CI Of Odds Ratio Research Articles

The causal relationship of serum uric acid on colorectal cancer: A Mendelian randomization study.

Colorectal cancer (CRC) is a significant public health issue owing to its widespread occurrence and substantial morbidity and mortality rates. Recent studies have highlighted serum uric acid (SUA) level as a probable risk factor for CRC; however, the inconsistency in these findings has created doubt. We performed a Mendelian randomization (MR) study utilizing extensive cohort data from the UK BioBank and the NHGRI-EBI Genome-Wide Association Study (GWAS) Catalog to investigate the causal connection between SUA levels and CRC incidence. Our MR study addresses the constraints of earlier studies, including limited sample sizes and inconsistent results. Considering SUA levels as the exposure and CRC as the outcome, the inverse variance-weighted (IVW) approach in MR showed that the odds ratios (ORs) for CRC for each unit increase in SUA were 0.232 (95% confidence interval [CI] of OR 0.094-0.570; P = .001) and 0.551 (95% CI of OR 0.325-0.934; P = .027). Pleiotropic tests and sensitivity analysis confirmed minimal horizontal pleiotropy and the robustness of causality. Our research deepens the understanding of the association between SUA levels and CRC, offering insights into prevention strategies and patient outcomes prediction.

Relationship between metabolic syndrome and depression: A study based on Rafsanjan Youth Cohort Study

BackgroundDepressed people are susceptible to metabolic syndrome ression and metabolic syndrome in the Rafsanjan Youth Cohort Study in 2021. MethodsIn this cross-sectional study, the data of 3005 young people aged 15–35 under the coverage of urban and rural health centers was investigated in the enrollment stage of the Rafsanjan Youth Cohort Study as a part of the prospective epidemiological research studies in IrAN (PERSIAN). Data was collected using face-to-face interview and electronic questionnaires of the Rafsanjan Youth Cohort Study. ResultsAge of the youth was 25.78 ± 6.06 years, 56 % (n = 1682) were female. The prevalence of metabolic syndrome (MetS) was 7.7 % (95 % CI: 6.8 %–8.8 %) and the prevalence of depression was 11.1 % (95 % CI: 10.0 %–12.3 %). Depression did not have a significant impact on the odds ratio of developing MetS in young people (P = 0.604). The odds ratio (OR) of MetS increases by 1.057 times with increasing age (95 % CI for OR: 1.020–1.094). This OR is also 1.715 times higher in married young people than in unmarried Youth (95 % CI for OR: 1.715–2.692) and 0.196 times lower in young people with medium and high MET index than in young people with low MET index (95 % CI for OR: 0.048–0.811). LimitationsInability to determine a causal relationship between MetS and depression. ConclusionDue to the growing trend of components of MetS among the young population, this issue needs to be addressed in future policies and planning for prevention and control as a health priority.

РЕГУЛЯЦИЯ СИСТЕМНОГО ВОСПАЛИТЕЛЬНОГО ОТВЕТА У ПАЦИЕНТОВ С МУЛЬТИФОКАЛЬНЫМ АТЕРОСКЛЕРОЗОМ

Introduction. Data on the role of inflammation in the progression and manifestation of multifocal atherosclerosis (MFA) are contradictory. The systemic process of multiple lesions of different vascular beds in patients with an established diagnosis of coronary heart disease (CHD) is due to several parallel pathological mechanisms. In general, in the pathogenesis of both coronary atherosclerosis and atherosclerosis of peripheral arteries, one of the factors is the variability of immune response genes and cytokines, regulators of the inflammatory response. The aim of this work was to determine the role of variability in the genes of cytokines and innate immune response receptors in the structure of mechanisms associated with the development of MFA in patients with coronary artery atherosclerosis. Materials and methods. 260 patients with CAD (mean age 58 years) were examined. Of all those included in the study, at the time of the survey, MFA was found in 180 people (69.23%), while the incidence of MFA in men and women is comparable (70.33 vs. 64.71%, respectively). There is also no significant difference in the incidence of MFA in the two age groups (up to 60 years, 45% have lesions of two or more vascular beds, and in people older than 60 years, MFA was found in 55% of cases). All patients were informed about the course of the study and voluntarily signed an informed consent. Blood was collected from the cubital vein into Vacutainer tubes with K3EDTA. DNA isolation was carried out using the phenol-chloroform extraction method. Genotyping of 47 polymorphic sites with a single nucleotide change (SNV) of 19 genes proven to be associated with the regulation of the systemic inflammatory response (cytokines, innate immunity receptors) was performed in a 96-well format using TaqMan technology (LifeTechnologies, USA) and real-time result detection with using the ViiATM 7 RealTime PCR System (LifeTechnologies, USA) for polymerase chain reaction in accordance with the instructions. Associations were analyzed using Snpstats (https://www.snpstats.net/start.htm). Odds ratio (OR) and 95% CI for OR were calculated for risk assessment. Results. One association has been established that demonstrates a negative impact and increases the risk of developing MFA in young and middle age. Carriage of the G rs11685424 IL1RL1 allele increases the risks of earlier development of peripheral arterial lesions by 2 times (OR 2.11 (95% CI 1.09-4.06), p = 0.024) according to the recessive inheritance model. At the same time, variability in three sites (rs1974675; rs6758936; rs3755276) of the IL18 receptor gene (IL18R1) reduces the risk of MFA detection by three times (p=0.12; p=0.034: p=0.026, respectively) and this pattern is also observed in patients older age group. In the carriers of the A/A rs1974675, T/T rs3755276 and A/A rs6758936 genotypes in persons over 60 years of age, MFA was diagnosed less frequently (p=0.024; p=0.037; p=0.011, respectively). Conclusion. It has been shown that in patients with significant coronary atherosclerosis, the progression of peripheral vascular atherosclerosis is more associated with the variability of the genes responsible for the regulation of the systemic inflammatory response, rather than genes and their variants that determine the severity and strength of the immune response.

