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Bhende VV, Tandon R, Krishnakumar M, Patel RM, Sharma AS. Successful Cardiac Surgical Management in a Trisomy 21 Child After Long-Term Hospitalization Associated With Bronchopneumonia and Hepatitis C Virus Seropositivity: A Case Report. Cureus 2024; 16:e61309. [PMID: 38813073 PMCID: PMC11135605 DOI: 10.7759/cureus.61309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 05/31/2024] Open
Abstract
A 31-month-old girl with trisomy 21 (Down syndrome) was seen in the emergency department of pediatrics because of oxygen desaturation associated with features of lower respiratory tract infections. She was born at full term and diagnosed with congenital heart disease (CHD) having ventricular septal defect (VSD), and patent ductus arteriosus (PDA); consequently, she underwent corrective surgery after adequate optimization of treatment. Incidentally, she was detected to have the presence of anti-hepatitis C virus (HCV) antibodies. In this case report, we mainly focus on the multi-modal approach to medical and surgical management.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Rahul Tandon
- Pediatrics, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | | | - Rupal M Patel
- Microbiology, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Ashwin S Sharma
- Internal Medicine, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, IND
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2
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Westerkam L, Pearson L, Sayed C. Safety and Efficacy of Biologic Medications and Janus Kinase Inhibitors in Patients with Down Syndrome: A Retrospective Cohort Study. Clin Drug Investig 2024; 44:219-222. [PMID: 38372935 DOI: 10.1007/s40261-024-01348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Linnea Westerkam
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Lauren Pearson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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3
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Jett J, Fossi A, Blonsky H, Ross W, Townsend S, Stephens MM, Chicoine B, Santoro SL. Retrospective review of the code status of individuals with Down syndrome during the COVID-19 era. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32080. [PMID: 38087874 DOI: 10.1002/ajmg.c.32080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 03/13/2024]
Abstract
Code status is a label in the medical record indicating a patient's wishes for end-of-life (EOL) care in the event of a cardiopulmonary arrest. People with intellectual disabilities had a higher risk of both diagnosis and mortality from coronavirus infections (COVID-19) than the general population. Clinicians and disability advocates raised concerns that bias, diagnostic overshadowing, and ableism could impact the allocation of code status and treatment options, for patients with intellectual disabilities, including Down syndrome (DS). To study this, retrospective claims data from the Vizient® Clinical Data Base (used with permission of Vizient, all rights reserved.) of inpatient encounters with pneumonia (PNA) and/or COVID-19 at 825 hospitals from January 2019 to June 2022 were included. Claims data was analyzed for risk of mortality and risk of "Do Not Resuscitate" (DNR) status upon admission, considering patient age, admission source, Elixhauser comorbidities (excluding behavioral health), and DS. Logistic regression models with backward selection were created. In total, 1,739,549 inpatient encounters with diagnoses of COVID-19, PNA, or both were included. After controlling for other risk factors, a person with a diagnosis of DS and a diagnosis of COVID-19 PNA had 6.321 odds ratio of having a DNR status ordered at admission to the hospital compared with those with COVID-19 PNA without DS. The diagnosis of DS had the strongest association with DNR status after controlling for other risk factors. Open and honest discussions among healthcare professionals to foster equitable approaches to EOL care and code status are needed.
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Affiliation(s)
- Jennifer Jett
- Department of Palliative Care, Intermountain Health, Salt Lake City, Utah, USA
| | - Alexander Fossi
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Wendy Ross
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sabra Townsend
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Special Healthcare Needs, Christiana Care, Christiana, Delaware, USA
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Department of Family Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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4
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Ghezzi M, Garancini N, De Santis R, Gianolio L, Zirpoli S, Mandelli A, Farolfi A, D’Auria E, Zuccotti GV. Recurrent Respiratory Infections in Children with Down Syndrome: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:246. [PMID: 38397357 PMCID: PMC10888118 DOI: 10.3390/children11020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.
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Affiliation(s)
- Michele Ghezzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Nicolò Garancini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Raffaella De Santis
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Laura Gianolio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Salvatore Zirpoli
- Pediatric Radiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Anna Mandelli
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Andrea Farolfi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Enza D’Auria
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Gian Vincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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5
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Sánchez Moreno B, Adán-Lirola L, Rubio-Serrano J, Real de Asúa D. Causes of mortality among adults with Down syndrome before and after the COVID-19 pandemic in Spain. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:128-139. [PMID: 37779228 DOI: 10.1111/jir.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The life expectancy of people with Down syndrome (DS) is limited by Alzheimer's disease (AD)-related deaths, mainly due to respiratory infections. The emergence of the COVID-19 pandemic could have changed known, past trends in mortality in this population. We analysed the differences in causes of mortality between individuals with DS deceased before and after the onset of the pandemic. METHOD This is a cross-sectional study of adults with DS recruited at a tertiary, university outpatient clinic in Madrid, Spain. Demographic and clinical data were retrospectively collected from their medical records, including information on their deaths, if any. RESULTS Five hundred seventy-two adults were included in the study, and 67 (11.7%) died. The main cause of death was respiratory infections, which occurred in 36 participants [9 (45.0%) before, and 27 (58.7%) after the appearance of COVID-19]. No significant differences were found in the determinants of pre-pandemic and post-pandemic death after adjusting for age and AD, except for an association between the use of psychotropic medication and death in the post-pandemic period (odds ratio: 2.24; 95% confidence interval: 1.04-4.82). Vaccination against COVID-19 showed a marked protective effect against mortality (odds ratio: 0.0002; 95% confidence interval: 6.7e10-6 to 0.004). CONCLUSIONS The appearance of COVID-19 has not impacted the overall trend of increase in mean age of death of adults with DS in our milieu, probably thanks to the very important protective effect of vaccination, which supports prioritising people with DS in future immunisation campaigns. The association between psychotropic medication use and mortality requires further exploration.
