Factors associated with the reporting of Down syndrome as the underlying cause of death on US death certificates.

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.

Cause of death in adults with intellectual disability in the United States.

BACKGROUND: Prior studies report that adults with intellectual disability (ID) have cause of death patterns distinct from adults in the general population but do not provide comparative analysis by specific causes of death. METHODS: Data are from the National Vital Statistics System 2005-2017 US Multiple Cause-of-Death Mortality files. We utilised adjusted odds ratios to identify causes of death that were more common for adults whose death certificate indicated ID (N = 22 512) than for adults whose death certificate did not indicate ID (N = 32 738 229), controlling for severity level of ID. We then examine the associations between biological sex and race-ethnicity and causes of death solely among adults with ID. RESULTS: The leading cause of death for adults with and without ID indicated on their death certificate was heart disease. Adults with ID, regardless of the severity of the disability, had substantially higher risk of death from pneumonitis, influenza/pneumonia and choking. Adults with mild/moderate ID also had higher risk of death from diabetes mellitus. Differences in cause of death trends were associated with biological sex and race-ethnicity. CONCLUSIONS: Efforts to reduce premature mortality for adults with ID should attend to risk factors for causes of death typical in the general population such as heart disease and cancer, but also should be cognisant of increased risk of death from choking among all adults with ID, and diabetes among adults with mild/moderate ID. Further research is needed to better understand the factors determining comparatively lower rates of death from neoplasms and demographic differences in causes of death among adults with ID.

Heterogeneity in age at death for adults with developmental disability.

BACKGROUND: Although increased attention has been devoted to mortality trends for adults with developmental disability, research has not accounted for possible differences in age at death between disability types. We examine whether heterogeneity is present in age at death between adults with different types of developmental disability. METHODS: Data were from the 2012-2016 U.S. Multiple Cause-of-Death Mortality files. Mean age at death and age at death distributions were analysed for adults, aged 18-126, with and without developmental disability collectively and then stratified by biological sex. RESULTS: There were 33 154 decedents with and 13 026 759 without developmental disability. Compared with adults without developmental disability, age at death was lower for all decedents with developmental disability but varied markedly by disability type and biological sex. Among adults with developmental disability, those with intellectual disability had the highest age at death, and those with cerebral palsy or other rare developmental disabilities, especially if co-morbid for a second developmental disability, had the lowest age at death. CONCLUSION: Research on age at death for adults with developmental disability must account for heterogeneity among disability types in order to ensure reliable estimates. Failure to do so conceals important differences between disability types, which can misguide public health and preventive care efforts to reduce premature mortality and/or provide aging-related supports.

Invasive lobular carcinoma of the breast; clinicopathologic profile and response to neoadjuvant chemotherapy over a 15-year period.

INTRODUCTION: Invasive lobular carcinoma (ILC) accounts for 5-15% of invasive breast cancers. Typical ILC is oestrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative. Atypical biomarker profiles (ER- and HER2+, ER+ and HER2+ or triple negative) appear to differ from typical ILCs. This study compared subtypes of ILC in terms of clinical and pathological parameters, and response to neoadjuvant chemotherapy (NACT) according to biomarker profile. METHODS: All patients with ILC treated in a single centre from January 2005 to December 2020 were identified from a prospectively maintained database. Clinicopathologic and outcome data was collected and analysed according to tumour biomarker profile. RESULTS: A total of 582 patients with ILC were treated. Typical ILC was observed in 89.2% (n = 519) and atypical in 10.8% (n = 63). Atypical ILCs were of a higher grade (35% grade 3 vs 9.6% grade 3, p < 0.001). A larger proportion of atypical ILC received NACT (31.7% vs 6.9% p < 0.001). Atypical ILCs showed a greater response to NACT (mean RCB (Residual Cancer Burden Score) 2.46 vs mean RCB 3.41, p = 0.0365), and higher pathological complete response rates (15% vs 0% p = 0.017). Despite this, overall 5-year disease-free survival (DFS) was higher in patients with typical ILC (91% vs 83%, p = 0.001). CONCLUSIONS: Atypical ILCs have distinct characteristics. They are more frequently of a higher grade and demonstrate a superior response to NACT. Despite the latter, atypical ILCs have a worse 5-year DFS which should be taken into consideration in terms of prognostication and may assist patient selection for NACT.

Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy.

