in young populations. Additionally, this study provides a foundation for further research to explore more specific risk factors and paves the way for broader studies focusing on young AMI cases in Myanmar.

TCT-658 Physiologic Coronary Artery Disease Pattern (Focal or Diffuse) as Assessed by Angiography Pull-Back Pressure Gradient Index (PPGI) in Vessels With Fractional Flow Reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) Discordance

TCT-658 Physiologic Coronary Artery Disease Pattern (Focal or Diffuse) as Assessed by Angiography Pull-Back Pressure Gradient Index (PPGI) in Vessels With Fractional Flow Reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) Discordance

Effects of Pressure, Hypoxia, and Hyperoxia on Neutrophil Granulocytes

Background: The application of normo- and hyperbaric O2 is a common therapy option in various disease patterns. Thereby, the applied O2 affects the whole body, including the blood and its components. This study investigates influences of pressure and oxygen fraction on human blood plasma, nutrient media, and the functions of neutrophil granulocytes (PMNs). Methods: Neutrophil migration, reactive oxygen species (ROS) production, and NETosis were examined by live cell imaging. The treatment of various matrices (Roswell Park Memorial Institute 1640 medium, Dulbecco’s Modified Eagle’s Medium, H2O, human plasma, and isolated PMNs) with hyperbaric oxygen (HBO) was performed. In addition, the expression of different neutrophil surface epitopes (CD11b, CD62L, CD66b) and the oxidative burst were investigated by flow cytometry (FACS). The application of cold atmospheric plasma (CAP) to normoxic and normobaric culture media served as a positive control. Soluble reaction products such as H2O2, reactive nitrogen species (RNS: NO2− and NO3−), and ROS-dependent dihydrorhodamine oxidation were quantified by fluoro- and colorimetric assay kits. Results: Under normobaric normoxia, PMNs migrate slower and shorter in comparison with normobaric hyper- or hypoxic conditions and hyperbaric hyperoxia. The pressure component has less effect on the migration behavior of PMNs than the O2 concentration. Individual PMN cells produce prolonged ROS at normoxic conditions. PMNs showed increased expression of CD11b in normobaric normoxia, lower expression of CD62L in normobaric normoxia, and lower expression of CD66b after HBO and CAP treatment. Treatment with CAP increased the amount of ROS and RNS in common culture media. Conclusions: Hyperbaric and normobaric O2 influences neutrophil functionality and surface epitopes in a measurable way, which may have an impact on disorders with neutrophil involvement. In the context of hyperbaric experiments, especially high amounts of H2O2 in RPMI after hyperbaric oxygen should be taken into account. Therefore, our data support a critical indication for the use of normobaric and hyperbaric oxygen and conscientious and careful handling of oxygen in everyday clinical practice.

A Rose by Any Other Name: The Long Intricate History of Localized Aggressive Periodontitis.

This review addresses the recent World Workshop Consensus Conference (WWCC) decision to eliminate Localized Aggressive Periodontitis (LAgP) in young adults as a distinct form of periodontitis. A "Consensus" implies widespread, if not unanimous, agreement among participants. However, a significant number of attendees were opposed to the elimination of the LAgP classification. The substantial evidence supporting a unique diagnosis for LAgP includes the (1) incisor/molar pattern of disease, (2) young age of onset, (3) rapid progression of attachment and bone loss, (4) familial aggregation across multiple generations, and (5) defined consortium of microbiological risk factors including Aggregatibacter actinomycetemcomitans. Distinctive clinical signs and symptoms of LAgP are presented, and the microbial subgingival consortia that precede the onset of signs and symptoms are described. Using Bradford-Hill guidelines to assess causation, well-defined longitudinal studies support the unique microbial consortia, including A. actinomycetemcomitans as causative for LAgP. To determine the effects of the WWCC elimination of LAgP on research, we searched three publication databases and discovered a clear decrease in the number of new publications addressing LAgP since the new WWCC classification. The negative effects of the WWCC guidelines on both diagnosis and treatment success are presented. For example, due to the localized nature of LAgP, the practice of averaging mean pocket depth reduction or attachment gain across all teeth masks major changes in disease recovery at high-risk tooth sites. Reinstating LAgP as a distinct disease entity is proposed, and an alternative or additional way of measuring treatment success is recommended based on an assessment of the extension of the time to relapse of subgingival re-infection. The consequences of the translocation of oral microbes to distant anatomical sites due to ignoring relapse frequency are also discussed. Additional questions and future directions are also presented.

