Nevin Manimala

Acta Diabetol. 2021 Mar 19. doi: 10.1007/s00592-021-01700-2. Online ahead of print.

ABSTRACT

BACKGROUND: Since 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabetic patients in ASST North Milano.

METHODS: Data presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabetic patients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabetic patients non utilizing Flash Glucose monitoring.

RESULTS: In a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = – 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down.

HYPOTHESIS AND DISCUSSION: The increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabetic patients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obese patients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present “second wave” lock-down.

PMID:33740123 | DOI:10.1007/s00592-021-01700-2

Calcif Tissue Int. 2021 Mar 19. doi: 10.1007/s00223-021-00817-4. Online ahead of print.

ABSTRACT

Genome-wide association studies (GWASs) have identified hundreds of genetic loci for osteoporosis (OP) and rheumatoid arthritis (RA), individually, however, a large proportion of the total trait heritability remains unexplained. Previous studies demonstrated that these two diseases may share some common genetic determination and risk factors, but they were generally focused on individual trait and failed to identify the common variants that play key functional roles in the etiology of these two diseases. Here, we performed a conditional false discovery rate (cFDR) analysis to identify novel pleiotropic variants shared between them by integrating two independent GWASs with summary statistics for total body bone mineral density (TB-BMD, a major risk factor for osteoporosis) (n = 66,628) and RA (n = 58,284). A fine-mapping approach was also applied to identify the most probable causal variants with biological effects on both TB-BMD and RA. As a result, we found 47 independent pleiotropic SNPs shared between TB-BMD and RA, and 40 of them were validated in heel ultrasound estimated BMD (eBMD), femoral neck BMD (FN-BMD) or lumbar spine (LS-BMD). We detected one SNP (rs13299616) was novel and not identified by previous BMD or RA-related studies. Combined with fine-mapping and GWAS-eQTL colocalization analyses, our results suggested that locus 1p13.2 (including PTPN22, MAGI3, PHTF1, and RSBN1) was an important region to regulate TB-BMD and RA simultaneously. These findings provide new insights into the shared biological mechanisms and functional genetic determinants between OP and RA, and novel potential targets for treatment development.

PMID:33740106 | DOI:10.1007/s00223-021-00817-4

Eur Radiol. 2021 Mar 19. doi: 10.1007/s00330-021-07785-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the diagnostic performance of two different sets of magnetic resonance imaging (MRI) for the detection of subchondral erosions in the sacroiliac joints regarding the application of fat-water separation techniques when acquiring T1-weighted (T1w) images, using multi-detector computed tomography (MDCT) as the reference standard.

METHODS: We retrospectively included 31 consecutive patients having or being suspected for axial spondyloarthritis (SpA) assessed using both MRI and MDCT. Three sets of images were independently assessed for the presence of erosions by two musculoskeletal radiologists (R1, R2): (1) MRI with standard T1w without fat suppression, (2) MRI with both T1w with and without fat suppression, and (3) MDCT. The diagnostic performance of both sets of MRIs was assessed using MDCT as the referent.

RESULTS: The assessment of T1w images with fat suppression substantially increased sensitivity (76% vs. 63% R1; 70% vs. 60% R2), specificity (97% vs. 84% R1; 96% vs. 81% R2), positive predictive value (85% vs. 45% R1; 81% vs. 40% R2), and overall accuracy (94% vs. 80% R1; 92% vs. 77% R2) in the detection of erosions when compared to the assessment using T1w images without fat suppression.

CONCLUSION: The assessment of T1w images with fat suppression substantially improves the diagnostic performance of MRI in the detection of erosions in the sacroiliac joints.

KEY POINTS: • The presence of erosions in the sacroiliac joints may influence the decision on the diagnosis of axial spondyloarthritis. • T1w fat-suppressed MR imaging relatively increases the contrast between the joint space (high signal) and the adjacent subchondral bone (low signal), potentially improving the detection of erosions in the sacroiliac joints. • T1w fat-suppressed images improve the diagnostic performance of MRI in the detection of erosions in the sacroiliac joints compared to T1w without fat suppression, using MDCT as the reference.

