64-year Age Group Research Articles

Assessment of Disparities in Diabetes Mortality in Adults in US Rural vs Nonrural Counties, 1999-2018

US rural vs nonrural populations have striking disparities in diabetes care. Whether rurality contributes to disparities in diabetes mortality is unknown. To examine rates and trends in diabetes mortality based on county urbanization. In this observational, cross-sectional study, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was searched from January 1, 1999, to December 31, 2018, for diabetes as a multiple cause and the underlying cause of death among residents aged 25 years or older in US counties. County urbanization was categorized as metro, medium-small, and rural. Weighted multiple linear regression models and jackknife resampling, with a 3-segment time component, were used. The models included exposures with up to 3-way interactions and were age standardized to the 2009-2010 population. The analyses were conducted from July 1, 2020, to February 1, 2022. County urbanization (metro, medium-small, or rural), gender (men or women), age group (25-54, 55-74, or ≥75 years), and region (Midwest, Northeast, South, or West). Annual diabetes mortality rate per 100 000 people. From 1999-2018, based on 4 022 238 309 person-years, diabetes was a multiple cause of death for 4 735 849 adults aged 25 years or older. As a multiple cause, diabetes mortality rates in 2017-2018 vs 1999-2000 were highest and unchanged in rural counties (157.2 [95% CI, 150.7-163.7] vs 154.1 [95% CI, 148.2-160.1]; P = .49) but lower in medium-small counties (123.6 [95% CI, 119.6-127.6] vs 133.6 [95% CI, 128.4-138.8]; P = .003) and urban counties (92.9 [95% CI, 90.5-95.3] vs 109.7 [95% CI, 105.2-114.1]; P < .001). In 2017-2018 vs 1999-2000, mortality rates were higher in rural men (+18.2; 95% CI, 14.3-22.1) but lower in rural women (-14.0; 95% CI, -17.7 to -10.3) (P < .001 for both). In the 25- to 54-year age group, mortality rates in 2017-2018 vs 1999-2000 showed a greater increase in rural counties (+9.4; 95% CI, 8.6-10.2) compared with medium-small counties (+4.5; 95% CI, 4.0-5.0) and metro counties (+0.9; 95% CI, 0.4-1.4) (P < .001 for all). Of all regions and urbanization levels, the mortality rate in 2017-2018 vs 1999-2000 was higher only in the rural South (+13.8; 95% CI, 7.6-20.0; P < .001). In this cross-sectional study, US rural counties had the highest overall diabetes mortality rate. The determinants of persistent rural disparities, in particular for rural men and for adults in the rural South, require investigation.

Incidence and Complications of Atrial Fibrillation in a Low Socioeconomic and High Disability United States (US) Population: A Combined Statistical and Machine Learning Approach.

Background Poor socioeconomic status coupled with individual disability is significantly associated with incident atrial fibrillation (AF) and AF-related adverse outcomes, with the information currently lacking for US cohorts. We examined AF incidence/complications and the dynamic nature of associated risk factors in a large socially disadvantaged US population. Methods A large population representing a combined poor socioeconomic status/disability (Medicaid program) was examined from diverse geographical regions across the US continent. The target population was extracted from administrative databases with patients possessing medical/pharmacy benefits. This retrospective cohort study was conducted from Jan 1, 2016, to Sep 30, 2021, and was limited to 18- to 80-year age group drawn from the Medicaid program. Descriptive and inferential statistics (parametric: logistic regression and neural network) were applied to all computations using a combined statistical and machine learning (ML) approach. Results A total of 617413 individuals participated in the study, with mean age of 41.7 years (standard deviation “SD” 15.2) and 65.6% female patients. Seven distinct groups were identified with different combinations of low socioeconomic status and disability constraints. The overall crude AF incidence rate was 0.49 cases/100 person-years (95% confidence limit “CI” 0.40–0.58), with the lowest rate for the younger group (temporary assistance for needy family “TANF”) (0.20, 95%CI 0.18–0.21), the highest rates for the older groups (age, blindness, or disability “ABD” duals—1.51, 95% CI 1.31–1.58; long-term services and support “LTSS” duals—1.45, 95% CI 1.31–1.58), and the remaining four other groups in between the lower and upper rates. Based on independent effects after accounting for confounders in main effect modeling, the point estimates of odds ratios for AF status with various clinical outcomes were as follows: stroke (2.69, 95% CI 2.53–2.85); heart failure (6.18, 95% CI 5.86–6.52); myocardial infarction (3.71, 95% CI 3.49–3.94); major bleeding (2.26, 95% CI 2.14–2.38); and cognitive impairment (1.74, 95% CI 1.59–1.91). A logistic regression-based ML model produced excellent discriminant validity for high-risk AF outcomes (c “concordance” index based on training data 0.91, 95%CI 0.891–0.929), together with similar measures for external validity, calibration, and clinical utility. The performance measures for the ML models predicting associated complications with high-risk AF cases were good to excellent. Conclusions A combination of low socioeconomic status and disability contributes to AF incidence and complications, elevating risks to higher levels relative to the general population. ML algorithms can be used to identify AF patients at high risk of clinical events. While further research is definitely in need on this socially important issue, the reported investigation is unique in which it integrates the general case about the subject due to the different ethnic groups around the world under a unified culture stemming from residing in the US.