Space-time cluster analysis and maximum entropy modeling of Peste des petits ruminants (PPR) in Türkiye.

Peste des petits ruminants (PPR) is an economically important highly serious transboundary disease that mainly occurs in small ruminants such as sheep and goats. The aim of this study was to identify the probability of risk and and space-time clusters of Peste des Petits Ruminants (PPR) in Türkiye. The occurrence of PPR in Türkiye from 2017 to 2019 was investigated in this study using spatial analysis based on geographic information system (GIS). Between these dates, it was determined that 337 outbreaks and 18,467 cases. The highest number of outbreaks were detected in the Central Anatolia region. It was determined that PPR is seen more intensely in sheep compared to goats in Türkiye. In this study, 34 environmental variables (19 bioclimatic, 12 precipitation, altitude and small livestock density variables) were used to explore the environmental influences on PPR outbreak by maximum entropy modeling (Maxent). The clusters of PPR in Türkiye were identified using the retrospective space-time scan data that were computed using the space-time permutation model. A PPR prediction model was created using data on PPR outbreaks combination with environmental variables. Nineteen significant (p < 0.001) space-time clusters were determined. It was discovered that the variables altitude, sheep density, precipitation in june, and average temperature in the warmest season made important contributions to the model and the PPR outbreak may be strongly related with these variables. In this study, PPR in Türkiye has been characterized significantly spatio-temporal and enviromental factors. In this context, the disease pattern and obtained these findings will contribute to policymakers in the prevention and control of the disease.

Assessment and Monitoring of the Wound Micro-Environment in Chronic Wounds Using Standardized Wound Swabbing for Individualized Diagnostics and Targeted Interventions.

Background/Objectives: Patient-specific diagnostic and therapeutic approaches are important in the care of people with chronic wounds. The heterogeneity of underlying disease profiles and the diversity of the wound micro-environment make generalized approaches difficult. While high-throughput molecular diagnostic methods are increasingly widespread and available, the analysis of objective biomolecular disease patterns has not found its way into everyday wound management. The aim of this study is to evaluate the use of wound swab samples for the analysis of biomarkers and disease patterns in people with chronic wounds. Methods: A sample cohort from the multicenter "Wound-BIOME" project was analyzed. The project aims to comprehensively investigate the local micro-environment of chronic wounds of various entities, healing tendencies and regeneration stages at the biomolecular level. A sample collection and handling protocol suitable for everyday use was tested and evaluated regarding feasibility for multiplex immunoassay, proteomics, small RNA sequencing (miRNA) and metagenome analyses (microbiomics). Results: It could be shown that standard wound swabs are well-suited for the analysis of the complex wound micro-environment using various high-throughput methods. Despite the sample heterogeneity, the quality was adequate to analyze biomolecular patterns. Conclusions: Initial analyses of protein signatures, microbial wound communities and miRNA patterns show promising results for future individualized diagnostics and targeted interventions.

Black Tea Suppresses Invasiveness and Reverses TNF-α-Induced Invasiveness and Cell Stemness in Human Malignant Melanoma Cells.

Invasiveness and epithelial-mesenchymal transition (EMT) are main patterns of metastatic disease, which is the major cause cancer-related mortality in human malignant melanoma cells. Tea and its consumption extract are associated with a lower risk of several types of cancer and have anti-inflammatory and antioxidative biological effects. However, the anti-EMT and anti-cancer stemness effect of black tea ethanol extracts (BTEE) in human melanoma remain poorly understood. In this study, the effects of BTEE-reduced invasiveness, EMT, and cancer stemness were evaluated in human A 375 and A2058 melanoma cells. BTEE inhibited the activity of u-PA, migration, and invasiveness by repressing p-FAK signaling pathway. BTEE affected the EMT by downregulating the expression of β-catenin, N-cadherin, fibronectin, vimentin, and Twist-1. BTEE also reduced tumor necrosis factor-alpha (TNF-α)-induced invasiveness and cancer stemness characteristics in vitro. The growth of melanoma in nude mice xenograft model showed that BTEE suppressed A 375 tumor growth in vivo.

Pattern of Failure in Patients with Biochemical Recurrence After PSMA Radioguided Surgery.

Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) is evolving as a new treatment modality for patients with early biochemical recurrence of prostate cancer and disease limited to locoregional lymph nodes on PSMA-ligand PET/CT. Nevertheless, the pattern of failure (locoregional vs. systemic) after PSMA RGS remains unknown. Therefore, the aim of this retrospective analysis was to evaluate the pattern of disease using PSMA-ligand PET in patients experiencing relapse after PSMA RGS. Methods: We evaluated 100 patients with biochemical recurrence after previous PET-guided PSMA RGS who underwent PSMA-ligand PET (median prostate-specific antigen [PSA], 0.9 ng/mL; range, 0.2-14.2 ng/mL). All suspicious lesions for recurrent prostate cancer were grouped according to the molecular imaging TNM classification system. Detection rates and lesion localization were determined and stratified by PSA values and the International Society of Urological Pathology grade group. Further, lesion localization was compared before and after PSMA RGS. Results: The median time between PSMA RGS and PSMA-ligand PET for relapse was 11.4 mo (range, 5.5-25.6 mo). In total, 91 of 100 (91%) patients showed PSMA-ligand-positive findings. PSMA PET detection rates were 82.6%, 92.6%, 91.3%, and 96.3% for PSA levels of 0.2-0.49, 0.5-0.99, 1-1.99, and at least 2 ng/mL, respectively. More than half of the patients (53%; 48/91) showed local recurrence or pelvic lymph node metastases only. Extrapelvic lymph node metastases, bone metastases, and visceral metastases were present in 22% (20/91), 16% (15/91), and 9% (8/91) of the patients, respectively. With increasing International Society of Urological Pathology grade group, the percentage of patients with bone and visceral metastases increased, whereas the number of patients with only locoregional disease decreased. Conclusion: PSMA-ligand PET is a useful method to detect and localize recurrent disease in patients with biochemical failure after PSMA RGS, with more than half of the patients presenting with locoregional recurrence, offering the potential for a second local therapy (e.g., radiation therapy or repeated surgery).

Interstitial lung disease presents with varying characteristics in patients with non-Hodgkin lymphoma undergoing rituximab-containing therapies.

Although the incidence and outcomes of rituximab-induced interstitial lung disease (RILD) have been partially reported, there are no systematic studies on the characteristics and types of RILD. This study aimed to investigate the clinical characteristics, bronchoalveolar lavage (BAL) findings, and treatment course of RILD in patients with non-Hodgkin lymphoma. We retrospectively analyzed the data from 321 patients with non-Hodgkin lymphoma who developed RILD between 2020 and 2022. The extent, distribution, and radiologic patterns of interstitial lung disease were determined using high-resolution computed tomography of the chest. BAL was performed in 299 (93.1%) patients to determine cellular distribution patterns and identify pathogenic microorganisms using metagenomic next-generation sequencing. All patients received combination therapy, with cyclophosphamide, doxorubicin, vincristine, and prednisone being the most commonly administered regimens. The median time from treatment to RILD development was 1.7 months. In the 217 patients who underwent metagenomic next-generation sequencing, 179 pathogenic microorganisms were detected, including 77 (43.0%) bacteria, 45 (25.1%) viruses, 28 (15.6%) Pneumocystis jirovecii strains, 17 (9.5%) fungi, 6 (3.5%) Mycobacterium tuberculosis, and 6 (3.5%) atypical pathogens. All RILD diagnoses were based on multidisciplinary team discussions and compliance with international standards. In conclusion, RILD exhibits a range of radiological and BAL patterns, reflecting different interstitial lung disease types. The most common patterns of RILD are infectious lung disease, organizing pneumonia, and nonspecific interstitial pneumonia. These findings enhance the understanding of RILD in patients with non-Hodgkin lymphoma and serve as a reference for best management guidelines in these patients.

Volumetric muscle composition analysis in sporadic inclusion body myositis using fat-referenced magnetic resonance imaging: Disease pattern, repeatability, and natural progression.

Fat-referenced magnetic resonance imaging (MRI) has emerged as a promising volumetric technique for measuring muscular volume and fat in neuromuscular disorders, but the experience in inflammatory myopathies remains limited. Therefore, this work aimed at describing how sporadic inclusion body myositis (sIBM) manifests on standardized volumetric fat-referenced MRI muscle measurements, including within-scanner repeatability, natural progression rate, and relationship to clinical parameters. Ten sIBM patients underwent whole-leg Dixon MRI at baseline (test-retest) and after 12 months. The lean muscle volume (LMV), muscle fat fraction (MFF), and muscle fat infiltration (MFI) of the quadriceps, hamstrings, adductors, medial gastrocnemius, and tibialis anterior were computed. Clinical assessments of IBM Functional Rating Scale (IBMFRS) and knee extension strength were also performed. The baseline test-retest MRI measurements were used to estimate the within-subject standard deviation (sw). 12-month changes were derived for all parameters. The MRI measurements showed high repeatability in all muscles; sw ranged from 2.7 to 18.0 mL for LMV, 0.7-1.3 percentage points (pp) for MFF, and 0.2-0.7 pp for MFI. Over 12 months, average LMV decreased by 7.4% while MFF and MFI increased by 3.8 pp and 1.8 pp, respectively. Mean IBMFRS decreased by 2.4 and mean knee extension strength decreased by 32.8 N. The MRI measurements showed high repeatability and 12-month changes consistent with muscle atrophy and fat replacement as well as a decrease in both muscle strength and IBMFRS. Our findings suggest that fat-referenced MRI measurements are suitable for assessing disease progression and treatment response in inflammatory myopathies.

