Stepwise use of genomics and transcriptomics technologies increases diagnostic yield in Mendelian disorders

Purpose: Multi-omics offer worthwhile and increasingly accessible technologies to diagnostic laboratories seeking potential second-tier strategies to help patients with unresolved rare diseases, especially patients clinically diagnosed with a rare OMIM (Online Mendelian Inheritance in Man) disease. However, no consensus exists regarding the optimal diagnostic care pathway to adopt after negative results with standard approaches. Methods: In 15 unsolved individuals clinically diagnosed with recognizable OMIM diseases but with negative or inconclusive first-line genetic results, we explored the utility of a multi-step approach using several novel omics technologies to establish a molecular diagnosis. Inclusion criteria included a clinical autosomal recessive disease diagnosis and single heterozygous pathogenic variant in the gene of interest identified by first-line analysis (60%-9/15) or a clinical diagnosis of an X-linked recessive or autosomal dominant disease with no causative variant identified (40%-6/15). We performed a multi-step analysis involving short-read genome sequencing (srGS) and complementary approaches such as mRNA sequencing (mRNA-seq), long-read genome sequencing (lrG), or optical genome mapping (oGM) selected according to the outcome of the GS analysis. Results: SrGS alone or in combination with additional genomic and/or transcriptomic technologies allowed us to resolve 87% of individuals by identifying single nucleotide variants/indels missed by first-line targeted tests, identifying variants affecting transcription, or structural variants sometimes requiring lrGS or oGM for their characterization. Conclusion: Hypothesis-driven implementation of combined omics technologies is particularly effective in identifying molecular etiologies. In this study, we detail our experience of the implementation of genomics and transcriptomics technologies in a pilot cohort of previously investigated patients with a typical clinical diagnosis without molecular etiology.

A Review Study Toward Clinical and Histopathological Diagnosis Agreement in Skin Diseases

Background

It is important to evaluate the agreement between clinical diagnosis and histopathological diagnosis. The aim of this study was to review studies and to calculate the degree of agreement between clinical and histopathological diagnosis.

Objective

The aim of this review was to find out the concordance level between clinical and histopathological diagnosis; to find out in which type of pathology concordance was the highest; to identify the types of pathologies for which biopsy was mostly performed and the anatomical region selected for biopsy.

Results and Discussion

Review was carried out in accordance with the PRISMA 2020 flow diagram for the selection of articles that met the criteria (years 2005-2021). Articles were found in Google scholar, PubMed, Scopus databases using different keywords. The main criterion was to involve studies that reported data about clinical and histopathological diagnosis. A mean concordance value was calculated and resulted of 72.8 % (95% CI).

Conclusion

To our knowledge, our study was the first review done regarding concordance between clinical and histopathological diagnosis in skin diseases with the aim to provide researchers with enriched literature and encourage them to bring about an appropriate systematic review study.

Limitations Using Neuroimaging to Reconstruct Mental State After a Crime

Neuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

Incidence of insomnia and obstructive sleep apnea in active duty United States military service members

STUDY OBJECTIVES

Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty the United States military service members.

METHOD

Data and service branch densities used to derive the expected rates of diagnoses on insomnia and OSA were drawn from the Defense Medical Epidemiology Database. Single sample chi-square goodness of fit tests and independent samples t-tests were conducted to address the aims of the study.

RESULTS

Between 2005 and 2019, incidence rates of OSA and insomnia increased from 11 to 333 and 6 to 272 (per 10,000), respectively. Service members in the Air Force, Navy, and Marines were diagnosed with insomnia and OSA below expected rates, while those in the Army had higher than expected rates (p < .001). Female service members were underdiagnosed in both disorders (p < .001). Comparison of diagnoses following the transition from ICD 9 to 10 codes revealed significant differences in the amounts of OSA diagnoses only (p < .05).

CONCLUSION

Since 2005, incidence rates of OSA and insomnia have markedly increased across all branches of the U.S. military. Despite similar requirements for overall physical and mental health and resilience, service members in the Army had higher rates of insomnia and OSA. This unexpected finding may relate to inherent differences in the branches of the military or the role of the Army in combat operations. Future studies utilizing military-specific data and directed interventions are required to reverse this negative trend.

Estimated Prevalence of Unreported IGD Cases in Routine Outpatient Children and Adolescent Psychotherapy

Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid “hidden” cases of IGD in the future.

The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014

BACKGROUND

The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985.

