Ethnic Populations Research Articles

WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study.

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.

Racial and Ethnic Disparities in Perceived Health Status Among Patients With Cardiovascular Disease.

Understanding health outcomes among people with cardiovascular disease (CVD) is crucial for improving treatment strategies and patient quality of life. This study investigated racial and ethnic disparities in perceived health status among non-Hispanic Black, Hispanic, and non-Hispanic White adults with CVD. The study had a retrospective cross-sectional design and used data from the Medical Expenditure Panel Survey spanning 8 calendar years (2014-2021). The study population consisted of adults diagnosed with various CVDs. We used ordinal logistic regression models adjusted for demographic and socioeconomic characteristics, CVD severity, comorbidities, and health care expenditures to assess racial and ethnic differences in perceived health status. Among the 11,715 (weighted frequency, 15,431,283) adults with CVD, we observed significant differences in perceived health status across racial and ethnic cohorts. The unadjusted analysis showed that non-Hispanic Black adults had significantly higher odds than non-Hispanic White adults of perceiving their health as poorer (odds ratio [OR]= 1.89; 95% CI, 1.74-2.07; P < .001), with a similar observation among Hispanic adults (OR = 2.05; 95% CI, 1.85-2.26; P < .001). Although female sex, higher education, and better income had protective effects on perceived health status independent of race, we found significant racial and ethnic differences in the effect of older age, physical and cognitive limitations, and health insurance status on perceived health status. This study revealed substantial racial disparities in perceived health status among adults with CVD, with notable differences in the effects of predictive factors. Addressing these disparities requires targeted interventions to improve health care access and enhance socioeconomic conditions tailored to the needs and experiences of racial and ethnic populations.

A new approach for sex prediction by evaluating mandibular arch and canine dimensions with machine-learning classifiers and intraoral scanners (a retrospective study).

In circumstances where antemortem information concerning the deceased individual is unavailable, forensic experts prepare biological profiling for unidentified human remains that aids in narrowing the search for identity. Biological profiling includes basic demographic information such as sex, age, stature, and ethnicity. Sex identification is the first and key step in the biological profiling of unidentified human remains, as it effectively reduces potential matches by excluding nearly one-half of the suspected cases and facilitates the subsequent stages. This study was conducted to assess the accuracy of artificial intelligence (AI) in predicting sex by analysing mandibular canine dimensions, mandibular intercanine distance (MICD), and mandibular canine index (MCI) obtained from three-dimensional (3D) digital impressions captured by using an intraoral scanner (IOS). The results of the receiver operating characteristic (ROC) test indicated that mean mandibular canine width (MeanMCW) had the highest sexual dimorphism with the area under the curve (AUC) of 0.912, and the Gaussian Naive Bayes (GNB) classifier demonstrated the highest testing accuracy among all machine learning (ML) models, achieving an accuracy of 92.5%. While the outcomes of this study are promising, further studies are imperative to validate these findings with larger sample sizes in different ethnic populations.

Effects of COVID-19 Pandemic on Patients with Kidney Disease and Kidney Replacement Therapy: Focus on Black, Asian, and Minority Ethnic Groups: A Systematic Review

Background COVID-19 pandemic significantly affected health services globally, resulting in poorer outcomes, especially in patients with chronic long-term illnesses. For patients with chronic kidney disease (CKD), potential effects might include, among others, disruption of dialysis services, reduced kidney transplant rates, and increased incidence of severe COVID-19 infections and death. Such differences may be further exacerbated in patients from Black, Asian, and Minority Ethnic (BAME) populations with CKD. Aim To conduct a systematic review to identify the global impact of COVID-19 on kidney replacement therapy and to determine the extent of any disparities in BAME patients with CKD. Materials and Methods PubMed, Embase (OVID), and CINAHL (EBSCO) databases were searched for relevant studies published between January 1, 2019, and November 24, 2023. Predetermined inclusion/exclusion criteria were utilized to shortlist abstracts. Two reviewers independently appraised articles and systematically extracted data and assessed the quality of studies. Thematic analysis was used for evidence synthesis; no quantitative meta-analysis was conducted. The review was registered with PROSPERO (CRD42020201771). Results Two hundred and eleven abstracts were shortlisted, 52 articles were identified for full-text review, and 20 articles published worldwide were included in the final review. Themes identified included: effects of the COVID-19 pandemic on patients with CKD undergoing dialysis (six studies); impact on kidney transplant recipients and transplant programs (eight studies); and differential impact of COVID-19 on BAME patients in comparison with the general population (six studies). The presence of CKD in patients with COVID-19 was identified as a poor prognostic factor, along with obesity, lower socioeconomic status, and BAME population. Conclusion The findings of this targeted review demonstrate the global impact of COVID-19 on various aspects of kidney replacement therapy and provide evidence of important disparities for BAME patients. In case of any future pandemic, vulnerable groups undergoing hemodialysis and those with kidney allografts will require special attention and care.