Analysis of the structure and trend prediction of China's total health expenditure.

In the context of rapid economic and social development, there has been a continuous intensification of population aging, transformation of disease patterns, and wide application of new medical technologies. As a result, health expenditures in various countries have sharply soared. How to utilize limited medical resources to maximize the improvement of health levels has become a hot and challenging issue related to the well-being of all humanity. The relevant indicators of total health expenditure play a crucial role in monitoring and evaluating the fairness of health financing and health security in the region. This study explores the changes in the main expenses that constitute China's total health expenditure and uses indicators related to health expenditure to observe the changes and future development trends of China's health expenditure. Based on this, the utilization of China's health expenditure is monitored to identify possible problems, and thereby targeted suggestions for promoting the development of China's health and wellness cause are put forward. Based on the comparison of previous literature, this paper analyzes the changes and future development trends in China's health expenditure by using the relevant indicators of China's health expenditure through the structural variation analysis method and the gray prediction model. The results show that the scale of government, social, and out-of-pocket health expenditures has continuously expanded, with social health expenditures becoming the main funding source for total health expenditures. The burden of medical expenditures on individuals has been further reduced. In the institutional method of total health expenditures, hospital expenditures account for about 60% of the total and are the main component. The expenditures of health administration and medical insurance management institutions are the main driving force behind the growth of total health expenditures. However, the proportion of health expenditures in China's GDP is relatively low, so more investment is needed in the healthcare sector, and the burden of individual medical expenses also needs to be continuously reduced. In the future, China should further increase its investment in the medical and health sector. Specifically, the government should persist in investing in fundamental medical and health services. Simultaneously, efforts should be made to establish a scientific cost control mechanism for pharmaceuticals and broaden financing channels for healthcare, such as accelerating the development of commercial health insurance.

Dietary habit, hygiene practice, and disease status among street children: A cross sectional survey

Child rag pickers in Dhaka city are increasing and very little known about their conditions and nutritional status. They lead a very vulnerable life and high risk of prone to different kinds of diseases. An observational cross-sectional study was carried out at selected areas of Dhaka to assess food habit, hygiene practice and disease pattern of street children. Data were collected from conveniently selected different areas of Dhaka City like Sadarghat, Gabtoli, Gulistan Airport, Kamlapur railway station. Total 150 street children were interviewed with semi structured pretested questionnaire by face to face interview. Disease history was taken from last six months. The mean age of the children was 10.55 ± 2.96 years. More than half (66.7%) of the respondents were boys. About half of the respondents were day labor. About 83.8% respondents did not have any disease currently. Fever, diarrhea, skin disease, and common cold were seen among 20%-30% respondents. More than 80% respondents had good appetite. Fish and fruits were taken randomly. They did not cut nail on regular basis. It is concluded that street children suffered those diseases which were preventable.

Language-model-based patient embedding using electronic health records facilitates phenotyping, disease forecasting, and progression analysis.

Current studies regarding the secondary use of electronic health records (EHR) predominantly rely on domain expertise and existing medical knowledge. Though significant efforts have been devoted to investigating the application of machine learning algorithms in the EHR, efficient and powerful representation of patients is needed to unleash the potential of discovering new medical patterns underlying the EHR. Here, we present an unsupervised method for embedding high-dimensional EHR data at the patient level, aimed at characterizing patient heterogeneity in complex diseases and identifying new disease patterns associated with clinical outcome disparities. Inspired by the architecture of modern language models-specifically transformers with attention mechanisms, we use patient diagnosis and procedure codes as vocabularies and treat each patient as a sentence to perform the patient embedding. We applied this approach to 34,851 unique medical codes across 1,046,649 longitudinal patient events, including 102,739 patients from the electronic Medical Records and GEnomics (eMERGE) Network. The resulting patient vectors demonstrated excellent performance in predicting future disease events (median AUROC = 0.87 within one year) and bulk phenotyping (median AUROC = 0.84). We then illustrated the utility of these patient vectors in revealing heterogeneous comorbidity patterns, exemplified by disease subtypes in colorectal cancer and systemic lupus erythematosus, and capturing distinct longitudinal disease trajectories. External validation using EHR data from the University of Washington confirmed robust model performance, with median AUROCs of 0.83 and 0.84 for bulk phenotyping tasks and disease onset prediction, respectively. Importantly, the model reproduced the clustering results of disease subtypes identified in the eMERGE cohort and uncovered variations in overall mortality among these subtypes. Together, these results underscore the potential of representation learning in EHRs to enhance patient characterization and associated clinical outcomes, thereby advancing disease forecasting and facilitating personalized medicine.