A new nomogram of urinary flow rate and volume based on multiple measurements per healthy adult Japanese men using a portable uroflowmeter (P-Flowdiary®)

BackgroundTo develop a nomogram of urinary volume and flow based on the data of Japanese men without lower urinary tract symptoms and multiple flows per participant whose characteristics were clear.MethodsOverall, 101 Japanese male volunteers without lower urinary tract symptoms aged between 20 and 59 years were enrolled. A portable uroflowmeter (P-Flowdiary®) was used to record urinary information (flow rate and volume) for 2 successive days. The model (quadratic, linear, or logarithmic regression) most fit for the relationship between maximum flow rate and voided volume was determined. The maximum flow rate at > 150 mL was compared among the 20–29-, 30–39-, 40–49-, and 50–59-year age groups. Nomograms appropriate for the age groups were created.ResultsThe mean age, International Prostate Symptom Score, and Overactive Bladder Symptom Score were 38.5 years, 0.42, and 0.24, respectively. The quadratic regression model was the most fit because its mean coefficient determination was 0.93 ± 0.06. The mean maximum flow rate was significantly lower in the 50–59-year age group (21.8 ± 5.05 mL/s, P < 0.01) than in the younger groups (24.14 ± 4.94, 24.05 ± 6.99, and 24.64 ± 5.72 mL/s). The 2 nomograms are Y = 28.99 {1 − exp(− 0.01 × X)} and Y = 25.67 {1 − exp(− 0.01 × X)} for the 20–49- and 50–59-year age groups, respectively.ConclusionsThe nomogram can predict maximum flow rate based on voided volume in Japanese men aged 20–59 years without lower urinary tract symptoms.

Determinants of metabolic syndrome among patients attending diabetes clinics in two sub-urban hospitals: Bono Region, Ghana

BackgroundOver 70% of individuals with type 2 diabetes mellitus (T2DM) may have metabolic syndrome in sub-Saharan Africa. Evidence about the prevalence, clustering, and determinants of metabolic syndrome components is needed to guide the implementation of interventions to prevent cardiovascular diseases in low-income countries.MethodsA clinic-based cross-sectional study was conducted among 430 out-patients attending two-selected diabetes mellitus clinics in the Bono Region of Ghana. Data was collected in June 2016 among participants aged 30–79 years. The prevalence of metabolic syndrome was assessed using the harmonized definition. Patients were interviewed using semi-structured questionnaires and T2DM status was confirmed by reviewing medical records. The components of MS that were assessed included body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein (HDL)-cholesterol, and blood glucose. Multiple logistic regression models were constructed to evaluate the risk factors of MS.ResultsThe mean age of participants was 58.8 ± 11.49 years. The prevalence of MS was 68.6% (95% CI: 64.0–72.8), higher among women (76.3%, 95% CI: 70.6–81.2) than men (58.0%, 95% CI: 35.0–49.4) and in the 50–59-year age group (32.1%). The majority of participants [248 (57.7%)] had either two [124 (28.8%)] or four [124 (28.8%)] components of MS. Excluding fasting blood glucose (78.4%), the predominant components of MS identified in the study were reduced HDL cholesterol (70.2%), high waist circumference (60.9%), and elevated systolic blood pressure (49.8%). The study found that the odds of MS in women are 2.2-fold higher than in men (95% CI: 1.29–3.58, p = 0.003). Duration of T2DM (OR 5.2, 95% CI: 2.90–9.31, p < 0.001) and overweight status (OR 6.1, 95% CI: 3.70–10.07 p < 0.001) were also found to be significant determinants of MS.ConclusionsMetabolic syndrome was common among patients attending routine diabetes mellitus clinics in sub-urban hospitals in the middle belt of Ghana. Significant factors associated with metabolic syndrome included being female, living with diabetes for more than five years, and being overweight. Nationwide advocacy for routine screening and prevention of the syndrome should be initiated to prevent cardiovascular disease and mortality in this vulnerable population.

