Post Diagnosis Research Articles

Myocardial deformation in multisystem inflammatory syndrome in children: layer-specific cardiac MRI insights from a pediatric cohort.

Multilayer strain magnetic resonance imaging (MRI) analysis offers detailed insights into myocardial mechanics and cardiac function by assessing different layers of the heart muscle, enabling a comprehensive understanding of cardiac involvement. This study aims to explore cardiac strain differences between patients with multisystem inflammatory syndrome and a control group at medium-term follow-up, utilizing a layer-specific cardiac magnetic resonance imaging (CMR) approach. In this retrospective study, patients with multisystem inflammatory syndrome in children (MIS-C) and a group of controls who had undergone cardiac magnetic resonance (CMR) imaging were selected and included. CMR was performed 30days after discharge (range 34-341days) for MIS-C patients. TrufiStrain research prototype software (Siemens Healthineers AG, Erlangen, Germany) was used for automated myocardial segmentation and strain calculation, to measure radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) at the epicardial, mid-wall, and endocardial levels. Statistical analysis included Shapiro-Wilk tests, Student t-tests, and Mann-Whitney U tests, ANOVA, and regression analysis, maintaining a significance level of α = 0.05. The study cohort consisted of 32 MIS-C patients (≤ 18years; 14 females) and 64 control participants (≤ 18years; 24 females). Median interval to CMR post diagnosis was 142days (range 34-341) with normal CMR findings for all patients. The mean age of the two groups was similar (MIS-C: 14.2years; controls: 14.1years, P = 0.49). There were no significant differences in height (MIS-C: 164.7cm; controls: 163.9cm, P = 0.84), weight (MIS-C: 68.2kg; controls: 59.4kg, P = 0.11), or body surface area (MIS-C: 1.7 m2; controls: 1.7 m2, P = 0.41). Global strain measurements showed no significant differences between the groups (global LS MIS-C patients - 16.2% vs - 15.7% in controls (P = 0.23); global RS 27.8% in MIS-C patients vs 29.5% in controls (P = 0.35); and global CS - 16.7% in MIS-C patients vs - 16.8% in controls (P = 0.92)). Similarly, layer-specific strain analysis across the endocardial (LS values of - 17.7% vs - 16.8% (P = 0.19), RS of 23.1% vs 24.8% (P = 0.25), and CS of - 19.9% vs - 19.9% (P = 0.92)), epicardial (LS - 14.9% vs - 14.5% (P = 0.31), RS of 31.2% vs 33.1% (P = 0.29), and CS of - 14.1% vs - 14.2% (P = 0.75)), and midmyocardial (LS - 16.5% vs - 16.3% (P = 0.18), RS 29.3% vs 31.8% (P = 0.31), and CS - 17.0% vs - 17.2% (P = 0.95)) levels revealed no significant disparities. The only notable finding was the reduced apical radial strain in MIS-C patients compared to controls (global RS MIS-C 12.4% vs 17.4% in controls, P = 0.03; endocardium RS MIS-C 4.9% vs 10.31% in controls, P = 0.01; epicardial RS MIS-C 17.7% vs 22.6% in controls, P = 0.02; and midmyocardium RS MIS-C 12.5% vs 17.9% in controls, P = 0.02). This study demonstrates that MIS-C does not significantly impact global or layer-specific myocardial strain values, as assessed by CMR, compared to a control group. The lower apical radial strain in MIS-C patients indicates a potential localized myocardial involvement.

Oral health statuses of individuals diagnosed with gastroparesis: A Cross-Section study.

Gastroparesis (GP) is a debilitating gastric motility disorder associated with digestive dysfunction, reduced quality of life (QoL), and increased mortality rates. There is no known cure for GP and treatment options are limited. The oral cavity is responsible for initiating digestion, yet the impact of GP symptom frequency on oral health status and oral healthcare utilization is not well understood. A 21-item electronic survey was developed and disseminated to a private GP social media forum. Survey questions explored GP symptom frequency, oral health status, dental care utilization, and oral health education post GP diagnosis. Descriptive and inferential statistics analysed data. There were 434 study participants. An overwhelming 83% reported GP negatively influenced their oral health and oral function. Significance was observed between GP symptom frequency and oral health status (p = <0.0001). The majority (81%) reported receiving dental care post GP diagnosis, yet (63%) reported current untreated dental concerns. Interestingly, (74%) of participants reported that they have never been educated about oral health risks associated with GP by any healthcare professionals. GP negatively affects oral health. Study participants reported a need for extensive dental treatments and high levels of untreated dental concerns. Results strongly support that preventive oral healthcare and education must be provided for individuals with a GP diagnosis. As leading oral disease prevention specialists, dental hygienists must be aware of the effects of GP on the oral cavity to help provide person-centred evidence-based care, improve digestive processes, and increase QoL for GP sufferers.