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Affiliation(s)
- Beatriz Sánchez Moreno
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Adán-Lirola
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Javier Rubio-Serrano
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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6
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Perrotta F, Piscopiello D, Rizzo D, Iosa G, Garzya G, Calò P, Gemma D. Cytomegalovirus Pneumonia in a Patient with Down Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:242. [PMID: 38399530 PMCID: PMC10890385 DOI: 10.3390/medicina60020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Down syndrome (DS) is a chromosomal disorder due to the presence of an additional chromosome 21 that causes intellectual deficit and physical anomalies and predisposes patients to develop infections throughout their lives. Pneumonias are more serious in patients with DS, requiring hospitalization, and they represent an important cause of mortality in this population. Cytomegalovirus (CMV) causes widespread and serious infections in immunocompromised individuals, affecting the respiratory tract and, when causing interstitial pneumonia, associated with a high mortality rate. However, CMV-induced pneumonia is not reported in DS patients. The prevalence and severity of CMV respiratory infections in subjects with DS is unknown. This case describes a 50-year-old female patient with DS who developed extensive bilateral pneumonia with severe respiratory failure which required hospitalization in intensive care, intubation, and mechanical ventilation after approximately 10 days of empiric antibiotic and anitimycotic therapy for fever, cough, and dyspnea. The patient was diagnosed with CMV pneumonia and recovered after treatment with ganciclovir. To the best of our knowledge, this is the first reported case of CMV pneumonia in a patient with DS. This case aims to highlight that CMV pneumonia in individuals with DS can be a life-threatening condition. It also clarifies the importance of early diagnosis of infections from opportunistic pathogens such as CMV to ensure timely and efficient treatment.
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Affiliation(s)
- Francesco Perrotta
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera Cardinale Panico, 73039 Tricase, Italy; (D.P.); (D.R.); (G.I.); (G.G.); (P.C.); (D.G.)
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7
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Santoro SL, Baloh CH, Hart SJ, Horick N, Kishnani PS, Krell K, Oreskovic NM, Shaffer M, Talib N, Torres A, Spiridigliozzi GA, Skotko BG. Pneumonia vaccine response in individuals with Down syndrome at three specialty clinics. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32070. [PMID: 37864360 DOI: 10.1002/ajmg.c.32070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
Individuals with Down syndrome (DS) have been particularly impacted by respiratory conditions, such as pneumonia. However, the description of co-occurring recurrent infections, the response to pneumococcal immunization, and the association of these was previously unknown. We screened individuals with DS using an 11-item screener and prospectively collected pneumococcal titers and laboratory results. We found that the screener did not successfully predict which individuals with DS who would have inadequate pneumococcal titers. Thirty four of the 55 individuals with DS (62%) had abnormal pneumococcal titers demonstrating an inadequate response to routine immunization. In the absence of a valid screener, clinicians should consider screening all individuals with DS through the use of pneumococcal titers to 23 serotypes to assess vaccine response.
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Affiliation(s)
- Stephanie L Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn H Baloh
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Nora Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicolas M Oreskovic
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mikayla Shaffer
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nasreen Talib
- Children's Mercy Hospital, Overland Park, Kansas, USA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gail A Spiridigliozzi
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke Medical Center, Durham, North Carolina, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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8
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Santoro SL, Baker S, Blake JM, Cabrera MJ, Caughman K, Chung J, Cullen S, Gallagher M, Haugen K, Hoke-Chandler R, Krell K, Maina J, McLuckie D, Merker VL, Michael C, O’Neill K, Peña A, Pless A, Royal D, Slape M, Spinazzi NA, Torres A, Torres CG, Skotko BG. Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds. Am J Med Genet A 2023; 191:2045-2056. [PMID: 37264986 PMCID: PMC10524618 DOI: 10.1002/ajmg.a.63233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.
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Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Jasmine M. Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria J. Cabrera
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA
| | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, MA
| | | | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Kate O’Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, MA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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9
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Grant LR, Meche A, McGrath L, Miles A, Alfred T, Yan Q, Chilson E. Risk of Pneumococcal Disease in US Adults by Age and Risk Profile. Open Forum Infect Dis 2023; 10:ofad192. [PMID: 37180598 PMCID: PMC10167987 DOI: 10.1093/ofid/ofad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Background Older age and certain medical conditions are known to modify the risk of pneumococcal disease among adults. We quantified the risk of pneumococcal disease among adults with and without medical conditions in the United States between 2016 and 2019. Methods This retrospective cohort study used administrative health claims data from Optum's de-identified Clinformatics Data Mart Database. Incidence rates of pneumococcal disease-all-cause pneumonia, invasive pneumococcal disease (IPD), and pneumococcal pneumonia-were estimated by age group, risk profile (healthy, chronic, other, and immunocompromising medical condition), and individual medical condition. Rate ratios and 95% CIs were calculated comparing adults with risk conditions with age-stratified healthy counterparts. Results Among adults aged 18-49 years, 50-64 years, and ≥65 years, the rates of all-cause pneumonia per 100 000 patient-years were 953, 2679, and 6930, respectively. For the 3 age groups, the rate ratios of adults with any chronic medical condition vs healthy counterparts were 2.9 (95% CI, 2.8-2.9), 3.3 (95% CI, 3.2-3.3), and 3.2 (95% CI, 3.2-3.2), while the rate ratios of adults with any immunocompromising condition vs healthy counterparts were 4.2 (95% CI, 4.1-4.3), 5.8 (95% CI, 5.7-5.9), and 5.3 (95% CI, 5.3-5.4). Similar trends were observed for IPD and pneumococcal pneumonia. Persons with other medical conditions, such as obesity, obstructive sleep apnea, and neurologic disorders, were associated with increased risk of pneumococcal disease. Conclusions The risk of pneumococcal disease was high among older adults and adults with certain risk conditions, particularly immunocompromising conditions.