Concerns About Breast Pain: How Useful Is Imaging?

Background: Breast pain is one of the most common reasons for referral to breast imaging. Objectives: This study aimed to determine the diagnostic yield of mammography and sonomammography in women complaining of breast pain in a teaching hospital in Southeast Nigeria. Methods: This descriptive study analyzed the mammographic/sonomammographic images and records of 241 consecutive adult women aged 18 - 81 years with breast pain who presented to the radiology department over three years. A non-random sampling method was employed to select the participants. The extracted variables were patient’s age, positive clinical history of breast pain, laterality of breast pain, type of imaging, presence or absence of lesion, type, and laterality of lesions if present, and Breast Imaging Reporting and Data System (BI-RADS) assignment of imaging findings on mammography and sonomammography. The descriptive analysis of continuous variables and inferential statistics of ordinal data were performed with Microsoft Excel and chi-squared test, respectively. In this study, P &lt; 0.05 was set as the significance level. Results: Most women (20%) with a complaint of breast pain were in the 40 - 44-year age group. Moreover, 32.3%, 33.2%, and 34.4% of the participants had left-sided, right-sided, and bilateral breast pain, respectively. Among the participants, 118 and 123 women had mammography and sonomammography, respectively. Furthermore, 76.3% had normal findings on mammography or sonomammography, and only 23.7% had positive imaging findings on breast imaging. These lesions were mostly observed among the women in the age group of 45 - 49 years. Of those with lesions detected on imaging, 79.2% and 20.8% demonstrated benign and malignant attributes, respectively. Masses with definite benign attributes assigned BI-RADS II were mostly fibroadenomata and cysts. Inferential statistics indicated that unilateral mastalgia was more likely to be associated with a breast lesion, while bilateral mastalgia usually resulted in normal breast imaging findings. Conclusions: Women referring to the Radiology Department with a complaint of breast pain alone are unlikely to have any significant breast imaging finding; hence, imaging serves as a tool for assuaging the anxiety of these patients and reassuring the referring physician. Unilateral but not bilateral mastalgia is likely to yield positive imaging findings, which are largely benign.

PRESCRIPTION PATTERN ANALYSIS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN TERTIARY CARE HOSPITAL

Objective: The aim of the study was to analyze the prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and to identify the commonly used NSAIDs and their drug-related problems (DRPs). Methods: A prospective and cross-sectional study on prescription pattern analysis of NSAIDs was conducted for the period of 6 months. Results: Prescriptions of 150 patients containing at least one NSAIDs were analyzed. About 56% of the prescription were prescribed for males and 44% prescription were female. NSAIDs were more prescribed for below 60-year age group (47%) but were most frequently used by 61–70-year age group (21%). Subjects were regularly prescribed with acetaminophen (95%) and diclofenac (22%). Among all the prescriptions, (19%) of the prescriptions contained NSAIDs in the form of fixed dose combinations (FDCs). About 37% of prescriptions had other analgesic coprescribed along with NSAIDs amid which tramadol was in majority (22%). Prescription was also coprescribed with antibiotic (90%) and gastroprotective agents (GPAs) (97%) that consisted of pantoprazole belonging to the class of proton pump inhibitors which was the persistently prescribed GPA (86%). Due to coprescription, (3%) suspected drug-drug interactions (DDIs) were observed. Conclusion: The goal of studying prescribing patterns was to monitor, assess, and, if required, advise changes in medical practitioners’ prescribing behavior to offer quality medical treatment and reasonable drug use. The prescribing pattern was rational and in accordance with national list of essential medicine (NLEM-2015) but was not in accordance with the World Health Organization (WHO) model list of essential medicines.

Extremity Injuries during Sporting Activities According to Life Course: Focusing on Fractures.