Adolescent autistic girls navigating their diagnosis in Swedish secondary school

IntroductionAdolescent autistic girls in mainstream schools experience more loneliness and exclusion than their peers. Swedish schools have a long tradition of working towards inclusion but, despite this commitment, these girls are at higher risk of absenteeism and failing to achieve educational objectives. Bearing this in mind, it is important to understand how autistic girls navigate their everyday school life from a first-hand perspective and develop a broader understanding of what shapes their opportunities for and barriers to participation.MethodsThis qualitative study draws on multiple semi-structured interviews with 11 autistic girls, aged 13–15, exploring how they navigate having an autism diagnosis within a Swedish secondary school context.ResultsWhile on a personal level the diagnosis itself was mostly perceived as positive, the girls expressed ambivalence about making sense of it in the school context. The girls expressed awareness of the perceptions and understanding of autism in their school setting, and their consequences in terms of both support and exclusion and stigmatisation. The sense of being perceived by others as different, accompanied by a desire to belong and an awareness of stigma, seemed to have a strong impact on how they navigated everyday school life. This created field of tension between the social context of school, its values and norms, and the girls’ personal experiences and views about autism.DiscussionThe girls’ accounts illustrate the complex reality of their school lives post diagnosis. Valuable implications for practice include the need to work towards a discourse in schools in which differences are seen as natural, and guidance post diagnosis to build the girls’ awareness and understanding and enable them to develop strategies for successfully navigating school.

Development and validation of a risk prediction model for worsening renal function in patients with incident heart failure

Abstract Background Worsening renal function (WRF) is one of the strongest predictors of outcome in patients with heart failure (HF). The presence of WRF often influences the decision to start, up-titrate, or discontinue disease modifying HF therapies and is one of the key determinants of suboptimal guideline-directed medical therapy. Existing WRF risk scores were developed in hospitalised HF patients to predict in-hospital WRF. Their performance among incident HF is far from ideal. It is therefore important to develop a new WRF risk prediction model in people with newly diagnosed HF. Purpose This study was to develop and validate a clinical risk prediction model for 180-day WRF post diagnosis of incident HF using data from a population-based longitudinal cohort. Methods We developed and validated a multivariable logistic regression model for WRF in the 180 days post diagnosis of incident HF. Data for individuals with incident HF between 2016 to 2021 were extracted from the NELSON study conducted in Tayside, Scotland. WRF was defined as a composite event of (i) having two consecutive eGFRs declined by 40% or greater; (ii) having an eGFR &amp;lt; 15mL/min/1.73m2; (iii) initiation of sustained dialysis; (iv) development of end-stage kidney disease; (v) receiving kidney transplantation; or (vi) kidney related death. Four candidate models included one model using literature knowledge; one multivariable fractional polynomial (MFP) model; and two stepwise selected models based on either Akaike or Bayesian information criterion (AIC or BIC). Calibration and discrimination were assessed, and performance stability were evaluated using optimism corrected performance via 1000 times bootstrapping. Results 4076 individuals (mean age 72.8 ± 13.2; 58% male; 1081 HF with reduced ejection fraction (HFrEF), 646 with HF with mildly reduced ejection fraction (HFmrEF), 1348 HF with preserved ejection fraction (HFpEF), and 1001 HF with unknown ejection fraction (EF)) who were WRF-free when diagnosed with HF were identified. Of these, 2095 (51.4%) were in-patients, and 1981 (48.6%) were out-patients. 285 (7%) patients developed WRF within 180 days post HF diagnosis. The selected MFP model (comprising 12 predictors, Table 1) showed good calibration (slope = 1.00 [0.86, 1.14]; intercept = 0.0 [-0.13, 0.13]) discrimination (C-statistic = 0.69 [95% CI: 0.65, 0.72]), and stability (optimism corrected: calibration slope = 0.94 [0.80, 1.07]; calibration intercept = -0.14 [-0.50, 0.20]; C-statistic = 0.67 [0.64, 0.71]). Discrimination of the developed model significantly outperformed two existing risk scores (Forman and Basel, both with a C-statistic = 0.62 [0.59 – 0.65]). Conclusions We have shown that the developed model performed better in predicting WRF in individuals with newly diagnosed HF. This could have utility in identifying at risk patients with HF early in the disease trajectory for therapies that can reduce renal decline.Calibration of predicted riskModel estimates for predicting 180d WRF

The effect of corticosteroids in developing active pulmonary tuberculosis among patients with COVID-19.