Gastroesophageal reflux disease and risk factors in schoolchildren

Aim. To study the association between family predisposition to gastrointestinal diseases with gastroesophageal reflux disease (GERD) in schoolchildren in ethnic populations of Tuva. Material and methods. A total of one thousand seventy nine children (761 Mongoloid-Tuvinian and 318 Caucasian) aged of 7–17 years in the Republic of Tyva were examined. Anamnestic data and information on gastrointestinal complaints in schoolchildren were obtained. The diagnostic criterion for GERD was complaints of weekly heartburn. Statistical analysis was performed using the Pearson chi-square test. Results. GERD children more often had anamnestic data on gastritis (p = 0.025), gastric ulcer (p = 0.039) and oncological diseases of the gastrointestinal tract (p = 0.052) in parents. At the same time, schoolchildren of the indigenous population with GERD manifestations had greater unfavourable conditions for a number of diseases in parents: gastritis (p = 0.01), gastric ulcer (p = 0.012). Whereas in Caucasians, a similar association was not established. The association between GERD in schoolchildren and gastrointestinal pathology in grandparents (2nd degree of kinship) also concerned only Tuvans in the presence of gastritis (p = 0.023). Summary data on family history of gastrointestinal diseases (1st and 2nd generation relatives) in GERD children, as expected, prevailed in Tuvans (gastritis (p = 0.004), peptic ulcer (p = 0.033) and specifically gastric ulcer (p = 0.02)). A more negative association between GERD in Tuvan children and a family predisposition to gastrointestinal diseases, in contrast to Caucasians, may be due to a higher prevalence of a number of gastrointestinal diseases in adults and is related with the functional features of the system, formed under the influence of the features of traditional life and nutrition. Conclusion. In the Republic of Tyva, GERD in native schoolchildren is associated with a wide range of gastrointestinal diseases in relatives.

Exploration into the equity of the impact of Exercise Referral Scheme (ERS) among different ethnic populations in the UK

Exploration into the equity of the impact of Exercise Referral Scheme (ERS) among different ethnic populations in the UK

CYP3A4*1B and CYP3A5*3 SNPs significantly impact the response of Egyptian candidates to high-intensity statin therapy to atorvastatin

