Age-matched Case-control Study Research Articles

Serum Selenium Levels and Their Relationship with Insulin Resistance in Individuals with Polycystic Ovary Syndrome.

Growing evidence indicates a potential link between polycystic ovary syndrome (PCOS) and selenium (Se) levels. This study aims to assess Se concentrations in Saudi women with and without PCOS and to explore the relationships between Se levels, insulin resistance (IR), adiponectin, and lipid markers. We randomly recruited 197 women aged 18 to 40, both with and without PCOS, for this age-matched case-control study. The PCOS participants were categorized into three groups based on their Se levels. All participants underwent interviews, and their anthropometric measurements and blood samples were collected for further analysis of biochemical variables. There was a notable difference between the two groups studied across all biochemical variables. Specifically, fasting blood glucose, insulin, the homeostasis model assessment (HOMA-IR) index, total cholesterol, low-density lipoprotein cholesterol, and triglycerides were significantly higher in the PCOS group compared to the control group (p < 0.01). Conversely, Se, high-density lipoprotein cholesterol, and adiponectin levels were significantly lower in women with PCOS than in their age-matched controls (p < 0.01). HOMA-IR was identified as the sole independent predictor of serum Se levels, explaining 17.2% of the variability in its circulating levels (β = - 0.57; 95% CI: - 0.96 to - 0.18, p = 0.004). The findings reveal that women with PCOS have lower serum Se levels compared to the controls. Furthermore, the results confirm a correlation between Se levels and insulin resistance.

Predicting new cases of hypertension in Swedish primary care with a machine learning tool

BackgroundMany individuals with hypertension remain undiagnosed. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in Swedish primary care. MethodsThis sex- and age-matched case-control (1:5) study included patients aged 30–65 years living in the Stockholm Region, Sweden, with a newly recorded diagnosis of hypertension during 2010–19 (cases) and individuals without a recorded hypertension diagnosis during 2010–19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary care for three years prior the hypertension diagnosis. ResultsThe model showed an area under the curve (95 % confidence interval) of 0.748 (0.742–0.753) for females and 0.745 (0.740–0.751) for males for predicting diagnosis of hypertension within three years. The sensitivity was 63 % and 68 %, and the specificity 76 % and 73 %, for females and males, respectively. The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence >1 %. The codes contributing most to the model, all with an odds ratio of marginal effects >1 for both sexes, were dyslipidaemia, obesity, and encountering health services in other circumstances. ConclusionsThis machine learning model, using prevailing recorded diagnoses within primary health care, may contribute to the identification of patients at risk of unrecognized hypertension. The added value of this predictive model beyond information of blood pressure warrants further study.

Face presentation at term: incidence, risk factors and influence on maternal and neonatal outcomes.

The incidence, diagnosis, management and outcome of face presentation at term were analysed. A retrospective, gestational age-matched case-control study including 27 singletons with face presentation at term was conducted between April 2006 and February 2021. For each case, four women who had the same gestational age and delivered in the same month with vertex position and singletons were selected as the controls (control group, n = 108). Conditional logistic regression was used to assess the risk factors of face presentation. The maternal and neonatal outcomes of the face presentation group were followed up. The incidence of face presentation at term was 0.14‰. After conditional logistic regression, the two factors associated with face presentation were high parity (adjusted odds ratio [aOR] 2.76, 95% CI 1.19-6.39)] and amniotic fluid index > 18cm (aOR 2.60, 95% CI 1.08-6.27). Among the 27 cases, the diagnosis was made before the onset of labor, during the latent phase of labor, during the active phase of labor, and during the cesarean section in 3.7% (1/27), 40.7% (11/27), 11.1% (3/27) and 44.4% (12/27) of cases, respectively. In one case of cervical dilation with a diameter of 5cm, we innovatively used a vaginal speculum for rapid diagnosis of face presentation. The rate of cesarean section and postpartum haemorrhage ≥ 500ml in the face presentation group was higher than that of the control group (88.9% vs. 13.9%, P < 0.001, and 14.8% vs. 2.8%, P = 0.024), but the Apgar scores were similar in both sets of newborns. Among the 27 cases of face presentation, there were three cases of adverse maternal and neonatal outcomes, including one case of neonatal right brachial plexus injury and two cases of severe laceration of the lower segment of the uterus with postpartum haemorrhage ≥ 1000ml. Face presentation was rare. Early diagnosis is difficult, and thus easily neglected. High parity and amniotic fluid index > 18cm are risk factors for face presentation. An early diagnosis and proper management of face presentation could lead to good maternal and neonatal outcomes.

