Standardized, interactive tests to diagnose autism spectrum disorder (ASD) and new diagnostic criteria in DSM-5

Opublikowana w maju 2013 roku nowa klasyfikacja zaburzeń psychicznych Amerykańskiego Towarzystwa Psychiatrycznego DSM-5 wprowadziła duże zmiany w kryteriach diagnostycznych dotyczących zaburzeń ze spektrum autyzmu. Zmianom uległy także wystandaryzowane, interaktywne narzędzia diagnostyczne z tzw. „złotego standardu” do diagnozy szeroko pojętego autyzmu. W klasyfikacji DSM-5 scalono wszystkie jednostki diagnostyczne w jedną wspólną jednostkę o nazwie zaburzenie ze spektrum autyzmu (ASD, Autism Spectrum Disorder) Słowo „spektrum” odnosi się do różnic w prezentacji i nasileniu symptomów wewnątrz grupy pacjentów z ASD oraz wskazuje na kontinuum pomiędzy populacją ogólną a osobami z tą diagnozą. Wyniki badań porównujące rozpoznania stawiane na podstawie klasyfikacji DSM-IV i DSM-5 pokazują, że wprowadzenie nowej klasyfikacji spowodowało zwiększenie swoistości diagnozy, co redukuje liczbę fałszywie dodatnich diagnoz, lecz jednocześnie spowodowało zmniejszenie czułości. Tym samym część pacjentów ze zdiagnozowanymi, na podstawie kryteriów klasyfikacji DSM-IV zaburzeniami ze spektrum autyzmu nie spełnia kryteriów w klasyfikacji DSM-5 do postawienia takiej diagnozy. W krajach, w których wystandaryzowane, interaktywne narzędzia diagnostyczne do diagnozy ASD są obecnie na etapie wprowadzania, między innymi w Polsce oraz w czasie gdy następują bardzo duże zmiany w ramach samych narzędzi oraz kryteriów diagnostycznych ASD, zasadne jest przekazywanie i publikowanie rzetelnej wiedzy na temat tych zmian.In May 2013, the American Psychiatric Association, APA released the Diagnostic and Statistical Manual of Mental Disorders, the fifth edition, DSM-5. The big changes to the new criteria of ASD in DSM-5 have been implemented. Also the standardized, interactive tests from the diagnostic “gold standard” have been revised. In DSM-5 all previously existing diagnosis of DSM-IV under Pervasive Developmental Disorders were merged into one diagnosis called Autism Spectrum Disorder, ASD. The term “spectrum” reflects both the differences within the ASD group itself in regards to the symptoms but also reflects continuum between general population and ASD group. DSM-IV and DSM-5 criteria were compared in research according to their sensitivity and specificity. The results of the study showed higher specificity of DSM-5 criteria which means less false positive diagnoses. However some of the patients who received ASD diagnosis based on DSM-IV criteria do not meet the current criteria of DSM-5. Due to the recent big changes to ASD criteria and also within the standardized, interactive diagnostic tests for ASD it seems important to provide and publish reliable facts and knowledge on it to the professionals, especially in the countries, Poland included, where these tests are being currently introduced

Exercise Training-Induced Changes in Inflammatory Mediators and Heat Shock Proteins in Canoeists

According to cytokine overtraining theory, skeletal muscle injuries are related to systemic inflammatory reaction. In response to inflammation, cells rapidly produce a series of proteins known as heat shock proteins (HSPs).These are considered to be molecular chaperones which play a universal role in maintaining cellular homeostasis. Among the subset of stress-responsive proteins, HSP27 and HSP70 are considered to be a new approach to monitoring exercise training and adaptive mechanisms. The study was designed to demonstrate the effect of sport training on changes in pro-inflammatory cytokines and HSPs, and their relation with muscle damage and body composition. Six elite canoeists (19.8 ±2.9 yr) were observed during preparatory training period (March) at the 1st, the 4th and after 7 days of the conditioning camp, and then after 3 days of recovery. The canoeing training did not induce muscle damage, decreased in IL-1β and HSP27, increased in TNFα and HSP70 concentrations. The highest changes in TNFα and HSP70 were observed 3 days after conditioning camp (during recovery) compared to initial level (the 1st day of conditioning camp). TNFα correlated with HSP27 (r = –0.563; P < 0.01) and HSP70 (r = 0.651; P < 0.001). Any significant changes in body composition were not observed. In conclusion, we could say that typical canoeing training improves cytokines and HSPs release, however, the changes are not related to muscle damage

An investigation of the 'female camouflage effect' in autism using a computerized ADOS-2 and a test of sex/gender differences.