BackgroundA single nucleotide polymorphism (SNP) is a variation in the DNA sequence that results from the alteration of a single nucleotide in the genome. Atorvastatin is used to treat hypercholesterolemia. It belongs to a class of drugs called statins, which lower elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Research findings on the associations between the response to atorvastatin and genetic polymorphisms in CYP3A4 and CYP3A5 are inconclusive. The effects of CYP3A4*1B (rs2740574 C/T) and CYP3A5*3 (rs776746 T/C) on atorvastatin therapy have not been previously studied among Egyptians.ObjectiveThis research aimed to investigate the effects of the genetic polymorphisms CYP3A4*1B and CYP3A5*3 on atorvastatin treatment in Egyptians.MethodsIn this prospective cohort study, 100 subjects were genotyped for these SNPs. All participants were screened for serum lipid profiles, liver enzymes, total bilirubin (TB), and creatine kinase (CK) before and after 40 mg postatorvastatin therapy. Atorvastatin plasma levels were assessed posttreatment; atorvastatin pharmacokinetics were evaluated in five carriers of the CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes.ResultsThe allele frequencies of the CYP3A4*1B and CYP3A5*3 SNPs were 86% and 83%, respectively. The CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes significantly improved the serum triglyceride (TG) level (P < 0.05) and elevated the TB level (P < 0.001). Atorvastatin plasma levels were greater in CYP3A4*1B (T/T) (P < 0.05) and CYP3A5*3 (C/C) (P < 0.001) genotype carriers. Both SNPs significantly affected the pharmacokinetics of atorvastatin compared with those of Egyptian volunteers and various ethnic populations.ConclusionsThe CYP3A4*1B and CYP3A5*3 variants were prevalent in the study participants and could impact the effectiveness and safety of atorvastatin therapy. The mutant genotype of the CYP3A4*1B SNP and the CYP3A5*3 SNP led to high atorvastatin levels. Both variants had a notable effect on the pharmacokinetics of atorvastatin among Egyptians compared with healthy Egyptians and volunteers from other ethnic populations. Overall, clinicians can learn more about the impact of both variants in response to atorvastatin.Graphical

Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature

ObjectiveDiagnostic delay is a pervasive patient safety problem that disproportionately affects historically underserved populations. We aim to systematically examine and synthesise published qualitative studies on patient experiences with diagnostic delay...

Introduction: migration and the First World War

ABSTRACT Studies of the nineteenth-century era of mass migration tend to conclude at the outbreak of the First World War. But what happened to these migrants and to patterns of migration during industrialised warfare? This special issue brings together two fields: migration history and First World War studies. We explore the fates and experiences of the large diasporic populations who found themselves in nations recently determined belligerent or neutral, where allegiances and enemies were newly defined. This introduction considers how migration history might inform approaches to First World War studies: who counts as a migrant in this period and how this was impacted by war. The issue consists of articles which address experiences of mobile populations and the infrastructure of mobility in this period. By addressing diverse ethnic and racial populations, including intersections of gender, the articles begin to explore the war as a period of ‘race-making’ and hybridity, where rather than just an acceleration of existing trends, new attitudes and ideas about identity, belonging and patriotism came to light. By considering how policies and processes of migration changed because of the conflict, authors contemplate war as a period of borders shifting and solidified, of immigration regimes tightened or newly controlled, often in tension with existing understanding of citizenship or home.

Type 2 diabetes complications in ethnic minority compared with European host populations: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to quantify differences in type 2 diabetes (T2D) complications between ethnic minority populations and European host populations, in both cross-sectional and prospective studies. Following...

Omidubicel for Hematopoietic Cell Transplants: Considerations for Patients and Treatment Outcomes.

For patients with hematologic malignancies requiring allogeneic stem cell transplantation, alternative donor sources are needed when lacking access to a matched related or unrelated donor. Umbilical cord blood (UCB) has been an important alternative allograft donor source for these patients; however, several limitations exist. Omidubicel is a nicotinamide modified allogeneic hematopoietic progenitor cell therapy derived from UCB. Omidubicel was approved in May 2023 by the United States Food and Drug Administration based on the results of a Phase III trial comparing it to UCB transplantation in patients with high-risk hematologic malignancies. Median time to neutrophil engraftment was faster with omidubicel compared to UCB transplantation (12 days vs 22 days; p<0.001). There was also a lower incidence of grade 2/3 bacterial or invasive fungal infections with omidubicel compared to UCB transplantation (37% vs 57%; p=0.027). From a safety perspective, omidubicel has a boxed warning due to the risk of life-threatening infusion reactions, graft-versus-host disease, graft failure, and engraftment syndrome. Omidubicel represents an important advancement in developing novel alternative allograft donor sources. This also has important implications in ensuring access to alternative donor sources for ethnic and minority populations.