Effect of Dietary Habits and Physical Activities on Abnormal Menstrual Cycle Pattern Amongst School-going Adolescent Girls Residing in the Foothills of the Himalayas: An Age-matched Case–Control Study

Abstract Background: The menstrual cycle pattern in women is related to high variability in cycle length of 21–35 days, flow lasts 4–7 days with an average loss of 15–80 ml of blood. The abnormal menstrual pattern is influenced by several factors, including dietary habits, physical exercises, family history of obesity and anthropometric parameters. Objectives: This research was carried out to establish numerous risk elements that depict abnormal menstrual cycle patterns amongst school-going adolescent girls in urban areas of Rishikesh, India. Methods: An age-matched case–control research was implemented in schools in the urban areas of Rishikesh between May and December 2019. A simple random sampling technique was carried out to choose urban wards and schools, and data were assembled in two steps. Adolescent girls (10–19 years) studying in the government and private schools (both Hindi and English medium) of urban Rishikesh areas were included and screened for abnormal menstrual patterns. Equal numbers of age-matched controls were also selected. Data were assembled using a self-scrutinised pre-designed pre-tested semi-structured questionnaire. The independent t-test, Mann–Whitney test, McNemar test, Chi-square test and Fisher’s exact tests were applied for data analysis using the SPSS software version 23.0. Results: A total of 200 school-going adolescent girls (100 cases and 100 age-matched controls) were included in this study. The strength of getting symptoms of menstruation was high amongst cases, and it was found that adolescent girls with high menstrual symptoms had more chances of developing menstrual abnormalities (odds ratio = 6.6; confidence interval = 2.9–17.2). Menstrual abnormality was found significantly associated (P &lt; 0.05) with reduced physical activity, unhealthy dietary patterns and family history of obesity amongst school-going adolescent girls. Conclusions: Unhealthy lifestyles, improper diet, reduced physical activity and family history of obesity were strongly associated with the abnormal menstrual cycle pattern.

DNMT3A/TET2/ASXL1 Mutations are an Age-independent Thrombotic Risk Factor in Polycythemia Vera Patients: An Observational Study.

Polycythemia vera (PV) patients are classified as high or low thrombotic risk based on age and prior history of thrombosis. Despite adherence to treatment recommendations, vascular events remain frequent, leading us to question whether thrombotic risk stratification could be improved. We previously reported an association between thrombotic events and mutations in DTA genes (DNMT3A, TET2, and ASXL1). The objective of this study was to confirm this observation in a larger series of PV patients. PV patients with a minimum follow-up of 3 years were recruited from 8 European centers. Medical history was searched for thrombotic event recorded at any time and next-generation sequencing carried out with a myeloid panel. Multivariable logistic regression evaluated the impact of variables on thrombotic risk. Kaplan-Meier thrombosis-free survival curves were compared by the log rank test. Associations in the total cohort were confirmed in a case-control study to exclude selection bias. Of the 136 patients recruited, 74 (56.1%) had a thrombotic event, with an incidence density of 2.83/100 person-years. In multivariable analysis, DTA mutation was a risk factor for thrombotic event, being predictive for shorter thrombosis-free survival in the whole cohort (p = 0.007), as well as in low-risk patients (p = 0.039) and older patients (p = 0.009), but not for patients with a prediagnostic event. A gender- and age-matched case-control study confirmed the increased risk of thrombotic event for PV patients with a DTA mutation. Our results support the use of molecular testing at diagnosis to help predict which PV patients are at higher risk of developing thrombosis.

Triglyceride glucose-body mass index as a novel predictor of slow coronary flow phenomenon in patients with ischemia and nonobstructive coronary arteries (INOCA)

