Disease Risk Assessment Research Articles

Estimation of Owned and Street Dog Population by Quesionnire Survey and Mark-Recapture Method in Three Urban Areas: Bishoftu, Dukem and Modjo Towns

The understanding of the structure of free-roaming and owning dog population’s estimation is of extreme importance for the planning and monitoring of dog population control strategies, animal welfare and health. The methods used to estimate the abundance of this group of dogs are more complex than the ones used with domiciled owned dogs. We point to enhancements necessary for the implementation of the studies and to potential updates and revisions to the recommendations of the World Health Organization with respect to the estimation of free-ranging and owning dog populations. Rabies is a fatal viral disease of animals and people. People usually infected via bites from an infected animal (e.g. dog). Post Exposure Prophylaxis (PEP) has to initiate immediately after bite wounds of suspected rabid animals in order to avoid fatalities. The situation of rabies poorly known in Ethiopia. Questionnaire survey was conducted in selected blocks in Dukem, Bishoftu and Modjo towns in order to capture information on dog population size estimates using mark-resight surveys has provided useful baseline data for understanding the population dynamics of dogs at the study sites. Mark-resight surveys provide useful information for designing and managing the logistics of dog vaccination or assessing vaccination coverage and for evaluating the impact of neutering programs on the size and structure of dogs’ populations over time. As part of a dog born zoonosis disease risk assessment project, surveys conducted to estimate the size of the dog population and to describe dog management practices of households belonging to different ethnic groups. A markedrecapture method employed and the number of unowned dogs estimated. A total of 599 dog owning households and 276 non-dog household interviewed from at selected 19 blocks at study sites. Owned dogs were more likely male, local breed and for the purpose of used to guard. These households kept their dogs either fully restricted, semi and free roaming but full restriction have reported only at the higher percentage of the total dog households. By counted method, study the ownerless dogs higher than owning and semi-restricted dogs.

Monitoring of Body Condition in Dairy Cows to Assess Disease Risk at the Individual and Herd Level.

A retrospective longitudinal study assessing the explanatory and predictive capacity of body condition score (BCS) in dairy cows on disease risk at the individual and herd level was carried out. Data from two commercial grazing herds from the Argentinean Pampa were gathered (Herd A = 2100 and herd B = 2600 milking cows per year) for 4 years. Logistic models were used to assess the association of BCS indicators with the odds for anestrus at the cow and herd level. Population attributable fraction (AFP) was estimated to assess the anestrus rate due to BCS indicators. We found that anestrus risk decreased in cows calving with BCS ≥ 3 and losing ≤ 0.5 (OR: 0.07-0.41), and that anestrus rate decreased in cohorts with a high frequency of cows with proper BCS (OR: 0.22-0.45). Despite aggregated data having a good explanatory power, their predictive capacity for anestrus rate at the herd level is poor (AUC: 0.574-0.679). The AFP varied along the study in both herds and tended to decrease every time the anestrous rate peaked. We conclude that threshold-based models with BCS indicators as predictors are useful to understand disease risk (e.g., anestrus), but conversely, they are useless to predict such multicausal disease events at the herd level.

Rapid and sensitive on-site detection of SARS-CoV-2 RNA from environmental surfaces using portable laboratory devices.

