Celiac Disease and the Risk of Micronutrient Deficiencies in Ethnic Minority Populations: A Retrospective Cohort Study.

INTRODUCTION: Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals. Historically, CD was primarily recognized and described as a disease of the Caucasian population. Data from a national survey in 2015 revealed that 0.79% of the population was formally diagnosed with celiac disease, with the non-Hispanic white population having a prevalence of 4-8 times higher than other underrepresented races. Although there is evidence that CD affects minorities at higher than reported rates, there is little data on its effects on minority populations. Our study aimed to characterize celiac-related complications among underrepresented populations in a large health database. METHODS: We performed a cohort study among patients aged ≥18, utilizing the TriNetX US Collaborative Network. Two cohorts of patients (minority and non-Hispanic white) with CD were identified between 2016 and 2021. Cohorts were propensity scores matched on demographics and baseline clinical characteristics. Outcomes were assessed up to 1 year after the index event (CD diagnosis), including vitamin/mineral deficiencies and hospital visits. Data were analyzed using the TriNetX Analytics function. RESULTS: Each group was matched with 817 patients. Compared to the non-Hispanic white population, the minority group had a similar incidence of iron, vitamin B, and zinc deficiencies. The minority group had a higher risk of vitamin D deficiency, anemia secondary to iron deficiency, inpatient hospital stays, and emergency department visits. CONCLUSION: Our results indicate that minority patients with celiac disease have a higher incidence of vitamin D and iron deficiency.

Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes.

BACKGROUND: Measures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear. PURPOSE: To examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes. STUDY DESIGN: Cross-sectional. METHODS: Five hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman's correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman's correlations. Individual-level data were plotted to visually depict the relationships. RESULTS: C3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches. CONCLUSION: Modest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis. LEVEL OF EVIDENCE: 2b.

Indeterminate Colitis - Update on Treatment Options.

Indeterminate colitis (IC) is described in approximately 5-15% of patients with inflammatory bowel disease (IBD). It usually reflects a difficulty or lack of clarity in distinguishing between ulcerative colitis (UC) and Crohn's disease (CD) on biopsy or colectomy specimens. The diagnostic difficulty may explain the variability in the reported prevalence and incidence of IC. Clinically, most IC patients tend to evolve over time to a definite diagnosis of either UC or CD. IC has also been interchangeably described as inflammatory bowel disease unclassified (IBDU). This review offers an overview of the available limited literature on the conventional medical and surgical treatments for IC. In contrast to the numerous studies on the medical management of UC and CD, there are very few data from dedicated controlled trials on the treatment of IC. The natural evolution of IC more closely mimics UC. Regarding medical options for treatment, most patients diagnosed with IC are treated similarly to UC, and treatment choices are based on disease severity. Others are managed similarly to CD if there are features suggestive of CD, including fissures, skin tags, or rectal sparing. In medically refractory IC, surgical treatment options are limited and include total proctocolectomy (TPC) and ileal pouch-anal anastomosis (IPAA), with its associated risk factors and complications. Post-surgical complications and pouch failure rates were historically thought to be more common in IC patients, but recent meta-analyses reveal similar rates between UC and IC patients. Future therapies in IBD are focused on known mechanisms in the disease pathways of UC and CD. Owing to the lack of IC-specific studies, clinicians have traditionally and historically extrapolated the data to IC patients based on their symptomatology, clinical course, and endoscopic findings.

Digital neuropsychological test performance in a large sample of uninjured collegiate athletes.

Digital neuropsychological test batteries are popular in college athletics; however, well-validated digital tests that are short and portable are needed to expand the feasibility of performing cognitive testing quickly, reliably, and outside standard clinical settings. This study assessed performance on digital versions of Trail Making Test (dTMT) and a modified Symbol Digit Modalities Test (dSDMT) in uninjured collegiate athletes (n = 537; 47% female) using the C3Logix baseline assessment module. Time to complete (dTMT) and the number of correct responses (dSDMT) were computed, transformed into z scores, and compared to age-matched normative data from analogous paper-and-pencil tests. Overall sample performance was compared to normative sample performance using Cohen's d. Sample averages on the dTMT, Part A, and dSDMT were similar to published norms; 97 and 92% of z scores fell within 2 standard deviations of normative means, respectively. The sample averaged faster completion times on dTMT, Part B than published norms, although 98% of z scores were within 2 standard deviations of the normative means. Brief, digitized tests may be useful in populations and testing environments when longer cognitive test batteries are impractical. Future studies should assess the ability of these tests to detect clinically relevant changes following a suspected head injury.

Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System.

BACKGROUND: Individualized baseline testing is resource and time intensive. The use of normative data to approximate changes after a suspected concussion is thus an appealing alternative. Yet, few peer-reviewed, large-sample studies are available from which to develop accurate normative averages of balance using force-plate technology. PURPOSE: This study sought to validate a normative dataset from the force-plate manufacturer and examine the magnitude and nature of sample variability. STUDY DESIGN: Cross-sectional. METHODS: Baseline balance and self-reported sex, sport, and concussion history were assessed in 533 prospective collegiate athletes (45% female) during pre-participation physical examinations. Balance was measured using four stances from the modified Clinical Test of Sensory Interaction and Balance and quantified as Sway Index Scores with the Biodex Biosway Portable Balance System. Group averages are contrasted to data from the force-plate manufacturer. Individual variability around these averages was visualized and analyzed by sex and sport. RESULTS: Male student athletes showed significantly more sway in the eyes open, soft stance condition than female athletes. These differences were maintained when concussion history was included as a covariate. Athletes, particularly male athletes, in the high versus low contact sport group showed significantly more sway in the eyes open, soft surface and the eyes closed, hard and soft surface stances. CONCLUSION: There was substantial individual variability that was partially explained by sex differences and sport differences. The development of normative averages for sway may benefit from consideration of sex and sport. Further studies should characterize other factors that influence baseline balance in collegiate athletes. LEVEL OF EVIDENCE: 2b.