BackgroundThe triglyceride glucose-body mass index (TyG-BMI index) has been suggested as a novel predictor of insulin resistance. However, its predictive value for slow coronary flow phenomenon (SCFP) in patients with ischemia and nonobstructive coronary arteries (INOCA) remains unclear.MethodsWe consecutively recruited 1625 patients with INOCA from February 2019 to February 2023 and divided them into two groups based on thrombolysis in myocardial infarction (TIMI) frame counts (TFCs): the SCFP group (n = 79) and the control group. A 1:2 age-matched case–control study was then performed. The TyG-BMI index was calculated as ln [plasma triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI.ResultsTyG-BMI index in the SCFP group (218.3 ± 25.2 vs 201.0 ± 26.5, P < .001) was significantly higher than in the normal controls. TyG-BMI index also increased with the number of coronary arteries involved in the SCFP. Multivariate logistic regression analysis showed that TyG-BMI, BMI, and TG were independent predictors for SCFP. Receiver operating characteristic (ROC) curve analysis showed that when the TyG-BMI index was above 206.7, the sensitivity and specificity were 88.6% and 68.5%, respectively, with an AUC of 0.809 (95% CI: 0.756–0.863, P = .027). Combined BMI with TG, the TyG-BMI index had a better predictive value for SCFP than BMI and TG (P < .001).ConclusionThe TyG-BMI index was an independent predictor for SCFP in INOCA patients, and it had a better predictive value than BMI and TG.

Epidemiological, and molecular investigation of Canine parvovirus-2 infection in Egypt.

Canine parvovirus enteritis (CPE) is a contagious viral disease of dogs caused by the canine parvovirus-2 (CPV-2) associated with high morbidity and mortality rates. CPV-2 has a high global evolutionary rate. Molecular characterization of CPV-2 and understanding its epidemiology are essential for controlling CPV-2 infections. This study examined the risk factors and survival outcomes of dogs infected with CPV-2. Molecular characterization of CPV-2 genotypes circulating in Egypt was performed to determine the evolution of CPV-2 nationally and globally. An age-matched case-control study was conducted on 47 control and 47 CPV-infected dogs. Conditional logistic regression analysis examined the association between the potential risk factors and CPE in dogs. Survival analysis was performed to determine the survival pattern of the infected dogs. Thirteen fecal samples from infected dogs were collected to confirm the CPV genotype by CPV-2 VP2 gene sequencing, assembly of nucleotide sequences, and phylogenic analysis. Unvaccinated and roamer dogs had eight and 2.3 times higher risks of CPV infection than vaccinated dogs and non-roamer dogs, respectively. The risk of death from CPE was high among dogs without routine visits to veterinary clinics and among non-roamer dogs. Molecular characterization of CPV-2 confirmed its genotype identity and relationship with the CPV-2 c and b clade types. This study highlights the potential factors for CPE control, especially vaccination and preventing dogs from roaming freely outside houses. Isolated CPV genotypes are closely related to southern Asian genotypes, suggesting a substantial opportunity for global transmission.

Psychological risk factors for upper extremity fractures in preschool children: A case-control study.

In school-age children, upper extremity fractures are associated with both parental and child-related factors and represent a multifactorial entity. This study aims to explore the psychological risk factors associated with upper extremity fractures in preschool children. This single-center, hospital-based, age-matched case-control study involved 55 cases of upper extremity fractures and 55 controls experiencing growing pains. Parents of the children participated in face-to-face interviews. We examined the potential as-sociations between scores on the Mother-to-Infant Bonding Scale (MIBS), Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), Autism-Spectrum Quotient (AQ), State-Trait Anxiety Inventory (STAI), and Strengths and Difficulties Questionnaire (SDQ), and the risk of upper extremity fractures. Advanced parental age and lower household income emerged as risk factors for upper extremity fractures, while longer maternal educational attainment was identified as a protective factor. In the univariate analyses, elevated scores on the Autism-Spec-trum Quotient Communication subscale (AQ-C), overall AQ score, Strengths and Difficulties Questionnaire Hyperactivity subscale (SDQ-H), and Strengths and Difficulties Questionnaire Emotional and Peer Problems subscale (SDQ-Int) were associated with an increased fracture risk (Odds Ratio [OR] (95% Confidence Interval [CI]): 1.15 (1.05-1.27), OR: 1.05 (1.01-1.09), OR: 1.25 (1.01-1.54), and OR: 1.19 (1.04-1.37), respectively). The AQ-C and SDQ-Int scales remained statistically significant as risk factors for upper ex-tremity fractures (OR: 1.15 (1.02-1.28) and OR: 1.21 (1.02-1.43), respectively) in the multivariate regression analyses. Our findings suggest that psychological factors affecting both parents and children could potentially increase the risk of upper extremity fractures in preschool children.

Investigation on an outbreak of bacillary dysentery due to infection of Shigella sonnei in a town of Guangxi Province.