Monitoring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on inanimate surfaces plays a crucial role in environmental surveillance, enabling the indirect detection of infected individuals and facilitating rapid infection control responses. However, developing a practical on-site, end-to-end method for detection remains a challenge. In this study, we established protocols for on-site detection of SARS-CoV-2 RNA on surfaces using two portable laboratory devices: The PicoGene PCR1100 and Bento Lab. Test particles comprised of inactivated viral particles containing partial sequences of SARS-CoV-2, type 1 poliovirus, coxsackie virus A16, and norovirus genogroups I and II were applied to reference materials as simulated contaminants. The direct detection method with the PicoGene PCR1100 achieved a recovery efficiency of 35.1% for the dried reference material. Furthermore, the Bento Lab, equipped with a microcentrifuge for on-site RNA purification, successfully detected a low concentration of inactivated SARS-CoV-2 reference standard. The recovery efficiency of the on-site RNA purification method on plastic, stainless steel, glass, and polyvinyl chloride surfaces ranged from 15.5% to 21.2%. Through the combination of these portable devices, SARS-CoV-2 RNA was detected within 1 h of swab sampling. This study contributes to the on-site risk assessment of infectious diseases by enabling the rapid detection of viral genomes. IMPORTANCE This study presents the development of a highly sensitive on-site method for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on various surfaces, including doorknobs and tables. Identifying SARS-CoV-2 RNA on these surfaces can be crucial in guiding decision-making for implementing non-pharmaceutical interventions, such as zoning strategies, improving ventilation, maintaining physical distancing, and promoting increased hand hygiene practices. Moreover, the on-site detection system can facilitate the swift initiation of mitigation responses in non-laboratory settings, including long-term care facilities and schools. The protocols established in this study offer a comprehensive approach for achieving both sensitivity and rapidity in on-site SARS-CoV-2 RNA detection. Furthermore, since the RT-qPCR assay serves as the gold standard for detecting viral RNAs, the developed protocol holds potential for application to other viruses, including enteroviruses and noroviruses.

Риск заболеваний щитовидной железы, связанных с йодной недостаточностью, ликвидаторов последствий аварии на Чернобыльской АЭС ‒ работников предприятий атомной промышленности

Purpose: Assessment of thyroid disease risk associated with iodine deficiency, liquidators of the Chernobyl accident consequences, employees of nuclear industry enterprises depending on the doses of different types of exposure. Material and methods: The dose-risk assessment study included 12663 men, 1327 of whom had occupational exposure data. A Poisson’s process with intensity parameter was chosen as a statistical model of morbidity risk. The statistical package of epidemiological data analysis EPICURE was used for the estimation of excess relative risk (ERR) of thyroid diseases related to iodine deficiency. There was conducted a cohort epidemiological study of a group of liquidators who worked in the 30-km zone in 1986‒1990 over a period of more than thirty years depending on the dose received both during liquidation of the Chernobyl accident consequences and during professional work with radioactive substances (RS) and ionizing radiation sources (IRS). Results: As a result of the study direct estimates of radiogenic risk of thyroid diseases associated with iodine deficiency in the liquidators of the Chernobyl accident consequences were obtained for the first time using the data on doses of Chernobyl and the sum of these doses with the doses of occupational exposure. It is shown that the risk of disease per unit dose (ERR/Zv) for dose loads received both at liquidation of Chernobyl accident consequences and for total doses give different results. Conclusion: Assessment of the risk of thyroid diseases associated with iodine deficiency, liquidators of the Chernobyl NPP accident consequences and workers of nuclear industry enterprises, serviced by FMBA health care institutions of Russia using the doses of different types of exposure gives different results. Correct results of assessing the risk of radiation-related diseases can only be given by the register using the total radiation dose (occupational, accidental, medical, natural), as required by the directive documents.

Strengthening risk assessment of the heart diseases in primary health care system

Strengthening risk assessment of the heart diseases in primary health care system

A Preliminary Method for Tracking In-Season Grapevine Cluster Closure Using Image Segmentation and Image Thresholding

Mapping and monitoring cluster morphology provides insights for disease risk assessment, quality control in wine production, and understanding environmental influences on cluster shape. During the progression of grapevine morphology, cluster closure (CC) (also called bunch closure) is the stage when berries touch one another. This study used mobile phone images to develop a direct quantification method for tracking CC in three grapevine cultivars (Riesling, Pinot gris, and Cabernet Franc). A total of 809 cluster images from fruit set to veraison were analyzed using two image segmentation methods: (i) a Pyramid Scene Parsing Network (PSPNet) to extract cluster boundaries and (ii) Otsu’s image thresholding method to calculate % CC based on gaps between the berries. PSPNet produced high accuracy (mean accuracy = 0.98, mean intersection over union (mIoU) = 0.95) with mIoU > 0.90 for both cluster and noncluster classes. Otsu’s thresholding method resulted in <2% falsely classified gap and berry pixels affecting quantified % CC. The progression of CC was described using basic statistics (mean and standard deviation) and using a curve fit. The CC curve showed an asymptotic trend, with a higher rate of progression observed in the first three weeks, followed by a gradual approach towards an asymptote. We propose that the X value (in this example, number of weeks past berry set) at which the CC progression curve reaches the asymptote be considered as the official phenological stage of CC. The developed method provides a continuous scale of CC throughout the season, potentially serving as a valuable open-source research tool for studying grapevine cluster phenology and factors affecting CC.

Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records.

To provide quantitative evidence for systematically prioritising individuals for full formal cardiovascular disease (CVD) risk assessment using primary care records with a novel tool (eHEART) with age- and sex- specific risk thresholds. eHEART was derived using landmark Cox models for incident CVD with repeated measures of conventional CVD risk predictors in 1,642,498 individuals from the Clinical Practice Research Datalink. Using 119,137 individuals from UK Biobank, we modelled the implications of initiating guideline-recommended statin therapy using eHEART with age- and sex-specific prioritisation thresholds corresponding to 5% false negative rates to prioritise adults aged 40-69 years in a population in England for invitation to a formal CVD risk assessment. Formal CVD risk assessment on all adults would identify 76% and 49% of future CVD events amongst men and women respectively, and 93 (95% CI: 90, 95) men and 279 (95% CI: 259, 297) women would need to be screened (NNS) to prevent one CVD event. In contrast, if eHEART was first used to prioritise individuals for formal CVD risk assessment, we would identify 73% and 47% of future events amongst men and women respectively, and a NNS of 75 (95% CI: 72, 77) men and 162 (95% CI: 150, 172) women. Replacing the age- and sex-specific prioritisation thresholds with a 10% threshold identify around 10% less events. The use of prioritisation tools with age- and sex-specific thresholds could lead to more efficient CVD assessment programmes with only small reductions in effectiveness at preventing new CVD events.

"There could be something going wrong and I wouldn't even know": a qualitative study of perceptions of people with cancer about cardiovascular disease (CVD) risk and its management.

Despite being at higher risk, many people with cancer do not receive adequate cardiovascular disease (CVD) risk assessment or management. The purpose of this research was to examine people with cancer's perceptions, experiences and needs regarding CVD risk factor awareness, assessment and management. We conducted 15 individual interviews to examine people with cancer's perspectives regarding CVD care in cancer. Reflexive thematic analysis was utilised to collect and organise data into themes and to synthesise findings. Fifteen people (6 males) diagnosed with diverse cancer types participated. Majority participants were not or only somewhat aware of CVD risk in cancer, but all expressed it was an important issue. A diverse range of priorities and needs for CVD care was discussed, including some participants' prioritisation of dealing with cancer and preferred amount, type and manner of information provision and support. Websites and brochures were identified as potential solutions for optimising CVD care. Codesign methodology should be used to engage patients in the development of flexible, tailored resources to increase awareness of CVD risk and strategies for its management. Perceptions of people with cancer regarding CVD care can inform new interventions that reduce the impact of CVD in cancer.

Artificial intelligence effectivity in fracture detection

The scientific study aimed to explore the practical implementation of artificial intelligence (AI) technologies in radiology and traumatology for fracture detection, as well as evaluate their overall effectiveness in modern medicine. In recent years, AI has gained significant traction in the healthcare industry, enabling the analysis of patients' clinical data and facilitating disease diagnosis, monitoring, risk assessment, and surgical intervention possibilities. The relevance of the scientific work is in the gradual expansion of practical applications of artificial intelligence technologies in medicine, particularly in radiology for diagnosing fractures. The study aimed to investigate the practical effectiveness of AI technology in fracture detection on example of Hospital of Traumatology and Orthopaedics in Riga, Latvia. The methodological approach combined system analysis of AI system implementation in modern medical institutions for creating X-ray images with a clinical study of fracture diagnosis experience at the Hospital of Orthopedics and Traumatology in Riga, Latvia. Fractures were detected by radiologists, attending physicians, and the AI program, with comparisons made between them. Results were analyzed to assess the program's efficacy. The results of the study demonstrated the high effectiveness of AI technologies in fracture detection. The application of these systems in clinical practice led to a significant reduction in diagnostic errors (by 2-3 times) and an increase in diagnostic accuracy (from 78.1% to 85.2%). Moreover, AI systems proved to be capable of detecting fractures that were not initially identified during routine examinations by paramedics and medical practitioners. This emphasized the practicality of expanding the use of these systems in clinical practice. The practical significance of the obtained results is in their potential use in the development of software systems based on AI, aimed at enhancing fracture diagnosis in medical institutions. These findings provided valuable insights for further advancements in AI-based technologies for fracture detection.