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Affiliation(s)
- Lindsay R Grant
- Medical Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | - Aster Meche
- Real World Evidence, Center of Excellence, Pfizer Inc, New York, New York, USA
| | - Leah McGrath
- Real World Evidence, Center of Excellence, Pfizer Inc, New York, New York, USA
| | - Amanda Miles
- Real World Evidence, Center of Excellence, Pfizer Inc, New York, New York, USA
| | - Tamuno Alfred
- Statistical Research and Data Science Center, Pfizer Inc, New York, New York, USA
| | - Qi Yan
- Medical Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | - Erica Chilson
- Medical Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania, USA
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10
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Aboud MA, Arya VK, Dutta V, Ducas R, Al-Moustadi W, Niyogi SG. Anesthetic Considerations for Adult Patients With Both Down Syndrome and Congenital Heart Disease Undergoing Noncardiac Surgery: A Review Article. J Cardiothorac Vasc Anesth 2023; 37:613-626. [PMID: 36610856 DOI: 10.1053/j.jvca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/27/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
The population of adult patients with both Down syndrome and congenital heart disease is increasing due to better medical and surgical care. This cohort presents with multiple unique comorbidities, secondary to both progressions of health conditions associated with the aging of patients with Down syndrome, as well as due to pathophysiologic effects of uncorrected, corrected, or palliated congenital heart disease. These patients need frequent medical care and interventions requiring multiple anesthetics. This review focuses on the various factors relevant to the perioperative medical care of adult patients with both Down syndrome and congenital heart disease, founded on existing literature. Various anesthetic considerations for the different patterns of noncardiac and cardiac comorbidities are reviewed, and a systematic approach for the perioperative anesthetic management of these patients is presented.
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Affiliation(s)
| | - Virendra K Arya
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Cardiac Anesthesia, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada.
| | - Vikas Dutta
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Cardiac Anesthesia, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada
| | - Robin Ducas
- Department of Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Cardiac Sciences Program, Saint Boniface Hospital, Winnipeg, Canada
| | - Waiel Al-Moustadi
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada
| | - Subhrashis Guha Niyogi
- Paediatric Cardiac Anaesthesia, Department of Anaesthesia and Intensive Care, Advanced cardiac Centre, PGIMER, Chandigarh, India
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11
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Gąsior JS, Zamunér AR, Madeyska M, Tomik A, Niszczota C, Williams CA, Werner B. Heart Rate Variability in Individuals with Down Syndrome: A Scoping Review with Methodological Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:941. [PMID: 36673696 PMCID: PMC9859252 DOI: 10.3390/ijerph20020941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/31/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Individuals with Down syndrome (DS) present similar heart rate variability (HRV) parameters at rest but different responses to selected movement maneuvers in comparison to individuals without DS, which indicates reduced vagal regulation. The present study undertakes a scoping review of research on HRV in individuals with DS, with special attention paid to the compliance of the studies with standards and methodological paper guidelines for HRV assessment and interpretation. A review was performed using PubMed, Web of Science and CINAHL databases to search for English language publications from 1996 to 2020 with the MESH terms "heart rate variability" and "down syndrome", with the additional inclusion criteria of including only human participants and empirical investigations. From 74 studies, 15 were included in the review. None of the reviewed studies met the recommendations laid out by the standards and guidelines for providing the acquisition of RR intervals and necessary details on HRV analysis. Since authors publishing papers on this research topic do not adhere to the prescribed standards and guidelines when constructing the methodology, results of the research papers on the topic are not directly comparable. Authors need to design the study methodology more robustly by following the aforementioned standards, guidelines and recommendations.
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Affiliation(s)
- Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Margaret Madeyska
- Pediatric Cardiology and General Pediatrics Clinic, Jan Polikarp Brudziński Pediatric Hospital, 02-091 Warsaw, Poland
| | - Anna Tomik
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Cezary Niszczota
- Pediatric Cardiology and General Pediatrics Clinic, Jan Polikarp Brudziński Pediatric Hospital, 02-091 Warsaw, Poland
| | - Craig A. Williams
- Children’s Health & Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
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12
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Malle L, Martin-Fernandez M, Buta S, Richardson A, Bush D, Bogunovic D. Excessive negative regulation of type I interferon disrupts viral control in individuals with Down syndrome. Immunity 2022; 55:2074-2084.e5. [PMID: 36243008 PMCID: PMC9649881 DOI: 10.1016/j.immuni.2022.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022]
Abstract
Down syndrome (DS) is typically caused by triplication of chromosome 21. Phenotypically, DS presents with developmental, neurocognitive, and immune features. Epidemiologically, individuals with DS have less frequent viral infection, but when present, these infections lead to more severe disease. The potent antiviral cytokine type I Interferon (IFN-I) receptor subunits IFNAR1 and IFNAR2 are located on chromosome 21. While increased IFNAR1/2 expression initially caused hypersensitivity to IFN-I, it triggered excessive negative feedback. This led to a hypo-response to subsequent IFN-I stimuli and an ensuing viral susceptibility in DS compared to control cells. Upregulation of IFNAR2 expression phenocopied the DS IFN-I dynamics independent of trisomy 21. CD14+ monocytes from individuals with DS exhibited markers of prior IFN-I exposure and had muted responsiveness to ex vivo IFN-I stimulation. Our findings unveil oscillations of hyper- and hypo-response to IFN-I in DS, predisposing individuals to both lower incidence of viral disease and increased infection-related morbidity and mortality.
