2-year Period Research Articles

Adult Food Poisoning in a Tertiary University Hospital: Retrospective Evaluation of Emergency Department Visits and Outcomes

Aim The clinical diagnosis, which occurs with various symptoms as a result of consumption of contaminated food, is defined as food poisoning (FP). A large number of people experience FP around the world each year. This report focuses on the clinical and descriptive characteristics of adult cases visiting the emergency department (ED) due to FP. Material and Methods This study was planned as a retrospective examination of adult FP cases who visited a tertiary ED in a 4-year period. Complaints, vital signs, physical examination and laboratory data at the time of the visit were recorded. The treatment given for ED and the ways to recover from ED were also evaluated. Results 61 patients were included. 43 patients (70.5%) were male. Median age was 31 years (min: 18- max: 73). The most common symptom was nausea (n=27, 44.3%). No relationship was detected between length of hospital stay and descriptive data. Most of cases except two (96.7%), were discharged after the treatments administered in the ED. Conclusion FP cases are often young and male. They most often visit ED with complaints of nausea and are often discharged from ED after treatment. Descriptive data is not predictive of outcomes.

A population-based study of incidence, aetiology, treatment and outcome of enterocutaneous fistula.

The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10-year period and to describe aetiology, treatments, care consumption and outcome. A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in-hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified. The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF-related in-hospital care until closure or end of follow-up was 4 (range 0-61) weeks. Eighty-eight patients (47%) received home-based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF-related death was 30.2%. This study defines the population-based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home-based healthcare.

Adverse drug reactions reported over 5 years in a regional university hospital

Adverse drug reactions (ADRs) are closely associated with increased morbidity and mortality rates, prolonged hospitalization durations, and higher healthcare costs. This study aimed to estimate the incidence, clinical features, and reporting status of ADRs to improve the current ADR reporting system and prevent recurrent ADRs in hospitals. This retrospective study was conducted at a regional referral hospital. Patients diagnosed with ADRs over a 5-year period (2009-2014) were recruited for this study. An ADR was identified as an ADRrelated diagnosis in a patient’s medical record or an ADR registered through the inhospital ADR reporting system. The incidence, culprit drug, clinical manifestations, reporting source, severity, related management, and recurrence rate were assessed. Among 1,112 patients, 1,375 ADR events were collected, an estimated 0.06% of the total number of patient visits. Diagnostic contrast agents (46.4%) were the most common culprit drugs, followed by antibiotics (22.0%), nonsteroidal anti-inflammatory drugs (9.9%), and opioids (4.5%). Skin reactions (67.5%) such as rashes and hives were the most frequent manifestations. Additional ADR-related medical attention was necessary in two thirds of cases. One hundred eighty ADR events (13.1%) were categorized as severe, and 19 patients (1.4%) experienced re-exposure to the culprit drugs. Four patients (0.3%) experienced fatal ADRs. Physicians were the most frequent ADR reporters in the in-hospital ADR reporting system. In conclusion, many ADR events may be overlooked, and re-exposure to causative drugs commonly occurs. Continuous education and maintenance of a reporting system may be important for preventing recurrent ADRs.

Longitudinal Impacts of High Versus Low Greenness on Cardiovascular Disease Conditions.

Greenness-or vegetative presence-has been identified as a factor in chronic disease. The present study examines the longitudinal relationship between objective measures of greenness at the residential block level and incidence of 6 cardiovascular disease conditions. Analyses examined the impact of consistently high versus consistently low "precision" greenness at the Census block level on the 5-year incidence of cardiovascular disease conditions, including acute myocardial infarction, atrial fibrillation, heart failure, ischemic heart disease, stroke/transient ischemic attack, and hypertension, among 229 034 US Medicare beneficiaries in Miami-Dade County, Florida, USA. Zero-inflated Poisson regression was used to model the odds of developing any new cardiovascular disease and number of new cardiovascular disease conditions based on greenness tertiles computed across 2011 and 2016 Normalized Difference Vegetation Index values, adjusting for individual age, sex, race, ethnicity, baseline cardiovascular disease conditions, neighborhood income, and walkability in 2011 and 2016. When compared with individuals consistently in the low greenness tertile in 2011 and 2016, those consistently in the high greenness tertile in 2011 and 2016 had a 9% lower odds of having any new cardiovascular conditions (odds ratio [OR], 0.91 [95% CI, 0.84-0.99]; P=0.021). Over a 5-year period, consistently high greenness, when compared with consistently low greenness, was associated with lower odds of any new cardiovascular disease conditions. Identifying the role of greenness exposure in such a small geographic area, the Census block on which the older adult resides, allows for more precise, strategic decisions on where additional trees can be added-by selecting at-risk blocks rather than entire neighborhoods for tree-planting interventions.