Unveiling the Hidden Power of Uromodulin: A Promising Potential Biomarker for Kidney Diseases.

Uromodulin, also known as Tamm-Horsfall protein, represents the predominant urinary protein in healthy individuals. Over the years, studies have revealed compelling associations between urinary and serum concentrations of uromodulin and various parameters, encompassing kidney function, graft survival, cardiovascular disease, glucose metabolism, and overall mortality. Consequently, there has been a growing interest in uromodulin as a novel and effective biomarker with potential applications in diverse clinical settings. Reduced urinary uromodulin levels have been linked to an elevated risk of acute kidney injury (AKI) following cardiac surgery. In the context of chronic kidney disease (CKD) of different etiologies, urinary uromodulin levels tend to decrease significantly and are strongly correlated with variations in estimated glomerular filtration rate. The presence of uromodulin in the serum, attributable to basolateral epithelial cell leakage in the thick ascending limb, has been observed. This serum uromodulin level is closely associated with kidney function and histological severity, suggesting its potential as a biomarker capable of reflecting disease severity across a spectrum of kidney disorders. The UMOD gene has emerged as a prominent locus linked to kidney function parameters and CKD risk within the general population. Extensive research in multiple disciplines has underscored the biological significance of the top UMOD gene variants, which have also been associated with hypertension and kidney stones, thus highlighting the diverse and significant impact of uromodulin on kidney-related conditions. UMOD gene mutations are implicated in uromodulin-associated kidney disease, while polymorphisms in the UMOD gene show a significant association with CKD. In conclusion, uromodulin holds great promise as an informative biomarker, providing valuable insights into kidney function and disease progression in various clinical scenarios. The identification of UMOD gene variants further strengthens its relevance as a potential target for better understanding kidney-related pathologies and devising novel therapeutic strategies. Future investigations into the roles of uromodulin and regulatory mechanisms are likely to yield even more profound implications for kidney disease diagnosis, risk assessment, and management.

B-189 Evaluate the suitability of urinary reference intervals for organophosphate flame retardants in healthy adult population from Southern Taiwan

Abstract Background Organophosphorus flame retardants (OPFRs) are chemical additives used to prevent fires and are widely used in furniture, electronics, plastics, and building materials. Its chemical structure is similar to human hormones, which are often misidentified and used in the human body, thereby interfering with the operation of normal physiological functions and causing endocrine system disorders, so it is also known as environmental hormones. Recently, it has been confirmed that exposure to OPFRs can cause health hazards such as neurotoxicity, endocrine disruption, hepatotoxicity, and reproductive dysfunction. In view of the increasing concern about the exposure of human OPFRs, but there is no laboratory in Taiwan to detect the content of human OPFRs. This study aims to develop a biomonitoring method for OPFRs, which is used to provide reliable information on the exposure status of individual OPFRs, and to establish a reference interval for OPFRs in the urine of different diseases and reference groups and confirm the potential of OPFRs as biomarkers in environmental medicine. Methods The Waters ACQUITY UPLC I-Class and Xevo TQ-XS IVD systems were developed to detect 10 OPFRs in urine: Tri-(n-butyl) phosphate (TNBP), Tris-(2-butoxyethyl) phosphate (TBEP), Tris-(1,3- dichloro-2-propyl) phosphate (TDCPP), Triphenyl phosphate (TPHP), Tris-(2-chloroethyl) phosphate (TCEP), Di-n-butylphosphate (DNBP), Bis-(butoxyethyl)-Phosphate (DBEP), Bis-(1,3-dichloro-2-propyl) phosphate (BDCPP), Diphenyl phosphate (DPHP), Bis (2-chloroethyl) phosphate (BCEP), and analytical methods. According to the CLSI C62A specifications, the methodology verification and confirmation passed the evaluation. A total of 538 patients (78 infertility, 167 hemodialysis, 96 esophageal cancer, 99 lung cancer and 98 endometrial cancer) and 175 reference groups were tested for urine samples. The ANOVA analysis was used to compare the differences in the content of 10 OPFRs compounds in the urine of subjects of different ethnic groups. ROC curve analysis was used to determine the best decision value of whether the disease was present, and Chi-square verification was used to conduct disease risk assessment and verify the feasibility of the set reference value. Results The BCEP (6.23 ± 2.19 ng/mL) of most patients with hemodialysis, lung cancer and esophageal cancer was significantly higher than the reference group (0.89 ± 0.38 ng/mL). Patients with gynecological diseases had a higher BDCPP (4.29 ± 1.97 ng/mL) than the reference population (0.76 ± 0.32 ng/mL), which was consistent with the conclusions of previous animal experiments. Since it is not easy to explain the direct correlation between OPFRs and the disease. We decided to sum the detection values of 10 OPFRs. We found that their sum was greater than 2.05 ng/mL. The risk of infertility was 37.8 (95% CI: 11.07–129.14), the risk value of esophageal cancer was 83.3 (95% CI: 25.25–274.85) and the risk value of severe chronic kidney disease was 56.7 (95% CI: 17.49–183.97). Conclusion Due to the different types of OPFRs used in different countries, it is impossible to directly apply the reference values of other countries to their own people. So we develop the OPFRs detect method and verify the reference values through a series of analysis and discussion. Which will help us further understand the association between these environmental hormones and diseases.