The impact of gastroesophageal reflux disease on the quality of life of children and adolescents in the Republic of Tyva

Aim of the study was to investigate quality of life indicators in children and adolescents with gastroesophageal reflux disease (GERD) in the Mongoloid and Caucasian populations of the Republic of Tyva. Material and Methods. Schoolchildren aged 7–18 years of the indigenous (25 Mongoloids – Tuvans with GERD and 354 practically healthy) and newcomers population Republic of Tyva (5 Caucasians with GERD and 158 practically healthy) were examined using a cross-sectional method. Gastroenterological complaints and demographic information were recorded. To assess the quality of life of children, adapted Russian parent (CHQ-PF28) and child (CHQ-PF45) versions of the Child Health Questionnaire (CHQ) were used. The questionnaire allows you to assess various areas of a child’s life. Results and discussion. A decrease in the quality of life was established in schoolchildren of both ethnic populations in the presence of GERD on a number of scales as assessed by the children themselves and their parents. However, unlike parents, children’s assessments tended to decrease in the “family cohesion” section (p = 0.068), which, to a certain extent, may reflect the presence of intrafamily problems that can have a traumatic effect on the child. According to parents’ assessments, in schoolchildren with GERD in the Caucasian population, the decrease in indicators concerned only the “physical activity” scale (p = 0.039). In the Tuvan population, more extensive deviations were noted ‒ in sections “general health assessment” (p = 0.041), “physical activity” (p = 0.024), “changes in health status” (p = 0.006), “pain/ discomfort” (p = 0.037). According to the assessment of children, Caucasians with GERD did not show a decrease in indicators, and Tuvans with GERD had fewer deviations on the scales than, according to their parents. Conclusions. Tyva schoolchildren with GERD showed a decrease in quality of life indicators, which was more pronounced among Mongoloids - Tuvans, and there were differences in its assessment by the children themselves and their parents.

Association of a healthy plant-based heart-protective diet with reduced cardiovascular disease incidence and mortality: findings from the UK Biobank Study

Abstract Importance Previous research examining the effects of omnivorous and plant-based diets on CVD outcomes has produced inconsistent findings, and the importance of diet quality is overlooked. Objective To assess the relation between adherence to a healthy plant-based, heart-protective diet and the risk of cardiovascular disease (CVD) events. Design: Prospective cohort study. Methods and Results 192,274 (mean age: 56.3±7.9 years, 43.3% males) participants in UK Biobank without CVD at baseline who completed a 24-hour recall questionnaire. Using data generated by Oxford WebQ, we developed a novel heart-protective diet score (HPDS) based on 22 food groups. Cox proportional hazard models were used to study associations. During a median follow-up of 12.3 years, there were 20,692 CVD events and 1,131 CVD deaths. After adjusting for demographics, Townsend deprivation index, lifestyle factors, and history of chronic diseases, participants in the top quartile of the HPDS were at the lower risk of overall CVD (HR: 0.92, 95% CI: 0.88 to 0.95), ischemic heart disease (HR: 0.88 [95% CI: 0.83 to 0.93]), myocardial infarction (HR: 0.82, 95% CI: 0.74 to 0.90), and heart failure (HR: 0.86, 95% CI: 0.78 to 0.95) than those in the bottom quartile. Participants who adhered closely to a healthy plant-based heart-protective diet had the lowest risk of overall CVD (HR: 0.72, 95% CI: 0.61 to 0.86), ischemic heart disease (HR: 0.68, 95% CI: 0.52 to 0.89), myocardial infarction (HR: 0.65, 95% CI: 0.46 to 0.91), and heart failure (HR: 0.51, 95% CI: 0.30 to 0.85) mortality. Conclusions and relevance: Adherence to a healthy plant-based heart-protective diet rich in non-starchy vegetables, fruits, whole grains, legumes, and fish, is associated with a reduced cardiovascular disease incidence and mortality. Further research in diverse ethnic populations is necessary to validate our findings and enhance their generalizability.

Identification and Functional Investigation of SOX4 as a Novel Gene Underpinning Familial Atrial Fibrillation.