To provide a scientific basis for identifying the causes of an outbreak and providing preventive and control measures to prevent the recurrence of similar outbreaks. A case-control study. We defined a suspected case as residents living in the affected town presented with inexplicable diarrhea (≥3 times/24 h) and at least with fever (above 37.5) or abdominal pain or vomiting from June 20 to July 14, 2016. The confirmed case was Shigella sonnei isolated from feces or rectal swabs of the suspected case. Cases were identified by reviewing medical records in different medical facilities in the affected town and interviewing physicians and cases using a questionnaire. The local water supply was checked on site. An age-matched case-control study was conducted. Epi-Info 7.0 software was used for data analysis. 133 cases aged from 1 to 77 were identified with 102 suspected and 31 confirmed. The attack rate was 0.7% (133/18131). The majority of clinical manifestations were diarrhea (100%), fever (83.5%) and abdominal pain (40.6%). Among 64 case-control pairs, 64.1% cases and 18.8% of controls drank non-boiled water (OR = 7.7, 95% CI 3.5-17.0) within 15 days before their onset. 42.2% cases and 10.1% controls had the illness in family members (OR = 6.5, 95% CI 2.5-16.3). 18 samples of Shigella sonnei were isolated from 50% (4/8) faces, 40% (13/33) rectal swabs and 14% (1/7) tap water. 8 were strain-typed by PFGE and showed 100% homology in the typing pattern. No disinfection was routinely implemented for water supply, 1household latrine was found to discharge directly into the river which is used as the local water source. This outbreak was caused by contaminated drinking water supply with household exposure helped facilitate further transmission. Water sources should be kept clear of defecation discharge and disinfected before supply, un-boiled water drinking habits need to be addressed through health promotion.

Assessment of the relationship between plasma fibrinogen-to-albumin ratio and slow coronary flow phenomenon in patients without obstructive coronary artery disease

BackgroundPrior studies have suggested that the chronic inflammatory response has an important role in the pathophysiology of slow coronary flow phenomenon (SCFP). However, data are scarce regarding the role of plasma fibrinogen-to-albumin ratio (PFAR) in patients having SCFP without obstructive coronary artery disease (CAD). In this study, we investigated the relationship between PFAR and the presence of SCFP in patients without obstructive CAD.MethodsFrom January 2021 to January 2023, we consecutively recruited 1085 patients without obstructive CAD according to the diagnostic and exclusion criteria. In total, SCFP was diagnosed in 70 patients. A 1:2 age-matched case–control study was then conducted using comparators without SCFP. Ultimately, this study enrolled 70 patients with angiographically normal coronary arteries and SCFP, along with 140 comparators with angiographically normal coronary arteries and normal coronary flow. Plasma fibrinogen and albumin levels were measured, and the PFAR was then calculated for each patient.ResultsPFARs were significantly greater in the SCFP group than in the comparators with normal coronary flow (82.8 ± 15.4 vs 73.1 ± 19.5, p < 0.001). PFAR increased with increasing numbers of vessels affected by SCFP. Multivariate logistic regression analysis showed that PFAR was an independent predictor of SCFP (odds ratio: 1.818, p = 0.015). Receiver operating characteristic (ROC) curve analysis indicated that PFAR showed a better predictive value of SCFP than fibrinogen or albumin, although not significantly (p > 0.05).ConclusionPFAR is an independent predictor of SCFP in patients without obstructive CAD. PAFR could improve the predictive value of SFCP than albumin or fibrinogen alone, but not significantly.

Ankle systolic pressure index in non-diabetic non-alcoholic fatty liver disease: A case-control study

Several studies have shown that mortality in Non-alcoholic Fatty Liver Disease (NAFLD) or metabolic steatopathy is more related to cardiovascular diseases than to hepatic complications. Our work aimed to verify the relationship between this liver disease and the ankle-brachial pressure index (ABPI), which is a good screening tool for peripheral arterial disease (PAD) and a reliable marker of cardiovascular risk. A prospective sex- and age-matched case-control study was conducted in non-diabetic patients aged 30 to 70 years. All patients underwent a clinical and biological evaluation. Hepatic steatosis was diagnosed by ultrasound. All participants had their ankle-brachial pressure index measured using a Dopplex® Pocket Doppler in addition to arterial ultrasound of the supra-aortic trunk and a carotid-femoral pulse wave velocity (CfPWV) measurement. An ABPI<0.9 was considered pathological (suggestive of PAD). Statistical analyses were performed using SPSS 21.0 software (IBM). In total, 213 NAFLD patients (100 men/113 women) with a mean age of 48.5±10.14 years were matched to 213 controls. Metabolic syndrome (MS) was more common in NAFLD than in controls, regardless of the International Diabetes Federation (IDF 2005) criteria used (P<0.001). Low ABPI (<0.90) was noted in 19 (8.9%) NAFLD patients vs. 5 (2.3%) in controls (P=0.003). The mean age of these patients was 48.8±8.6 years with a female predominance (20 patients). 62.5% reported dyslipidemia on questioning, 70.8% a metabolic syndrome according to the IDF and 12.5% (3/24) of them were active smokers. There were no records of mediacalcosis. PAD was significantly associated with NAFLD in univariate analysis (OR=4.0 CI 95% (1.4-11.1)). Factors independently associated with PAD in NAFLD patients were nocturnal systolic blood pressure, smoking, thigh circumference, and being a female. The findings of our study show a significant association between NAFLD and low ABPI, likely reflecting the high vascular risk of this patient population.