Effect of Optimal Heart Rate on Left Ventricular Remodeling in Patients with Systolic Heart Failure Following Acute Coronary Syndrome.

The optimal therapeutic approach to facilitate reverse remodeling is desired in patients with systolic heart failure following acute coronary syndrome (ACS). The association between heart rate (HR) and reverse remodeling in this cohort has remained elusive.Patients with left ventricular ejection fraction (LVEF) < 50% who received echocardiography assessments following ACS were retrospectively included. Theoretically ideal HR was calculated using a previously established formula: 93 - 0.13 × (deceleration time [msec]). Impacts of HR on echocardiographic left ventricular (LV) reverse remodeling during the 2-year observational period were compared between 2 groups stratified by the HR difference between theoretically ideal and actual values: optimal HR group (HR difference ≤ 10 bpm) versus sub-optimal HR group (HR difference > 10 bpm).A total of 27 patients (median 72 years old, 23 males) were included. There were no significant differences in the baseline characteristics including maximum serum creatinine kinase level and the dose of beta-blocker between the 2 groups. LV ejection fraction increased significantly only in the optimal HR group at follow-up (from 42% to 54%; P = 0.001). The optimal HR group exhibited a more pronounced decrease in LV end-diastolic diameter (from 57 to 52 mm) compared to the sub-optimal HR group (from 58 to 56 mm).Optimal HR, which was calculated using a previously proposed formula, was associated with more substantial post-infarct LV reverse remodeling. The implications of aggressive HR modulation targeting theoretically ideal HR among those with systolic heart failure following ACS are the focus of our investigation here.

Cervical Lymphadenitis Tuberculosis Coexistent with Metastatic Papillary Thyroid Carcinoma.

Malignant lesions and tuberculosis coexisting at the same anatomical site in a patient are extremely uncommon. We present a case of a 53-year-old female with cervical lymphadenitis tuberculosis combined with metastatic papillary thyroid carcinoma. Thyroidectomy was performed on the patient with central and lateral neck dissection. The patient received anti-tuberculosis medication and radioactive iodine ablation. No recurrence was observed during a 2-year follow-up period.

Prescribing patterns for older-age bipolar disorder patients discharged from two public mental hospitals in Taiwan, 2006-2019.

Older-age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. There have been no studies to examine temporal trends in the pharmacological treatment of OABD. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019. OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilisers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics (SGAs and FGAs)), and antidepressants, were investigated. Complex polypharmacy was defined as the use of three or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilisers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilisers, lithium, FGAs, and antidepressants plus mood stabilisers significantly decreased. Prescribing patterns changed remarkably for OABD patients over a 14-year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.

Changes in Proportion of International Patients Attending An Urban Stroke Service Over 10 Years

Abstract Background The population of Ireland has become increasingly ethnically diverse. St James’s Hospital is a large inner-city hospital with a diverse multi-ethnic catchment and, because of its location, also admits quite a large number of tourists and international visitors. About 30% of the population of the St James’s catchment were not born in Ireland. We evaluated the effect of this in 2014 and repeated the study in 2024 to determine the how this has changed over the succeeding decade. Methods We reviewed admissions with primary or secondary diagnoses of ischaemic stroke or primary intracerebral haemorrhage (ICD 10 i61 or i63) over 4-year periods, identified by HIPE. Data for the period 2010-2013 were compared with that for the period 2020-2023. Data were confirmed from patient records. International patients (non-Irish/UK) were identified, and demographic details noted. Results Between 2010 and 2013 there were 1550 admission of which 62 (4.0%) were international. Between 2020 and 2023 1266 patients were admitted of which 101 (8.0%) were international (Chi Sq 19.5, p&amp;lt;0.0001). Mean age of the international population increased from 52 to 56 years over the period compared to an increase from 71 to 73 for the indigenous population. Mean length of stay (LoS) for the international population had reduced for international patients (2010-13: 20.9 days. 2020-23: 12.2 days. Between 2020 and 2023, LoS was significantly shorter for the international than the indigenous population (Mean LoS 12.2 days, vs. 19.6 days, p&amp;lt;0.0003 t test). The international population had a higher proportion of males (67.3% vs. 53.9%, Chi Sq 6.8, p=0.009). Conclusion Over the 10-year period the number of international patients admitted doubled. As a proportion of admissions, they remain low and represent a lower proportion than in the community. Length of stay of international stroke patients is lower and there are a higher proportion of males.