Background: Atrial fibrillation (AF) signifies the most prevalent supraventricular arrhythmia in humans and may lead to cerebral stroke, cardiac failure, and even premature demise. Aggregating strong evidence points to genetic components as a cornerstone in the etiopathogenesis of familial AF. However, the genetic determinants for AF in most patients remain elusive. Methods: A 4-generation pedigree with idiopathic AF and another cohort of 196 unrelated patients with idiopathic AF as well as 278 unrelated healthy volunteers were recruited from the Chinese population of Han ethnicity. A family-based whole-exome sequencing examination followed by a Sanger sequencing assay in all research subjects was implemented. The functional impacts of the identified SOX4 mutations were explored via a dual-reporter assay. Results: Two new heterozygous SOX4 mutations, NM_003107.3: c.211C>T; p.(Gln71*) and NM_003107.3: c.290G>A; p.(Trp97*), were observed in the family and 1 of 196 patients with idiopathic AF, respectively. The two mutations were absent in the 278 control individuals. The biochemical measurements revealed that both Gln71*- and Trp97*-mutant SOX4 failed to transactivate GJA1 (Cx43). Moreover, the two mutations nullified the synergistic activation of SCN5A by SOX4 and TBX5. Conclusions: The findings first indicate SOX4 as a gene predisposing to AF, providing a novel target for antenatal genetic screening, individualized prophylaxis, and precision treatment of AF.

Causal relationship between hyperthyroidism and cataracts: a two-sample bi-directional mendelian randomization study

Clinical studies and meta-analyses have suggested a link between thyroid dysfunction and lens opacification. The objective of this study is to investigate the causal relationship between hyperthyroidism and the development of cataracts using the Mendelian randomization approach, with the aim of filling the gap in knowledge about the systemic effects of hyperthyroidism on ocular health. Leveraging genetic variants as instrumental variables, the analysis used extensive datasets from the UK Biobank and the FinnGen Database and employed three common approaches for causal inference (the Inverse Variance Weighted method, a regression based method the Weighted Median estimator, and MR-Egger regression) and accompanying sensitivity analyses to ensure robustness. The results demonstrate that there is a strong likely causal relationship, with hyperthyroidism increasing the risk of developing senile cataracts (OR = 361.09, 95%CI 5.024 to 2.60 × 104, P = 0.007). A sensitivity analysis provided no evidence of horizontal pleiotropy and no significant outliers, suggesting the results are robust. In conclusion, our study established a significant causal relationship between hyperthyroidism and increased risk of cataract development, underscoring the importance of considering the systemic effects of hyperthyroidism in clinical and public health interventions and policies. Future research should focus on elucidating the molecular mechanisms underlying this association, exploring the potential benefits of early intervention in hyperthyroidism to prevent cataract development, and investigating whether these findings translate across different ethnic populations. Additionally, further GWAS studies aimed at identifying genetic variants associated with both hyperthyroidism and cataracts are warranted to confirm and expand upon our results.

Genetic Polymorphisms Associated with Fetal Hemoglobin (HbF) Levels and F-Cell Numbers: A Systematic Review of Genome-Wide Association Studies.

Elevated fetal hemoglobin (HbF), which is partly controlled by genetic modifiers, ameliorates disease severity in β hemoglobinopathies. Understanding the genetic basis of this trait holds great promise for personalized therapeutic approaches. PubMed, MedRxiv, and the GWAS Catalog were searched up to May 2024 to identify eligible GWAS studies following PRISMA guidelines. Four independent reviewers screened, extracted, and synthesized data using narrative and descriptive methods. Study quality was assessed using a modified version of the Q-Genie tool. Pathway enrichment analysis was conducted on gene lists derived from the selected GWAS studies. Out of 113 initially screened studies, 62 underwent full-text review, and 16 met the inclusion criteria for quality assessment and data synthesis. A total of 939 significant SNP-trait associations (p-value < 1 × 10-5) were identified, mapping to 133 genes (23 with overlapping variant positions) and 103 intergenic sequences. Most SNP-trait associations converged around BCL11A (chr.2), HBS1L-MYB, (chr.6), olfactory receptor and beta globin (HBB) gene clusters (chr.11), with less frequent loci including FHIT (chr.3), ALDH8A1, BACH2, RPS6KA2, SGK1 (chr.6), JAZF1 (chr.7), MMP26 (chr.11), COCH (chr.14), ABCC1 (chr.16), CTC1, PFAS (chr.17), GCDH, KLF1, NFIX, and ZBTB7A (chr.19). Pathway analysis highlighted Gene Ontology (GO) terms and pathways related to olfaction, hemoglobin and haptoglobin binding, and oxygen carrier activity. This systematic review confirms established genetic modifiers of HbF level, while highlighting less frequently associated loci as promising areas for further research. Expanding research across ethnic populations is essential for advancing personalized therapies and enhancing outcomes for individuals with sickle cell disease or β-thalassemia.