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Affiliation(s)
- Louise Malle
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marta Martin-Fernandez
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sofija Buta
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Richardson
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dusan Bogunovic
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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13
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Santoro SL, Donelan K, Constantine M. Proxy-report in individuals with intellectual disability: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1088-1108. [PMID: 35676858 PMCID: PMC9378492 DOI: 10.1111/jar.13013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Views can be collected from individuals (self-report) or others on their behalf (proxy-report). OBJECTIVE We aimed to review the literature on methods and statistical approaches used to evaluate observer versus self-report responses from individuals with intellectual disability or Down syndrome. METHODS A series of key questions related to statistical approaches and data collection methods were formulated a priori to inform the search strategy and review process. These addressed the topics of self-report in individuals with intellectual disability, including Down syndrome. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarised, and knowledge gaps and research needs were identified. RESULTS Fifty relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. Review of studies of individuals with intellectual disability which used a variety of statistical approaches showed mixed agreement between self-report and proxy-report. CONCLUSION Few studies identified to-date have used self-report from individuals with Down syndrome, but lessons from the existing intellectual disability literature can guide researchers to incorporate self-report from individuals with Down syndrome in the future.
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Affiliation(s)
- Stephanie L. Santoro
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Donelan
- Institute on Healthcare Systems, Brandeis University, Waltham, Massachusetts, United States
- Survey Research and Implementation Unit, Division of Clinical Research, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Melissa Constantine
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
- Evidera Inc, Bethesda, Maryland, USA
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14
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Smith A, Bussmann N, Breatnach C, Levy P, Molloy E, Miletin J, Curley A, McCallion N, Franklin Mrcpch O, El-Khuffash A. Serial Assessment of Cardiac Function and Pulmonary Hemodynamics in Infants with Down Syndrome. J Am Soc Echocardiogr 2022; 35:1176-1183.e5. [PMID: 35868547 DOI: 10.1016/j.echo.2022.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is a dearth of longitudinal data describing the evolution of cardiopulmonary haemodynamics in infants with Down Syndrome (DS) beyond infancy. We hypothesized that babies with DS, independent of the presence of congenital heart disease (CHD), demonstrate biventricular systolic and diastolic impairment and sustained elevation of pulmonary pressures compared to controls over the first two years of age. METHODS This was a prospective observational cohort study of 70 infants with DS (48 with CHD and 22 without CHD) and 60 controls carried out in three tertiary neonatal intensive care units in Dublin, Ireland. Infants with DS with and without CHD and non-DS controls underwent serial echocardiograms at birth, 6 months, 1 year and 2 years of age to assess biventricular systolic and diastolic function using deformation analysis. Pulmonary vascular resistance (PVR) was assessed using pulmonary artery acceleration time (PAAT) and left ventricular (LV) eccentricity index. RESULTS Infants with DS exhibited smaller LV (Birth: 27±4 vs. 31±2 mm, p<0.01; 2 years: 43±5 vs. 48±4 mm, p<0.01) and RV (Birth: 28±3 vs. 31±2 mm, p<0.01; 2 years: 40±4 vs. 44±3 mm, p<0.01) lengths and lower LV (Birth: -19±3 vs. -22±2 %, p<0.01; 2 years: -24±2 vs. -26±2 %, p<0.01) and RV (Birth: -19±4 vs. -22±3 %, p<0.01; 2 years: -29±6 vs. -33±4 %, p<0.01) systolic strain over the two year period. PAAT was lower in the DS group throughout the study period (Birth: 44±10 vs. 62±14 ms, p<0.01; 2 years 71±12 vs. 83±11 ms, p<0.01). No differences were observed between DS infants with and without CHD (all p >0.05). CONCLUSIONS Infants with DS exhibit impaired maturational changes in myocardial function and PVR. Such novel findings provide valuable insights into the pathophysiology affecting cardiorespiratory morbidity in this population.
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Affiliation(s)
- Aisling Smith
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Neidin Bussmann
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Colm Breatnach
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Philip Levy
- Boston Children's Hospital Department of Pediatrics, Boston, Massachusetts, USA; Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleanor Molloy
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland; Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | - Jan Miletin
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Anna Curley
- Department of Neonatology, The National Maternity Hospital, Dublin, Dublin, Ireland
| | - Naomi McCallion
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Orla Franklin Mrcpch
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
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15
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Hines CB, Simmons SA. Down Syndrome: A Review of Key Perioperative Implications. AORN J 2022; 116:4-20. [PMID: 35758744 DOI: 10.1002/aorn.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 11/11/2022]
Abstract
Down syndrome (DS) is the most common chromosomal abnormality in humans that is compatible with life. This syndrome occurs when there is an extra copy of the 21st chromosome. Down syndrome is associated with numerous comorbidities that can pose challenges for the perioperative nurse caring for a patient with DS undergoing surgery. These challenges can affect the patient assessment, communication with the patient, and patient safety (eg, preventing complications). As the life expectancy of people with DS has increased, so too have the chances that perioperative nurses will care for a patient with this disorder. This article reviews the pathophysiology of DS, discusses common comorbidities that may directly affect perioperative care, and reviews an exemplar case study that demonstrates how personnel with knowledge of DS can positively influence surgical team decision making for these patients in the perioperative setting.