Abnormal spirometry is a predictor of exercise capacity in patients with tetralogy of Fallot

&lt;p&gt;We investigated the association between cardiac factors, spirometry, and exercise testing in patients with tetralogy of Fallot (TOF). Clinical data from patients with TOF performing a cardiopulmonary exercise test (CPET) was collected retrospectively over a 10-year period. 122 patients with TOF were identified, 52 excluded for incomplete exercise, spirometry, or cardiac data for 70 total patients included in the study. There was a male predominance 39 (56%), a mean age of 25 ± 12 years, with 28 (40%) &amp;lt; 18 years of age. The mean number of cardiac surgeries was 2.1 ± 1.2. Most, 46 (69%) had moderate to severe pulmonary valve insufficiency (PI) and 34 (51%) had moderate to severe right ventricular (RV) dilation. Mean forced vital capacity (FVC) was low at 81.8% predicted, and 32 (46%) with low FVC (&amp;lt; 80% predicted). Overall peak VO&lt;sub&gt;2&lt;/sub&gt;/kg was low with a mean of 58.2 ± 13.2 % predicted. Using multiple regression analysis, a higher number of cardiac surgeries was an independent predictor of lower FVC (&lt;em&gt;p&lt;/em&gt; = 0.01). Lower FVC was itself an independent predictor of lower peak VO&lt;sub&gt;2&lt;/sub&gt;/kg and O&lt;sub&gt;2&lt;/sub&gt; pulse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Moderate or severe RV systolic dysfunction was an independent predictor of stroke volume response (&lt;em&gt;p&lt;/em&gt; = 0.03).&lt;strong&gt; &lt;/strong&gt;Higher body mass index (BMI) was an independent predictor of all exercise measures being worse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Low FVC and reduced exercise capacity were common in our population of TOF patients. Low FVC was predictive of low exercise capacity while, of the cardiac measures only RV systolic dysfunction was significant and predictive of stroke volume response. Spirometry may be a valuable screening tool in evaluation of TOF patients.&lt;/p&gt;

Validation of a 5-Year Prognostic Model for Parkinson's Disease.

A simple prognostic model was previously developed to predict the probability of recently-diagnosed patients reaching negative outcomes (postural instability, dementia or death) in a 5-year period. To validate this model in an independent cohort and establish utility at later time points. Validation was performed using data collected in an incident cohort at baseline, 2 and 4 years. Predicted negative outcome probabilities were compared to actual 5-year outcomes. The model, based on age, MDS-UPDRS axial score and 60-second animal fluency, predicted poor 5-year outcome when applied at baseline, (area under the curve (AUC) 0.80), 2 years (AUC 0.82) and 4 years (AUC 0.71). Power calculations showed that selecting a subgroup with prognostic score >0.5 reduced the sample size required for a disease-modifying trial. This 5-year prognostic model has good accuracy when employed up to 4 years from diagnosis and may help stratification for disease-modifying trials.

Analysis of 2-Year Survival Outcomes of Japanese Older Populations on Hemodiafiltration: A Propensity Score-Matched Study Based on Insurance Claims Data

Despite the lack of evidence that suggests hemodiafiltration (HDF) offers a better survival outcome than standard hemodialysis (HD), the number of patients initiating HDF in Japan continues to rise. This study examined the temporal change in the number of HDF incidents, evaluated factors associated with all-cause mortality, and compared the mortality risk and survival time of patients on HDF with patients receiving standard HD in three sets of 2-year cohorts. The primary analyses included the insurance claims data of 460 HDF patients and propensity score-matched 903 standard HD patients who initiated dialysis therapy between 1 April 2012 and 31 March 2018. Patient follow-up was censored at the time of death or the end of the 2-year study period. The number of patients who initiated HDF and the proportion of all-cause mortality cases were evaluated. Additionally, the survival outcomes between propensity score-matched HDF and standard HD patient groups were compared throughout cohorts. The number of HDF patients increased throughout cohorts, but the proportions of mortality cases across cohorts slowly decreased. Adjusting for all study covariates, we observed that HDF patients had a lower mortality risk and longer survival time than patients on standard HD. This study supports the notion that HDF lowers all-cause mortality compared with standard HD in an incident dialysis population in Fukuoka Prefecture, Japan.