BACKGROUND: Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP. AIM: To assess the relationship between health status in older adults with ID either with or without coincident diagnoses of CP. METHOD: Health status data were drawn from 1373 adults aged 33 to 79 years with ID living in small group homes in New York State. Their health status was defined by the presence of common health disorders. Of these, 177 subjects had coincident CP. Prevalence data for nine diseases representing different organ systems were obtained and compared in individuals with and without CP. A Severity of Functional Impairment Index (SFII) was developed based on subjects' capabilities in activities of daily living (ADLs) and mobility. Two logistic regression analyses were conducted to determine if CP diagnosis was an independent predictor of health disorder prevalence, or rather exerted effects similar to those without CP via severity of functional impairment as determined by SFII scores. In addition, older age, gender, and severity of intellectual disability were examined as predictors of health disorder prevalence in all study subjects. RESULTS: Individuals with CP had higher frequencies in four out of the nine health disorders (overweight/obesity, gastroesophageal reflux, urinary tract infections and dysphagia). Analysis revealed a statistically significant association between SFII score and CP diagnosis. CP diagnosis alone was a statistically significant predictor for all of the above four common disorders; however, after adjustment for SFII score was included in health disorder models, only dysphagia showed an independent correlation with a CP diagnosis. CONCLUSION: With the exception of dysphagia, impairment in ADLs and walking capabilities, and not CP diagnosis alone, accounted for disparities in specific diseases. Although the diagnosis of CP may be correlated with functional impairment, it alone may play a minor role in determining health trajectories in older persons with conjoint ID and CP.

Antimicrobial susceptibility and serotypes of Actinobacillus (Haemophilus) pleuropneumoniae recovered from Missouri swine.

The antimicrobial susceptibility of 73 Actinobacillus (Haemophilus) pleuropneumoniae isolates from swine in Missouri was determined with a microdilution minimal inhibitory concentration test system. Serotyping was accomplished by means of co-agglutination. Serotype 1 (39/73) and serotype 5 (30/73) were commonly found, whereas serotype 7 (4/73) was infrequently encountered. Most isolates (MIC90) were found susceptible to ampicillin (amoxicillin), cephalothin, penicillin, erythromycin, gentamicin, and kanamycin. Marked resistance was found with oxytetracycline, tylosin, and sulfadimethoxine. The data indicate that use of ampicillin (amoxicillin) or penicillin may correlate well with the favorable outcome of treatment.

Photophobia in patients with traumatic brain injury: Uses of light-filtering lenses to enhance contrast sensitivity and reading rate.

Patients who have sustained traumatic brain injury (TBI) often experience a new, intense and chronic photophobia. Photophobia, an intolerance to light, is an incompletely understood, subjective symptom, which has been divided into ocular and central types. Various commercial sources of light-filtering lenses have been developed, which have proven to be successful in diminishing visual symptoms expressed by patients who are photophobic. However, despite the many subjective reports of improved visual performance and comfort with use of these filters, there has been little documentation of actual enhanced visual sensitivity/efficiency. Letter contrast sensitivity (CS) and reading rate were measured in patients with TBI, who, despite good ocular health, experienced significant light intolerance. These patients exhibited up to two fold increases (0.3 log units) in binocular letter contrast sensitivity, as measured with the Pelli-Robson Letter CS Chart, in the presence of selected Corning Photochromic Filters (CPF), as compared to performance in the absence of CPF filters, or to that of similarly treated normal observers. These same patients demonstrated reading rates enhanced up to 39% above that measured in the presence of nearpoint optical correction alone. Reading performance of normal observers was unaffected by similar light filtration. These data provide objective evidence for improvement of visual function provided by light-filtering lenses in patients who become photophobic after TBI. Contrast sensitivity testing and assessment of reading rate add objective criteria for the clinical selection of light-filtering lenses in the treatment of TBI-induced photophobia.

3-methylindole as a model of equine obstructive lung disease.

3-methylindole was administered orally and intravenously to horses and ponies in order to determine the ability of this chemical to provide a model of equine pulmonary disease. Both routes produced a severe and sometimes fatal pulmonary disease, characterised by bronchiolitis. Clinical signs developed 48 to 72 h after dosing and were most severe between Days 4 and 10 post dosing. Intravenous administration of 3-methylindole produced lung injury more rapidly and at a lower dose rate than the oral route. It is suggested that the respiratory condition induced by this chemical could become a method for standardisation of lung function techniques and interpretation in equine obstructive pulmonary disease.

Effects of phenobarbital treatment on 3-methylindole toxicosis in ponies.

To study the role of cytochrome P-450-dependent mixed function oxidase reactions in equine 3-methylindole (3MI) toxicosis, ponies were given 20 mg of phenobarbital/kg of body weight at 72, 60, 48, 36, and 24 hours before 100 mg of oral 3MI/kg to induce cytochrome P-450 or no treatment (controls). Maximal 3MI plasma concentration was decreased and clearance was faster in phenobarbital-treated ponies. Plasma 3MI was still detectable 12 and 36 hours after dosing in phenobarbital-treated and control ponies, respectively. Phenobarbital treatment induced a distribution phase with transition from a 1-compartment to a 2-compartment extravascular model. Bronchiolitis occurred in all ponies 72 hours after 3MI, but was more severe in those treated with phenobarbital. Appearance of a distribution phase, increased total body clearance, and more severe bronchiolitis in phenobarbital-treated ponies indicated that mixed function oxidases are involved in metabolism and conversion of 3MI to a toxic metabolite.