Relationship Between Metabolic Syndrome and Polycystic Ovary Syndrome with Special Reference to C-Reactive Protein

ObjectivesTo estimate C-reactive protein (CRP) levels in Saudi women with and without polycystic ovary syndrome (PCOS), and to investigate the associations between CRP and metabolic syndrome (MetS) components. MethodsWe randomly recruited 200 women with and without PCOS, between 18 and 38 years, in this age-matched case-control study. Study subjects were allocated to 1 of 4 groups according to the presence or absence of MetS. Interviews were conducted with all participants, and anthropometric measurements and blood samples were obtained for subsequent analysis of biochemical variables. ResultsTwo-thirds of the study population and all study subjects had central obesity. Fasting insulin and homeostasis model assessment insulin resistance index were significantly higher in PCOS and MetS groups than all other groups (P < 0.05). CRP levels were significantly higher among women with PCOS than their age-matched controls, regardless of the presence of MetS (P < 0.05). Body mass index was the only independent predictor of serum high-sensitivity-CRP, accounting for 17% of the variability in circulating levels (β = 0.407; 95% CI 0.248–0.472, P < 0.0001). ConclusionsObesity and insulin resistance are important risk factors for MetS in PCOS. The presence of MetS in PCOS subjects aggravates the proinflammatory state reflected by CRP levels.

Pregnancy Complications Are Associated with Premature Coronary Artery Disease: Linking Three Cohorts.

Background: There is increasing evidence that women who experience placenta-mediated pregnancy complications and gestational diabetes mellitus (GDM) are at higher risk for the development of coronary artery disease (CAD) later in life. We hypothesized that there is an association between placenta-mediated pregnancy complications, GDM, and risk of premature CAD (PCAD). Methods: This research project involved a data linkage approach merging three databases of South Australian cohorts by using a retrospective, age-matched case-control study design. Cases (n = 721) were ascertained from the Coronary Angiogram Database of South Australia (CADOSA). Women <60 years from CADOSA were linked to South Australian Perinatal Statistics Collection (SAPSC) to ascertain their prior pregnancy outcomes. Controls (n = 194) were selected from North West Adelaide Health Study (NWAHS) and comprised women who were healthy or had other health conditions unrelated to CAD, age-matched to CADOSA (±5 years), and linked to SAPSC to determine their pregnancy outcomes. PCAD was defined as >50% stenosis in one or more coronary arteries at coronary angiography. Results: Compared with women without a history of PCAD, women who were diagnosed with PCAD were more likely to have experienced the placenta-mediated pregnancy complications of preterm birth (adjusted odds ratio [OR] = 2.46, 95% confidence interval [CI]: 1.21-5.00) or low-birth weight (adjusted OR = 2.44, 95% CI: 1.22-4.88), or have been diagnosed with active asthma during pregnancy (adjusted OR = 3.52, 95% CI: 1.05-11.76). Conclusion: Placenta-mediated pregnancy complications should be recognized as clear risk markers for future PCAD.

Predicting EGFR Mutation in Lung Adenocarcinoma: Development and Validation of the EGFR Mutation Predictive Score (EMPS) in Bali, Indonesia.