Impact of the Disc Vacuum Phenomenon on Surgical Outcomes in Lumbar Spinal Stenosis: A Comparative Study between Endoscopic Decompression and Minimally Invasive Oblique Lateral Interbody Fusion

Objective: This study investigated the influence of the vacuum phenomenon (VP) on surgical outcomes in patients with lumbar spinal stenosis, comparing minimally invasive oblique lateral interbody fusion (MIS OLIF) and endoscopic decompression. Methods: A cohort of 110 patients diagnosed with lumbar spinal stenosis underwent either endoscopic decompression or MIS OLIF. Patients were classified into two groups based on the presence or absence of the VP on preoperative CT scans, non-VP (n = 42) and VP (n = 68). Radiologic and clinical outcomes, including back and leg pain assessed using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the EuroQol-5 Dimension (Eq5D), were compared pre- and postoperatively over a 2-year follow-up period. Results: Preoperatively, the VP group exhibited significantly greater leg pain (p = 0.010), while no significant differences were observed in back pain or the ODI between the groups. In the non-VP group, decompression and fusion yielded similar outcomes, with decompression showing a better ODI score at 1 month (p = 0.018). In contrast, in the VP group, patients who underwent fusion showed significantly improved long-term leg pain outcomes compared to those who underwent decompression at both 1-year (p = 0.042) and 2-year (p = 0.017) follow-ups. Conclusions: The VP may indicate segmental instability and may play a role in the persistence of radiculopathy. Fusion surgery appears to offer better long-term relief in patients with the VP, whereas decompression alone is a viable option in non-VP cases. These findings suggest that the VP may be a useful factor in guiding surgical decision-making.

Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance.

Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender, and whether disparities varied by insurance. We also examined whether criminal legal history and socioeconomic status moderated disparities in treatment. We used data from the nationally representative 2017 to 2019 National Survey on Drug Use and Health, the most recent 3-year period available. The analytic sample included noninstitutionalized adults aged 18 to 64 who met criteria for past year AUD and identified as White, Black, or Latinx (n = 7782). We examined disparities in AUD treatment utilization by race, ethnicity, and gender subgroup and by insurance status, estimating weighted logistic regressions, and adjusting for indicators of clinical need in concordance with the Institute of Medicine definition of healthcare disparity. Only 5.4% of adults with AUD in the United States utilized AUD treatment in the past year. AUD treatment utilization did not significantly differ between White males and other racial, ethnic, and gender groups; however, we did identify disparities among Medicaid enrollees and those who were uninsured. Among Medicaid enrollees, Latinx females (3.2%) had lower treatment utilization than White males (9.3%, P < .05). Among uninsured individuals, Latinx males (1.8%) had lower treatment utilization than White males (6.2%, P < .05). AUD treatment utilization was extremely low among adults in the United States aged 18 to 64 who met criteria for AUD. Ethnic and gender disparities in treatment utilization were revealed when examining differences in AUD treatment utilization by insurance status. Strategies for improving access to AUD treatment that address structural barriers to care are needed and should consider targeted approaches for Medicaid enrollees and those uninsured.

Extreme Heat Events and Emergency Department Visits among Older Adults in California from 2012–2019