Effects of radiofrequency hyperthermia on the healthy canine cornea.

Radiofrequency hyperthermia was used to induce axial corneal lesions in the eyes of 10 dogs. Clinical observations were continued for up to 6 months, using biomicroscopy and indirect ophthalmoscopy. Eyes were harvested at intervals for light and electron microscopic evaluation. Clinical alterations included immediate corneal opacification and epithelial disruption at the site of electrode contact. Ulcerative keratitis persisted for 4 to 6 days, accompanied by anterior uveitis. Additional corneal changes included stromal thinning, edema, and vascularization. Final evaluation revealed negligible alterations in corneal contour or clarity 6 months after treatment. Microscopically, epithelial and superficial stromal necrosis preceded epithelial loss. Stromal alterations included edema (associated with focal endothelial detachments), vascularization, and inflammatory cell infiltration. Recovery was characterized by keratocytic hyperplasia and hypertrophy, epithelial proliferation, and stromal condensation.

Efficacy of ivermectin in injectable and oral paste formulations against eight-week-old Strongylus vulgaris larvae in ponies.

A controlled test method was used to evaluate the efficacy of injectable micelle and oral paste formulations of ivermectin (22,23-dihydroavermectin B1) against 8-week-old Strongylus vulgaris larvae in experimentally infected pony foals. The dosage level of the drug in both formulations tested was 0.2 mg/kg. Ponies were euthanatized and necropsied 5 weeks after treatment. Based on the recovery of live vs dead S vulgaris from mesenteric arteries, both formulations were greater than 99% effective. Increased weight gains and marked reductions in the severity of arterial lesions were observed in treated ponies.

Sequential mesenteric arteriography in pony foals during repeated inoculations of Strongylus vulgaris and treatments with ivermectin.

Semiselective mesenteric arteriography was performed at regular intervals (inoculation weeks [IW] 0, 11, 18, and 24) in 9 of 10 pony foals raised to be free of parasites. Fifty infective larvae (L3) of Strongylus vulgaris were administered weekly for 4 weeks, then every 2 weeks through the 20th week. Three ponies were given ivermectin (oral paste, 0.2 mg/kg of body weight) treatment at IW 8, 16 and 24. Four ponies were inoculated, but did not receive ivermectin, and a third group of 2 ponies acted as uninoculated controls. Control ponies did not have gross or arteriographic lesions, whereas the inoculated untreated ponies had gross and progressive arteriographic lesions typical of verminous arteritis. Arteriographic lesions in the ivermectin-treated inoculated ponies were not as severe those in the untreated inoculated group, and there was either a partial resolution or a lack of progression of arteriographic lesions in all treated ponies. One untreated inoculated pony did not have progressive arterial lesions as did the 3 others in the group, and may develop resistance to the parasite.

Effects of repeated Strongylus vulgaris inoculations and concurrent ivermectin treatments on mesenteric arterial lesions in pony foals.

Eight of 10 pony foals reared under helminth-free conditions were inoculated PO with 50 Strongylus vulgaris infective larvae/week for 4 weeks, at which time 1 foal died of acute verminous arteritis. Inoculation of 7 remaining foals continued at 2-week intervals for 20 weeks. Of the 7 foals, 3 were treated with ivermectin (0.2 mg/kg of body weight) in an oral paste formulation at experiment weeks 8, 16, 24; 4 foals were not treated. Two foals were not inoculated or treated and served as controls. After the first ivermectin treatment, ivermectin-treated foals had fewer days (12 +/- 2.9) with rectal temperatures greater than 38.6 C than did nontreated foals (23.3 +/- 3.8). Mean baseline rectal temperatures were 38 +/- 0.2 C. Adverse clinical reactions to ivermectin treatment were not observed in foals. Foals were euthanatized and necropsied 3 weeks after the last ivermectin treatment (week 24). Ivermectin was effective in reducing S vulgaris arterial larval and intestinal adult parasite numbers by 100% in 3 treated foals. Strongylus vulgaris arterial larvae and/or adults were recovered from all 4 nontreated inoculated foals. One nontreated inoculated foal lacked arterial larvae or active arterial lesions, indicating that protective resistance had developed in this individual. Marked gross and histopathologic lesions typical of chronic S vulgaris infection were observed in the 3 nontreated inoculated foals with arterial larvae. Repeated killing of intra-arterial S vulgaris fourth-stage larvae in ivermectin-treated foals did not exacerbate lesions associated with verminous arteritis or induce unique lesions associated with repeated destruction of arterial larvae.(ABSTRACT TRUNCATED AT 250 WORDS)

The health of women with cerebral palsy.