Preventive care recommendations to promote health equity.

Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.

Agreement between ten-years cardiovascular disease risk assessment tools: An application to Iranian population in Shahedieh Cohort Study

Background and aimCardiovascular risk-prediction models are efficient primary prevention tools to detect high-risk individuals. The study aims to use three tools to estimate the 10-year risk of developing cardiovascular disease (CVD) and investigate their agreement in an Iranian adult population. MethodsThe current cross-sectional study was carried out on 8569 adults between 35 and 70 who participated in the first phase of the Shahedieh cohort study in Yazd, Iran, and were free of CVDs (cardiac ischemia or myocardial infarction or stroke). World Health Organization/International Society of Hypertension (WHO/ISH) chart, Laboratory-Based (LB) and Non-Laboratory-Based (NLB) Framingham Risk Score (FRS) were used to predict the 10-year risk of developing CVD. The agreement across tools was determined by Kappa. ResultsWHO/ISH chart indicated the highest prevalence of low CVD risk for males (96.10%) and females (96.50%), while NLB Framingham had the highest prevalence of high CVD risk for males (19.40%) and females (5.30%). In total, there was substantial agreement between both FRS models (Kappa = o.70), while there was a slight agreement between WHO/ISH and both FRS tools. For under 60 years males and females, substantial agreements were observed between FRS methods (kappa = 0.73 and kappa = 0.68). For males and females over 60 years, this agreement was moderate and substantial, respectively (kappa = 0.54 and kappa = 0.64). WHO/ISH and LB Framingham model had substantial agreement for over 60 years females (kappa = 0.61). ConclusionsFramingham models classified more participants in the high-risk category than WHO/ISH. Due to the lethality of CVDs, categorizing individuals based on FRS can ensure that most of the real high-risk people are detected. Remarkable agreement between FRS methods in all sex-age groups suggested using the NLB Framingham model as a primary screening tool, especially in a shortage of resources condition.