Corticosteroids can reduce the mortality rate among patients with severe COVID-19 pneumonia. However, opportunistic infections such as Mycobacterium tuberculosis are of concern, especially among those on high doses of corticosteroids. It is unknown whether the risk of developing subsequent TB infection is high or not among COVID-19 patients on high doses of corticosteroids. Hence, this study was conducted to address this gap of knowledge. We conducted a retrospective, cross-sectional study at the King Chulalongkorn Memorial Hospital from October 12, 2022 to June 30, 2023. Two hundred forty-three participants with documented COVID-19 diagnosis on high dose corticosteroids were enrolled into the study. Baseline characteristics and risk factors of developing TB were collected. The prevalence of TB was significantly different among participants with chronic kidney disease (CKD) stages 2-4 and chronic lung diseases. The incidence of TB post 1-year diagnosis of COVID-19 was 4 out of 243 patients (1.6%) or 1,646 cases per 100,000 person-year. The mortality rate among subsequent TB group was significantly much higher than the non-TB group (50% vs 0.4%; p-value = 0.001). COVID-19 participants on high doses of corticosteroids also were co-infected with other infections such as bacteria (37.1%), fungi (5.3%), and Pneumocystis jirovecii (PJP) (1.2%). We found that the incidence of TB in participants with COVID-19 on high doses of corticosteroids was 11 times higher than the general population. Therefore, we recommend screening for latent TB among these patients to prevent/early diagnose TB disease.

Relationship between Experiential Avoidance and Emotional Disturbances in Coping with Disease in Patients with Multiple Sclerosis.

Multiple sclerosis (MS) is a neurodegenerative disease that presents with both motor and non-motor symptoms, with anxiety and depression being prominent and potentially exacerbated by negative thoughts. Therefore, the experiential avoidance (EA) exhibited by patients post diagnosis is particularly relevant. This study aimed to measure the degree of EA in patients with MS and determine its relationship with emotional disturbances. A cross-sectional descriptive study was conducted using a sample of 64 patients diagnosed with MS. In October 2018, these patients underwent evaluations of functional and cognitive variables, such as anxiety, depression, and avoidant behaviors towards the disease, using the Expanded Disability Status Scale, Acceptance and Action Questionnaire-II, Self-Compassion Scale Short Form, Five Facet Mindfulness Questionnaire-15, prefrontal symptoms inventory, Beck Depression Inventory II, and State-Trait Anxiety Inventory to assess coping mechanisms in handling the disease. Higher levels of state anxiety (β = 0.79; p < 0.001), trait anxiety (β = 0.82; p < 0.001), and depression (β = 0.62; p < 0.001) were observed in patients with MS as their EA and psychological inflexibility increased. Participants with high self-compassion/self-acceptance tended to have fewer negative thoughts and exhibited better coping with the disease, which may, in turn, affect patterns of psychological rigidity or inflexibility. Dimensions such as kindness and humility could act as positive factors in coping with the disease, whereas self-judgment and isolation are negative elements often associated with avoidant behaviors that hinder effective coping with the illness.

6971 Effects of the Hybrid Closed-loop System in Pediatric-Onset Type 1 Diabetes

Abstract Disclosure: H. Woo: None. J. Yoo: None. S. Shin: None. Y. Lee: None. H. Kim: None. M. Gu: None. J. Kim: None. J. Kim: None. C. Shin: None. Y. Lee: None. Purpose: We evaluated the effectiveness and limitations of the MiniMedTM 770G, a hybrid closed-loop (HCL) system which adjusts basal insulin every five minutes using continuous glucose monitoring (CGM) data, for glycemic control in pediatric-onset type 1 diabetes (T1D) in South Korea. Methods: We enrolled 20 patients (10 boys and 10 girls) who had been using the 770G pump for over three months, initiating its use between February 2022 and May 2023. Prior to this, they were CGM users and were followed for over a year post T1D diagnosis. Clinical and biochemical data, along with CGM metrics such as time in range (TIR), time below range (TBR), time above range (TAR), and coefficient of variation (CV), were analyzed. Additionally, the percentage of SmartGuard Auto Mode system usage was collected. Results: The median age at the start of 770G was 13.97 years (IQR 11.24–17.86), with a median of 6.5 years of duration of type 1 diabetes. After utilizing the 770G pump (n=20), TIR, TAR, and CV improved over the year (P&amp;lt;0.05). Patients utilizing Auto Mode over 85% of the time exhibited significant improvements in HbA1c (P=0.02), TIR (P=0.04), CV (P&amp;lt;0.01), and TAR 250 (P=0.02), in contrast to those who used Auto Mode 85% or less. Hyperglycemia and lack of calibration contributed to over 50% of the exits from Auto Mode. Conclusions: The implementation of HCL in adolescents and young adults with T1D enhanced glycemic control over one year. Educating patients on sustained Auto Mode use without interruptions is crucial. Presentation: 6/2/2024