Risk Factors for Adjacent Segment Disease in Short Segment Lumbar Interbody Fusion-A Case Series.

Adjacent segment disease (ASD) is a common problem after lumbar spinal fusions. Ways to reduce the rates of ASD are highly sought after to reduce the need for reoperation. To find predisposing factors of ASD after lumbar interbody fusions, especially in mismatch of pelvic incidence and lumbar lordosis (PI-LL). We conducted a retrospective cohort study of all patients undergoing lumbar interbody fusions of less than 4 levels from June 2015 to July 2020 with at least 1 year of follow-up and in those who had obtained postoperative standing X-rays. We found 243 patients who fit inclusion and exclusion criteria. Fourteen patients (5.8%) developed ASD, at a median of 24 months. Postoperative lumbar lordosis was significantly higher in the non-ASD cohort (median 46.4° ± 1.4° vs 36.9° ± 3.6°, P < .001), pelvic tilt was significantly lower in the non-ASD cohort (16.0° ± 0.66° vs 20.3° ± 2.4°, P = .002), PI-LL mismatch was significantly lower in the non-ASD cohort (5.28° ± 1.0° vs 17.1° ± 2.0°, P < .001), and age-appropriate PI-LL mismatch was less common in the non-ASD cohort (34 patients [14.8%] vs 13 [92.9%] of patients with high mismatch, P < .001). Using multivariate analysis, greater PI-LL mismatch was predictive of ASD (95% odds ratio CI = 1.393-2.458, P < .001) and age-appropriate PI-LL mismatch was predictive of ASD (95% odds ratio CI = 10.8-970.4, P < .001). Higher PI-LL mismatch, both age-independent and when adjusted for age, after lumbar interbody fusion was predictive for developing ASD. In lumbar degenerative disease, correction of spinopelvic parameters should be a main goal of surgical correction.

Cervical Cancer Screening in Women Aged Older Than 65 Years.

Considerable debate exists among guidelines regarding when cervical cancer screening can be safely stopped. The authors aimed to compare the efficiency of human papillomavirus (HPV) test, cytology, and previous screening history for the diagnosis of cervical intraepithelial neoplasia (CIN) 2+ lesions in women aged older than 65 years. This is a retrospective cohort study. Multiple logistic regressions were used to compare the efficiency of the HPV test, cytology, and previous screening history for the diagnosis of histologically proven CIN 2+ lesions. A total of 5,427 women were included in the study. A total of 2,143 women were tested with HPV and 52 (2.4%) of them were HPV-positive. Abnormal cytology was detected in 359 (6.6%) women. Most of the women (70.4%) had inadequate screening in the previous 10 years. According to regression analysis, an HPV-positive test increases the risk of probability of CIN 2+ 136.111 times [95% CI for odds ratio (OR) = 41.212-449.538] compared with an HPV-negative test ( p < .001). Abnormal cytology increases the probability of CIN 2+ 13.072 times (95% CI for OR = 3.878-44.062) compared with normal cytology ( p < .001). Inadequate or positive previous screening increases the likelihood of CIN 2+ 9.705 times (95% CI for OR = 1.603-58.756) compared with adequate and negative previous screening ( p = .013). Adequate previous screening is a valuable strategy, and abnormal cytology is an important screening test in women aged older than 65 years. However, the HPV test is the most determinant parameter for CIN 2+ risk in elderly women.