Toxic vascular effects of polystyrene microplastic exposure

Polystyrene microplastics (PSMPs) are some of the most common microplastic components, and the resulting pollution has become a global problem. Extensive studies have been conducted on the toxic effects of PSMPs on the heart, lungs, liver, kidneys, nerves, intestines and other tissues. However, the impact of PSMPs on vascular toxicity is poorly understood at present. The aim of this study was to reveal the vascular toxicity of microplastics (MPs). Patients were assigned to a calcification group (25 patients) or a non-calcification group (22 patients) based on the presence or absence of calcification in the thoracic aorta wall. We detected 7 polymer types in human feces. Patients with vascular calcification (VC) had higher levels of total MPs, polypropylene (PP) and polystyrene (PS) in feces than patients without VC. The thoracic aortic calcification score was significantly positively correlated with the total MP abundance (Spearman r = 0.8109, p < 0.0001), PP (Spearman r = 0.7211, p = 0.0160) and PS (Spearman r = 0.6523, p = 0.0471) in feces. We then explored the effects of PSMP exposure on normal and vitamin D3 + nicotine (VDN)-treated rats. PSMP exposure induced mild VC in normal rats and aggravated VC in VDN-treated rats. PSMP exposure disturbed the gut microbiota, causing Proteobacteria and Escherichia_Shigella to be the dominant phylum and genus, respectively. It also induced intestinal inflammatory responses in normal rats, aggravated intestinal inflammation in VDN-treated rats, impaired the intestinal mucosal barrier, and increased intestinal permeability. This study provides a theoretical basis for the risk assessment of MP-induced cardiovascular disease.

Risk Assessment of Coronavirus Disease (COVID-19) Transmission among Physicians Working at a COVID-dedicated Tertiary-care Hospital

Background and aims: In the earlier stage of pandemic, a sizeable number of physicians and other healthcare workers were infected with SARS-CoV-2. The aim of this study was to assess the factors associated with the risk of SARS-CoV-2 infection among physicians working at a COVID-dedicated tertiary care hospital, within and outside the medical workplace.&#x0D; Methods: This case control study was conducted among the physicians and surgeons working at different departments of Mugda Medical College and Hospital and undergone different pattern of exposure to COVID patients within the period of 20 April, 2020 and 20 July, 2020. Respondents were queried regarding job description, workplace exposures, respiratory protection, hospital policy of disease prevention, and extra-occupational activities during duty period. Chi-square test was done and odds ratios for physicians’ infection were calculated. A p-value &lt;0.05 was considered as statistical significant.&#x0D; Results: Increased risk of SARS-CoV-2 infection in physicians was associated with the use of mobile phone during duty hour (OR, 15, 95% confidence interval 1.971 to 121.905, p=0.001), and breech of PPE during doffing (OR, 2.52, 95% confidence interval 0.821 to 7.76, p=0.099). Extra-occupational risk factors included contact with known COVID patient (OR, 5.735, 95% confidence interval 2.072 to 15.872, p=&lt;0.001), and visit any gathering (OR, 1.076, 95% confidence interval 0.412 to 2.81, p=0.881). Physicians worked in roster group (50%) and round group (34.38%) were mostly infected than other facilities.&#x0D; Conclusion: COVID-19 transmissions to physicians was associated with exposure at workplace, breech in PPE during doffing, use of device during round/roster period, extra-occupational exposure to known COVID patients outside the hospital, and visit any gathering. Close monitoring of infection control measures in workplace and increase awareness of the risks of outdoor activities in pandemic situation, may reduce the incidence of infection among physicians.&#x0D; Mugda Med Coll J. 2022; 5(2): 93-97

Construction, evaluation, and AOP framework-based application of the EpPRS as a genetic surrogate for assessing environmental pollutants

BackgroundEnvironmental pollutant measurement is essential for accurate health risk assessment. However, the detection of humans’ internal exposure to pollutants is cost-intensive and consumes time and energy. Polygenic risk scores (PRSs) have been widely applied in genetic studies of complex trait diseases. It is important to construct a genetically relevant environmental surrogate for pollutant exposure and to explore its utility for disease prediction and risk assessment. ObjectivesThis study enrolled 714 individuals with complete genomic data and exposomic data on 22 plasma-persistent organic pollutants (POPs). MethodsWe first conducted 22 POP genome-wide association studies (GWAS) and constructed the corresponding environmental pollutant-based PRS (EpPRS) by clumping and P value thresholding (C + T), lassosum, and PRS-CS methods. The best-fit EpPRS was chosen by its regression R2. An adverse outcome pathway (AOP) framework was developed to assess the effects of contaminants on candidate diseases. Furthermore, Mendelian randomization (MR) analysis was performed to explore the causal association between POPs and cancer risk. ResultsThe C + T method produced the best-performing EpPRSs for 7 PCBs and 4 PBDEs. EpPRSs replicated the correlations of environmental exposure measurements based on consistent patterns. The diagnostic performance of type 2 diabetes mellitus (T2DM) PRS was improved by the combined model of T2DM-EpPRS of PCB126/BDE153. Finally, the AKT1-mediated AOP framework illustrated that PCB126 and BDE153 may increase the risk of T2DM by decreasing AKT1 phosphorylation through the cGMP-PKG pathway and promoting abnormal glucose homeostasis. MR analysis showed that digestive system tumors, such as colorectal cancer and biliary tract cancer, are more sensitive to POP exposure. ConclusionsEpPRSs can serve as a proxy for assessing pollutant internal exposure. The application of the EpPRS to disease risk assessment can reveal the toxic pathway and mode of action linking exposure and disease in detail, providing a basis for the development of environmental pollutant control strategies.