Abstract A051: Association of residential economic and racial segregation with pediatric cancer survival

Abstract Purpose: Studies have linked residential segregation to inferior outcomes in adult-onset cancers. However, its association with pediatric cancer outcomes remains poorly understood. Racial and ethnic disparities in pediatric cancer outcomes are well-documented, and residential segregation may contribute, at least in part, to these disparities. This study examines the association between residential economic and racial segregation and survival in a statewide, population-based cohort of pediatric oncology patients. Methods: We studied a cohort of children diagnosed with their initial cancer between 2009 and 2016 at age 21 or younger, who were treated at Children’s Healthcare of Atlanta. The Index of Concentration at the Extremes (ICE) was mapped to the ZIP Codes of patient residence at diagnosis to measure economic and racial segregation. ICE was calculated by the difference between the number of non-Hispanic White people with &amp;gt;80th percentile household income and non-Hispanic Black people with &amp;lt;20th percentile household income, divided by the total number of people in the ZIP Code. ICE tertiles were categorized from the most deprived/segregated (tertile 1) to the most privileged/least segregated (tertile 3). We used the Cox proportional hazards model to estimate 5-, 3-, and 1-year overall survival from diagnosis by ICE tertiles, or by ICE tertiles and patient race. All models adjusted for sociodemographic (age at diagnosis, sex, health insurance, rurality) and clinical factors (cancer type, year of diagnosis). Results: Of our cohort (N=2,790), a higher proportion of non-Hispanic Black patients (50.8% vs. 13.4%) and publicly insured patients (62.3% vs. 30.8%) was found in tertile 1 compared to tertile 3. Patients living in tertile 1 consistently exhibited a higher risk of death at 5 years (adjusted hazard ratio [aHR]=1.32, 95% confidence interval [CI]=1.03-1.69, p=0.026), 3 years (aHR=1.35, 95% CI=1.04-1.75, p=0.026), and 1 year (aHR=1.38, 95% CI=0.94-2.03, p=0.099) post diagnosis, compared to those in tertile 3. In addition, compared to non-Hispanic White patients living in ICE tertiles 2-3 (more privileged areas), no survival difference was found among non-Hispanic Black children living in the same tertiles, while non- Hispanic Black children living in ICE tertile 1 had a significantly higher risk of death at 5 years (aHR=1.46, 95% CI=1.11-1.90, p=0.006), 3 years (aHR=1.56, 95% CI=1.17-2.07, p=0.002), and 1 year (aHR=1.65, 95% CI=1.11-2.45, p=0.014) post diagnosis. Conclusion: Our data indicate that residence in more racially segregated and economically deprived neighborhoods is associated with poorer overall survival among children diagnosed with cancer. Further research should explore the mediation and moderation effects of residential segregation on racial disparities in pediatric cancer-specific survival. Citation Format: Xu Ji, Lu Zhang, Xuesong Han, Heeju Sohn, Kinsey Meggett, Rebecca Williamson Lewis, Sharon M Castellino. Association of residential economic and racial segregation with pediatric cancer survival [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A051.