Remain or return? An empirical study of influencing factors on the return of Chinese international students during the COVID-19 pandemic.

COVID-19 is now a global public health crisis with unprecedented political, economic, and social consequences affecting nations across the world. It also has a profound impact on the mobility of international students. When the COVID-19 was under control in China, and it was spreading dramatically in the United Kingdom, Chinese international students studying in the United Kingdom have been caught in a double bind over whether to return home or not. This study aims to explore the factors that influenced Chinese international students' choices of return during the COVID-19 pandemic when the COVID-19 was under control in China, while it was spreading dramatically in the United Kingdom. Taking Chinese international students studying in the United Kingdom as an empirical case, this study used qualitative and quantitative research methods to explore the factors that influenced their choices of return. Based on the Rational Choice Theory and qualitative analysis of text data, this paper constructed the influencing factors model of returning to China. On this basis, we developed a questionnaire and collected data from 1,333 students in late April and early May 2020. Binary Logistic Regression with 95% CI for odds ratio (OR) was used to identify significant factors. The reserve of epidemic prevention supplies (OR = 0.712), transportation expenses (OR = 0.618), and quarantine expenses (OR = 0.702) negatively affected the return choice of overseas students. The supply of daily necessities (OR = 1.495), the anti-epidemic policy of the United Kingdom (OR = 1.684), and the demand for job hunting after graduation (OR = 1.661) had positive effects. The institutional rationality had the biggest promoting effect, replaced development rationality, and became the most important factor for overseas students to return to China during the COVID-19 pandemic. Economic rationality, which has a significant negative effect, is the biggest obstacle to returning home. These conclusions have policy implications for governments' response to the COVID-19 epidemic and improvement of the quality of services for overseas students.

Uptake of cervical cancer screening and its predictors among women of reproductive age in Gomma district, South West Ethiopia: a community-based cross-sectional study

BackgroundCervical cancer is a public health challenge despite the available free screening service in Ethiopia. Early screening for cervical cancer significantly improves the chances of successful treatment of pre-cancers and cancers among women of reproductive age. Therefore, this study aimed to assess the uptake of screening and identify the factors among women of reproductive age.MethodsA community-based cross-sectional study was conducted in Gomma Woreda, Jimma Zone, Ethiopia, from 1st to the 30th of August, 2019. The total sample size was 422. A systematic random sampling technique was employed. Data were collected using a structured questionnaire, entered in epidata, and exported and analyzed using SPSS version 20.0 software packages. Descriptive, bivariate and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were performed to declare a significant predictors.ResultA total of 382 study participants were involved with a response rate of 90.5%. The mean age of the study participants was 26.45 ± 4.76 SD. One hundred forty-eight (38.7%) of participants had been screened for CC. Marital status (AOR = 10.74, 95%, CI = 5.02–22.96), residence (AOR = 4.45, 95%, CI = 2.85–6.96), educational status (AOR = 1.95, 95% CI = 1.12–3.49), government employee (AOR = 2.61, 95%, CI = 1.33–5.15), birth experience (AOR = 8.92, 95% CI = 4.28–19.19), giving birth at health center and government hospitals (AOR = 10.31, 95% CI = 4.99–21.62; AOR = 5.54, 95% CI = 2.25–13.61); distance from health facility (AOR = 4.41, 95% CI = 2.53–9.41), health workers encouragement (AOR = 3.23, 95% CI = 1.57–6.63), awareness on cervical cancer (AOR = 0.37, 95% CI = 0.19–0.72), awareness about CC screening (AOR = 4.52, 95%, CI = 2.71–7.55) and number of health facility visit per year (AOR = 3.63, 95%, CI = 1.86–6.93) were the predictors for the uptake of cervical cancer screening.ConclusionThe uptake of cervical cancer screening was low. Marital status, residence, occupation, perceived distance from screening health facility, health workers encouragement, number of health facility visits, birth experience, place of birth, and knowledge about cervical cancer screening were the predictors. There is a need to conduct further studies on continuous social and behavioral change communication.

Impact of COVID-19 on Health Seeking Behavior of Patients with Chronic Disease at Public Hospitals in Jimma Zone, South West Ethiopia.