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16
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Trutner Z, Hwang R, Bowen R. Pediatric Septic Arthritis of the Knee due to Fusobacterium necrophorum in a Patient with Down Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00023. [PMID: 35977036 DOI: 10.2106/jbjs.cc.22.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 16-year-old boy with a history of Down syndrome presented with right knee pain and swelling. He was diagnosed with isolated septic arthritis of the knee due to Fusobacterium necrophorum in the absence of current or recent oropharyngeal infection. He was successfully treated with arthroscopic irrigation and debridement and 12 weeks of oral antibiotics. CONCLUSION Fusobacterium necrophorum is a part of the normal oral flora and a rare cause of septic arthritis, typically associated with recent oropharyngeal infection. However, patients with immune dysregulation such as those with Down syndrome may develop isolated septic arthritis due to transient hematogenous seeding.
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Affiliation(s)
- Zoe Trutner
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
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17
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Baksh RA, Strydom A, Pape SE, Chan LF, Gulliford MC. Susceptibility to COVID-19 Diagnosis in People with Down Syndrome Compared to the General Population: Matched-Cohort Study Using Primary Care Electronic Records in the UK. J Gen Intern Med 2022; 37:2009-2015. [PMID: 35386043 PMCID: PMC8985744 DOI: 10.1007/s11606-022-07420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, people with Down syndrome (DS) have experienced a more severe disease course and higher mortality rates than the general population. It is not yet known whether people with DS are more susceptible to being diagnosed with COVID-19. OBJECTIVE To explore whether DS is associated with increased susceptibility to COVID-19. DESIGN Matched-cohort study design using anonymised primary care electronic health records from the May 2021 release of Clinical Practice Research Datalink (CPRD) Aurum. SETTING Electronic health records from approximately 1400 general practices (GPs) in England. PARTICIPANTS 8854 people with DS and 34,724 controls matched for age, gender and GP who were registered on or after the 29th January 2020. MEASUREMENTS The primary outcome was COVID-19 diagnosis between January 2020 and May 2021. Conditional logistic regression models were fitted to estimate associations between DS and COVID-19 diagnosis, adjusting for comorbidities. RESULTS Compared to controls, people with DS were more likely to be diagnosed with COVID-19 (7.4% vs 5.6%, p ≤ 0.001, odds ratio (OR) = 1.35; 95% CI = 1.23-1.48). There was a significant interaction between people with DS and a chronic respiratory disease diagnosis excluding asthma and increased odds of a COVID-19 diagnosis (OR = 1.71; 95% CI = 1.20-2.43), whilst adjusting for a number of comorbidities. CONCLUSION Individuals with DS are at increased risk for contracting COVID-19. Those with underlying lung conditions are particularly vulnerable during viral pandemics and should be prioritised for vaccinations.
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Affiliation(s)
- R Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. .,The LonDowns Consortium, London, UK.
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Li F Chan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
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18
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Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW, Burke LW, Berry SA, Geleske TA, Holm I, Hopkin RJ, Introne WJ, Lyons MJ, Monteil DC, Scheuerle A, Stoler JM, Vergano SA, Chen E, Hamid R, Downs SM, Grout RW, Cunniff C, Parisi MA, Ralston SJ, Scott JA, Shapira SK, Spire P. Health Supervision for Children and Adolescents With Down Syndrome. Pediatrics 2022; 149:e2022057010. [PMID: 35490285 DOI: 10.1542/peds.2022-057010] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Marilyn J Bull
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Tracy Trotter
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | | | - Celanie Christensen
- Department of Pediatrics, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Randall W Grout
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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19
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Landes SD, Turk MA, Finan JM. Factors associated with the reporting of Down syndrome as the underlying cause of death on US death certificates. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:454-470. [PMID: 35191108 PMCID: PMC9018509 DOI: 10.1111/jir.12926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Efforts aimed at preventing premature mortality for people with Down syndrome are hindered by the practice of reporting disability as the underlying cause of death. Prior research suggests this form of diagnostic overshadowing may be the result of increased uncertainty surrounding the death. METHODS This study uses bivariable analysis and multivariable logistic regression models to investigate associations between sociodemographic characteristics, comorbidities, and death context and processing characteristics with the reporting of Down syndrome as the underlying cause of death in 2005-2017 US Multiple Cause of Death data files. RESULTS The reporting of Down syndrome as the underlying cause of death was associated with characteristics indicative of an increased amount of uncertainty surrounding the death. Results also suggest other mechanisms may inform inaccurate reporting, such as racial bias, and the continued conflation of disability and health. CONCLUSIONS Medical personnel certifying death certificates should strive for accuracy when reporting the causes of death. To ensure this outcome, even in the midst of increased uncertainty, Down syndrome should not be reported as the underlying cause of death unless the decedent was diagnosed with Alzheimer's disease or unspecified dementia. Future research should further explore the possibility that increased death certification errors for adults with Down syndrome, or other developmental disabilities, are associated with racial bias.