Abstract B144: Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors

Abstract Background: Sub-Saharan African immigrants (SSAI) in the United States (US) constitute one of the fastest-growing segments of the immigrant population. Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that period. We define SSAI as the 2 million individuals living in the US originally from the region of the African continent located south of the Saharan desert. Despite their growing numbers, little is published about the extent to which SSAI adapt to health behaviors more common in the US or remain immersed in the values, beliefs, and practices reflective of their country of origin. Importantly, no study has comprehensively examined the social determinants of health factors among this population and its influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment. Aim: This study seeks to better understand the lived experiences, unmet needs and the impact of migration on the quality of life of SSAI cancer survivors in the US. Methods. We employ a qualitative approach guided by grounded theory. Selective sampling was used to identify potential participants from a database obtained via the Florida and Minesota cancer registries. We proceeded to conduct in-depth interviews with 16 cancer survivors recruited from the two caner registries. Results. We developed a conceptual framework illuminating the full range of social, behavioral, environmental, and structural factors associated with the experiences of SSAI prostate cancer survivors. From the data, the post diagnosis experiences of study participants can be categorized into three domains: 1) health behaviors; 2) treatment decision and antecedents; 3) challenges of being an immigrant. Characteristics of health behaviors include using informal care teams for social support and second opinions before treatment. Selective disclosure of diagnosis, changes to diet, exercise and searching for information about the diseases were other manifestation of behavior. While some participants made decisions about treatment soon after diagnosis, others took a more deliberative approach and relied on faith and family for social support. Some challenges in terms of being an immigrant include knowledge gaps about the US health system, lack of health insurance and transportation to hospital during treatment. Implication for public health practice. Some of the unmet needs of study participants include transportation cost to and from hospital for radiotherapy and other treatment and reducing the high out of pocket cost for co-payment and drugs. The knowledge deficit about navigating the US health system can be addressed through community-based intervention in partnerships with immigrant groups, advocacy organizations and faith-based organizations. The focus of this intervention should be to educate and empower SSAI men on how to navigate the US health system and be more assertive about their health needs and desires for treatment during doctor’s visit. Citation Format: Ernie Kaninjing, Gladys Asiedu, Kaitlin Van Voorhis, Daniel Lee, Rakinya Hinson, Mary Ellen Young. Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B144.

P055 ELECTROCARDIOGRAPHIC ABNORMALITIES AND ASSOCIATED FACTORS IN NORMOTENSIVE TYPE II DIABETIC PATIENTS

Background/Objective: Type II diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the presence of target organ damage or at least three cardiovascular disease (CVD) risk factors. Resting electrocardiography (ECG) is recommended in T2DM patients only in the presence of hypertension or on suspicion of CVD. ECG abnormalities occur early in T2DM, are associated with future cardiovascular events/mortality after adjustment for traditional CVD risk factors. Early screening and detection may improve long term survival in T2DM patients hence, aim of study- to assess the patterns and factors associated with ECG abnormalities in T2DM patients without co-existing hypertension. Methods: One hundred normotensive (BP&lt;130/80mmHg, not on any antihypertensive agent) T2DM patients were recruited consecutively, from the Endocrinology and Diabetes clinics of the Medical Outpatient Clinic and Family Medicine department of the University of Nigeria Teaching Hospital. Consents were obtained, before interviewers, administered questionnaire to get the biodata, T2DM history, complications and treatment. Anthropometric and blood pressure readings were taken using standard methods. A 12-hour overnight fasting blood sample was taken for biochemical assessment of blood glucose, glycated haemoglobin, lipids, urea and creatinine. A 12 lead ECG was performed and interpreted by one cardiologist using the Minnesota ECG code criteria. Descriptive statistics was used for patterns of ECG abnormalities while association between categorical variables were cross tabulated and tested using chi square. Results: Participants were majorly females 68(68.0%), overweight/obese 52(52.0%) with a mean age of 55.56±9.89 years. Duration of T2DM illness post diagnosis was 6.57±6.26years. T2DM was poorly controlled in 92(92.0%) while 93(93.0%) had dyslipidaemia. ECG was abnormal in 56(56.0%) with multiple abnormality in 12(21.4)%. Left atrial abnormality was the commonest 14(25.0%) ECG abnormality. No factor was associated with ECG abnormality. Conclusions: ECG abnormalities are common in T2DM, occurring early in the absence of co-existing hypertension. ECG should be done at diagnosis of T2DM irrespective of CVD risk factors, with frequent monitoring than recommended by guidelines. Table. Pattern of electrocardiographic abnormalities in normotensive type II diabetic patients.

Experiences of Parent Coaches in an Intervention for Parents of Young Children Newly Diagnosed with Type 1 Diabetes.

This paper explores parent coaching experiences supporting parents of young children newly diagnosed with type 1 diabetes in a clinical trial. In a trial for 157 parents, those in the intervention arm (n = 116) were paired with a parent coach (n = 37; Mage = 37.9 years, SD = 3.9; 94.6% mothers, 81.1% White non-Hispanic). Parent coaches provided diabetes-specific social support. Parent coaches completed monthly surveys and satisfaction/feasibility surveys, with a subset (n = 7) undergoing qualitative interviews at the end of this study. There were 2262 contacts between participants and their parent coaches, averaging 14.4 (SD = 9.3) per participant. Parent coaches reported that the most commonly used methods were text messages (67.9%) and emails (18.7%), with 33.6% having in-person visits. Coaches reported high satisfaction and belief in their usefulness to participants during the first 9 months after T1D diagnosis. Themes discussed by parent coaches about their experience in mentoring included relationship building, expertise sharing, personal growth, gratification, and intervention optimization suggestions. Parent coaching post T1D diagnosis involves regular, multi-method contacts. It is highly acceptable and valuable for parent coaches to mentor other parents of young children newly diagnosed with T1D.