BackgroundCOVID-19 is a global pandemic with unprecedented medical, economic and social consequences affecting nations across the world. This epidemic arises while chronic diseases are continued to be a public health concern. Though evidence is generated on its impact on the health care system, little is known about the Impact of COVID −19 on the care-seeking behavior of chronic patients.ObjectiveTo assess the Impact of COVID-19 on healthcare-seeking behavior of patients with chronic diseases attending follow-up at public hospitals in Jimma zone, South West Ethiopia.MethodsFacility-based cross-sectional study design was employed. The sample was calculated using the single population proportion formula. Hospitals were selected by using simple random sampling. Then, the final calculated sample size for the study was proportionally allocated to each selected hospital. Data were collected from 400 participants through face-to-face interviews and card reviews. Data were entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. Binary and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were used to identify significant factors.ResultsOf the total respondents 156 (39.0%) of them had poor health-seeking behavior. Contact history with COVID −19 patient (AOR = 2.8; 95% CI = 1.1–7.0), perceived moderate depression (AOR = 2.3; 95% CI = 1.2–4.2), perceived extreme depression (AOR = 4.3; 95% CI = 1.8–10.5), shortage of medication (AOR = 2.4; 95% CI = 1.0–6.2) increases the odds of poor health-seeking behavior. In addition, the odds of poor health-seeking in patients with no formal education were higher compared to patients with higher educational status (AOR = 2.7; 95% CI = 1.0–9.0).ConclusionCOVID −19 outbreaks affected the health-seeking behavior of patients with chronic diseases. The impact was found to be more significant among patients who had a contact history with COVID −19 patients. Moreover, perceived depression, shortage of medication, and low educational status were significant predictors of poor health-seeking behavior. Therefore, working on the barriers to the health-seeking behavior of chronic patients may reduce the effect of COVID-19.

Delay in Reaching Institutional Delivery Service Utilization among Mothers Attending Jimma Medical Center, Ethiopia.

Maternal delay in the utilization of delivery services is one of the contributing factors for high maternal mortality in developing countries. However, it is preventable by timely arrival for obstetric care. The difference between life and death in obstetrics might be a matter of timely arrival and management. The objective of this study was to assess factors associated with maternal delay in reaching institutional delivery service utilization among mothers attending Jimma Medical Center. Facility-based cross-sectional study design was employed. The sample size was determined by a single population proportion formula and entered into epi data version 3.1, then exported to SPSS version 23. The data was presented using texts and tables. Binary and multivariable logistic regression analysis with 95% CI for odds ratio (OR) was used to assess the factors. The prevalence of maternal delay in reaching institutional delivery service utilization was 163(40.2%). Low husbands' educational levels were significantly associated with delay in reaching: illiterate (AOR=4.22, 95% CI: 1.10-16.19), primary (AOR=3.88, 95% CI: 1.24-12.1). Mothers who live in rural areas have been delayed 2 times more than mothers who live in urban areas (AOR=2.22, 95% CI: 1.044-4.73). Likewise, mothers who live a long distance from health facilities are 13 times more likely to delay than mothers who live ≤ 10 kilometers (AOR= 12.89,95%CI:6.66-24.94). Delay in reaching institutional delivery service was high. Factors such as husband's education, distance of health facility, and living area were significant factors with delay in reaching.

Parent-adolescent discussion about reproductive health issues and associated factors among parents in Debre Markos town, Northwest, Ethiopia: a cross-sectional study.

Introductionadolescence is a transition phase from being a child to an adult. Open positive parent-adolescent communication on reproductive health issues has many positive effects on adolescents, families, and society.Methodsa community-based cross-sectional study design was employed, and a multistage sampling technique was used. Data were collected through face-to-face interviews with pre-tested structured questionnaires. After data collection, data were coded and entered using Epi data version 3.1 and analysed using SPSS version 25 statistical software. Binary logistic regression analysis was used to ascertain the association between explanatory variables and the outcome variable. Variables with a P value less than 0.25 in the bivariable analysis and P-value < 0.05 in the multivariable analysis and corresponding 95% CI of odds ratio were considered to declare a result as statistically significant.Resultsthis study has revealed parent-adolescent discussion on reproductive health issues was 55.2%. Age 45-54 (AOR=2.37, 95% CI: 1.28-4.39) and 55-64 (AOR=2.54, 95% CI: 1.15-5.56) years, male parents (AOR= 0.51, 95% CI: 0.29-0.89) and monthly income above 158 USD (AOR=3.31, 95% CI: 1.79-6.12) were statistically significant.Conclusionmore than half of the parents discuss reproductive health issues with adolescents. Age 45-54 and 55-64 years, male parents, and higher incomes were the factors that allowed parent-adolescent discussion on reproductive health issues.