The examination of epidermal growth factor receptor (EGFR) mutations may not be routinely available to all patients due to the limited availability and the expensive price of the examination, especially in area with limited resources such as in Indonesia. Therefore, we aimed to build a nomogram to predict the EGFR mutation in patients with lung adenocarcinoma by incorporating significant clinical and radiological parameters. We conducted an age-matched case-control study using 160 treatment-naïve patients [80 patients with EGFR-mutated (EGFRmut) and 80 with EGFR-wild-type (EGFRwt)] with pathologically confirmed lung adenocarcinomas with tumor specimens available for genetic analysis taken from 2017 through 2021 in Bali, Indonesia. Radiomics features were extracted from contrast CT images. The cut-off of the tumor diameter was defined using Receiver Operating Characteristic Curve. A conditional logistic regression model was constructed to identify significant risk factors, and a nomogram was developed for predicting the risk of EGFR mutation. A cohort was done to validate the nomogram. Being female, never-smoker, having a smaller tumor diameter (<48.5mm), located in the upper lobe, have bubble-like lucency and air-bronchogram in the chest CT scan were identified as independent risk factors of EGFR mutation at the multivariate logistic regression model. The forming normogram model produced an area under the curve of 0.993 (95 % CI = 0.98-1.00) and 0.91 (95 % CI = 0.84-0.99) in development and validation group, respectively. The calibration curve showed good agreement between predicted and actual probability. At the cut-off point of the normogram score 246 shows a sensitivity of 97.5%, a specificity of 98.8%, a positive predictive value of 99.0%, and a negative predictive value of 96.8%. Our study indicated that the EGFR Mutation Normogram could provide a non-invasive way to predict the risk of EGFR mutation in patients with lung adenocarcinoma in clinical practice. This normogram need to be validated in other area in Indonesia.

Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

PurposeTo evaluate the incidence of malignancies in acromegaly and to identify risk factors for newly-diagnostic cancers, especially the excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1).MethodsA retrospective cohort including 1738 consecutive hospitalized patients with acromegaly in a single referral center between 2012 and 2020 (mean follow-up 4.3 years). A gender- and age-matched case-control study (280 patients from the cohort) was performed for risk factor analysis.ResultsOne hundred thirteen malignancies (67 diagnosed after acromegaly) were observed. The overall newly-diagnostic cancer risk of acromegaly was higher than the general population (standardized incidence ratio (SIR) 2.81; 95% CI 2.18–3.57). The risk of thyroid cancer (n = 33, SIR 21.42; 95% CI 13.74–30.08) and colorectal cancer (n = 8, SIR 3.17; 95% CI 1.37–6.25) was elevated. In the overall cohort, IGF-1 (ULN: 1.27 vs. 0.94, p = 0.057), GH (1.30 vs. 1.00 ng/ml, p = 0.12), and disease-controlled rate (34.9% vs. 45.9%, p = 0.203) at the last visit did not reach significance between patients with and without post-diagnostic cancer. In the case-control study, GH (1.80 vs. 0.90 ng/ml, p = 0.018) and IGF-1 (ULN: 1.27 vs. 0.91, p = 0.003) at the last visit were higher in patients with post-diagnostic cancers, with a lower disease-controlled rate. Elder age was a risk factor for cancer. Other metabolic comorbidities and the size of pituitary tumors were similar.ConclusionThe risk of malignancies, especially thyroid cancer, was increased in patients with acromegaly in our center. More cancer screening should be considered when managing acromegaly, especially in patients with higher posttreatment GH and IGF-1.

Epidemiological Risk Factors for Cancers of the Lung, Breast, Colon-rectum &amp; Oral cavity: A case-control study in the Philippines

Introduction. In the Philippines, lung, breast, colon-rectum, and oral cavity cancers are among the top 10 most common cancers. This study evaluates the risk factors for these cancers among Filipinos.&#x0D; Methods. This age-matched case-control study included incident primary cancers (histologically-diagnosed) of the lung, breast (also matched for sex), colon-rectum and oral cavity. Controls(clinically free and no history of cancer) were obtained from the same tertiary hospitals as the cases. Target sample size was 283 cases and 283 controls per cancer type. Conditional logistic regression was done.&#x0D; Results. Exposure to cigarette/tobacco was a significant risk factor for lung (OR of current smoker compared to non-smoker [95% Confidence Interval]: 3.6 [1.6-7.9]) and oral cavity cancers (2.0 [1.2-3.3]); family history (1st degree) for lung (4.3 [1.3 – 14.2]) and breast cancers (3.0 [1.2-7.5]); every year increase in age at first pregnancy for breast cancer (1.06 [1.02-1.11]). Other risk factors for oral cavitywere passive smoking (2.8 [1.6-5.1]), chewing tobacco (5.2[1.4-19.5]) and inverted cigarette smoking (3.2[1.3-8.1]). Fish sauce (patis) was found to be a protective factor for breast cancer (0.34 [0.22-0.51]) and oral cavity (0.44 [0.25-0.78]) and use of shrimp paste (bagoong) (0.48 [0.27-0.84]) for oral cavity.&#x0D; Conclusion and Recommendations. Except for family history of cancer, the identified risk factors for lung, colon-rectum, and oral cavity cancers are preventable. Proper diet and lifestyle, avoidanceof cigarettes and tobacco, and environmental safety in the workplace are key cancer prevention measures. Public awareness campaign and continuing healthcare provider education must always be part of a cancer prevention program.