Evaluating the reliability and validity of the Strengths and Difficulties Questionnaire in a heterogeneous ethnic young cohort from northeast India

Abstract Introduction: The strengths and difficulties questionnaire (SDQ) is extensively utilized to assess adolescent psychosocial problems. Despite its global use, the instrument’s reliability and validity across diverse ethnic populations remain under-examined. This study evaluates the reliability and validity of the SDQ among adolescents from an ethnic young cohort from Northeast India. Methodology: The present study followed a cross-sectional descriptive study design. The population for the study comprised children aged 13–17 years, studying in various government and public schools located in districts in Northeast India. In this study, a total sample size of 400 participants was selected. The SDQ was used. The researcher used the Statistical Package for the Social Sciences (SPSS) version 23 to analyze and measure the data. The study was undertaken with the approval of the scientific committee and ethical committee. Results: The internal consistency of the SDQ, as indicated by a Cronbach’s α of 0.846, suggests high reliability. Exploratory factor analysis identified five distinct factors from the SDQ items, with Bartlett’s Test of Sphericity and the Kaiser–Meyer–Olkin (KMO) measure confirming the appropriateness of factor analysis (χ² =1880, df = 276, P &lt; 0.001; KMO = 0.848). Factors were deemed significant with loadings ≥0.3. Conclusion: The findings affirm the SDQ’s reliability and factor structure within this multiethnic context of Northeast India, underscoring its potential as a valid tool for screening psychosocial issues among diverse ethnic groups. This validation enhances the SDQ’s applicability for mental health assessments and interventions across varied Indian ethnicities.

A classification system for identifying persons with an unknown cardiovascular disease (CVD) status for a multiracial/ ethnic Caribbean population.

The need for classification systems for cardiovascular disease (CVD) that is population-specific is important towards understanding the clinical disease and diagnostics associated with the disease. This paper presents the form and validation results of this classification system. The survey data used was captured from 778 participants, 526 persons with no prior CVD, and 252 who reported prior CVD. Binomial logistic regression and Discriminant analysis were utilised to develop classification models. This classification system provided a general measure of severity of disease by utilising scores estimated from two algorithms developed from 13 routine physiologic measurements, along with demographic information of age and ethnicity, inter alia, and previous health status. For each model, specific score ranges were identified, which gave the best classification for those with a prior CVD incident (higher scores) and for others labelled as non-CVD (lower scores). The two classification models (Logistic Regression Model and Discriminant Analysis Model) developed had high area under the receiver-operating characteristic (AUROC) values (98% & 99%) and sensitivity (86 and 90%), which improved discrimination between Non-CVD and CVD participants and, more importantly, correctly classified a greater proportion of CVD participants. New to this type of research was the estimation and detailed evaluation of a range of scores, labelled non-differentiating, which fell in the middle of the spectrum and which contained the higher-end scores for the non-CVD individuals and the lower-end scores for CVD patients, all of whom were incorrectly classified, based on their prior history. The classification system of scores is able to differentiate the CVD status of individuals, with good predictability, and could assist physicians with recommending different treatment plans. The two models in this classification system each individually outperformed the three established models in terms of the strength of their correct classifications of individuals with or without prior reported CVD incidents. More importantly, they have smaller non-differentiating ranges than the three known models and, in that range, the two new models have lower CVD/non-CVD ratios suggesting they are more likely to misclassify non-CVD individuals compared to CVD patients, which is a more benign misclassification. Further, when used in combination, the two models increased the sensitivity, in classifying individuals of different ethnicities, beyond that of either one used independently or of any of the three standard European/North American models. These efforts will be instrumental in advancing personalised CVD management strategies and improving health outcomes across diverse populations.