POSA364 Inequity in Health-Related Quality of Life Among Chinese Patients with Hip Fracture

The study aimd to investigate inequity in health-related quality of life (HRQoL) among Chinese patients with hip fracture across different socioeconomic groups. Data was from the 2013, 2015 and 2018 three waves of the China Health and Retirement Longitudinal Study, a nationwide longitudinal survey. Participants were asked if they had a clinically diagnosed hip fracture since the last intervie. HRQoL was evaluated in each wave, including depression, body pain, physical activity, and activity of daily living (ADL). Demographic and socioeconomic information including age, sex, income, educational level, marital status and residence of participants was collected. The t-test, chi-square test and pooled regression were conducted and a two-tailed p-value of 0.05 was considered statistically significant. A total of 375 participants were included with a mean age of 62.21 years and 50.27% of them were male. HRQoL in all domains in patients after the fracture were significantly lower than their HRQoL before fracture. Among all included factors, age and education level were found with significant impact on all HRQoL domains. Patients with higher school education had a lower level of depression (95% confidence interval, CI, of β: -3.59 to -1.43), higher basic ADL (95% CI of β: -2.05 to -1.07), higher instrumental ADL (95% CI of β: -1.74 to -1.15), higher ability of physical activity (95% CI of β: -3.68 to -2.04) and lower prevalence of body pain (95% CI of odds ratio: 0.30 to 0.57). On the contrary, an older age was negatively associated with HRQoL (p<0.05). Hip fracture had a negative impact on all aspects of HRQoL in Chinese patients irrespective of their socioeconomic status. Marked disparities of HRQoL are evidenced across patients with different school education levels and ages.

Phase 2 Study of Carfilzomib in Combination with Induction Chemotherapy in Children with Relapsed or Refractory (R/R) Acute Lymphoblastic Leukemia (ALL)

Phase 2 Study of Carfilzomib in Combination with Induction Chemotherapy in Children with Relapsed or Refractory (R/R) Acute Lymphoblastic Leukemia (ALL)

Moderate Alcohol Consumption Predicts Tobacco Use And Illicit Drug Abuse: Implications For Health Screening

The health and harm of alcohol consumption has been long debated. In recent decades, multiple epidemiological analyses have demonstrated a strong correlation between moderate consumption and a reduced risk of myocardial infarction, peripheral vascular disease, and ischemic stroke. While moderation may confer a cardiovascular protective effect, the same cannot be said of alcohol abuse, cigarette smoking, and illicit drug use. PURPOSE: To test the predictive power of moderate alcohol use on alcohol abuse and the use of cigarettes and illicit drugs. METHODS: We analyzed the registry of a U.S. hospital in an urban-suburban setting, consisting of 2,306 patients admitted over a 5-year period. At intake, demographic and health data were recorded, including alcohol, tobacco, and illicit drug use, and previous histories thereof. Blood alcohol content (BAC) and toxicology screens were administered to patients suspected of current alcohol or drug use. Logistic regressions tested the effects of alcohol consumption on alcohol abuse, smoking status, and use of illicit drugs. RESULTS: Patients were 52.1 ± 22.4 years of age, 56.0% were men, 11.8% were currently using alcohol (BAC of 0.05 ± 0.10), 5.7% had a history of alcohol abuse, 25.8% reported regular smoking, 5.0% had a history of illicit drug use, and 27.1% had a positive toxicology screen. Holding potential confounders constant, logistic regression found current alcohol use to predict a 13.5-fold increase in the odds of alcohol abuse (p < 0.001; 95% CI of odds ratio: 8.96 to 20.27), a 213% increase in the odds of smoking (p < 0.001; 95% CI of odds ratio: 1.63 to 2.79), and a 209% increase in the odds of illicit drug use (p < 0.001; 95% CI of odds ratio: 1.34 to 3.27). A history of alcohol abuse predicted a 428% increase in the odds of smoking (p < 0.001; 95% CI of odds ratio: 2.95 to 6.22) and a 783% increase in the odds of illicit drug use (p < 0.001; 95% CI of odds ratio: 4.82 to 12.72). CONCLUSIONS: While some cardiovascular benefits correlate with moderate alcohol consumption, there may be a paradoxical effect whereby its association with high-risk behaviors (i.e., smoking and illicit drug use) leads to health detriments in a large subset of drinkers. Accordingly, it might be prudent to consider more than cigarette exposure in pre-exercise health screening practices.

Changes in lipidomic profile by anti-retroviral treatment regimen: An ACTG 5257 ancillary study.