Background:The increased participation in sports has led to an increased number of sports-related injuries. We aimed to identify the incidence of sports-related injuries by life course and the risk factors for sports-related extremity fractures.Methods:We analyzed data of patients with sports-related extremity injuries from Emergency Department-based national injury surveillance systems, obtained from Jan 2013 to Dec 2016. A multiple logistic regression analysis was performed to identify risk factors of extremity fracture by life course after adjusting for sex, injury season, injury time, injury place, sports type, and mechanism of injury.Results:Overall, 23385 patients met our inclusion criteria. Soccer injuries were most common in the 5–14-year (32.4%), 15–24-year (43.0%), and 25–44-year groups (32.7%), and hiking injuries were most common in the 45–64-year (23.6%) and ≥65-year age groups (38.0%). The upper extremity injury and fracture rates were higher in the younger-age group; nevertheless, the injury and fracture rates of the lower extremities increased with increasing age. Moreover, the rate of hip and thigh injuries and fractures increased significantly in the ≥65-year age group.Conclusion:The incidence and severity of sports injuries are affected by player factors and the sports activity itself. The age of players is a major determinant that affects their medical and physiologic conditions and the sport of choice. The strategy for preventing sports injuries should be structured based on age.

Mortality trend of heart diseases in China, 2013–2020

Background and purpose: Heart diseases are the leading cause of death in China. Understanding of the secular trend of different subcategories of heart disease is important for policy making. The purpose of this study is to analyze the mortality trend of heart diseases in China from 2013 to 2020. Methods: A population-based longitudinal analysis was conducted using the China National Mortality Surveillance System to examine heart disease mortality change during a period from 2013 to 2020. The causes of death were coded using the International Classification of Diseases-10th Revision. The number of deaths and mortality rate were calculated based on sex, subcategories of heart disease, urban versus rural setting, and across different geographic locations. Data from the sixth census in China in 2010 was used as the standard population, and the mortality rates were adjusted based on the under-reporting rate. Results: Ischemic heart disease (IHD), hypertensive heart disease (HHD), and rheumatic heart disease (RHD) are the three leading causes of heart disease deaths during 2013–2020. There was a trend for increased age-standardized mortality rate (ASMR) of cardiac arrest, aortic aneurysm (AA), and nonrheumatic valvular heart diseases (NRVHDs) during the study period. In comparison to men, women had higher ASMR of RHD, and lower ASMR of IHD, HHD, cardiac arrest, AA, and NRVHDs. In comparison to rural areas, urban areas had lower ASMR of IHD, HHD, and RHD, and higher ASMR of cardiac arrest, AA, and NRVHDs. The spectrum of heart diseases differed significantly across age groups. In 2020, the percentages of IHD and HHD in the ≥65-year age group were higher than in other age groups. Significant differences in ASMR were noted across different geographic locations, with the highest in Xinjiang (198.14/100,000) and the lowest in Shanghai (62.19/100,000) in 2020. Conclusions: The mortality rate decreased for IHD, HHD, and RHD during the study period, but remained the leading causes of heart disease death in China. There was a trend for increasing mortality of cardiac arrest, AA, and NRVHDs, and significant difference across different geographic locations.

The Proportion of p16 Expression in Penile Squamous Cell Carcinoma Based on Immunohistochemistry Examination in the Balinese Population

Background: : Penile cancer is a rare type of cancer in men and was the highest in Bali compared to other regions in Indonesia. Around 95% of malignancies in the penis are squamous cell carcinoma (SCC) type. One of the risk factors associated with penile squamous cell carcinoma is an infection caused by Human Papillomavirus (HPV). Human Papillomavirus E6 and E7 oncoproteins play a significant role in penile squamous cell carcinoma carcinogenesis. Overexpression of p16 protein can be used as a marker of HPV infection. This study aims to determine the expression of p16 protein in penile squamous cell carcinoma.Methods: This study was conducted to determine the prevalence of p16 protein expression was assessed by immunohistochemical examination from paraffin block tumors of penile cancer patients. Expression of p16 was observed to be positive when stained with a strong brown color in the nucleus and cytoplasm of tumor cells. The analysis method used in this study is a descriptive statistic to provide a general description of the characteristics of each research variable. The data were processed using SPSS to determine the frequency and median of the age of patients with penile squamous cell carcinoma and the prevalence of p16 protein expression in cell penile squamous cell carcinoma. The data shown in this study are the age range and prevalence of p16 protein expression in penile squamous cell carcinoma using the prevalence table.Results: This study used 142 penile squamous cell carcinoma samples derived from biopsy, partial, and total penectomy. The results of the IHC examination showed that the expression of p16 protein was positive in penile cancer tumor cells in 68 cases (47.9%), with the highest age distribution in the 50–59-year age group (28.2%).Conclusions: Further research is needed to confirm the correlation between HPV infection and p16 protein overexpression in penile squamous cell carcinoma, including HPV genotyping