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Affiliation(s)
- Scott D. Landes
- Department of Sociology and Aging Studies Institute,
Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New
York
| | - Margaret A. Turk
- Department of Physical Medicine and Rehabilitation, SUNY
Upstate Medical University, Syracuse, New York
| | - Julia M. Finan
- Department of Sociology and Aging Studies Institute,
Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New
York
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20
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Fitzpatrick V, Rivelli A, Chaudhari S, Chicoine L, Jia G, Rzhetsky A, Chicoine B. Prevalence of Infectious Diseases Among 6078 Individuals With Down Syndrome in the United States. J Patient Cent Res Rev 2022; 9:64-69. [PMID: 35111884 PMCID: PMC8772611 DOI: 10.17294/2330-0698.1876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2023] Open
Abstract
A recent disease prevalence study of the largest documented Down syndrome (DS) cohort in the United States strongly suggested significant disparity in general infectious disease conditions among individuals with DS versus those without DS. In this follow-up retrospective analysis, we explored these differences in greater detail by calculating prevalence of 52 infectious diseases, across 28 years of data among 6078 individuals with DS and 30,326 age- and sex-matched controls, abstracted from electronic medical records within a large Midwestern health system. We found that the DS cohort had higher prevalence of pneumonias (including aspiration, viral, bacterial, pneumococcal, and unspecified/atypical); otitis externa; and the skin infections impetigo, abscess, and cellulitis. To the contrary, the DS cohort had lower prevalence of many respiratory infections other than pneumonia (including influenza, strep pharyngitis, upper respiratory infection, sinusitis, tonsillitis, laryngitis, bronchitis, scarlet fever, and otitis media); sexually transmitted infections (including bacterial vaginosis, chlamydia, genital herpes, HIV/AIDS, human papillomavirus, pelvic inflammatory disease, and trichomoniasis); mononucleosis; shingles; unspecified hepatitis; intestinal infections; and enteritis. These findings highlight that individuals with DS could be more or less prone to different infectious diseases than their non-DS matched counterparts. Additional research to understand why these differences exist and how they might affect the clinical approach to patients with DS is warranted.
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Affiliation(s)
- Veronica Fitzpatrick
- Advocate Aurora Health, Downers Grove, IL
- Advocate Aurora Research Institute, Downers Grove, IL
| | - Anne Rivelli
- Advocate Aurora Health, Downers Grove, IL
- Advocate Aurora Research Institute, Downers Grove, IL
| | - Sagar Chaudhari
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Laura Chicoine
- Advocate Aurora Health, Downers Grove, IL
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | | | | | - Brian Chicoine
- Advocate Aurora Health, Downers Grove, IL
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
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21
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Lee M, Nagashima K, Yoon J, Sun J, Wang Z, Carpenter C, Lee HK, Hwang YS, Westlake CJ, Daar IO. CEP97 phosphorylation by Dyrk1a is critical for centriole separation during multiciliogenesis. J Cell Biol 2022; 221:e202102110. [PMID: 34787650 PMCID: PMC8719716 DOI: 10.1083/jcb.202102110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
Proper cilia formation in multiciliated cells (MCCs) is necessary for appropriate embryonic development and homeostasis. Multicilia share many structural characteristics with monocilia and primary cilia, but there are still significant gaps in our understanding of the regulation of multiciliogenesis. Using the Xenopus embryo, we show that CEP97, which is known as a negative regulator of primary cilia formation, interacts with dual specificity tyrosine phosphorylation regulated kinase 1A (Dyrk1a) to modulate multiciliogenesis. We show that Dyrk1a phosphorylates CEP97, which in turn promotes the recruitment of Polo-like kinase 1 (Plk1), which is a critical regulator of MCC maturation that functions to enhance centriole disengagement in cooperation with the enzyme Separase. Knockdown of either CEP97 or Dyrk1a disrupts cilia formation and centriole disengagement in MCCs, but this defect is rescued by overexpression of Separase. Thus, our study reveals that Dyrk1a and CEP97 coordinate with Plk1 to promote Separase function to properly form multicilia in vertebrate MCCs.
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Affiliation(s)
| | - Kunio Nagashima
- Electron Microscopy Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Jaeho Yoon
- National Cancer Institute, Frederick, MD
| | - Jian Sun
- National Cancer Institute, Frederick, MD
| | - Ziqiu Wang
- Electron Microscopy Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Christina Carpenter
- Electron Microscopy Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | - Christopher J. Westlake
- Laboratory of Cellular and Developmental Signaling, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD
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22
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Motegi N, Yamaoka Y, Moriichi A, Morisaki N. Causes of death in patients with Down syndrome in 2014-2016: A population study in Japan. Am J Med Genet A 2021; 188:224-236. [PMID: 34622557 PMCID: PMC9292866 DOI: 10.1002/ajmg.a.62526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Accepted: 09/18/2021] [Indexed: 11/06/2022]
Abstract
Despite the higher mortality rates in patients with Down syndrome compared with the general Japanese population, the life span has dramatically increased in Japan and other countries. We aimed to clarify recent causes of death in patients with Down syndrome in Japan. We calculated proportionate mortality and standardized mortality odds ratios (SMORs) among all deaths registered with Down syndrome as the cause of death (ICD‐10 code, Q90) in the Japanese National Death Registry Database in 2014–2016. In the study period, 762 in patients with Down syndrome died. The main causes of death were pneumonia/respiratory infections (20.5%), congenital malformations of the circulatory system (11.2%), other diseases of the circulatory system (9.2%), and aspiration pneumonia (8.4%). The SMORs (95% confidence intervals) were higher for natural death, defined as death of an elderly person with no other cause of death to be mentioned (55.73 [36.92–84.12]), early‐onset Alzheimer's disease, defined as Alzheimer's disease with onset <65 years of age (29.36 [16.44–52.44]), aspiration pneumonia (18.33 [14.03–23.96]), pneumonia/respiratory infections (8.11 [6.76–9.73]), congenital malformations of the circulatory system (8.07 [5.98–10.88]), and leukemia/lymphoma (2.16 [1.55–2.99]) but lower for malignant solid tumors (0.04 [0.02–0.06]) in patients with Down syndrome. Patients with Down syndrome had the greatest relative risk of dying from natural death, early‐onset Alzheimer's disease, and respiratory illnesses, highlighting the need for appropriate medical, health, and welfare services.