High cardiovascular disease risk in people living with HIV is partly attributed to antiretroviral therapy (ART). Lipid response to ART has been extensively studied, yet, little is known how small molecule lipids respond to Integrase inhibitor-based (INSTI-based) compared to Protease inhibitor-based (PI-based) ART regimens.Ancillary study to a phase 3, randomized, open-label trial [AIDS Clinical Trial Group A5257 Study] in treatment-naive HIV-infected patients randomized in a 1:1:1 ratio to receive ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r) (both PI-based), or raltegravir with Tenofovir Disoproxil Fumarate-TDF plus emtricitabine (RAL, INSTI-based).We examined small molecule lipid response in a subcohort of 75 participants. Lipidomic assays of plasma samples collected pre- and post-ART treatment (48 weeks) were conducted using ultra-performance liquid chromatography coupled to time-of-flight mass spectrometry. The effect of ART regimens was regressed on lipid species response adjusting for the baseline covariates (lipids, age, sex, race, CD4 level, BMI, and smoking). Results were validated in the Centers for AIDS Research Network of Integrated Clinical Systems study (N = 16).Out of 417 annotated lipids, glycerophospholipids (P = .007) and sphingolipids (P = .028) had a higher response to ATV/r and DRV/r compared to RAL. The lysophosphatidylcholine (LPCs(16:1),(17:1),(20:3)) and phosphophatidylcholine species (PCs(40:7),(38:4)) had an opposite response to RAL versus ATV/r in the discovery and validation cohort. The INSTI-based regimen had an opposite response of ceramide species ((d38:1), (d42:2)), PCs((35:2), (38:4)), phosphatidylethanolamines (PEs(38:4), (38:6)), and sphingomyelin(SMd38:1) species compared with the PI-based regimens. There were no differences observed between 2 PI-based regimens.We observed differences in response of small molecule lipid species by ART regimens in treatment-naive people living with HIV.

Pre-transplantation plasma vitamin D levels and acute graft-versus-host disease after myeloablative hematopoietic cell transplantation in adults

BackgroundThe association between vitamin D and acute graft-versus-host disease (GvHD) remains controversial, especially for patients receiving myeloablative conditioning. MethodsWe measured pre-transplantation plasma vitamin D (25-hydroxyvitamin D3 + D2) levels by competitive electrochemiluminescence in plasma samples from 116 adult patients who underwent a myeloablative allogeneic transplantation at Rigshospitalet, Copenhagen between July 2015 and August 2018. ResultsThe median (Q1, Q3) pre-transplantation plasma vitamin D level was 64 (47, 85) nmol/L (normal range: 50–160 nmol/L). Vitamin D insufficiency (<50 nmol/L) and moderate deficiency (<25 nmol/L) were observed in 29% and 8% of patients, respectively. No patients had a severe deficiency (<12 nmol/L). Pre-transplantation vitamin D levels were slightly higher in patients who later developed grade II–IV acute GvHD (mean difference: 8.1 nmol/L), but the 95% confidence interval [CI] encompassed clinically insignificant differences (CI: −2.2, 19.2 nmol/L). From multivariable logistic regression, we found that a patient with a pre-transplantation vitamin D level of 85 nmol/L (Q3) had 1.5 times higher odds of grade II–IV acute GvHD than a patient with a level of 47 nmol/L (Q1; CI of odds ratio: 0.84, 2.7; adjusted for patient age, donor type, use of anti-thymocyte globulin, and use of 12 Gy total-body irradiation). Patients with pre-transplantation vitamin D insufficiency (N = 34) had a cumulative incidence of grade II–IV acute GvHD similar to that of patients with vitamin D sufficiency (26% [CI: 11%, 42%] versus 35% [CI: 25%, 46%], respectively). ConclusionsOur data did not support an association between pre-transplantation vitamin D levels or vitamin D insufficiency and acute GvHD in adult patients receiving myeloablative conditioning.

Delay in Seeking Institutional Delivery Service Utilization and Associated Factors Among Mothers Attending Jimma Medical Center, Jimma, Ethiopia.