Pediatric Emergency Medicine Physicians' Perceptions of Colleagues' Clinical Performance Over Career Span.

The US physician workforce is aging, prompting concerns regarding clinical performance of senior physicians. Pediatric emergency medicine (PEM) is a high-acuity, multitasking, diagnostically complex and procedurally demanding specialty. Aging's impact on clinical performance in PEM has not been examined. We aimed to assess PEM physician's' perceptions of peers' clinical performance over career span. We surveyed 478 PEM physician members of the American Academy of Pediatrics' Section on Emergency Medicine survey study list-serve in 2020. The survey was designed by the investigators with iterative input from colleagues. Respondents rated, using a 5-point Likert scale, the average performance of 4 age categories of PEM physicians in 9 clinical competencies. Additional items included concerns about colleague's performance and preferences for age of physician managing a critically ill child family member. We received 232 surveys with responses to core initial items (adjusted response rate, 49%). Most respondents were 36 to 49 (34.9%) or 50 to 64 (47.0%) years old. Fifty-three percent reported ever having concern about a colleague's performance. For critical care-related competencies, fewer respondents rated the ≥65-year age group as very good or excellent compared with midcareer physicians (36-49 or 50-64 years old). The ratings for difficult communications with families were better for those 65 years or older than those 35 years or younger. Among 129 of 224 respondents (58%) indicating a preferred age category for a colleague managing a critically ill child relative, most (69%) preferred a 36 to 49-year-old colleague. Pediatric emergency medicine physicians' perceptions of peers' clinical performance demonstrated differences by peer age group. Physicians 65 years or older were perceived to perform less well than those 36 to 64 years old in procedural and multitasking skills. However, senior physicians were perceived as performing as well if not better than younger peers in communication skills. Further study of age-related PEM clinical performance with objective measures is warranted.

Epidemiology of Toxoplasmosis among the Pakistani Population: A Systematic Review and Meta-Analysis.

Toxoplasma gondii is an intracellular obligate parasite that causes toxoplasmosis, a zoonotic infection that affects warm-blooded animals and humans worldwide. To comprehensively characterize the disease condition in Pakistan for future reference, we ascertained the prevalence of Toxoplasma infection and predisposing factors in the Pakistani population over a 20-year period. We systematically reviewed research articles published in English (2000–2020) from PubMed and Google Scholar. The search results 26 publications involving 10,924 people and 2611 seropositive cases. The toxoplasmosis seropositivity rate was higher in women (25.44%) as compared to men (21.48%) and were statistically significant (p < 0.001). Furthermore, seropositivity was high among people with direct contact with cats, who consumed uncooked meat and raw vegetables, had poor education, and lived in rural areas. The 35–65-year age group had the highest prevalence rate of T. gondii infection. Toxoplasma infection was significantly more prevalent in Khyber Pakhtunkhwa province (25.87%) than in Punjab (20.42%) (p < 0.001). This is the first comprehensive analysis of T. gondii infection epidemiology in Pakistan. It reveals a high frequency of infection among women. We strongly encourage further research to aid patient care and the development of more efficient diagnostic tests and preventative techniques.