OBJECTIVE

We aimed to assess the American Academy of Dermatology's national skin cancer screening program from 1986 to 2014 by analyzing the risk factor profile, access to dermatologic services, and examination results.

METHODS

We conducted several detailed statistical analyses of the screening population.

RESULTS

From 1986 to 2014, records were available for 2,046,531 screenings, 1,963,141 (96%) of which were subjected to detailed analysis. Men comprised 38% of all participants. The number of annual screenings reached approximately 100,000 in 1990 and remained relatively stable thereafter. From 1991 to 2014 (data for 1995, 1996 and 2000 were unavailable), clinical diagnoses were rendered for 20,628 melanomas, 156,087 dysplastic nevi, 32,893 squamous cell carcinomas, and 129,848 basal cell carcinomas. Only 21% of screenees had a regular dermatologist. Those with a clinical diagnosis of skin cancer were more likely than the general screening population to be uninsured.

LIMITATIONS

Inability to verify clinical diagnoses histopathologically.

CONCLUSION

Our findings suggest that the SPOTme program has detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.

Mood and anxiety disorders in very preterm/very low-birth weight individuals from 6 to 26 years

BACKGROUND

Very preterm (<32 weeks' gestational age; VP) or very low-birth weight (<1,500 g; VLBW) birth has been associated with increased risk for anxiety and mood disorders and less partnering in adulthood. The aim was to test whether (a) VP/VLBW are at increased risk of any anxiety or mood disorders from 6 to 26 years compared with term-born individuals; (b) social support from romantic partners is associated with protection from anxiety and mood disorders; and (c) VP/VLBW adults' lower social support mediates their risk for any anxiety and mood disorders.

METHODS

Data are from a prospective geographically defined longitudinal whole-population study in South Bavaria (Germany). Two hundred VP/VLBW and 197 term individuals were studied from birth to adulthood. Anxiety and mood disorders were assessed at 6, 8, and 26 years with standardized diagnostic interviews and social support via self-report at age 26.

RESULTS

At age 6, VP/VLBW children were not at increased risk of any anxiety or mood disorder. At age 8, VP/VLBW more often had any anxiety disorder than term comparisons (11.8% vs. 6.6%, OR = 2.10, 95% CI [1.08-4.10]). VP/VLBW adults had an increased risk for any mood (27.5% vs. 18.8%, OR = 1.65 [1.02-2.67]) but not for any anxiety disorder (33.0% vs. 28.4%, OR = 1.27 [0.82-1.96]). None of the significant differences survived correction for multiple testing. Social support was associated with a lower risk of anxiety or mood disorders in both groups (OR = 0.81 [0.68-0.96]) and mediated the association of VP/VLBW birth with any anxiety or any mood disorders at age 26.

CONCLUSIONS

This study does not show a persistently increased risk for any anxiety or mood disorder after VP/VLBW birth. Low social support from a romantic partner mediates the risk for anxiety or mood disorders after VP/VLBW birth.

Factor structure and clinical utility of BDI-II factor scores in postpartum women

BACKGROUND

The purpose of the current study was to examine the factorial dimensions underlying Beck Depression Inventory-II (BDI-II) in a large ethnically and economically diverse sample of postpartum women and to assess their relative contribution in differentiating clinical diagnoses in a subsample of depressed women.

METHODS

We administered the BDI-II to 953 women between 4 and 20 weeks postpartum. Women who had low (1-7) and high (>12) BDI-II total scores were administered the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I).

RESULTS

Exploratory (EFA) and confirmatory factor analysis (CFA) revealed three factors, Cognitive, Somatic, and Affective, that accounted for 49.09% of the overall variance of items. Logistic regression analyses showed that somatic and affective factors contributed to diagnosis of major depression, while the somatic factor alone contributed to the diagnosis of depression with comorbid anxiety. The cognitive factor differentiated women with major depression from women who were never depressed.

LIMITATIONS

Our definition of clinical depression included episodes of depression during the child's lifetime, and depressive symptoms were not necessarily current at the time of the assessment, which may impact the relative contribution of BDI-II factors to clinical diagnosis.

CONCLUSION

Conceptualizing the structure of the BDI-II using these three factors could contribute to refining the measurement and scoring of depressive symptomatology and severity in postpartum women. Although somatic symptoms of depression may be difficult to differentiate from the physiological changes of normative postpartum adjustment, our results support the inclusion of somatic symptoms of depression in the calculation of a BDI-II total score.