BackgroundPregnancy and childbirth-related complications are unpredictable; however, it is preventable by timely care-seeking to obstetric care service.ObjectiveTo assess delay in seeking institutional delivery service utilization and associated factors among mothers attending Jimma medical center, Southwest Ethiopia.MethodsFacility-based cross-sectional study design was employed. The sample size was determined by a single population proportion formula. Data were collected from 405 mothers by face-to-face interview and entered using epi-data version 3.1, then exported to SPSS version 23 for analysis. Binary and multivariable logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors.ResultsThe prevalence of delay in seeking institutional delivery service utilization was 189 (46.7%). Husbands’ educational status was found to be significantly associated with a maternal delay in seeking care, (AOR= 4.9; 95% CI=2.1–11.3). Unemployed mothers and mothers with a low income had shown higher odds of delay (AOR= 6.0; 95% CI=1.7–21.2), (AOR=2.1; 95% CI=1.2–3.7) respectively. Similarly, mothers who live >10 kilometers from health facility delayed about 2times, (AOR=1.8; 95% CI= 1.0–3.2). Moreover, the likelihood of mothers with no antenatal care follow-up was found to have higher delay than mothers who have antenatal care follow-up (AOR =2.8; 95% CI =1.1–6.7).ConclusionDelay in seeking institutional delivery service was high. Factors such as the husband’s educational status, distance from the health facility, income, Antenatal care follow-up, and occupation of the mother were found significant factors of delay in seeking care. Therefore, it is important to reduce delay in seeking care for institutional delivery service utilization by working on barriers, plus empowering women, promoting antenatal care, and education.

Risk of heart failure depending on the structure and subclinical target organ damage in patients with hypertension

Aim. To determine the risk of heart failure (HF) in patients with hypertension (HTN) depending on the structure of subclinical target organ damage (TOD). Material and methods. The study included 234 patients with HTN without signs of HF. The mean age was 45,96±8,54 years. The patients underwent echocardiography with an assessment of myocardial mass index, ejection fraction, left ventricular diastolic function. Volumetric sphygmoplethysmography with determination of cardio-ankle vascular index (CAVI1) and carotid-femoral pulse wave velocity (PWVcf). Cystatin C blood concentration with the calculation of the glomerular filtration rate (GFR) was performed. NT-proBNP blood levels was also determined. Patients were divided into 4 groups depending on the presence and structure of subclinical TOD. The first group consisted of 74 (31,6%) patients without documented subclinical TOD; the second group — 99 (42,3%) patients with one subclinical TOD; the third group — 42 (18,0%) patients with two TOD; the fourth group -19 (8,1%) patients with three TOD. Results. Patients in the groups differed significantly in blood NT-proBNP concentration (p&lt;0,001). As the amount of TOD increased, NT-proBNP increased above the reference value 125 pg/ml (p=0,010). The odds ratio (OR) and relative risk (RR) of HF, determined by NT-proBNP concentration &gt;125 pg/ml, were significantly associated with the TOD structure compared to the group without confirmed TOD (p=0,035, p=0,21, p=0,044, respectively). Correlation analysis revealed direct relationships between the NT-proBNP level and TOD amount (r=0,56; p&lt;0,005), LVH (r=0,33; p&lt;0,005), cystatin C level (r=0,31; p&lt;0,005), CAVI1 and PWVcf (r=0,23; p&lt;0,005 and r=0,26; p&lt;0,005, respectively). Conclusion. The risk of HF in patients with hypertension depends on the presence and structure of subclinical TOD. With the involvement of one target organ, OR and RR for HF were 4,23 and 3,74, respectively (95% CI for OR, 1,09-19,19; for RR, 1,08-16,03); with the involvement of two target organs — 5,57 (95% CI, 1,2328,51) and 4,70 (95% CI, 1,21-21,84), respectively; with the multiple TOD — 6,31 (95% CI, 1,4-40,83) and 5,19 (95% CI, 1,04-27,95), respectively.

Efficacy of immunosuppressive therapy in myocarditis: A 30-year systematic review and meta analysis.

Myocarditis is an inflammation of the heart muscle, due to infectious, toxic or autoimmune causes. Literature reported controversial results in relation to the effect of immunosuppression (IS)/immunomodulation (IM). We aimed at assessing the effect of IS/IM by meta analysis. Using the P.R.I.S.M.A. approach, two researchers searched for relevant studies on PubMed, Embase, and the Central Registry of Controlled Trials of the Cochrane Library. Proposed MeSH terms were: "immunotherapy OR immune therapy OR immune modeling OR Immunosuppressive Agents" AND "combination OR combined with OR plus" AND "myocarditis OR cardiomyopathies OR inflammatory cardiomyopathy". The language was restricted to English. Reference lists of included articles and those relevant to the topic were hand searched for the identification of additional, potentially relevant articles. The cutoff date was from 1987 until 30th Nov 2019. Reported survival or mortality events or change of left ventricular ejection fraction (LVEF) after IS/IT were primary outcomes of the study; in addition, improvement of New York Heart Association class, follow-up biopsy (Bx) findings, viral genome clearance on Bx and recurrence of myocarditis were recorded if reported. Statistical analysis was conducted using Review Manager 5.3; 5452 studies were screened, of these 73 were assessed for eligibility, including 8 randomized control studies, 26 retrospective studies, 2 prospective studies and 1 case control study, 34 case reports and 2 case series. In prospective studies, the difference in mortality between the IS and control groups tended to be lower in the combined IS groups (12.5% vs. 18.2%) (95% CI of odds ratio 0.7(0.3, 1.64)) and the pooled difference of the increase of LVEF between the IS and control groups tended to be higher in the combined IS groups (95% CI 7.26 (-2.29, 16.81)). In retrospective studies, the difference of survival between the IS and control group was significantly in favor of IS (95%CI Hazard ratio 0.82(0.69, 0.96)). A tailored IS may be considered in myocarditis, depending on the phase of the disease, and the type of underlying autoimmune or immune-mediated form.