Selected Articles from This Issue

Physical activity and body mass index (BMI) are well established risk factors of colorectal cancer. Whether physical activity can counteract adverse obesity-induced metabolic profiles, including inflammation, remains unclear. Using data from the ColoCare Study, Himbert and colleagues tested associations of individual and combined physical activity and BMI groups with pro-inflammatory biomarkers in the largest cohort of colorectal cancer patients to date. The authors identified BMI as the key driver of inflammation, yet, biomarker levels were higher among inactive colorectal cancer patients across BMI groups. Results suggest that physical activity may reduce obesity-induced inflammation among colorectal cancer patients.Hodgkin lymphoma (HL) survivors (HLS) treated with infradiaphragmatic radiotherapy (IRT) and/or procarbazine have an increased risk of developing colorectal cancer (CRC). Ykema, Gini, and colleagues investigated the cost-effectiveness of CRC surveillance in Dutch HLS to determine the optimal surveillance strategy for different HL subgroups. The authors adjusted well-established MISCANColon model to reflect the HL survivor population. Subsequently the model was used to evaluate benefits, harms and costs of a range of potential surveillance strategies. CRC surveillance in HL survivors at increased risk for CRC (treated with IRT and/or procarbazine-containing chemotherapy) is cost-effective and should commence earlier than in the general population. For all examined HL subgroups, FIT surveillance was the most cost-effective strategy.Multiple myeloma disproportionately affects individuals of African descent, occurring more often in Black populations compared to White. Cicero and colleagues investigated the prevalence of monoclonal gammopathy of undetermined significance (MGUS), the precursor to myeloma, in 386 Black South African men. They found MGUS in 8.03% of their cohort, nearly 1.6-fold higher than the historic White Olmsted County males. Moreover, they explored the association between MGUS and various clinical factors, notably determining a correlation between MGUS and HIV status, as well as cigarette use. Their study demonstrates that racial disparities in MGUS exist and may be associated with potentially modifiable risk factors.This study by Chien and colleagues proposed methods for adapting risk models, with or without polygenic score, for another population without prospective cohorts to help alleviate the health disparities caused by advances in absolute risk models. The authors adapted the lung cancer risk model PLCOM2012 for Taiwan, by forming an age-matched case-control study of ever-smokers, synthesizing a dataset resembling the population of cancer-free ever-smokers in 2010, and estimating the number of ever-smoking lung cancer patients in 2011–2016. The adapted PLCOT models had high performance in calibration, discrimination, and clinical usefulness, and could be used to counsel individuals and design screening programs in Taiwan. The methods could be applicable to other cancer models.

Indoor Urban Environment and Conventional Risk Factors for Pediatric Tuberculosis Among 1–12 Years Old Children in a Megacity in Pakistan: A Matched Case–Control Study

Background: Estimated 1.1 million children developed tuberculosis (TB) globally in 2020. Household air pollution has been associated with increased respiratory tract infections among children. Nonetheless, there are scarce data regarding the association of indoor environment with pediatric TB. Objectives: To determine the association of indoor urban environment and conventional risk factors for pulmonary TB among children 1-12 years and to discern the differences of these factors among younger (1-5 years) and older children (6-12 years). Materials and Methods: We conducted an age-matched case-control study among children in 2 hospitals (tertiary and secondary care) in megacity, Karachi, Pakistan. A total of 143 pulmonary TB cases, diagnosed on Pakistan Paediatric Association Scoring Chart for Diagnosis of Tuberculosis (PPASCT), were compared with 286 age-matched controls (ratio 1:2). Indoor urban environment and other conventional risk factors were ascertained through a questionnaire and analyzed by conditional logistic regression. Results: Overall, being a female child [matched odds ratio (mOR): 2.03, 95% confidence interval (CI): 1.16-3.53], having household TB contact (mOR: 8.64, 95% CI: 4.82-15.49), open kitchen for cooking in household (mOR: 1.99, 95% CI: 1.59-5.66), and poorly ventilated house (mOR: 2.37, 95% CI: 1.09-3.65) increased the risk of TB among children (1-12 years). Open kitchen was a risk factor for younger children (1-5 years), whereas poorly ventilated house and being female child was a risk factor for older children (6-12 years), respectively. Conclusions: This study strengthens the evidence that a poor indoor environment increases the risk for childhood TB. Concerted efforts are needed to improve the indoor air environment in urban areas for prevention of TB in addition to addressing the conventional risk factors.