Coronary artery calcium score: we know where we are but not where we may be.

Cardiac computed tomography angiography (CCTA) has emerged as a cost-effective and time-saving technique for excluding coronary artery disease. One valuable tool obtained by CCTA is the coronary artery calcium (CAC) score. The use of CAC scoring has shown promise in the risk assessment and stratification of cardiovascular disease. CAC scores can be complemented by plaque analysis to assess vulnerable plaque characteristics and further refine risk assessment. This paper aims to provide a comprehensive understanding of the value of the CAC as a prognostic tool and its implications for patient risk assessment, treatment strategies, and outcomes. CAC scoring has demonstrated superior ability in stratifying patients, especially asymptomatic individuals, compared to traditional risk factors and scoring systems. The main evidence suggests that individuals with a CAC score of 0 have a good long-term prognosis, while an elevated CAC score is associated with increased cardiovascular risk. Finally, the clinical power of CAC scoring and the development of new models for risk stratification could be enhanced by machine learning algorithms.

Multicriteria Risk Ranking of Zoonotic Diseases in a Developing Country: A Case Study of Zambia

The integration of a multicriteria decision analysis approach, including techniques such as the Analytic Hierarchy Process (AHP) and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), has yielded valuable insights in the realm of zoonotic disease risk assessment. This analytical framework draws from the OIE-supported manual, utilizing impact assessments, transmission pathways, and categorizations as provided by the OIE itself. Moreover, the consideration of specific zoonotic disease scenarios tailored to individual countries enhances the contextual relevance of the analysis. Through this approach, the ranking of zoonotic diseases is systematically established, offering a comprehensive evaluation of their potential impacts and risks. This methodology encompasses pivotal criteria, including prevalence, economic impact, health impact, transmission pathways, and healthcare capacity, collectively offering a holistic perspective that mirrors the intricate nature of zoonotic diseases. The resultant rankings, derived from both ECDC and OIE data, illuminate diseases that harbor significant threats to both human and animal populations. This ranking fosters the identification of diseases with potential for rapid spread and substantial impact, guiding resource allocation towards prevention, control, and mitigation strategies. The alignment between ECDC and OIE rankings underscores the robustness of the applied methodology, with Plague and Zoonotic TB consistently emerging as high-ranking diseases, reinforcing their acknowledged significance. A consolidated ranking, amalgamating data from both sources, provides an insightful overview of potential risks linked to various zoonotic diseases. Plague, Zoonotic TB, Brucellosis, Trypanosomiasis, and Rabies consistently occupy top positions, presenting a valuable instrument for policymakers, public health officials, and stakeholders in prioritizing resource allocation and intervention strategies. The implementation of a multicriteria decision analysis approach, integrating AHP and TOPSIS methodologies, underpins the generation of informed rankings for Zambian zoonotic diseases. The intricate interplay of criteria like prevalence, economic impact, health impact, transmission pathways, and healthcare capacity forms a comprehensive framework for evaluating the potential risks of diverse diseases. The ensuing ranking, led by Plague and succeeded by Anthrax, Rabies, and others, mirrors their collective risk scores calculated via the adopted methodology. This approach empowers strategic decision-making by pinpointing diseases with heightened potential for adverse impacts on both human and animal populations. The rankings serve as invaluable aids in directing resources, devising strategic interventions, and formulating targeted measures for prevention and control. However, acknowledgment of the dynamic disease landscape and the imperative of adaptive strategies underscores the ongoing importance of monitoring and managing zoonotic diseases effectively in Zambia. By amalgamating data from authoritative sources and embracing a systematic, evidence-based approach, this study accentuates the necessity of addressing zoonotic diseases with a holistic lens, fostering proactive perspectives that augment public health and avert future outbreaks.