Background and Objectives: Extreme heat events are increasing with climate change impacting human health. This study investigates the impact of extreme heat events on Emergency Department (ED) utilization by older adult patients. Materials and Methods: We conducted a study of all 324 non-federal hospital EDs in California during an 8-year period from data extracted from the California Department of Health Care Access and Information (HCAI). The study utilized a time-stratified case-crossover design to investigate ED visited in patients aged 65 years and older during 1-day and 2-day heat wave events. Extreme heat temperatures were measured and weighted using historical data at the zip code level at the 95th, 97.5th, and 99th percentiles 2012 through 2019. Conditional logistical regression was used to estimate the odds of ED visits during extreme heat events compared to non-extreme heat days. Stratified analyses by age and comorbidity status were conducted. Results: During the study period, 8,744,001 of ED visits among older patients were included in the study analysis. Odds ratios (OR) increased for during 1-day heat events (95th percentile (OR = 1.023, 95%CI: 1.020, 1.027), 97.5th percentile (OR = 1.030, 95%CI: 1.025, 1.035), 99th percentile (OR = 1.039, 95%CI: 1.032, 1.058)) and more so with 2-day heat wave events (95th percentile (OR = 1.031, 95%CI: 1.026, 1.036), 97.5th percentile (OR = 1.039, 95%CI: 1.031, 1.046), 99th percentile (OR = 1.044, 95%CI: 1.032, 1.058)). Older patients with three or more comorbidities had the highest odds of ED visits (OR = 1.085, 95%CI: 1.068, 1.112) at the 99th percentile. Conclusions: Our findings indicate that ED visits increase for older patients during extreme heat events, particularly with event intensity and duration. Older patients with at least one comorbidity were at greater risk.

Advances and trends in pressure ulcer care research over the last 20 years: A bibliometric and visual analysis

ObjectiveThis study aims to investigate the current status and trends of pressure ulcer care studies over the past two decades using bibliometric and visual analysis, with the objective of providing guidelines for the development of relevant clinical practices or further research. MethodsWe conducted a search on the Web of Science Core Collection database using the subject terms “pressure ulcers” or “pressure injuries” for the period from January 2002 to December 2021. Bibliometric tools such as CiteSpace (version 5.8.R3), VOS viewer (version 1.6.17) and the R software 4.0.3 were used to visualize and analyze annual publications, country, institution, author, keyword and cited literature. ResultsWe identified 5102 publications related to pressure ulcers during the 20-year period, including 4034 articles published in 1557 journals. The number of annual publications on the relevant topics has been increasing annually at an annual growth rate of 4.89 %. The keyword cluster analysis of these studies can be divided into four areas: epidemiology, risk assessment, caring intervention and prognostic analysis. Keyword temporal analysis revealed that the “Braden score” was the most commonly used keyword over a long-term span. The dissemination of knowledge and student training on pressure ulcers have become hot topics of research in recent years. Additionally, pressure ulcer care in COVID-19 patients has emerged as another research hotspot due to the pandemic. ConclusionBibliometric analyses have shown that there has been a steady increase in research on pressure ulcer care, with studies related to pressure ulcer risk scores accounting for a large portion of this research. In recent years, education on pressure ulcer-related knowledge and pressure ulcer care in COVID-19 patients have emerged as research hotspots. Future research on pressure ulcer care in the elderly may be a research hotspot as the aging population progresses.

Evaluation of water supply function in the Economic Belt of the Northern Slope of the Tianshan Mountains based on the InVEST model

The Economic Belt of the Northern Slope of the Tianshan Mountains (EBNSTM) is a composite ecosystem with mountains, oases, and desert areas; it also serves as an active area for anthropogenic activities. Frequent changes in soil and water resources have significant impacts on regional ecosystems. However, research on the ecosystem water yield function of EBNSTM is relatively limited; additionally, the spatiotemporal variations in the water supply function based on land use changes have not been sufficiently elucidated. This study aimed to explore the land use changes and the spatial variability of water supply service functions in the region at the macro level and uses the land transfer matrix as an important tool to study the changes in land use in the different years of 2000, 2005, 2010, 2015, and 2020. Using the InVEST model, we conducted a quantitative assessment and comprehensive study on the water supply function of EBNSTM across the aforementioned years. Additionally, the study delved into the structure of ecosystem service functions, alongside investigating the spatial and temporal variability of ecosystem services under the multi-scale units of administrative divisions, ecological zones, and land classes. We found that during the 20-year period, the area of construction land of EBNSTM increased by 1089 km2, with the highest dynamic change rate of 4.09 %; 2015–2020 period was the most drastic period of change for each land use type. The average multi-year depth of water production was 87.49 mm, totaling 71.59 × 108 m3. The spatial distribution pattern of the water supply function in the study area during the last 20 years consistently exhibited a distinct pattern: mountainous areas displayed the highest water supply capacity, followed by oases, and deserts ranked the lowest. Further, the water supply service function within the study area is currently experiencing a modest rate of increase. The rate of change in water supply depth was 2.76 mm/a, while the rate of change in water supply volume was 0.47 × 108 m3/a. Areas with enhanced water supply capacity are mostly distributed in the southeast of EBNSTM, whereas the northwest, encompassing the mountainous areas, exhibited a declined water supply capacity. Between 2000 and 2020, the water supply capacity in the study area was ranked as follows: woodland > grassland > unutilized land > cultivated land > urban construction land, with woodland displaying the strongest water supply capacity. When woodlands, grasslands, and croplands were converted to other land use types, their water supply functions generally decreased, and vice versa. Our findings provide a scientific basis for the sustainable management of water and soil resources in EBNSTM.