PMID:33740094 | DOI:10.1007/s00330-021-07785-1

Pediatr Radiol. 2021 Mar 19. doi: 10.1007/s00247-021-05026-7. Online ahead of print.

ABSTRACT

BACKGROUND: While congenital heart disease (CHD) is known to be associated with sternal abnormalities, its association with absent sternal ossification is less well known. The literature is sparse and based on radiographs.

OBJECTIVE: To quantify delayed sternal ossification in CHD using computed tomography (CT).

MATERIALS AND METHODS: An imaging database search identified children with complex CHD and controls younger than 3 years of age who underwent chest CT from 2010 to 2019. Records were reviewed for demographics, CHD type and other pertinent history. Images were reviewed for manubrial or sternal segment ossification. Controls consisted of children undergoing chest CT for noncardiac reasons. Statistical analyses were conducted using a significance threshold of 0.05.

RESULTS: Fifty-nine children had complex CHD (mean age: 9.4 months); 36 (61.0%) had cyanotic CHD. There were 189 controls (mean age: 17.9 months). Delayed sternal ossification was present in 7 children (11.9%) in the study group; 6 had cyanotic heart disease (85.7%). Patterns of ossification included manubrium only; manubrium and first sternal segment; first and second sternal segments; and manubrium, first segment and hypoplastic second segment. Three controls (1.6%) had sternal ossification delay, all with manubrial ossification only. Delayed sternal ossification was more prevalent in the study group than in the controls (P=0.002). Compared to the controls, a higher incidence of delayed sternal ossification was seen in children with cyanotic CHD (P<0.001) but not acyanotic CHD (P=0.37).

CONCLUSION: Delayed sternal ossification occurs in children with CHD, particularly cyanotic forms, and requires no additional work-up.

PMID:33740086 | DOI:10.1007/s00247-021-05026-7

Eur Arch Otorhinolaryngol. 2021 Mar 19. doi: 10.1007/s00405-021-06743-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate objective vestibular function after endolymphatic sac surgery (ELSS) for Menière’s disease (MD), using comparative vestibular function tests: videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP) and video head-impulse test (VHIT) METHODS: Patients with definite MD using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) of 1995 criteria modified in 2015 and treated with ELSS (sac decompression or sac opening) were included. The primary outcome was the preservation of vestibular function, comparing pre- and postoperative vestibular function tests: VNG, VEMP, VHIT. Secondary outcomes were control of episodes of vertigo, hearing outcome using AAO-HNS criteria, and QoL using the Menière’s disease outcome questionnaire.

RESULTS: 73 patients were included in the study. We found a significant preservation of vestibular function as measured by VNG and VHIT. There was no statistical difference in the presence or absence of cervical and ocular (P13/N23 and N1/P1) waves on VEMP pre- and postoperatively. 67% of patients had good control of episodes of vertigo post-operatively, with significantly better results in the sac opening group (75%). There was no significant change in hearing postoperatively, and QoL scores were significantly improved after surgery (p < 0.0001).

CONCLUSION: Endolymphatic sac surgery (ELSS) is a conservative surgical treatment, which does not negatively impact vestibular function. It was associated with improved control of episodes of vertigo, preservation of hearing, and a clear improvement in QoL scores. Despite its pathophysiology not being fully understood, it remains a first-line procedure preserving vestibular function, for MD refractory to medical management.

PMID:33740085 | DOI:10.1007/s00405-021-06743-3

Eur J Orthod. 2021 Mar 19:cjab008. doi: 10.1093/ejo/cjab008. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to analyse the soft tissue changes produced by the functional treatment of mandibular advancement in growing Class II patients.