Association between JAK2V617F variable allele frequency and risk of thrombotic events in patients with myeloproliferative neoplasms.

Myeloproliferative neoplasms (MPNs) are a group of chronic disorders of the bone marrow characterised by the overproduction of clonal myeloid stem cells. The most common driver mutation found in MPNs is a point mutation on exon 14 of the JAK2 gene, JAK2V617F. Various studies have suggested that measuring the variable allele frequency (VAF) of JAK2V617F may provide useful insight regarding diagnosis, treatment, risks and outcomes in MPN patients. In particular, JAK2V617F has been associated with increased risk of thrombotic events, a leading cause of mortality in MPNs. The aim of this study was to determine if JAK2V617F VAF was associated with clinical outcomes in patients with MPN. JAK2V617F VAF was determined by quantitative PCR (qPCR) in a cohort of 159 newly diagnosed MPN patients, and the association of JAK2V617F VAF and risk of thrombosis was examined in this cohort. We observed a significantly higher JAK2V617F VAF in PV and PMF versus ET. A significant association was observed between JAK2V617F VAF and risk of thrombotic events. When patients were stratified by thrombotic events prior to and post diagnosis, an association with JAK2V617F VAF was only observed with post diagnosis thrombotic events. Of note, these associations were not observed when looking at each MPN subtype in isolation. We have shown that a higher JAK2V617F VAF is associated with thrombotic events post MPN diagnosis. JAK2V617F VAF may therefore provide a valuable prognostic indicator for risk of thrombosis in MPNs.

A Machine Learning Model for Risk Stratification of Postdiagnosis Diabetic Ketoacidosis Hospitalization in Pediatric Type 1 Diabetes: Retrospective Study.

Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in pediatric type 1 diabetes (T1D), occurring in approximately 20% of patients, with an economic cost of $5.1 billion/year in the United States. Despite multiple risk factors for postdiagnosis DKA, there is still a need for explainable, clinic-ready models that accurately predict DKA hospitalization in established patients with pediatric T1D. We aimed to develop an interpretable machine learning model to predict the risk of postdiagnosis DKA hospitalization in children with T1D using routinely collected time-series of electronic health record (EHR) data. We conducted a retrospective case-control study using EHR data from 1787 patients from among 3794 patients with T1D treated at a large tertiary care US pediatric health system from January 2010 to June 2018. We trained a state-of-the-art; explainable, gradient-boosted ensemble (XGBoost) of decision trees with 44 regularly collected EHR features to predict postdiagnosis DKA. We measured the model's predictive performance using the area under the receiver operating characteristic curve-weighted F1-score, weighted precision, and recall, in a 5-fold cross-validation setting. We analyzed Shapley values to interpret the learned model and gain insight into its predictions. Our model distinguished the cohort that develops DKA postdiagnosis from the one that does not (P<.001). It predicted postdiagnosis DKA risk with an area under the receiver operating characteristic curve of 0.80 (SD 0.04), a weighted F1-score of 0.78 (SD 0.04), and a weighted precision and recall of 0.83 (SD 0.03) and 0.76 (SD 0.05) respectively, using a relatively short history of data from routine clinic follow-ups post diagnosis. On analyzing Shapley values of the model output, we identified key risk factors predicting postdiagnosis DKA both at the cohort and individual levels. We observed sharp changes in postdiagnosis DKA risk with respect to 2 key features (diabetes age and glycated hemoglobin at 12 months), yielding time intervals and glycated hemoglobin cutoffs for potential intervention. By clustering model-generated Shapley values, we automatically stratified the cohort into 3 groups with 5%, 20%, and 48% risk of postdiagnosis DKA. We have built an explainable, predictive, machine learning model with potential for integration into clinical workflow. The model risk-stratifies patients with pediatric T1D and identifies patients with the highest postdiagnosis DKA risk using limited follow-up data starting from the time of diagnosis. The model identifies key time points and risk factors to direct clinical interventions at both the individual and cohort levels. Further research with data from multiple hospital systems can help us assess how well our model generalizes to other populations. The clinical importance of our work is that the model can predict patients most at risk for postdiagnosis DKA and identify preventive interventions based on mitigation of individualized risk factors.