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Affiliation(s)
- Narumi Motegi
- Department of Specific Pediatric Chronic Disease Information, National Center for Child Health and Development, Tokyo, Japan.,Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Kyoto, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akinori Moriichi
- Department of Specific Pediatric Chronic Disease Information, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
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23
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Real de Asua D, Mayer MA, Ortega MDC, Borrel JM, Bermejo TDJ, González-Lamuño D, Manso C, Moldenhauer F, Carmona-Iragui M, Hüls A, Sherman SL, Strydom A, de la Torre R, Dierssen M. Comparison of COVID-19 and Non-COVID-19 Pneumonia in Down Syndrome. J Clin Med 2021; 10:3748. [PMID: 34442043 PMCID: PMC8397064 DOI: 10.3390/jcm10163748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/02/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022] Open
Abstract
Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey (n = 86) with admissions for non-COVID-19 pneumonias from a retrospective clinical database of the Spanish Ministry of Health (n = 2832 patients). In-hospital mortality rates were significantly higher for COVID-19 patients (26.7% vs. 9.4%), especially among individuals over 40 and patients with obesity, dementia, and/or epilepsy. The mean length of stay of deceased patients with COVID-19 was significantly shorter than in those with non-COVID-19 pneumonias. The rate of admission to an ICU in patients with DS and COVID-19 (4.3%) was significantly lower than that reported for the general population with COVID-19. Our findings confirm that acute SARS-CoV-2 infection leads to higher mortality than non-COVID-19 pneumonias in individuals with DS, especially among adults over 40 and those with specific comorbidities. However, differences in access to respiratory support might also account for some of the heightened mortality of individuals with DS with COVID-19.
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Affiliation(s)
- Diego Real de Asua
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Miguel A. Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - María del Carmen Ortega
- Department of Psychiatry, Research Institute i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Domingo González-Lamuño
- Department of Pediatrics, University Hospital Marqués de Valdecilla-Universidad de Cantabria, 39008 Santander, Spain;
| | | | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, 08029 Barcelona, Spain
| | - Anke Hüls
- Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK;
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom and South London and the Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Rafael de la Torre
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), 08003 Barcelona, Spain
| | - Mara Dierssen
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), 08003 Barcelona, Spain
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24
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Malinzak EB. Perioperative care of adults with Down syndrome: a narrative review. Can J Anaesth 2021; 68:1549-1561. [PMID: 34165727 DOI: 10.1007/s12630-021-02052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022] Open
Abstract
Because of enhanced life expectancy due to medical and surgical therapeutic advances, it is estimated that there are more adults than children living with Down syndrome (DS), or trisomy 21, in the United States. Therefore, DS can no longer be considered a syndrome limited to the pediatric population. These patients are presenting for surgery and anesthesia in adult care settings, where anesthesiologists will encounter these patients more frequently. As these patients age, their commonly associated co-morbidities not only progress, but they also develop other cardiac, respiratory, gastrointestinal, and neurologic conditions. The manifestations and consequences of chronic disease can present new challenges for the anesthesiologist and require expertise and judgement to minimize patient risk. The purpose of this narrative review is to describe the common pediatric co-morbidities associated with DS and discuss the age-acquired manifestations. Additionally, considerations for anesthetic care of the adult with DS will be presented, including the preoperative assessment, intraoperative management, and postoperative care.
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Affiliation(s)
- Elizabeth B Malinzak
- Department of Anesthesiology, Duke University School of Medicine, DUMC 3094, Durham, NC, 27710, USA.
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25
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Blake JM, Estrada Gomez D, Skotko BG, Torres A, Santoro SL. Pneumonia and respiratory infection in Down syndrome: A 10-year cohort analysis of inpatient and outpatient encounters across the lifespan. Am J Med Genet A 2021; 185:2878-2887. [PMID: 34056836 DOI: 10.1002/ajmg.a.62355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
Respiratory illnesses are a significant contributor of morbidity and mortality among persons with Down syndrome (DS). Reviews have described respiratory illnesses of DS in childhood, but few have looked across the lifespan. Retrospective chart review of patients in our DS program with clinical encounters for respiratory illnesses from 2011 to 2020 was completed. Eighteen percent of clinical encounters were due to respiratory illnesses. Of these, 120 were seen in the emergency department, 88 were admitted, and 21 were seen in urgent care. Common comorbidities included congenital heart disease, asthma, and dysphagia. Admission was common for children under the age of 5 years and adults over the age of 45 years. Admitted patients were more likely to have history of pneumonia and chronic lung disease. Of admitted patients, 77% required supplemental oxygen and 46% required intensive care unit admission. Our findings highlight that respiratory illnesses are a common cause of healthcare utilization among patients with DS, particularly early in childhood and later in life. Patients were seen predominately in outpatient settings; when an inpatient setting was needed, they frequently required higher levels of care. With our findings, clinicians can stratify patients most at risk for respiratory infections and provide targeted monitoring.