MATERIALS: The treated group consisted of 25 Caucasian patients (12 females and 13 males) with dento-skeletal Class II malocclusion treated with functional therapy (Activator). All patients were evaluated before treatment (T1; mean age, 9.9 years), at the end of functional treatment phase (T2; mean age, 11.9 years), and at a post-pubertal follow-up observation (T3; mean age, 18.5 years). The treated group was compared with a matched control group of 25 untreated subjects (13 females, 12 males) with untreated Class II division 1 malocclusion. Statistical comparisons between the two groups were performed with independent samples t-tests (P < 0.05).

RESULTS: Significant improvements were found during the long-term interval for mandibular sulcus (9.9°) and the profile facial angle (9.8°) in the treated group. No significant effects were found in terms of lower face percentage between the two groups.

CONCLUSION: Removable functional appliances induced positive effects on the soft tissue profile in Class II growing subjects with good stability in the long-term.

PMID:33740061 | DOI:10.1093/ejo/cjab008

Am J Clin Nutr. 2021 Mar 19:nqab003. doi: 10.1093/ajcn/nqab003. Online ahead of print.

ABSTRACT

BACKGROUND: The literature on associations of circulating concentrations of minerals and vitamins with risk of colorectal cancer is limited and inconsistent. Evidence from randomized controlled trials (RCTs) to support the efficacy of dietary modification or nutrient supplementation for colorectal cancer prevention is also limited.

OBJECTIVES: To complement observational and RCT findings, we investigated associations of genetically predicted concentrations of 11 micronutrients (β-carotene, calcium, copper, folate, iron, magnesium, phosphorus, selenium, vitamin B-6, vitamin B-12, and zinc) with colorectal cancer risk using Mendelian randomization (MR).

METHODS: Two-sample MR was conducted using 58,221 individuals with colorectal cancer and 67,694 controls from the Genetics and Epidemiology of Colorectal Cancer Consortium, Colorectal Cancer Transdisciplinary Study, and Colon Cancer Family Registry. Inverse variance-weighted MR analyses were performed with sensitivity analyses to assess the impact of potential violations of MR assumptions.

RESULTS: Nominally significant associations were noted for genetically predicted iron concentration and higher risk of colon cancer [ORs per SD (ORSD): 1.08; 95% CI: 1.00, 1.17; P value = 0.05] and similarly for proximal colon cancer, and for vitamin B-12 concentration and higher risk of colorectal cancer (ORSD: 1.12; 95% CI: 1.03, 1.21; P value = 0.01) and similarly for colon cancer. A nominally significant association was also noted for genetically predicted selenium concentration and lower risk of colon cancer (ORSD: 0.98; 95% CI: 0.96, 1.00; P value = 0.05) and similarly for distal colon cancer. These associations were robust to sensitivity analyses. Nominally significant inverse associations were observed for zinc and risk of colorectal and distal colon cancers, but sensitivity analyses could not be performed. None of these findings survived correction for multiple testing. Genetically predicted concentrations of β-carotene, calcium, copper, folate, magnesium, phosphorus, and vitamin B-6 were not associated with disease risk.

CONCLUSIONS: These results suggest possible causal associations of circulating iron and vitamin B-12 (positively) and selenium (inversely) with risk of colon cancer.

PMID:33740060 | DOI:10.1093/ajcn/nqab003

Gynecol Oncol. 2021 Mar 15:S0090-8258(21)00231-6. doi: 10.1016/j.ygyno.2021.03.011. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical trials demonstrated that PARPi (poly [adenosine diphosphate-ribose]-ADP polymerase inhibitor) therapy is effective in solid tumors. However, long term effects such as therapy-related myelodysplastic syndrome or acute myeloid leukemia (MDS/AML) are poorly described. We sought to quantify whether PARPi therapy is associated with the development of MDS/AML.