Worse fibro-inflammatory activity on diagnostic liver biopsy adversely impacts biochemical remission in autoimmune hepatitis

BackgroundAutoimmune hepatitis (AIH) patients can present with advanced fibrosis at diagnosis or may progress to the same if biochemical remission on treatment is not achieved. MethodsWe conducted a single-center retrospective analysis of 34 pediatrics and 39 adult AIH patients. Three pathologists, blinded to clinical information, reviewed the diagnostic liver biopsy (DLB) slides of AIH patients. We evaluated the impact of clinical, laboratory, and histopathologic parameters on outcomes including biochemical remission (BR). ResultsIncidence of advanced (Ludwig stage 3 or 4) fibrosis on DLB was 45.2 %. AIH patients with advanced fibrosis had higher median Ishak score (p < 0.001) and higher IgG level (p = 0.01) at diagnosis. The incidence of BR at 6-month (31.2% vs. 88.6 %, p = 0.001) and 1-year (68.8% vs. 88.6 %, p = 0.04) post-diagnosis was significantly lower in AIH patients with advanced fibrosis. Although not statistically significant, a higher proportion of AIH patients with advanced fibrosis were on high dose of steroids (58% vs. 37.9 %, p = 0.1) at 1 year post diagnosis. Higher serum IgG level at diagnosis was associated with lower odds of achieving BR at 6-month (p = 0.004) and 1-year (p = 0.03) post-diagnosis in multivariate analysis. Pediatric age at diagnosis (p = 0.02) was associated with higher steroid dose at 1-year post-diagnosis in univariate analysis. ConclusionsFindings of advanced fibrosis on DLB of AIH patients was accompanied by more pronounced necro-inflammatory activity and higher serum IgG level, which translated to lower rates of BR and higher exposure to steroids during the first year after diagnosis.

Emotional and functional well-being in long-term breast cancer survivorship.

Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors. The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis. Multinomial logit models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and well-being change relative to baseline. Among 2,781 participants with BC, average EWB and FWB improved with time since diagnosis. Persistent FWB decrements were associated with Black race [OR 1.4 (95% CI 1.2-1.7) and 1.3 (95% CI 1.1-1.6), at 25-months and 84-months respectively], older age [OR 1.4 (95% CI 1.1-1.7) and 1.5 (95% CI 1.2-1.8), respectively], no chemotherapy, and recurrence [OR 2.9 (95% CI 1.8-4.8) and 3.1 (95% CI 2.1-4.6), respectively]. EWB decrements were associated with advanced stage and recurrence. Decrements in combined (FWB+EWB) well-being were associated with recurrence at both follow-up survey timepoints [ORs 4.7 (95% CI 2.7-8.0) and 4.3 (95% CI 2.8-6.6), respectively]. Long-term well-being varies by demographics and clinical features, with Black women and women with aggressive disease at greatest risk of long-term decrements.

Clinical descriptive and long-term outcome of melanocytic uveal lesions in young dogs: 40 cases (45 eyes) including 13 cases of sector iridectomy.

To describe the clinical features surgical technique, early and long-term outcome with or without surgery, and histopathological findings of melanocytic anterior uveal lesions in young dogs. Medical records of dogs at a guide dog facility removed from training due to a pigmented iris lesion were reviewed from 2014 to 2021. Selected dogs had surgical iridectomies performed. Iridal melanocytic lesions were characterized as well-delineated, pigmented, and flat (nevus) or raised (mass) lesions of the iris. Forty dogs (18 Labrador retrievers, 18 German shepherd dogs, 1 Golden retriever, 3 Labrador/Golden mixes) ranging from 0.5 to 3.1 years of age were affected unilaterally (n = 35) or bilaterally (n = 5). Sector iridectomy was performed in 13 dogs with prominent and well-isolated mass lesion and enucleation was carried out in 2 dogs with extensive lesions, while all other cases were monitored without surgical intervention. Postoperative complications included dyscoria (13/13), focal posterior synechia (9/13) and focal nonprogressive cataract (8/13). All eyes remained visual and comfortable up to 6.2 years post-iridectomy with no clinically identifiable local recurrence. Histopathology was consistent with uveal melanocytoma in all samples obtained surgically. All cases that did not undergo surgery remained free of complications up to 4.5 year post diagnosis. Melanocytic anterior uveal lesions may be overrepresented in certain lineages of breeds and be present at a young age. While none of the eyes developed complications when monitored without surgery, early surgical excision of the mass by sector iridectomy yields noteworthy functional outcome and retention of a comfortable globe.

Smoking and alcohol habits in head and neck cancers: How many patients stop after diagnosis?

