Subcortical brain volume, regional cortical thickness, and cortical surface area across disorders: findings from the ENIGMA ADHD, ASD, and OCD Working Groups

Objective Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. We aimed to directly compare all three disorders. The ENIGMA consortium is ideally positioned to investigate structural brain alterations across these disorders. Methods Structural T1-weighted whole-brain MRI of controls (n=5,827) and patients with ADHD (n=2,271), ASD (n=1,777), and OCD (n=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. We examined subcortical volume, cortical thickness and surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults using linear mixed-effects models adjusting for age, sex and site (and ICV for subcortical and surface area measures). Results We found no shared alterations among all three disorders, while shared alterations between any two disorders did not survive multiple comparisons correction. Children with ADHD compared to those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller ICV than controls and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared to adult controls and other clinical groups. No OCD-specific alterations across different age-groups and surface area alterations among all disorders in childhood and adulthood were observed. Conclusion Our findings suggest robust but subtle alterations across different age-groups among ADHD, ASD, and OCD. ADHD-specific ICV and hippocampal alterations in children and adolescents, and ASD-specific cortical thickness alterations in the frontal cortex in adults support previous work emphasizing neurodevelopmental alterations in these disorders

Irish Roma: a literature review

It is estimated that the Roma are the largest ethnic minority population in Europe (HSE in Roma Intercultural Guide, 2020). There is a dearth of information in the Irish medical literature on the Roma in Ireland. The aim of this paper is to provide an overview of the Roma in Ireland, to identify Roma-specifc culture, family structure, paediatric illness, and health equality within the context of the Irish population. To do this, a review was completed of the English language literature on Roma available from 2010 to 2021 using web of science databases. Relevant clinicians and organisations were contacted to compile data on the Irish Roma to inform appropriate action in Roma child health. Up until 2021, the national census in Ireland did not include Roma as a category in ethnicity (HSE in Roma Intercultural Guide, 2020). As such, it is difficult to get an accurate number of the population in Ireland. Pavee Point Traveller and Roma Centre in 2009 estimated a population of approximately 5000 (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). The majority of the Roma in Ireland are Romanian (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). There is limited understanding of their culture in Ireland (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Often overlooked, small indigenous groups or nomadic races have unmet medical needs (National Traveller and Roma Inclusion Strategy in Justice. ie, 2017). Across Europe, they have a lower life expectancy and higher burden of illness due to lower socioeconomic status, discrimination, and poor access to health services (National Traveller and Roma Inclusion Strategy in Justice.ie, 2017). Cultural competence is necessary to provide effective healthcare.</p

A child with autoimmune polyendocrinopathy candidiasis and ectodermal dysplasia treated with immunosuppression: a case report

Abstract Introduction Common features of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia include candidiasis, hypoparathyroidism and hypoadrenalism. The initial manifestation of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia may be autoimmune hepatitis, keratoconjunctivitis, frequent fever with or without a rash, chronic diarrhea, or different combinations of these with or without oral candidiasis. Case presentation We discuss a profoundly affected 2.9-year-old Caucasian girl of Western European descent with a dramatic response to immunosuppression (initially azathioprine and oral steroids, and then subsequently mycophenolate mofetil monotherapy). At four years of follow-up, her response to mycophenolate mofetil is excellent. Conclusion The clinical features of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia may continue for years before some of the more common components appear. In such cases, it may be life-saving to diagnose autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia and commence therapy with immunosuppressive agents. The response of our patient to immunosuppression with mycophenolate mofetil has been dramatic. It is possible that other patients with this condition might also benefit from immunosuppression