Endothelial Nitric Oxide Synthase T-786C and G-894T Gene Polymorphisms: A Risk Assessment of Coronary Heart Disease.

The polymorphism of the endothelial nitric oxide synthase (eNOS) gene is thought to enhance the risk of coronary heart disease (CHD). The most protruding reason for endothelial dysfunction is the diminished production of NO. In the eNOS encoding gene, a number of mutations were associated with decreased NO effect promoting the presence of CHD. This study aims to look at the role of polymorphisms in the eNOS genes G-894T and T-786C in young South Indians. From January 2022 to May 2022, 91 angiographically proven CHD subjects attending the Department of Cardiology and Medicine and 91 controls from a master health checkup in the age group of 45 years participated in this observational cross-sectional study at SRM Medical College Hospital and Research Centre in Chennai, Tamil Nadu, India. Overnight fasting plasma samples were taken for analysis of the lipid profile as well as NO by Griess reaction utilizing an enzyme-linked immunosorbent assay (ELISA) technique. Polymerase chain reaction (PCR) and restricted fragment length polymorphism (RFLP) were used to amplify the T-786C and G-894T eNOS genes. When compared to controls, the mean level of serum NO in CHD patients was considerably lower. For eNOS T-786C polymorphism, the distribution of TC genotype (p = 0.017), odds (OD) ratio = 2.1, CC genotype (p = 0.011), OD ratio = 3.75, and minor C allele frequency (p = 0.001). And for eNOS G-894T polymorphism, the distribution of GT genotype (p = 0.01), TT genotype (p =0.02) with OD ratio and minor T allele frequency (p = 0.002) with OD ratio = 1.07 and 0.83. Our study concludes that the polymorphism of eNOS T-786C and G-894T genes may be the main causative association for the presence of CHD. How to cite this article: Jaishankar T, Shivasekar M, Vinodhini VM. Endothelial Nitric Oxide Synthase T-786C and G-894T Gene Polymorphisms: A Risk Assessment of Coronary Heart Disease. J Assoc Physicians India 2023;71(9):45-50.

Assessment of Atherosclerotic Cardiovascular Disease Risk in Hypertensive Patient at Dhulikhel Hospital

Introduction: Cardiovascular disease is the leading cause of death worldwide and the burden of which is rising in low and middle-income countries. Atherosclerotic cardiovascular disease risk scoring is a part of treatment guideline for hypertension and dyslipidemia management.&#x0D; Aims: This study is carried out to for the assessment of atherosclerotic cardiovascular disease risk among hypertensive patient.&#x0D; Methods: Hypertensive patients presenting to outpatient department were assessed for atherosclerotic cardiovascular disease risk and the 10 years risk score calculation was done using American College of Cardiology/ American Heart Association pooled cohort equation.&#x0D; Results: Out of total 212 patients 103 were male and 109 were female. 70 (33.02%) patients were smoker. The average systolic BP was 152 ± 18 mm Hg. Out of all hypertensive patients 164(77.36%) were receiving treatment and 48(22.64%) were newly diagnosed. Total of 76 (35.8%) patients were diabetic, 14 newly diagnosed. Total cholesterol was in the range of 367 mg /dl to 68mg/dl with mean 190 ±35mg/dl. HDL cholesterol range was 15 mg/dl to 78mg/dl with mean 42 ± 12 mg /dl. 10 years atherosclerotic cardiovascular disease risk was &lt; 5% in 51(24.06%), 5 to &lt; 7.5% in 34(16.04%), 7.5 to &lt; 10% in 68(32.08%), 10 to &lt;15% in 35(16.51%) and &gt;15 % in 24(11.32%).&#x0D; Conclusion: From this study we can conclude that atherosclerotic cardiovascular disease risk among hypertensive population is considerable and risk score calculation should be a part of patient evaluation so that they can be managed appropriately and the future cardiovascular events can be prevented.