FAKTOR RISIKO KEJADIAN HIPERTENSI PADA REMAJA

Sustainable Development Goals (SDGs) are a world agreement for a long period by maximizing resources as the potential of each country and taking into account sustainable development for the well-being of human, environmental, social, and other parts of life in the world. Health is currently the main problem faced by Indonesia, especially the problem of the double burden of disease, where infectious diseases are still the main focus that must be addressed. However, on the other hand, non-communicable diseases (PTM) also show an increasingly positive trend which has an impact on increasing mortality and morbidity rates in Indonesia. The change in epidemiology from infectious diseases to non-communicable diseases is starting to hit developing countries. Hypertension is a cardiovascular disease that is often found in society, including among teenagers. Thus, hypertension is determined to be a major problem and if not treated immediately it will lead to several complications and become a risk factor for the onset of other diseases, such as stroke, diabetes, kidney failure, and heart disease. Based on the results of Riskesdas 2018, there was an increase in the prevalence of 34.1% in the 18-year age group. This literature review uses a systematic method (systematic review). Research also provides an overview of risk factors that are strongly associated with hypertension in adolescents. The results showed that lifestyle became the main factor accompanied by smoking, diet, physical activity, nutritional status, obesity, and education. This is the basis for determining policies in the prevention and control of hypertension.

Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India.

Retrospective study. To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21-30years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.

Disability Following COVID-19: A Cross-Sectional Study at an Apex COVID Care Hospital of Central India

Purpose: This study was done to assess the extent of disability in COVID-19 survivors using the World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0) and to identify the predictor variables. Methodology: Patient recruitment for this cross-sectional study started after ethical clearance. Most of the recruited patients were telephonically invited from medical records data of institutional COVID-19-admitted patients. All patients aged 18years or above, who recovered from COVID-19 infection at least 3months back, were recruited in the study after fulfilment of other inclusion and exclusion criteria. Informed consent of each recruited patient was taken and disability assessment was done using WHODAS 2.0. Results: Fifty patients were enrolled in the study, and the mean WHODAS 2.0 score was found to be 35.49(0=no disability; 100=full disability), the most involved subdomains being getting around(mean=45.524), life activities(mean=42.8692), societal participation(mean=42.8095) and understanding–communicating(33.568). The overall WHO DAS-2 score was significantly higher in the above 45-year age group, recent follow-up patients(3months completed but&lt;4months) and those having comorbidities(all comorbidities combined as well as diabetes alone). On the other hand, no such relationship could be established with gender, educational status, duration of COVID-19 admission, smoking history, body mass index categories, family size or family income. Furthermore, the effect of age and follow-up interval to the severity of disability was contributing only 6.58% on multiple linear regression analysis. Seventy per cent of respondents had moderate-to-extreme difficulty with walking a long distance, 60% had similar difficulty in standing for long periods, 54% in day-to-day work/school responsibilities, 60% in joining community activities and 58% were emotionally affected by their health problems. Conclusion: COVID-19 survivors suffered from significant disability even after 3months of disease, especially amongst aged persons with pre-existing comorbidities; the severity of disability was significantly higher in those who have just completed 3months in comparison to higher follow-up intervals. It was concluded that recognising post-COVID-19 sequelae and the initiation of rehabilitation services can be beneficial in preventing disability after acute COVID-19.

Prognostic Impact of Postoperative Loss of Skeletal Muscle Mass in Patients Aged 70 Years or Older with Esophageal Cancer.

The number of patients with esophageal cancer aged ≥70 years with a poor prognosis is increasing. In general patients with esophageal cancer, postoperative loss of skeletal muscle mass (SMM) is a prognostic factor. This study was designed to investigate the prognostic impact of postoperative loss of SMM in patients aged ≥70 years with esophageal cancer. This study was a single-center, retrospective cohort study. Patients with esophageal cancer who underwent R0 esophagectomy between 2016 and 2020 were included. The percentage postoperative loss of skeletal muscle mass index (SMI%) was calculated using computed tomography images before and at 4 ± 2 months after surgery. The number of subjects in the ≥70-year and <70-year age groups was 166 and 218, respectively. The median SMI% was 5% in all patients; thus, 5% was defined as the cutoff point to define major loss of SMI. Major loss of SMI impacted 3-year overall survival (OS) in the ≥70-year age group, independent of age, sex, clinical stage, pathological T and N factors, Charlson comorbidity index, and length of hospital stay (adjusted hazard ratio [HR]: 4.400; 95% confidence interval: 1.202-16.105; P = 0.025). The adjusted HR of major loss of SMI in the ≥70-year age group was higher than in the <70-year age group (adjusted HR: 4.400 vs. 2.388, respectively). Postoperative loss of SMI in patients with esophageal cancer aged ≥70 years more strongly impacted 3-year OS than in patients aged <70 years.