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Affiliation(s)
- Jasmine M Blake
- Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Brian G Skotko
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Down Syndrome Program, Division of Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Torres
- Down Syndrome Program, Division of Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie L Santoro
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Down Syndrome Program, Division of Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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26
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Chicoine B, Rivelli A, Fitzpatrick V, Chicoine L, Jia G, Rzhetsky A. Prevalence of Common Disease Conditions in a Large Cohort of Individuals With Down Syndrome in the United States. J Patient Cent Res Rev 2021; 8:86-97. [PMID: 33898640 DOI: 10.17294/2330-0698.1824] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Given the current life expectancy and number of individuals living with Down syndrome (DS), it is important to learn common occurrences of disease conditions across the developmental lifespan. This study analyzed data from a large cohort of individuals with DS in an effort to better understand these disease conditions, inform future screening practices, tailor medical care guidelines, and improve utilization of health care resources. Methods This retrospective, descriptive study incorporated up to 28 years of data, compiled from 6078 individuals with DS and 30,326 controls matched on age and sex. Data were abstracted from electronic medical records within a large Midwestern health system. Results In general, individuals with DS experienced higher prevalence of testicular cancer, leukemias, moyamoya disease, mental health conditions, bronchitis and pneumonia, gastrointestinal conditions, thyroid disorder, neurological conditions, atlantoaxial subluxation, osteoporosis, dysphagia, diseases of the eyes/adnexa and of the ears/mastoid process, and sleep apnea, relative to matched controls. Individuals with DS experienced lower prevalence of solid tumors, heart disease conditions, sexually transmitted diseases, HIV, influenza, sinusitis, urinary tract infections, and diabetes. Similar rates of prevalence were seen for lymphomas, skin melanomas, stroke, acute myocardial infarction, hepatitis, cellulitis, and osteoarthritis. Conclusions While it is challenging to draw a widespread conclusion about comorbidities in individuals with Down syndrome, it is safe to conclude that care for individuals with DS should not automatically mirror screening, prevention, or treatment guidelines for the general U.S. population. Rather, care for those with DS should reflect the unique needs and common comorbidities of this population.
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Affiliation(s)
- Brian Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Anne Rivelli
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Veronica Fitzpatrick
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Laura Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Gengjie Jia
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
| | - Andrey Rzhetsky
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
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27
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Peterson JK, Kochilas LK, Knight J, McCracken C, Thomas AS, Moller JH, Setty SP. Long-Term Survival and Causes of Death in Children with Trisomy 21 After Congenital Heart Surgery. J Pediatr 2021; 231:246-253.e3. [PMID: 33359302 PMCID: PMC8005470 DOI: 10.1016/j.jpeds.2020.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate long-term transplant-free survival and causes of death in the trisomy 21 (T21) population after surgery for congenital heart disease (CHD) in comparison with patients who are euploidic. STUDY DESIGN This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, enriched with prospectively collected data from the National Death Index and the Organ Procurement and Transplantation Network for patients with sufficient direct identifiers. Kaplan-Meier survival plots were generated and multivariable Cox proportional hazards models were used to examine risk factors for mortality between patients with T21 and 1:1 matched patients with comparable CHD who are euploidic. RESULTS A long-term survival analysis was completed for 3376 patients with T21 (75 155 person-years) who met inclusion criteria. The 30-year survival rate for patients with T21 ranged from 92.1% for ventricular septal defect to 65.3% for complex common atrioventricular canal. Of these, 2185 patients with T21 were successfully matched with a patient who was euploidic. After a median follow-up of 22.86 years (IQR, 19.45-27.14 years), 213 deaths occurred in the T21 group (9.7%) compared with 123 (5.6%) in the euploidic comparators. After adjustment for age, sex, era, CHD complexity, and initial palliation, the hazard ratio of CHD-related mortality was 1.34 times higher in patients with T21 (95% CI, 0.92-1.97; P = .127). CONCLUSIONS CHD-related mortality for patients with T21 after cardiac surgical intervention is comparable with euploidic comparators. Children with T21 require lifelong surveillance for co-occurring conditions associated with their chromosomal abnormality.
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Affiliation(s)
- Jennifer K. Peterson
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205
| | - Lazaros K. Kochilas
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322,Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322
| | - Jessica Knight
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 101 Buck Road, Athens, GA 30602
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322
| | - Amanda S. Thomas
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322
| | - James H. Moller
- Departments of Pediatrics and Medicine, University of Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| | - Shaun P. Setty
- Long Beach Memorial Heart and Vascular Institute, 2801 Atlantic Avenue, Long Beach, CA 90806,Children’s Heart Institute, MemorialCare Miller Children’s and Women’s Hospital, 2801 Atlantic Avenue, Long Beach, CA 90806
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28
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Santoro SL, Donelan K, Haugen K, Oreskovic NM, Torres A, Skotko BG. Transition to virtual clinic: Experience in a multidisciplinary clinic for Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:70-82. [PMID: 33385186 DOI: 10.1002/ajmg.c.31876] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic necessitated a rapid transition from in-person office visits to virtual visits in the Down syndrome specialty program at Massachusetts General Hospital (MGH DSP). We describe the clinic transition to virtual visits in April 2020 and reflect on our six-month experience in virtual visits. Clinic metrics were tracked. Electronic survey responses were collected from caregivers attending virtual visits. Input from the MGH DSP team was collected. From April to September 2020, we maintained patient volume (45 visits per month) and overall satisfaction score (6.7 out of 7) following a sudden, unanticipated transition to virtual visits. Survey of 17 caregivers attending virtual visits found that most were equipped with technology, had access to a private location, and most were able to access visit without any limitations. Caregivers appreciated the convenience of virtual visits but sometimes missed the personal connection of an in-person visit. Overall, though, virtual visits were frequently viewed as no different than office visits. Team members identified benefits and challenges of virtual visits, as well as lessons learned from this transition. We were able to maintain multidisciplinary, specialty care with optimal caregiver feedback and sustained number of patient visits.
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Affiliation(s)
- Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Donelan
- Survey Research and Implementation Unit, Division of Clinical Research, Massachusetts General Hospital, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey Haugen
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicolas M Oreskovic
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Torres
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian G Skotko
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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