Over the past 10 years, there has been interest in describing the health and functional status of persons with CP. More recently, information specific to women with CP has become available. From these studies a better appreciation of the affect a lifelong primary disability such as CP has on an individual's life has developed. An understanding of aging with a disability, secondary conditions, associated conditions, comorbidities, and health have promoted a health and wellness agenda for women and men with CP. Women with CP are generally healthy. There appears to be no significant risk for any specific comorbiditv from CP. Women may note a modest change in function over time that may represent issues of aging, but there should be no dramatic loss of function. Any loss of function must be evaluated further for cause, and cannot be attributed to aging alone. Common secondary conditions and health issues include pain and musculoskeletal issues, bladder and bowel problems, poor dental hygiene, and possibly gastroesophageal reflux. Osteoporosis at all ages from limited mobility (secondary osteoporosis) likely is common, but only recently has bone densitometry been used for more routine evaluations; consequently, no data are available in women with CP regarding this. All health issues should be evaluated and appropriate intervention prescribed. There appear to be no significant reproductive health issues for women with CF. Women should engage in all decisions regarding diagnosis and treatment. Women with CP likely participate in some healthy behaviors. However implementing health promotion programs requires some understanding of health behavior theories and models. It may not be enough to modify existing programs for accessibility (e.g., transportation, cost. environment). Engagement in health promotion programs by women with CP must take into account individual perceptions and values, social networks, a sense of personal control, and a readiness to change attitude toward changing lifestyles.

Diagnosis of primary generalized epilepsy in a cow.

On the basis of history, electrodiagnostic and neuropharmacologic studies, and results of laboratory testing and necropsy, a seizure disorder of 1.5 years' duration in an 8-year-old Hereford cow was diagnosed as primary generalized epilepsy. Evidence of metabolic, toxicologic, head trauma, or genetic cause of the seizures was not found. A morphologic cause for the convulsions also was not detected. One naturally occurring seizure was recorded electroencephalographically, but interictal EEG abnormalities were not seen. Attempts to evoke a seizure with photostimulation or therapeutic doses of acepromazine, ketamine, tripelennamine, and estradiol cypionate were unsuccessful. The seizure threshold for the CNS stimulant pentylenetetrazol was found to be less than 6 mg/kg, IV; the seizure threshold in a control cow was found to be greater than 12 mg/kg, IV. The pharmacologic protocol used for this cow may be useful for diagnosis of epilepsy in other animals.

Benign cutaneous mastocytomas in two litters of Siamese kittens.

Histiocytic-like cutaneous mast cell tumors were found in related Siamese cats less than 6 months old. The 2- to 5-mm diameter tumors developed only on the head and regressed within 4 months of diagnosis. Attempts to treat 2 of 4 affected kittens with topically or parenterally administered corticosteroids did not speed tumor regression, and the cause of the tumors was not determined.

Bacillus piliformis infection (Tyzzer's disease) in foals in northwestern United States: a retrospective study of 21 cases.

From Jan 1, 1967 through June 1980, 21 cases of Bacillus piliformis infection (Tyzzer's disease) in foals were diagnosed at the Washington Animal Disease Diagnostic Laboratory. Affected foals died between 7 and 35 days of age. Of 4 Arabian foals with the disease, 2 also had combined immunodeficiency.

Disseminated cutaneous squamous cell carcinoma in a ferret.

A 3-year-old male ferret was admitted with ulcerated nodules and fistulous draining tracts on the pads and digits of the right front and left hind feet. Proteus sp and Escherichia coli were isolated from the exudate. Histologic examinations revealed that all skin lesions were associated with an underlying squamous cell carcinoma. Surgical removal was attempted, followed by chemotherapy. Regression of remaining lesions was noted before discharge; however, the ferret died 5 days later and was not available for necropsy.

Follicular cysts in sheep.

A flock of 188 sheep was surveyed for cutaneous lesions that were noticed 3 days after shearing. On the basis of histologic features of the cyst wall, ie, association with sebaceous glands and lack of follicular structures or rete pegs, the cysts were classified as follicular cysts.

Diskospondylitis in a kennel of dogs: clinicopathologic findings.

Selected aspects pertaining to the cause and pathogenesis of diskospondylitis were investigated in a kennel of 45 Airedale Terriers. Diskospondylitis was detected via spinal radiography in 17 male and 14 female dogs. Bacteria isolated from the coat, vagina, and urine of affected Airedales were not statistically different from those isolated from clinically normal Airedales. Serologic evidence of Brucella canis infection was not detected. There was no difference in response to thyrotropin stimulation tests between affected and clinically normal dogs. Necropsy findings in affected dogs included hypercellular renal glomeruli and pulmonary arterial thrombi.