Assessing a decade of leukaemia-related premature mortality costs: impact on productivity loss in Spain.

Cancer mortality is one of the dominant causes of productivity loss; and within all cancer sites, blood cancer is the fourth most common cause of death in Spain. Thus, its impacts in work productivity are a major concern and represent a high social impact. The aim of this study was to evaluate the productivity losses resulting from of premature deaths due to leukaemia in Spain. The productivity costs stemming from premature mortality due to leukaemia were estimated using the human capital method. Information pertaining to mortality rates, typical incomes, and joblessness figures was gathered throughout a decade-long period spanning from 2012 to 2021. Leukaemia caused 40% of haematological malignancies losses. It represented a 3.39% of all cancer-related deaths. In addition, it was responsible for 7,851 years of potential productive life lost (YPLPLL) in 2021, and productivity losses of €4,206.52million over the 10-year period. All these numbers are relevant for Spain as will help on a more efficient distribution of resource. These productivity losses obtained, highlight the burden of leukaemia on the Spanish population, providing novel data on the number of deaths, trends and productivity losses for this type of cancer. This evaluation offers fresh insights that can aid policymakers in efficiently distributing resources, thereby lessening the economic burden it imposes on individuals of working age.

Assessment of the economic benefit of smoking cessation in cancer patients

Introduction. In 2021, the results of the first large-scale prospective cohort study were published showing the negative impact of post-diagnosis smoking on the prognosis of non-small cell lung cancer (I-IIIа). The purpose of the study is to assess the possible benefits of postdiagnosis smoking cessation of patients with non-small cell lung cancer (NSLC) stage I–IIIa to both the health care system society as a whole. Materials and methods. A mathematical model (calculator) has been developed to calculate the economic benefits of smoking cessation among patients with a confirmed diagnosis of NSCLC (I–IIIa). The calculator uses indicators characterizing the postdiagnosis smoking status of patients with stage I–IIIa NSCLC, the probability of disease progression and survival in the groups of those who continue to smoke and those who quit smoking. These data were obtained from the prospective epidemiologic study performed in the department of clinical epidemiology, N. N. Blokhin NMRC of oncology in cooperation with the IARC. The calculator takes into account the average cost of treating patients with late-stage NSCLC (IIIb-IV stage) in 2020–2022, which is calculated based on an analysis of the medical records of patients who were treated in the Department of Medical Cancer Therapy No. 3 of the of the Federal State Budgetary Institution «N. N. Blokhin National Medical Research Center of Oncology» (Head K. K. Laktionov), statistical data on incidence and mortality from NSCLC in Russia, the Gross Domestic Product (GDP) per capita indicator, and the MINEC Forecast of socio-economic development of the Russian Federation for 2023, 2024 and 2025. Results. Stopping smoking after diagnosis of NSCLC stage I–IIIa results in cost savings due to a reduced likelihood of relapses and an increased number of patients who avoid relapses when quitting smoking. Taking into account the fact that the average cost of treatment for patients with stage IIIb–IV NSCLC is 4,000,000 rubles, savings on treatment due to a decrease in the likelihood of relapses and as a result of an increase in the number of relapse-free patients who quit smoking amounted to 3,321 million rubles. and 9,251 million rubles, respectively, per year. Thus, the total cost savings on treatment will amount to 12,588 million rubles or slightly more than 2.3 million rubles per patient who quit smoking. The second source of saving is maintaining the economically active potential of some patients diagnosed with stage I–IIIa NSCLC, due to increased progression free survival as a result of smoking cessation аmounts to 3 304 million rubles per year in terms of per capita GDP. If 100 % of patients with stage I–IIIa NLCLC hypothetically quit smoking, the potential budget savings could reach a significantly greater value of 29,480 million rubles per year. The economic benefit to society in the total metric of per capita GDP, obtained as a result of increased survival and possible preservation of labor activity, could exceed 14 billion rubles over a 5-year period. Conclusion. Smoking cessation in cancer patients is accompanied not only by clinical benefits, i. e. it reduces mortality and improves survival rates, but also by economic benefits for the healthcare system and the country as a whole.