BackgroundSmoking and alcohol are the main risk factors for head and neck cancer. Despite the significant psychological impact, many patients continue to smoke and drink alcohol after diagnosis of cancer. This study aims to analyze the patients’ behavior post diagnosis and treatment of head and neck cancer. MethodsAn observational retrospective study was conducted on patients suffering from head and neck cancer. Their smoking and alcohol habits before and after diagnosis of cancer were studied. ResultsA total of 85 patients were recruited: 80 % males, mean age 61.77±9.30 years. Among smokers, 35.80 % continued smoking post-diagnosis. A statistically significant correlation was found between smoking habit after diagnosis of cancer and type of treatment and tracheostomy. Among drinkers, 65.52 % continued to consume alcohol after diagnosis of cancer. A statistically significant correlation was found between alcohol consumption post-diagnosis and sex. ConclusionsPatients undergoing more invasive treatments are more likely to quit smoking and/or drinking alcohol, suggesting the strong psychological impact of cancer and its therapy. Many patients continue smoking and consuming alcohol due to unawareness, depression, or addiction. However, most patients reduced cigarette smoking and alcohol consumption. Comprehensive care, including psychological support, is essential for these patients.

946 Soft Tissue Sarcoma Survival Analysis and Evaluation of Management Options in Wales: A 3-Year Retrospective Single-Centre Analysis

Abstract Aim Soft tissue sarcomas (STS) are a rare group of mesenchymal neoplasm with great heterogeneity in their histologic subtype, anatomy, natural biological behaviour, and prognosis. The aim of this project is to evaluate the need of early detection and review the prognostic factors contributing to the overall STS survival outcome among patients who were under the care of the Welsh Sarcoma Service over a three-year period. Method Patients are selected from the Morriston Hospital sarcoma database from March 2019 to March 2022. Demographic data, tumour grade, histological subtype, performance status, treatment type, operative details and outcomes were recorded. Results 159 patients with a diagnosis of STS were selected from the database. The median overall survival was 2.19 years; with a 23.9% of mortality rate in the first-year post diagnosis and 10.8% in the third-year post diagnosis. Of all factors evaluated, grading (p = 0.008), performance status (p &amp;lt;0.001), treatment types (p= &amp;lt;0.001) and site of cancer recurrence (p = 0.024) resulted statistically significant. Metastatic development has a significant increased risk of death by 2.5-fold compared to those without recurrence. Conclusions This study evaluates the management of STS at a single centre over three years and summarises the significant prognostic factors contributing to the overall survival rate. Analysis further highlights development of metastasis carry a poorer prognosis. Hence, the importance of early detection and treatment within the first year of diagnosis should not be overlooked.

Developing Cumbria’s post dementia diagnostic support using Cognitive Stimulation Therapy (CST): Results and reflections on the treatment’s reintroduction post Covid-19

Cognitive Stimulation Therapy (CST, Spector et al., 2006) groups were part of the treatment provided by North Cumbria’s Community Older Adult Service until the Covid pandemic halted provision. Subsequently, treatment provided by the service to those diagnosed with a dementia relied heavily on pharmacological interventions to target the rate of cognitive decline. This paper documents the methodology of a service development project in Cumbria that reintroduced community CST groups, weekly for fourteen weeks across the year 2023. Preliminary findings demonstrate CST’s efficacy as a treatment for those living with a dementia diagnosis and coinciding low mood. Reflections shared from the project on the successes and challenges across its duration show its feasibility despite service pressures and resource limitations in a rural locality.In documenting this work, the project team aim to showcase the benefits of providing biopsychosocial care for older adults living with a dementia diagnosis and hope to inspire other Older Adult services to develop their post dementia diagnosis service provision using the CST protocols. With future iterations, more conclusive findings will be drawn and continued service development work has commenced in Cumbria on this project’s foundation within the Care Home and Educational Support System’s pathway.

Living with My Autistic Sibling: A Phenomenology Study

This research aims to understand the experiences and meaning of individuals who have siblings with autism spectrum disorder (ASD). Participants were seven individuals aged 12 to 25 years who had siblings with ASD living in Indonesia. Data were collected through 60-90 minute semi-structured interviews discussing their personal experiences and perspectives on daily life with their autistic sibling. The interview results were analyzed using thematic analysis which found four main themes: early experiences post siblings' diagnosis, implication on siblings, siblings' relationships, and siblings' perspectives. Young adult participants shared the process of receiving siblings' diagnosis that were influenced by age, how it was communicated by parents, and their own viewpoint of the diagnosis, several adjustments they had to withstand up to their acceptance of the siblings' condition. They also described caregiving role and responsibility for their siblings' future, whereas adolescent participants expressed their own struggles, hope and needs for siblings' recovery.