A Retrospective Study of the Profiles of Outpatients Attending the State Adolescent Friendly Health Resource Center, Andhra Pradesh, South India.

Adolescents compose a significantly large age group, and attention to their health needs is lacking due to insufficient data and policy implementation globally and in India. India, having 268 million adolescents, faces the world's largest adolescent population, which highlights the importance of addressing their health requirements. The aim of this study was to describe the morbidity profiles of adolescent patients attending the State Adolescent Friendly Health Resource Centre at a tertiary-level healthcare institution in South India. A retrospective secondary data analysis was conducted at the State Adolescent Friendly Health Resource Center from 2022 to 2023. Data on adolescent health were collected from this center's OPD using a structured questionnaire, which included information on demographics, immunization status, chief complaints, and dietary intake. Diagnosis coding was done using the International Classification of Diseases, Tenth Revision (ICD-10), with estimated energy and protein intake. The study analyzed 4,000 adolescent patients, with a nearly equal gender distribution across physical OPD and telemedicine services. Adolescent females between 15 and 16 years had more visits for consultation. Most patients were within the normal BMI range, and telemedicine was popular among females with normal BMI. Obesity was more common in males, while overweight was prevalent in females. Energy and protein intake varied across BMI categories, with obese individuals having the highest intake. The morbidity profiles revealed significant gender differences in healthcare utilization and disease patterns. Gender differences in adolescent morbidity and the underutilization of telemedicine highlight the need for tailored healthcare interventions and further research based on socioeconomic factors.

The role of advanced physiological guidance in contemporary coronary artery disease management.

This review evaluates the emerging role of the pullback pressure gradient (PPG) as a standardized metric for assessing coronary artery disease (CAD) patterns and its implications for clinical decision-making when managing patients undergoing percutaneous coronary interventions (PCIs). By integrating PPG with existing physiological assessments, this review highlights the potential benefits of PPG in predicting treatment outcomes and refining therapeutic strategies for CAD. Recent studies, particularly the PPG Global study have demonstrated a strong correlation between PPG values and post-PCI outcomes, revealing that focal disease is associated with improved fractional flow reserve (FFR) and lower rates of adverse events than vessels with diffuse disease (low PPG). Additionally, PPG has been linked to specific atherosclerotic plaque characteristics, indicating its utility in identifying high-risk plaques. The integration of PPG with advanced imaging techniques further enhances the understanding of CAD patterns and their implications for treatment planning. The PPG represents a significant advancement in the management of CAD, providing a reproducible and objective assessment of coronary artery disease patterns that can inform clinical decision-making. As research continues to explore the relationship among PPG, atherosclerotic characteristics, and patient outcomes, its integration into routine practice is expected to improve the effectiveness of PCI and optimize patient management strategies. Future studies are warranted to establish specific PPG thresholds and further investigate its potential in identifying vulnerable plaques and guiding treatment decisions.

The lung in inborn errors of immunity.

The lungs are integral to immune defense, and inborn errors of immunity (IEI) often manifest as lung disease. Lung complications of IEI can involve the airways, alveolar spaces, interstitium, vasculature, and pleura. Accurate identification of these lung disease patterns requires a thorough clinical history, physical examination, and high-resolution computed tomography (HRCT), as lung imaging patterns guide further respiratory and immunological evaluations. Respiratory assessment may also include pulmonary function tests, bronchoscopy with bronchoalveolar lavage, and, in some cases, lung biopsy. Additionally, molecular diagnosis of underlying immune defects, typically through comprehensive clinical phenotyping, functional immune studies, and genetic testing, is crucial for informing patient management and guiding targeted therapies. Importantly, given the complexity of IEI, a multidisciplinary approach is necessary. Furthermore, ongoing research is required to refine therapies and improve outcomes for lung complications.