Immunogenicity and safety of the 9-valent human papillomavirus vaccine in Chinese females 9–45 years of age: A phase 3 open-label study

BackgroundThe 9-valent human papillomavirus (9vHPV; HPV6/11/16/18/31/33/45/52/58) vaccine was approved for use in Chinese women aged 16–26 years in 2018. This phase 3, open-label study (NCT03903562) compared 9vHPV vaccine immunogenicity and safety in Chinese females aged 9–19 years and 27–45 years with Chinese females aged 20–26 years; we report results from day 1 through 1 month post-Dose 3. The study will continue through 54 months post-Dose 3 to assess antibody persistence in Chinese girls aged 9–19 years. MethodsParticipants aged 9–45 years received three doses of the 9vHPV vaccine. Geometric mean titers (GMTs) and seroconversion percentages for anti-HPV6/11/16/18/31/33/45/52/58 antibodies were determined by competitive Luminex immunoassay in serum samples obtained at day 1 and 1 month post-Dose 3. Adverse events (AEs) within 30 days post-vaccination and serious AEs (SAEs) occurring at any time were recorded. ResultsIn total, 1990 participants (690 aged 9–19 years; 650 aged 20–26 years; 650 aged 27–45 years) were enrolled. At 1 month post-Dose 3, >99% of participants in the per-protocol immunogenicity population seroconverted to each vaccine HPV type. Anti-HPV6/11/16/18/31/33/45/52/58 antibody GMTs in the 9–19-year age group were non-inferior to those in participants aged 20–26 years. Anti-HPV6/11/16/18/31/33/45/52/58 seroconversion percentages in the 27–45-year age group were non-inferior to those in participants aged 20–26 years. Injection-site and systemic AEs were reported by 43.3% and 50.9%, 50.5% and 57.1%, and 43.8% and 43.4% of participants aged 9–19, 20–26, and 27–45 years, respectively. There were no vaccine-related SAEs, discontinuations due to AEs, and deaths. ConclusionAntibody responses induced by 9vHPV vaccination in Chinese females aged 9–19 years and 27–45 years were non-inferior to those in Chinese females aged 20–26 years. The vaccine was generally well tolerated.ClinicalTrials.gov Identifier: NCT03903562.

Biomechanical analysis of all-polyethylene total knee arthroplasty on periprosthetic tibia using the finite element method

Background and objectiveTotal knee arthroplasty (TKA) with modern all-polyethylene tibial (APT) components has shown high long-term survival rates and comparable results to those with metal-backed tibial components. Nevertheless, APT components are primarily recommended for older and low-demand patients. There are no evidence-based biomechanical guidelines for orthopaedic surgeons to determine the appropriate lower age limit for implantation of APT components. A biomechanical analysis was assumed to be suitable to evaluate the clinical results in patients under 70 years. The scope of this study was to determine biomechanically the appropriate lower age limit for implantation of APT components. MethodsTo generate data of the highest possible quality, the geometry of the computational models was created based on computed tomography (CT) images of a representative patient. The cortical bone tissue model distinguishes the change in mechanical properties described in three parts from the tibial cut. The cancellous bone material model has a heterogeneous distribution of mechanical properties. The values used to determine the material properties of the tissues were obtained from measurements of a CT dataset comprising 45 patients. ResultsComputational modeling showed that in the majority of the periprosthetic volume, the von Mises strain equivalent ranges from 200 to 2700 με; these strain values induce bone modeling and remodeling. The highest measured deformation value was 2910 με. There was no significant difference in the induced mechanical response between bone models of the 60-year and 70-year age groups, and there was <3% difference from the 65-year age group. ConclusionsConsidering in silico limitations, we suggest that APT components could be conveniently used on a bone with mechanical properties of the examined age categories. Under defined loading conditions, implantation of TKA with APT components is expected to induce modeling and remodeling of the periprosthetic tibia. Following clinical validation, the results of our study could modify the indication criteria of the procedure, and lead to more frequent implantation of all-polyethylene TKA in younger patients.