Abstract 10005: Pregnancy Complications Are Associated With Premature Coronary Artery Disease - Linking Three South Australian Cohorts

Introduction: There is increasing evidence that women who experience placenta-mediated pregnancy complications and gestational diabetes mellitus (GDM) are more likely to develop coronary artery disease (CAD) at a younger age. This is the first study to assess the relationship between pregnancy complications and premature coronary artery disease (PCAD) in Australian women. Hypothesis: We hypothesized that there is an association between placenta-mediated pregnancy complications, GDM and risk of CAD prior to 60 years of age. Methods: The research project involved a data linkage approach merging three databases of South Australian cohorts by employing a retrospective, age-matched case-control study design. Cases (n=721) were ascertained from Coronary Angiogram Database of South Australia (CADOSA). Women &lt;60 years from CADOSA were linked to South Australian Perinatal Statistics Collection (SAPSC) to determine their pregnancy outcomes. Controls (n=194) were ascertained from North West Adelaide Health Study (NWAHS) and comprised of women who were healthy or had health conditions other than CAD, age-matched to CADOSA (+/- 5 years) and linked to SAPSC to determine their pregnancy outcomes. PCAD was defined as &gt; 50% stenosis in one or more coronary arteries at coronary angiography. Results: Women who were diagnosed with PCAD were more likely to have experienced a placenta-mediated pregnancy complication, previous miscarriage, asthma or anaemia and/or have risk factors for CAD including pre-existing diabetes (I &amp; II), active smoking and obesity during pregnancy compared to women without a history of CAD as shown in the table below (p &lt; 0.05). GDM was not associated with PCAD in these cohorts. Conclusion: Women diagnosed with PCAD have conventional CVD risk factors and some that are uniquely related to their pregnancy. These clinical events may be considered novel risk factors for future PCAD and require attention in contemporary preventative cardiology practice.

Visceral fat loss by whole-body electromyostimulation is attenuated in male and absent in female older Non-Insulin-Dependent diabetes patients.

Type 2 diabetes and its reversal correlate with increases and decreases in visceral fat (VF). Resistance exercise reduces VF in healthy persons, but little is known in type 2 diabetes. Muscle contractions induced by whole-body electromyostimulation (WB-EMS) provide a very effective form of resistance training. We hypothesized that WB-EMS reduces VF and improves plasma glucose measures in older non-insulin dependent diabetes mellitus (NIDDM) males and females. A four-arm age-matched case control study was done on WB-EMS twice a week in older NIDDM patients (27 males, 18 females) compared with controls (15 males, 15 females). VAT area (VAT, cm2 ), total fat mass (TFM, kg) and lean body mass (LBM, kg) were assessed by DEXA-scanning. HbA1c, fasting glucose and plasma lipoproteins were measured at baseline and after 4months. Baseline control VAT was higher in males than females (140.5 ± 35.6 vs. 96.7 ± 42.3, p< .001). In NIDDM, VAT was higher with no significant sex difference (206.5 ± 65.0 vs. 186.5 ± 60.5). In controls, WBEMS reduced VAT in males and females to similar extent (-16.9% and -16.4%, p< .001 vs. baseline) and in preference to TFM (-9.2% and -3.6%) or body weight loss (-2.8 and -2.1%). In NIDDM, VF loss was attenuated in males (-7.3%, p< .01) but completely absent in females. WBEMS reduced HbA1c and cholesterol and increased HDL levels (all p< .05) only in male NIDDM CONCLUSIONS: WBEMS induced VF loss in healthy older males and females an effect strongly attenuated in male and completely absent in female NIDDM patients. This questions the effectiveness of muscle contraction-induced VF lipolysis in NIDDM. Sex differences may dictate the success of resistance training in NIDDM, a subject that needs to be addressed in future studies.