METHODS: Medline, Embase, and Cochrane databases were searched (inception to January 6, 2020) and phase 2 and 3 clinical trials that randomized patients with solid tumors to a PARPi or control therapy were included. The PRISMA guidelines were used to extract data independently by multiple authors. We extracted person-time and number of cases of MDS/AML in the PARPi and control arms of each study and pooled results with a random-effects Poisson regression model. The pooled incidence rate ratio (IRR) for MDS/AML among patients randomized to PARPi therapy was compared to those randomized to a control.

RESULTS: We identified 14 studies that included 5739 patients. Accounting for intra-study clustering, the risk of MDS/AML was similar in patients who were randomly assigned to receive PARPi compared to controls (IRR 1.32, 95% confidence interval [CI] 0.78-2.26). In the front-line setting, PARPi therapy was associated with developing MDS/AML (IRR 5.43, 95% CI 1.51-19.60). Among patients treated for recurrence, however, the risk of MDS/AML appeared to be similar among patients randomized to PARPi or control treatment. Among studies that included only patients with a BRCA mutation, the risk of MDS/AML was similar in both treatment groups (IRR 0.83, 95% CI 0.45-1.53), but PARPi therapy was associated with MDS/AML in studies with an unrestricted population (IRR 2.43, 95% CI 1.17-5.06).

CONCLUSION: The pooled overall effect was not statistically significant. However, treatment with PARPi was associated with a statistically significant increase in the incidence of MDS/AML among patients receiving front-line cancer therapy and those with limited prior exposure to chemotherapy.

PMID:33736856 | DOI:10.1016/j.ygyno.2021.03.011

Sci Justice. 2021 Mar;61(2):187-192. doi: 10.1016/j.scijus.2020.10.003. Epub 2020 Oct 24.

ABSTRACT

When found at crime scenes, footprints may be evidentially valuable and can assist with the identity of a perpetrator based on their features and/or measurements. Footprints can be either static (made while standing) or dynamic (made while walking). While extensive research has been performed on the linear measurements obtained from static and dynamic footprints, research on the comparisons between the contact area of static and dynamic footprints in the forensic context are limited. The present study compares the contact area of static and dynamic bare footprints to determine if statistically significant differences exist between the two. Static and dynamic footprints were obtained from a sample of randomly-selected 461 Jatt Sikh adults (230 males and 231 females) of Indian origin between the ages of 19 and 32 years. The footprint contact area was calculated from each footprint (excluding the toes) using a PedoGRID® sheet. No statistically significant differences were observed between the contact area of static and dynamic footprints for each foot among males and females. However, statistically significant differences between both the sexes were found in the footprint contact areas of both footprint types. The right dynamic footprint contact area was found to be the most predictive measurement for classifying and estimating sex from a footprint’s contact area. The study has implications in the analysis of footprints recovered from crime scenes.

PMID:33736852 | DOI:10.1016/j.scijus.2020.10.003

Sci Justice. 2021 Mar;61(2):170-174. doi: 10.1016/j.scijus.2020.11.001. Epub 2020 Nov 21.

ABSTRACT

The Phadebas® Forensic Press Test (PFPT) is an enzyme-based colorimetric test used to visualise and locate latent saliva stains on forensic exhibits. The test relies upon the presence of the enzyme α-amylase which is present in high levels in saliva. Even though the optimal in vitro temperature for α-amylase activity is 37 °C, the PFPT manufacturer’s protocol specifies that the PFPT should be carried out at room temperature (RT). In this study, we compared the performance of the PFPT at RT and 37 °C using combinations of four fabric types (cotton, polyester, acrylic and a cotton/polyester blend), three saliva dilutions (neat, 1:10 and 1:100) and stains aged for four time periods (1 day, 1 week, 1 month and 3 months). The intensity of the PFPT colour reactions at RT and 37 °C were not statistically different across all fabric types, saliva concentrations and stain ages, indicating that maximum sensitivity and performance of the PFPT can be achieved at RT.

PMID:33736849 | DOI:10.1016/j.scijus.2020.11.001