Evaluation of the Steno Type 1 Risk Engine in predicting cardiovascular events in an ethnic mixed population of type 1 diabetes mellitus and its association with chronic microangiopathy complications

BackgroundThe Steno Type 1 Risk Engine (ST1RE) was developed to aid clinical decisions in primary prevention for individuals with type 1 diabetes (T1D), as existing cardiovascular (CV) risk models for the general population and type 2 diabetes tend to underestimate CV risk in T1D. However, the applicability of ST1RE in different populations remains uncertain, as prediction models developed for one population may not accurately estimate risk in another. This study aimed to evaluate the performance of the ST1RE in predicting CV events among ethnically mixed T1D individuals and its association with the progression of microangiopathy complications.MethodsA retrospective survey of 435 adults with T1D who were free of CV events at baseline was assessed by ST1RE and chronic diabetes complications at 5 and 10 years of follow-up. The estimated CV risk rates were compared with the observed rates at 5 and 10 years using statistical analyses, including Receiver Operating Characteristic (ROC) curve analysis, Hosmer-Lemeshow test, Kaplan-Meier curves analysis and Cox-regression models.ResultsAmong 435 patients (aged 25 years; interquartile range [IQR]: 21–32) with a median T1D duration of 13 years (IQR: 9–18), only 5% were categorized into the high ST1RE group. Within a median follow-up of 9.2 years (IQR 6.0-10.7), 5.5% of patients experienced a CV event (1.6%, 14.9%, and 50% from the low, moderate, and high-risk groups, respectively). The hazard ratios (HRs) for CV events were greater in the high-risk group (HR 52.02; 95% CI 18.60–145.51, p < 0.001) and in the moderate-risk group (HR 8.66; 95% CI 2.90–25.80, p < 0.001) compared to the low-risk group. The ST1RE estimated CV events were similar to the observed at 5 years (3.4% vs. 3.5%; χ2 = 10.12, p = 0.899) and 10 years (6.8% vs. 9.9%; χ2 = 14.80, p = 0.676) of follow-up. The progression of microangiopathies was greater in the high vs. low for retinopathy (p = 0.008), diabetic kidney disease (p < 0.001), peripheral neuropathy (p = 0.021), and autonomic neuropathy (p = 0.008).ConclusionsST1RE performed well in predicting CV events at 5 and 10 years of follow-up. Moreover, higher ST1RE scores were associated with the progression of microangiopathy complications in this genetically heterogeneous T1D population.Graphical abstract

Spectrum of renal diseases in the pediatric population of Nepal

Background: The spectrum of renal diseases varies with different ethnic populations, geographical locations and environmental factors. In children, many signs of kidney disease are either hidden or mimic other systemic diseases. There is a need of identifying renal disorders at an early stage to retard the rapid progression. This study aims to identify the different histopathological spectrum of glomerular diseases in pediatric renal biopsies. Materials and Methods: This was a cross-sectional prospective study undertaken at the Pathology Department at Pratham Pathology Laboratory, Lazimpat for 17 months duration (May 1ST - December 31ST 2023). The final diagnosis was made by a pathologist after correlating the histopathological findings with immunofluorescence and other clinical and laboratory findings. Results: A total of 97 pediatric patients’ renal biopsy specimens were evaluated. Patients’ age ranged from 0-16 years. The majority of patients were in the age group of 11-16 years (62.8%). The study showed slight female predominance with male to female ratio of 0.8:1. The most common glomerular disease was Lupus Nephritis with a frequency of 19 (19.6%). The most common cause for Rapid progressive Glomerulonephritis in the pediatric population was Post Infectious Glomerulonephritis with a frequency of 5 (50%). Conclusions: The most commonly diagnosed glomerular disease in pediatric renal biopsies was Lupus Nephritis. The leading cause of Rapid Progressive Glomerulonephritis was Post Infectious Glomerulonephritis and Lupus was one of the leading causes of chronic kidney disease.