The etiology and pattern distribution of closed long bone diaphyseal fractures: A prospective survey in a regional trauma center Enugu, Nigeria

Extremity injuries have attained a significant position in musculoskeletal trauma. This study aims to describe the pattern of closed long bone diaphyseal fractures in acute trauma setting. A prospective study of patients who presented at the trauma unit of National Orthopaedic Hospital Enugu over a 6months period was undertaken. Sixty two patients with closed long bone diaphyseal fractures of femur, tibia and humerus who consented and met the study inclusion criteria were prospectively included and evaluated. Data was analyzed using the Statistical Package for the Social Sciences version 20. A total of 2880 patients presented during the period of study out of which, 62 (37 males and 25 females) presented with closed long bone diaphyseal fractures giving an incidence of 21.5/1000 trauma unit attendance (and occurring mostly in males 32.1/1000). The 21-30years age group distribution were the mostly affected (35.5%) with closed long bone diaphyseal fracture at presentation. Motor vehicular accident was the leading cause of closed long bone diaphyseal fractures (66.7%) followed by tricycle accident (19.4%) and assault (1.9%), the least. Transverse fractures (40.3%) were the most common fracture pattern followed by the comminuted fracture (27.4%), The anatomic location of fractures in diaphyseal long bones of the humerus, femur and tibia did not show any significant difference (p&lt;0.05). With transverse and comminuted fracture being the commonest fracture patterns distribution and motor vehicular accidents the leading cause, these could be of a guide for orthopaedic surgeons to decide on the best interventional approach and to improve functional outcome.

The Pattern of Thyroid Malignancy and Its Associated Characteristics Among United Arab Emirates Population With More Focus on Patients in the Bethesda III Category.

Introduction: Thyroid cancer is the most prevalent endocrine cancer worldwide. It is the second most common type of cancer among United Arab Emirates (UAE) women and ranks as the sixth most common type of cancer overall among the UAE population. There are limited studies in the UAE related to thyroid malignancy. This study aimed to determine the pattern of thyroid malignancy among the UAE population and its associated characteristics, with more emphasis on patients categorized as Bethesda III by cytopathology, and furthermore, to determine the significance of advanced diagnostic methods in the assessment of thyroid nodules.Methods: A retrospective review of the electronic medical charts of adult patients (age 18 and above) who were diagnosed with a thyroid nodule by ultrasound during the years 2019 and 2020. It is a comparative study of different variables associated with thyroid nodules and thyroid malignancy.Results: A total of 1072 patients were diagnosed with thyroid nodules upon initial ultrasound. We had 174 patients diagnosed with thyroid malignancy, constituting 16% (95% CI 0.14-0.19) of the total study population. 78% of the thyroid malignancy patients were women as compared to men, and this difference was statistically significant (p=0.042). Non-UAE nationals comprised 61% of the population diagnosed with thyroid malignancy (95% CI 1.37-2.68). Malignancy was found to be more common in patients with multinodular goiter, in the 30 to 39-year age group, and in patients with high ultrasound and Bethesda grades. From the total study population, 140 patients had cytology reports in the Bethesda III category. Thyroid malignancy was found in 30 patients with Bethesda III, and this comprised 17% of the total population who were diagnosed with thyroid malignancy.Conclusion: Despite being a single-center study, it highlights the percentage of thyroid malignancy and its associated factors among the UAE population. Thyroid ultrasound grading and Bethesda classification guide physicians in risk stratification, but it remains challenging in patients who fall into the Bethesda III category. Intervention versus regular follow-up should not depend on a single value but on the overall clinical picture and the use of advanced diagnostic methods.

Evaluating the Risk of Prescription Opioid Misuse among Adult Emergency Department Patients.

Background Pain is the most commonly treated symptom in the emergency department, and opioids are often prescribed from the emergency department to treat pain. The American College of Emergency Physicians recommends that providers assess the patient's risk of abusing opioids prior to prescribing opioids. In this study, we use a validated risk assessment tool to assess the risk of opioid abuse among emergency medicine patients and the patients' perceptions of their potential dangers. Methods This is an observational study conducted in an academic emergency department (ED). All adults presenting to ED were eligible to participate in the study. Individuals were randomly selected to complete a survey which included the Opioid Risk Tool (ORT) and perceptions of sharing controlled substances. Results There were 300 participants in the study. The 18–45-year age group was the most commonly represented group (58%), and nearly two-thirds (63%) of the population was female. The average opioid risk score was 8 or high risk. Individuals that were at high risk of opioid abuse were less likely to dispose of their additional medications appropriately (19% vs. 12%) and were more likely to share their additional controlled medications with family or friends (18% vs. 3%). Conclusion The emergency department population is at high risk to abuse opioids. The introduction of safer pain management options should be considered among this high-risk group.