BACKGROUND: Autism spectrum conditions (autism) are diagnosed more frequently in boys than in girls. Females with autism may have been under-identified due to not only a male-biased understanding of autism but also females' camouflaging. The study describes a new technique that allows automated coding of non-verbal mode of communication (gestures) and offers the possibility of objective, evaluation of gestures, independent of human judgment. The EyesWeb software platform and the Kinect sensor during two demonstration activities of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) were used. METHODS: The study group consisted of 33 high-functioning Polish girls and boys with formal diagnosis of autism or Asperger syndrome aged 5-10, with fluent speech, IQ average and above and their parents (girls with autism, n = 16; boys with autism, n = 17). All children were assessed during two demonstration activities of Module 3 of ADOS-2, administered in Polish, and coded using Polish codes. Children were also assessed with Polish versions of the Eyes and Faces Tests. Parents provided information on the author-reviewed Polish research translation of SCQ (Social Communication Questionnaire, Current and Lifetime) and Polish version of AQ Child (Autism Spectrum Quotient, Child). RESULTS: Girls with autism tended to use gestures more vividly as compared to boys with autism during two demonstration activities of ADOS-2. Girls with autism made significantly more mistakes than boys with autism on the Faces Test. All children with autism had high scores in AQ Child, which confirmed the presence of autistic traits in this group. The current communication skills of boys with autism reported by parents in SCQ were significantly better than those of girls with autism. However, both girls with autism and boys with autism improved in the social and communication abilities over the lifetime. The number of stereotypic behaviours in boys significantly decreased over life whereas it remained at a comparable level in girls with autism. CONCLUSIONS: High-functioning females with autism might present better on non-verbal (gestures) mode of communication than boys with autism. It may camouflage other diagnostic features. It poses risk of under-diagnosis or not receiving the appropriate diagnosis for this population. Further research is required to examine this phenomenon so appropriate gender revisions to the diagnostic assessments might be implemented.SBC was supported by the Autism Research Trust and the Medical Research Council UK during the period of this work, and the team were supported by the EU ASC-Inclusion.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s13229-016-0073-0

Treatment of hypertension in emergent and urgent cases. Part II. Hypertensive emergencies

W stanach nagłych w nadciśnieniu tętniczym wzrostowi ciśnienia tętniczego towarzyszą uszkodzenia narządów docelowych. Do sytuacji takich zaliczamy między innymi: obrzęk płuc, niedokrwienie mięśnia sercowego, incydent naczyniowo-mózgowy, encefalopatię nadciśnieniową i ostre krwawienie tętnicze. Różnicowanie stanów naglących i pilnych ma kluczowe znaczenie dla planowania terapii. Leczenie stanów nagłych wymaga natychmiastowego obniżania ciśnienia tętniczego za pomocą leków dożylnych. Pacjent powinien trafić na oddział intensywnej opieki medycznej w celu obniżenia ciśnienia tętniczego w ciągu minut lub godzin do bezpiecznego poziomu (niekoniecznie do uzyskania prawidłowych wartości ciśnienia). Wskazana jest jednak ostrożność, ponieważ konsekwencją agresywnej terapii hipotensyjnej może być obniżenie perfuzji narządów krytycznych, a zwłaszcza mózgu.Severe elevations of blood pressure are classified as "hypertensive emergencies" in the presence of acute or ongoing end-organ damage or as "hypertensive urgencies" in the absence of target-organ involvement. Distinguishing hypertensive emergencies from urgencies is important in formulating the therapeutic plan. Treatment of hypertensive emergency calls for reduction in blood pressure over minutes to hours with intravenous medications. Overly-agressive blood pressure reduction is associated with poor outcomes, especially in the setting of an acute cerebrovascular event

Treatment of hypertension in emergent and urgent cases. Part I. Hypertensive urgencies

Strategia leczenia wysokiego ciśnienia tętniczego ze wskazań doraźnych jest uzależniona od współistniejących powikłań, takich jak ostre lub szybko postępujące uszkodzenie narządów. Wczesna ocena stanu pacjenta z wysokim ciśnieniem tętniczym ma bardzo duże znaczenie dla wdrożenia najlepszego leczenia. Wywiad, badanie przedmiotowe oraz wybrane badania dodatkowe zapewniają prawidłową ocenę stanu klinicznego oraz stopnia uszkodzenia narządów. Stany pilne w nadciśnieniu wiążą się z ciężkim nadciśnieniem tętniczym bez towarzyszących objawów ostrego lub szybko postępującego uszkodzenia narządów. Duży wzrost ciśnienia tętniczego bez objawów szybko pogarszającej się funkcji narządów rzadko bywa wskazaniem do intensywnej terapii w trybie ratunkowym. Zwykle wystarczająca jest terapia preparatami doustnymi, której towarzyszy prawidłowa kontrola ambulatoryjna.Treatment of hypertensive emergencies and urgencies depends on severity of complications such as target organ dysfunction. Early triage of patients with elevated blood pressure is critical to assure the best therapy. History, physical examination with selected laboratory studies can ascertain clinical status and degree of target organ dysfunction. Hypertensive urgencies are severe elevations in blood pressure without evidence of acute or rapidly progressive target organ damage. High blood pressure alone in the absence of symptoms of progressive target organ dysfunction rarely requires emergency therapy. Usually it can be managed by orally administered drugs with appropriate follow-up