EPID-27. THE VANISHING TUMOR PHENOMENON IN THE DIAGNOSIS OF PRIMARY CNS LYMPHOMA

Abstract INTRODUCTION Steroid is commonly initiated for newly recognized brain tumors. For primary CNS lymphoma (PCNSL), however, its lympholytic effect can partially treat the tumor and obfuscate the surgical-pathological diagnosis needed to initiate chemotherapy. Evidence for this remains controversial. In this study we investigated the incidence of the vanishing tumor phenomenon and its association with steroid use. METHODS Patients &amp;gt; age 18 with PCNSL were identified from January 1, 2000 to April 30, 2020 within the University of Michigan Health System. Clinic and operative notes, pathology, imaging, and lumbar puncture results were reviewed. Inclusion required histopathologic diagnosis from brain tissue, cerebrospinal fluid, or autopsy, including diagnosis on repeat biopsy. Patients with prior/concurrent systemic lymphoma, HIV, organ transplant, or diagnosis established from primary ocular disease were excluded. Date(s) of biopsy, steroid initiation, and recurrence (by imaging) were abstracted. We defined vanishing tumor as a lesion whose radiographic improvement or disappearance resulted in deferred or nondiagnostic biopsy, with later confirmation of PCNSL. Steroid use and vanishing tumor were modeled using univariable logistic regression. RESULTS We identified 162 cases of PCNSL, of which 103 patients (63.6%) received steroids prior to biopsy. Twenty-three had vanishing tumor: 11 with deferred biopsies, 12 with non-diagnostic biopsies. Twenty-two of the 23 received steroid. Mean cumulative dose, in dexamethasone equivalents, was 555 + 704 mg prior to nondiagnostic/deferred biopsy (N=17) compared to 186 + 376 mg prior to successful biopsy (N=76) (Wilcoxon p&amp;lt; .001). Median time to recurrence after deferred or non-diagnostic biopsy (N=21) was 53 days (range: 8–648); two cases never recurred. Steroid use increased the risk of vanishing tumor by 14% per 100 mg dexamethasone equivalent (95% CI of odds ratio [1.03–1.29], p=0.02). CONCLUSION Vanishing tumor phenomenon is common in PCNSL, delays diagnosis, and is driven by steroid use.

Maternal Depressive Symptoms, Lung Function, and Severe Asthma Exacerbations in Puerto Rican Children

Maternal depression has been linked to health care use for asthma in cross-sectional or short-term follow-up studies of school-aged children. To examine whether increased or persistent maternal depressive symptoms over approximately 5 years are associated with severe asthma exacerbations or worse lung function in youth. A prospective study of 386 youth living in Puerto Rico, aged 6 to 14 years at a baseline visit and 9 to 20 years at a second visit, was performed. Our exposure of interest was change in persistence of maternal depressive symptoms, assessed at both visits using the Center for Epidemiologic Studies Depression Scale (CESD). Our outcomes of interest were change in percent predicted forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) between the first and second visits in all subjects, and ≥1 severe asthma exacerbation in the year before the second visit in subjects with asthma. In a multivariable analysis, each 1-point increment in the CESD score was associated with decrements of 0.15% in percent predicted FEV1 (95% confidence interval [CI]=-0.28% to-0.01%; P= .03) and 0.10% in percent predicted FEV1/FVC (95% CI=-0.20% to 0.001%; P= .05) between visits, as well as with 1.03 times increased odds of ≥1 severe asthma exacerbation at the second visit (95% CI for odds ratio= 0.99 to 1.06, P= .09). In a multivariable analysis, the presence of maternal depressive symptoms (a CESD score ≥21 points) at the second visit or at both visits was significantly associated with 3.17 to 3.52 times increased odds of ≥1 severe asthma exacerbation in the year before the second visit. Increasing or persistent maternal depressive symptoms over approximately 5 years are associated with worse lung function measures and severe asthma exacerbations among Puerto Rican youth, a high-risk population.