HTLV1 infection and long term association with liver function and lipid indices; 10 years’ follow-up

BackgroundHuman T-cell leukemia virus type 1 (HTLV-1) is a well-known retrovirus, particularly prevalent in northeastern Iran, where it is associated with a range of disorders, including liver dysfunction. Previous studies have demonstrated that HTLV-1 infection can alter lipid profiles, yet no research has examined lipid indices and liver function tests in these patients in the long term.MethodsThis data is part of the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study. A total of 1116 participants were randomly selected, including 837 healthy individuals and 279 HTLV-1-infected patients. Following a 10-year follow-up period, Serum levels of liver enzymes were measured. Lipid indices such as the Atherogenic Index of Plasma (AIP), Body Adiposity Index (BAC), Castelli risk index (CRI-I, CRI-II), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), Triglyceride-glucose index (TyG), and Triglyceride and HDL-C Ratio (THR) were calculated.ResultsMultivariable-adjusted regression analysis demonstrated a significant coefficient for the Visceral Adiposity Index (VAI) in HTLV-infected patients compared to healthy controls (B: -0.014, 95% CI: -0.02, 0.00, p = 0.046). However, no significant differences were observed in other lipid indices between HTLV-infected patients and healthy individuals. Regarding liver enzymes, significant variations were noted in HTLV-infected patients compared to healthy controls: Aspartate Aminotransferase (AST) (B: 2.978, 95% CI: 1.34, 4.61, p < 0.001), Alanine Aminotransferase (ALT) (B: 3.687, 95% CI: 1.59, 5.78, p = 0.001), Alkaline Phosphatase (ALP) (B: 18.232, 95% CI: 6.81, 29.65, p = 0.002), and Gamma-Glutamyl Transferase (GGT) (B: 3.714, 95% CI: 0.18, 7.24, p = 0.039).ConclusionIndividuals with HTLV-1 infection exhibit reduced VAI but elevated levels of liver enzymes such as AST, ALT, ALP, and GGT, indicating liver damage. These findings emphasize the virus’s involvement in liver pathology. Also, HTLV-I is associated with reduced visceral fat tissue.

Survival of Children with Acute Lymphoblastic Leukemia with Risk Group-Based Protocol Changes: A Single Center Experience with 460 Patients over a 20-Year Period.

Recent treatments for pediatric acute lymphoblastic leukemia (ALL) are founded on risk stratification. We examined the survival rates and prognostic factors of patients over a 20-year period at a single institution. This study analyzed patients diagnosed with ALL and treated at the Pediatric Department of Samsung Medical Center (SMC). Patients were categorized into standard-risk (SR), high-risk (HR), and very high-risk (VHR) groups. The SMC protocol for the HR group underwent two changes during the study period: A modified Children's Cancer Group (CCG)-1882 protocol was used from 2000 to 2005, the Korean multicenter HR ALL-0601 protocol from 2006 to 2014, and the Korean multicenter HR ALL-1501 protocol from 2015 to 2019. Of the 460 patients, complete remission was achieved in 436 patients (94.8%). The 10-year overall survival rate (OS) was 83.8±1.9% for all patients. OS according to the SMC risk group was as follows: 95.9±1.4% in the SR group, 83.8±3.6% in the HR group, and 66.2±6.9% in the VHR group. The 5-year OS within the HR group varied according to the treatment protocol: 73.9±7.5%, in the modified CCG-1882 protocol, 83.0±3.9%, in the 0601 protocol, and 96.2±2.6%, in the 1501 protocol. For those aged 15 years and older, the OS was only 56.5±13.1%. Relapse occurred in 71 patients (15.4%), and the OS after relapse was 37.7±6.0%. The treatment outcomes of patients with ALL improved markedly. However, there is a need to further characterize adolescents and young adult patients, as well as those who have experienced relapses.