Carotid intima–media thickness (IMT) in patients with severe familial and non-familial hypercholesterolemia: The effect of measurement site on the IMT correlation with traditional cardiovascular risk factors and calcium scores

Background: The carotid intima–media thickness (IMT) measurement may be carried out proximally (pIMT) or distally (dIMT) in relation to the bulb of the common carotid artery which has significant implications on the results and correlation with risk factors. The aim of the study was to compare the pIMT and dIMT in patients with familial hypercholesterolemia confirmed by genetic testing (FH group) and patients with severe non-familial hypercholesterolemia, with negative results of genetic testing (NFH group) and to determine the correlation of results with traditional atherosclerotic risk factors and calcium scores.Methods: A total of 86 FH and 50 NFH patients underwent pIMT and dIMT measurements of both carotid arteries as well as computed tomography (CT) with coronary and thoracic aorta calcium scoring.Results: The meanpIMT of both right and left common carotid artery were significantly higher in patients with FH compared to the NFH group (meanpRIMT 0.721 ± 0.152 vs. 0.644 ± 0.156, p < 0.01, meanpLIMT 0.758 ± 0.173 vs. 0.670 ± 0.110, p < 0.01). Patient age, pre-treatment lowdensity lipoprotein (LDL) cholesterol levels (LDLmax) at baseline and systolic blood pressure were independent predictors of pIMT increases in both carotid arteries. Smoking history, age and LDLmax were independent predictors of dIMT increase. There was a significant correlation between the calcium scores of the ascending aorta, coronary artery and aortic valve and all IMT parameters.Conclusions: The IMT measured proximally better between patients with familial and non-familial hypercholesterolemia. The association between IMT and traditional cardiovascular risk factors varies between measurement sites. IMT values correlate CT calcium scores in all patients with hypercholesterolaemia regardless of genetic etiology

Hemorrhagic stroke as a complication of fibrynolytic treatment in myocardial infarction

Thromboembolic stroke most often occurs in patients who do not receive fibrynolytic treatment. Intracranial hemorrhage is the most common form of stroke in patients receiving thrombolytic therapy. Majority of thromboembolic stroke occures more than 48 hours after fibrynolytic therapy administration. Hemorrhagic stroke usually occurs in the first 24 hours after fibrynolytic therapy. It is well known that some groups of patients have high risk intracranial hemorrhage as a complication of thrombolytic treatment of myocardial infarction. Fibrynolytic therapy reduces risk of death in myocardial infarction with ST segment elevation and is commonly used in many hospitals. The risk of as serious complication as cerebral hemorrhage, which can cause impaired neurological functions or even death, is very high in patients with recent myocardial infarction and stoke in history, so in this situations primary percutaneous angioplasty should be prefered.Udar zakrzepowo-zatorowy jest najczęstszą formą udaru u chorych nieleczonych fibrynolitycznie, natomiast u pacjentów poddanych terapii fibrynolitycznej najczęściej dochodzi do krwawienia śródczaszkowego. Większość udarów niedokrwiennych występuje ponad 48 godzin od zastosowania tej terapii. Udary krwotoczne powstają najczęściej w ciągu pierwszych 24 godzin. Wiadomo, że niektórzy chorzy są bardziej narażeni na krwawienie śródczaszkowe jako powikłanie leczenia fibrynolitycznego stosowanego w zawale serca. Leczenie takie zmniejsza śmiertelność w zawale serca z uniesieniem odcinka ST i nadal jest powszechnie stosowaną metodą terapeutyczną w wielu ośrodkach. Jednak - ze względu na ryzyko wystąpienia tak poważnego powikłania, jakim jest krwawienie śródczaszkowe, które wiąże się z ryzykiem ciężkiego inwalidztwa, a nawet zgonu - u chorych z zawałem serca i przebytym udarem w wywiadzie oraz towarzyszącymi innymi czynnikami ryzyka krwawienia śródczaszkowego należy preferować pierwotną angioplastykę przed leczeniem fibrynolitycznym

Badanie rezonansem magnetycznym przeprowadzone bez powikłań u chorego z wszczepionym kardiowerterem-defibrylatorem

The number of patients with cardiac pacemakers (PM), implantable cardioverter-defibrillators (ICD) and cardiac resynchronisationtherapy PM systems is increasing. The number of magnetic resonance imaging (MRI) examinations is also growingand amounts to about 60 million tests per year worldwide. The presence of an ICD is still considered to be an absolute contraindicationto MRI by most experts. We present a patient with an implanted ICD who successfully underwent brain MRIwith use of special precautions

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation