Confidence Interval Research Articles

Investigating the causal impact of gut microbiota on arthritis via inflammatory proteins using mendelian randomization

Previous studies have suggested a potential association between the gut microbiota and arthritis. However, the causal links between the gut microbiota and various types of arthritis, as well as the potential mediating role of inflammatory proteins, remain unclear. Mendelian randomization was used to explore the causal relationships between gut microbiota, inflammatory proteins, and various forms of arthritis (osteoarthritis, rheumatoid and psoriatic arthritis, and ankylosing spondylitis [AS]). The inverse variance-weighted method was the primary analytical approach used. Furthermore, we examined the mediating role of inflammatory proteins in the pathway linking the gut microbiota to arthritis. Sensitivity analyses were performed to verify the robustness of the findings, and enrichment analyses were conducted to investigate the biological functions and pathways involved. We identified 11 positive and 14 negative causal effects linking the genetic liability of the gut microbiota to arthritis. Similarly, 9 positive and 8 negative causal effects between inflammatory proteins and arthritis were identified. Notably, an increased abundance of the order Bacillales (odds ratio [OR] = 1.199, 95% confidence interval [CI] = 1.030–1.394, P = 0.019) and higher interleukin-7 levels (OR = 1.322, 95% CI = 1.004–1.741, P = 0.046) significantly elevated the risk of AS. Furthermore, interleukin-7 mediated 13.8% of the effect caused by the order Bacillales, with a mediation effect size of β = 0.025 (95% CI = 0.001–0.064). Sensitivity and supplementary analyses revealed no significant evidence of horizontal pleiotropy or heterogeneity. Overall, our findings demonstrate causal links between the gut microbiota, inflammatory proteins, and four arthritis types, highlighting the gut microbiota as a potential therapeutic target. Crucially, interleukin-7 not only strongly correlated with AS but also partially mediated the effect exerted by the gut microbiota on AS, suggesting that managing the gut microbiota to modulate inflammatory proteins could serve as an effective therapeutic strategy for arthritis.

Predictive score for diagnosing acute colonic diverticulitis in the emergency department: a retrospective study

BackgroundAcute diverticulitis is commonly misdiagnosed among patients with acute abdominal pain in the emergency department (ED). There are predictive scores that assist in the diagnosis of acute left-sided diverticulitis, but no scoring system is available for diagnosing acute diverticulitis without regard to the affected side. Therefore, developing a predictive score for diagnosing acute diverticulitis that is not limited to the left side will guide physicians in making a diagnosis and increase the appropriateness of computed tomography. This study aimed to establish a predictive score for diagnosing acute diverticulitis.MethodThis single-centre retrospective study included adult patients (≥ 18 years) who presented to the ED with acute abdominal pain. Multivariate logistic regression analysis was used to identify essential factors for diagnosing acute diverticulitis, and the Akaike information criterion was calculated to identify significant predictive factors for diagnosing acute diverticulitis using a clinical scoring system.ResultsOf 424 patients who fulfilled the inclusion criteria, 72 (17%) were diagnosed with acute diverticulitis. The significant factors associated with acute diverticulitis were age ≥ 60 years (adjusted odds ratio (adj.OR) 2.23, 95% confidence interval (CI): 1.20 − 4.14, p = 0.01), duration of abdominal pain ≥ 48 h (adj.OR 2.64, 95% CI: 1.28 − 5.45, p = 0.017), history of a diverticulum (adj.OR 7.77, 95% CI: 3.27 − 18.45, p < 0.001), absence of nausea and vomiting (adj.OR 3.42, 95% CI: 1.65 − 7.10, p < 0.001), absence of anorexia (adj.OR 3.33, 95% CI: 1.34 − 8.33, p = 0.026), absence of tachycardia (adj.OR 3.51, 95% CI: 1.39 − 8.87, p = 0.003), and abdominal guarding (adj.OR 2.99, 95% CI: 1.52 − 5.91, p = 0.002). These predictive factors were converted into predictive scores for diagnosing acute diverticulitis. For the score of ≥ 4, the sensitivity and specificity were 73.24% (95% CI: 0.61–0.83) and 80.40% (95% CI: 0.76–0.84), respectively, and the negative predictive value was 93.71% (95% CI: 0.90–0.96). No significant signs, symptoms, or laboratory findings were associated with complicated diverticulitis.ConclusionPredictive factors for diagnosing acute diverticulitis included age ≥ 60 years, duration of abdominal pain ≥ 48 h, history of a diverticulum, abdominal guarding, and absence of nausea and vomiting, anorexia, and tachycardia. A predictive score ≥ 4 suggested the presence of acute diverticulitis.

Factors associated with under-5 mortality in the south-south region of Nigeria

PurposeUnder-5 mortality rates (U5MR) have declined drastically globally. However, it remains high in Nigeria, with variations across the Country’s six geo-political zones. Understanding the factors associated with under-5 mortality (U5M) among lesser-explored subpopulations will inform strategies to curtail U5M. We investigated the factors associated with U5M in the south-south geopolitical zone (SSGZ) of Nigeria and population attributable risk percent (PAR%).MethodWe analyzed population-based data from the Nigeria Demographic and Health Survey (NDHS) for 2013 and 2018. Logistic regression analysis was used in SPSS version 26.0 to calculate the Odds Ratios (OR) with 95% Confidence Intervals (CI) for U5M associated with various factors, while the PAR% was computed using Levine's formula.ResultsThe adjusted logistic regression analysis model showed maternal overweight (OR = 1.39, 95% CI 1.12–1.72, p < 0.05), primary education (OR = 2.18, 95%CI 1.18–4.04 p < 0.05) and secondary education (2.05, 95%CI 1.13–3.72, p < 0.05) levels, male gender (OR=1.22, 95%CI 1.01–1.47, p < 0.05), birth interval of less than two years (OR = 2.93, 95%CI 2.10–4.10, p < 0.001), and small birth size (OR = 2.54, 95% CI 1.94–3.31, P < 0.001) significantly increased U5M risk, while having seven or more household members (OR = 0.73, 95%CI 0.59–0.89, p < 0.05) and 2 under-five children in the household (OR = 0.66, 95% CI 0.52–0.83, p < 0.001) were protective factors, with PAR% for the factor significantly associated with U5M ranging from 4.5% to 47.1%.ConclusionIncreased interventions on maternal weight, maternal education, low birth size, and child spacing could reduce U5M in the SSGZ of Nigeria.

The protective role of vitamin d in nasopharyngeal carcinoma: insights from Mendelian randomization and meta-analysis

BackgroundIn recent years, the anti-tumor effects of vitamin D have garnered increasing attention. However, previous epidemiological studies on the relationship between vitamin D and nasopharyngeal carcinoma (NPC) have yielded inconsistent results. This study aims to further explore whether vitamin D helps reduce the risk of NPC through Mendelian randomization (MR) and meta-analysis.MethodsBased on the core assumption of MR study, instrumental variables (IVs) for vitamin D, serving as genetic proxies, were obtained from summary data of large genome-wide association study (GWAS). Inverse-variance weighted (IVW) was utilized as the primary MR analytical method to explore the causal relationship between vitamin D and NPC. Sensitivity analyses included heterogeneity testing and horizontal pleiotropy testing. To further validate the robustness of the result, meta-analysis was employed to obtain pooled effects from databases of different sources.ResultsIn the discovery cohort, the IVW result suggest that vitamin D is a potential protective factor against NPC (odds ratio (OR) = 0.35, 95% confidence interval (CI): 0.13–0.89, P = 0.028). The finding was further corroborated by two independent replication cohorts [OR = 0.32, 95% CI: 0.13–0.80, P = 0.018 (ukb-d-30890_irnt); OR = 0.34, 95% CI: 0.13–0.90, P = 0.029(ebi-a-GCST90025967)]. Subsequent meta-analysis indicated that vitamin D markedly reduces the risk of NPC (OR = 0.34, 95% CI: 0.19–0.58, P < 0.001). Multiple sensitivity analyses, including heterogeneity analysis and horizontal pleiotropy tests, did not reveal any significant findings (all P > 0.05).ConclusionThis study provides robust evidence that vitamin D significantly reduces the risk of NPC. Through MR and meta-analysis, we have demonstrated a protective role of vitamin D in NPC development. These findings suggest that maintaining adequate vitamin D levels may be a potential strategy for reducing NPC. Further research is warranted to confirm these results and explore the underlying mechanisms involved.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BackgroundSevere acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.MethodsWe collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.ResultsOur results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.ConclusionsOur research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

The optimal approach for retrieving systematic reviews was achieved when searching MEDLINE and Epistemonikos in addition to reference checking: a methodological validation study

BackgroundSystematic reviews (SRs) are used to inform clinical practice guidelines and healthcare decision making by synthesising the results of primary studies. Efficiently retrieving as many relevant SRs as possible is challenging with a minimum number of databases, as there is currently no guidance on how to do this optimally. In a previous study, we determined which individual databases contain the most SRs, and which combination of databases retrieved the most SRs. In this study, we aimed to validate those previous results by using a different, larger, and more recent set of SRs.MethodsWe obtained a set of 100 Overviews of Reviews that included a total of 2276 SRs. SR inclusion was assessed in MEDLINE, Embase, and Epistemonikos. The mean inclusion rates (% of included SRs) and corresponding 95% confidence intervals were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking. Features of SRs not identified by the best database combination were reviewed qualitatively.ResultsInclusion rates of SRs were similar in all three databases (mean inclusion rates in % with 95% confidence intervals: 94.3 [93.9–94.8] for MEDLINE, 94.4 [94.0-94.9] for Embase, and 94.4 [93.9–94.9] for Epistemonikos). Adding reference checking to MEDLINE increased the inclusion rate to 95.5 [95.1–96.0]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (98.1 [97.7–98.5]). Among the 44/2276 SRs not identified by this combination, 34 were published in journals from China, four were other journal publications, three were health agency reports, two were dissertations, and one was a preprint. When discounting the journal publications from China, the SR inclusion rate in the recommended combination (MEDLINE, Epistemonikos and reference checking) was even higher than in the previous study (99.6 vs. 99.2%).ConclusionsA combination of databases and reference checking was the best approach to searching for biomedical SRs. MEDLINE and Epistemonikos, complemented by checking the references of the included studies, was the most efficient and produced the highest recall. However, our results point to the presence of geographical bias, because some publications in journals from China were not identified.Study registrationhttps://doi.org/10.17605/OSF.IO/R5EAS (Open Science Framework).

Dietary amino acids intake and all-cause and cause-specific mortality: results from the Golestan Cohort Study

BackgroundLess is known whether the amino acid composition of dietary protein sources effects on long-term health outcomes. We aimed to evaluate the association between dietary amino acid composition and all-cause and cause-specific mortality.MethodsThis study used data from the Golestan Cohort Study, which was performed in the Golestan Province of Iran from January 2004 to June 2008. Mortality, which was the primary outcome, was ascertained through September 2022. The Cox proportional hazards regression models were used to determine the adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality according to the quintiles of amino acid consumption, taking the third quintile as the reference.ResultsA total of 47,337 participants (27,293 [57.7%] women) with a mean (standard deviation) age of 51.9 (8.9) years were included. During a median follow-up of 15 years, 9,231 deaths were documented. Regarding essential amino acid intakes, the HRs of all-cause mortality were 1.16 (95% CI, 1.07–1.26) in the first quintile, compared with the reference group (P for non-linear trend < 0.001). Similarly, non-linear associations were observed between risk of all-cause mortality and intake of branched-chain, aromatic, sulfur-containing, or non-essential amino acids (P for non-linear trend < 0.001 for all comparisons), with higher HRs for participants in the first quintiles. There was an age interaction for the associations between dietary amino acids and mortality (P for interaction ˂0.05). While high amino acid diets were detrimental in middle-aged adults (< 65 years), increased hazards of mortality were observed among older adults (≥ 65 years) with low amino acid intake.ConclusionsThis study showed the non-linear trend between amino acids intake and risk of mortality in the middle-aged and older Iranian population. Overall, our findings suggest that diets lower in amino acids were associated with increased hazards of mortality, particularly among older adults.

Combined healthy lifestyle factors and psychosocial outcomes among cancer survivors: a systematic review and meta-analysis

Abstract Purpose This systematic review aims to summarize the associations between combined healthy lifestyles and psychosocial outcomes (health-related quality of life (HRQOL), depression, anxiety, psychological distress (PD), and posttraumatic stress disorder (PTSD)) among cancer survivors. Methods PubMed, Web of Science, Cochrane Library, and EMBASE were searched for observational and interventional studies examining healthy lifestyle scores (HLS, calculated by a combination of at least three lifestyles) and psychosocial outcomes among cancer survivors from inception to April 2024. A minimum of two studies with the same study design were pooled using random effects models. Results Twenty-one studies (44,812 survivors) were included. Of all studies, 16 of which were included in meta-analysis. The pooling of cross-sectional evidence shows significant association between HLS and overall, physical, and psychosocial HRQOL. Significance was only observed for overall and physical HRQOL but not for psychosocial HRQOL in cohort studies. The estimations and 95% confidence interval (CI) with 1-point increase in HLS were 1.47 (0.83–2.12) and 1.42 (0.19–2.65) for overall and physical HRQOL, respectively. The evidence from interventional studies also indicated that interventions on multiple lifestyles have positive effects on the physical but not psychosocial HRQOL. Despite the limited number of studies, significant associations were found between HLS and depression, anxiety, PD, and PTSD. Conclusions Although evidence is limited, we found that the combination of multiple healthier lifestyles is associated with better psychosocial outcomes in cancer survivors. Implications for cancer survivors This review underscores the potential for adhering to multiple healthy lifestyles to improve psychosocial outcomes and enhance HRQOL for cancer survivors.

Immunohistochemical Status Predicts Pathologic Complete Response to Neoadjuvant Therapy in HER2-Overexpressing Breast Cancers

Abstract Background Human epidermal growth factor receptor 2 (HER2) overexpression (HER2+) is defined by immunohistochemistry (IHC) and in situ hybridization (ISH) as IHC3+ or IHC2+/ISH+. Response differences to neoadjuvant anti-HER2 therapy (NT) in IHC3+ versus IHC2+/ISH+ breast cancer patients are poorly characterized. We explored whether pathologic complete response (pCR) varies by HER2 IHC status. Methods Patients with stage I–III HER2+ breast cancer undergoing NT and surgery between 2013 and 2020 were identified from the National Cancer Database and stratified by IHC status. Breast and nodal pCR were analyzed. Results Of 40,711 HER2+ patients, 83% were IHC3+ and 17% were IHC2+/ISH+. IHC3+ patients were more likely to be hormone receptor (HR)-negative (33 vs. 21%), have cT3/4 tumors (24 vs. 21%), and be cN+ (52 vs. 47%; all p &lt; 0.0001). Breast conservation rates were similar (each 43%, p = 0.32), although IHC3+ axillary lymph node dissection rates were lower (41 vs. 45%, p &lt; 0.0001). Among all patients, breast pCR was 49%, while nodal pCR was 64%. Compared with IHC2+/ISH+, IHC3+ had higher unadjusted breast (54 vs. 22%, p &lt; 0.0001) and nodal (69 vs. 37%, p &lt; 0.0001) pCR rates. When stratified by HR status, pCR was lower for HR+ disease but remained higher among IHC3+ patients. Analysis of T1cN0 primaries mirrored these trends. In multivariable analysis, IHC3+ remained an independent predictor of breast (odds ratio [OR] 3.91, confidence interval [CI] 3.65–4.19, p &lt; 0.0001) and nodal (OR 3.40, CI 3.12–3.71, p &lt; 0.0001) pCR. Conclusion HER2 IHC status predicts pCR and may help select breast cancer patients who derive the greatest benefit from NT. These findings provide further evidence that revision of HER2 classification may improve clinical management.

Predictors of tolerability for postoperative adjuvant S1 plus docetaxel chemotherapy for gastric cancer: a multicenter retrospective study

Abstract Background Adjuvant docetaxel plus S1 (DS) chemotherapy after gastrectomy with D2 lymph node dissection is the standard treatment for stage III gastric cancer in Japan; however, some patients are unable to receive adequate drug administration because of the deterioration of their conditions. This study aimed to investigate the correlation between tolerability for postoperative adjuvant DS chemotherapy and prognosis, and the factors affecting tolerability. Methods This retrospective study involved patients with stage III gastric cancer who underwent curative resection between 2018 and 2021 from a multicenter database. Patients with a cumulative dose of docetaxel and S1 greater than 120 and 8400 mg/m2, respectively, were considered tolerable. The prognostic impact and factors predicting tolerability were analyzed. Results Of the 103 patients, the tolerable group comprised of 63 (61%) patients and had a significantly better 3-year recurrence-free survival than the intolerable group (83% vs. 64%, P = 0.02). Among the preoperative factors, only performance status (PS, P = 0.04) was significantly correlated with tolerability in the univariate analysis. Among the postoperative factors, PS (P = 0.001) and perioperative weight loss rate (P = 0.02) were significantly correlated with tolerability in the univariate analysis. The multivariate analysis showed significant differences in the PS (odds ratio [OR]: 4.94, 95% confidence interval [CI] 1.79–14.98, P = 0.002) and weight loss rate (OR: 1.10, 95% CI 1.01–1.21, P = 0.03). Conclusions Tolerance to postoperative adjuvant DS chemotherapy has a significant prognostic impact. Postoperative PS and perioperative weight loss rates were independent predictors of tolerability.

Celiac risk doubles in patients with alopecia areata: a nationwide case -control study

Abstract Both alopecia areata (AA) and celiac disease are common immune-mediated diseases. Despite accumulating evidence of bi-directional associations between the two disorders, data remains unclear and inconsistent. In this study we explored the association between alopecia areata and celiac disease in a large representative population cohort. Patients with alopecia areata diagnosed during 2005-2019 were compared with age and gender matched healthy controls for celiac autoimmunity. A total of 33,401 patients with alopecia areata and 66,802 controls were included in the analysis. Overall, 754 patients (0.85) had celiac disease. Compared to controls, celiac prevalence increased twofold among AA patients (1.1% Vs 0.6%, Odds ratio (OR) 1.95, 95% Confidence Interval (CI) 1.69-2.25). Higher prevalence rates were observed among all age groups, with the highest risk in AA patients older than 40 years and older. Alopecia areata may be associated with a significant increased risk for celiac disease, suggesting early diagnostic and preventive measures.

Commercial insurers' market power and hospital prices in Medicaid managed care

AbstractObjectiveTo examine the relationship between insurers' commercial market power and negotiated prices in Medicaid Managed Care (MMC) plans for hospital care.Data SourcesMMC prices from hospital‐disclosed price transparency data as of July 2023 compiled by Turquoise Health, insurance enrollment information from the 2021 Clarivate InterStudy enrollment data.Study DesignLog‐transformed linear regression with hospital and procedure fixed effects estimating the within‐hospital MMC price variation as a function of insurers' commercial market share quartile and MMC market share for 15 common outpatient hospital services.Data Collection/Extraction MethodsA total of 39,049 MMC price samples measured at hospital‐procedure‐MMC insurer level are merged with county‐insurer level market share data.Principal FindingsAround 25% of price variation in MMC plans are driven by within‐hospital factors. Compared with MMC insurers from the lowest commercial market share quartile (&lt;0.8%), those from the highest commercial market share quartile (&gt;17%) are associated with negotiating 4.6% (95% confidence interval: [2.8%–6.4%], p &lt; 0.001) lower MMC prices for outpatient hospital care, including 3.6% (p &lt; 0.05) for medical/surgical procedures, 3.6% (p &lt; 0.01) for radiology, and 6.7% (p &lt; 0.001) for emergency department visits.ConclusionsMMC insurers with substantial commercial market share negotiate lower MMC prices for multiple outpatient hospital services.

Association between serum glucose potassium ratio and mortality in critically ill patients with intracerebral hemorrhage

The effect of serum glucose-to-potassium ratio (GPR) on cerebrovascular diseases has been previously validated. However, the value of the GPR in patients with severe intracerebral hemorrhage (ICH) requiring ICU admission remains unclear. This study aimed to investigate the association between the GPR and the clinical prognosis of critically ill patients with ICH. This study identified patients with severe ICH requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database and divided them into quartiles based on GPR levels. Outcomes included 30-day, 90-day, and 1-year mortality rates. The association between the GPR and clinical outcomes in critically ill patients with ICH was elucidated using Cox proportional hazards regression analysis and restricted cubic splines. In total, 2018 patients (53.8% male), with a median age of 70 years, were enrolled in the study. The 30-day, 90-day, and 1-year mortality rates were 23.9%, 30.1%, and 38.4%, respectively. Per multivariate Cox proportional hazards analysis, an elevated GPR was significantly associated with all-cause mortality. After adjusting for age, sex, Charlson Comorbidity Index, white blood cell count, red blood cell count, platelet count, and Glasgow Coma Scale, patients with an elevated GPR had a higher 30-day mortality (hazard ratio [HR]: 1.32; 95% confidence interval [CI]: 1.22–1.42; P < 0.001), 90-day mortality (HR: 1.27; 95% CI: 1.18–1.37; P < 0.001) and 1-year mortality (HR: 1.22; 95% CI: 1.14–1.31; P < 0.001) when analyzed as a continuous variable. Furthermore, analysis using restricted cubic splines demonstrated a consistent and progressive escalation in the risk of all-cause mortality with an elevated GPR. The GPR was significantly associated with short- and long-term all-cause mortality in critically ill patients with ICH. This finding demonstrates that GPR may be useful in identifying patients with ICH at a high risk of all-cause mortality.

The association between the fluoxetine use and the occurrence of coronary heart disease: a nationwide retrospective cohort study

BackgroundWe explored if the administration of fluoxetine, recognized for its potential in adipocyte browning, entails a differential risk of coronary heart disease (CHD) in comparison to other SSRI medications.MethodsUsing the National Health Insurance Research Database of Taiwan from 2000 to 2013, we conducted a retrospective cohort study. The exposure cohort comprised individuals prescribed fluoxetine for over 90 days (n = 2,228). Conversely, those administered other SSRIs (excluding fluoxetine) for a duration surpassing 90 days were designated as the non-exposed cohort (n = 8,912). CHD incidence served as our primary outcome measure, and we employed Cox proportional hazards models to scrutinize the relationship between fluoxetine exposure and CHD development rates.ResultsCompared with the non-exposed cohort, the fluoxetine use had a significantly decreased 21% risk of developing CHD in the exposed cohort (adjusted hazard ratio: 0.79%, 95% confidence interval: 0.68–0.92). Noticeably, results indicated that there was an inverse association between the fluoxetine exposure and the risk of CHD, regardless of whether men, women or other age groups.ConclusionOur findings suggest that clinical use of fluoxetine was associated with a 21% reduced risk of CHD relative to other SSRI prescriptions.

Evaluation of the effect of disposal of landfill leachate in a sewage treatment plant composed of stabilization ponds

This study aimed to evaluate the combined treatment system of domestic sewage and leachate by serial stabilization ponds in a Wastewater Treatment Plant (WWTP). The WWTP had two parallel pond modules, one receiving (module II—pond M10) and the other not receiving leachate (module I—pond M5). Physical, chemical, and biological monitoring parameters collected from January 2017 to December 2021 were evaluated. High reducing efficiency for ammonium nitrogen was found, with an average of 95.7 ± 2.5%. BOD5 and COD can be considered statistically different for a 95% confidence level in the two pond modules. The phytoplankton community was composed of 46 taxa distributed in four taxonomic classes: 6 belonging to the Cyanobacteria group (13%), 22 to the Green Algae group (48%), 4 to the Diatoms group (9%), and 14 to the Phytoflagellate group (30%). No ecotoxicity was detected for the evaluated pond effluent samples. Thus, although the insertion of leachate impacted the quality of the final effluent of the ponds and the organic matter, it may not have affected the effluents’ ecotoxicity. This research helps to understand the impacts of long-term leachate insertion in a real treatment system using stabilization ponds for combined treatment. In addition to the usual efficiency evaluation parameters, ecotoxicological tests and phytoplankton are also evaluated.

Characteristics of Breast Cancer Patients Who Refused Conventional Treatment in a Teaching Hospital in Southwestern Nigeria

Background Patients’ adherence to treatment recommendations is in the form of a spectrum: complete adherence or total rejection of the offered standard treatments. The aim of this study was to describe the characteristics of breast cancer patients who refused standard treatments in order to engender a focused intervention. Methods This was a retrospective study of breast cancer patients from 2017-2022. Data generated were analyzed using SPSS version 23.0. The results were presented using descriptive statistics. Inferential statistics for subgroup analysis was by chi-square test or risk difference with confidence intervals Results Among 343 patients, 86 (25% (95% CI 21-30) did not initiate conventional oncologic treatment. All were females and their age range was 33–83 years (mean, 49.9±12.0 years). The majority of the women were married (73%), educated (79%), low-income earners (69%), rural dwellers (63%) with advanced disease (81%). None of the patients had government insurance. The mean duration of symptoms was 11.9±9.7 months. Among 71patients with vital information, 50 (70% (95%CI 58-71) were confirmed dead in the last 3 years. The probability of death within 3 years was 38% (95%CI 8.0-68%) and was higher among those diagnosed as late-stage disease. Conclusions A large number of patients still fail to accept conventional treatments after breast cancer diagnosis. Understanding the patients’ characteristics may be necessary to recognize situations where active education and support can help patients accept standard treatment thereby prolonging survival.

Provincial distribution and factors associated with self-reported sexually transmitted infections and their symptoms among women in Sierra Leone

BackgroundSexually transmitted infections (STIs) are a significant public health concern worldwide. These infections can have severe consequences for women’s health, including pelvic inflammatory disease, infertility, and increased risk of HIV acquisition. Understanding the prevalence and factors associated with STIs among women in Sierra Leone is crucial to developing effective prevention and treatment strategies. This study investigated the provincial distribution and factors associated with self-reported STIs (SR-STIs) and STI symptoms among women in Sierra Leone.MethodsThe study used data from the 2019 Sierra Leone Demographic and Health Survey, comprising 13,965 women aged 15 to 49 who have ever had sex. Provincial variations in the prevalence of SR-STIs and STI symptoms were presented using a spatial map. A binary logistic regression analysis was performed to assess the factors associated with SR-STIs and STI symptoms among women in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe overall prevalence of SR-STIs and their symptoms was 21.6% [20.4, 22.9] among women in Sierra Leone. Higher odds of SR-STIs and their symptoms were associated with being aged 25–29 (aOR = 1.35, 95% CI = 1.10,1.66), 30–34 (aOR = 1.38, 95% CI = 1.09,1.74), 35–39 (aOR = 1.39, 95% CI = 1.10, 1.77), having tested for HIV (aOR = 1.16, 95% CI = 1.04, 1.29), and having multiple sexual partners (aOR = 2.25, 95% CI = 1.80, 2.83) compared to those in the reference category. Being in the rich wealth index (aOR = 1.32, 95% CI = 1.11, 1.57), living in the Northern (aOR = 2.43, 95% CI = 2.08, 2.83) and Northwestern province (aOR = 3.28, 95% CI = 2.81, 3.83), and being covered by health insurance (aOR = 3.19, 95% CI = 2.62, 3.88) were associated with higher odds of SR-STIs and their symptoms. Lower odds of SR-STIs and their symptoms were found among women with one (aOR = 0.81, 95% CI = 0.68, 0.96), two (aOR = 0.75, 95% CI = 0.61, 0.93), three (aOR = 0.66, 95% CI = 0.53, 0.83), and four or more children (aOR = 0.62, 95% CI = 0.49, 0.77], those residing in rural areas (aOR = 0.81, 95% CI = 0.69, 0.94), and women living in the Southern province (aOR = 0.67, 95% CI = 0.57, 0.80) compared to those in the reference category.ConclusionThe findings indicate that SR-STIs and their symptoms are prevalent among women in Sierra Leone. Our findings underscore the urgent need for targeted public health interventions to address the SR-STIs and their symptoms among women in Sierra Leone. The increased risk among women aged 25–39, those with multiple sexual partners and those from wealthier backgrounds, suggests that educational programmes focusing on safe sexual practices and STI prevention should be prioritized in urban and affluent areas. Additionally, the lower odds of SR-STIs among women with more children and those in rural regions indicate that family dynamics and geographic factors may offer protective benefits, which could be leveraged in public health messaging. Our findings highlight the importance of tailoring health services and outreach efforts to effectively reach and support vulnerable populations, ultimately aiming to reduce the incidence of SR-STIs.

Endovascular Repair of Aortic Arch Zones 0 to 2 Using Physician-Modified Endografts: A Systematic Review and Meta-Analysis

Purpose: The purpose of this study was to collect all the available evidence concerning technical success and early and mid-term clinical outcomes of physician-modified endografts (PMEGs) for the treatment of aortic arch pathologies in zones 0 to 2. Material and methods: We performed a systematic review to identify all the eligible studies that reported outcomes to the PMEGs for aortic arch pathologies in zones 0 to 2 and then conducted a qualitative synthesis and meta-analysis of the results. The main outcomes were technical success, mortality, stroke rate, bridging stents’ complications, and reintervention rate. We estimated pooled proportions and 95% confidence intervals (CIs). Results: A total of 134 study titles were identified by the initial search strategy, of which 14 (zone 0 n=6; zone 1 n=1; zones 1 t o2: n=7) were considered eligible for inclusion in the meta-analysis. A total of 777 patients (80% male; 62±6 years) were identified among the eligible studies. The pooled technical success for the PMEG in zone 0 was 96.6% (95% CI=93.9%-98.2%), whereas in zones 1 to 2 was 95.9% (95% CI=92.9%-97.6%). The pooled 30-day mortality was 4.6% (95% CI=2.0%-10%) and 4.3% (95% CI=2.2%-8.2%) for zones 0 and 1 to 2, respectively, whereas the prevalence of late mortality was 8.2% (95% CI=4.7%-14%) and 3.4% (95% CI=1.9%-6%). The pooled stoke rate was 3.7% (95% CI=2.1%-6.4%) in zone 0 and 2.7% (95% CI=1.4%-5%) in zones 1 to 2. The early reintervention rate was 3.5% (95% CI=1.5%-8.0%) and 4.2% (95% CI=2.4%-7.2%) for zones 0 and 1 to 2, respectively, whereas during the mean follow-up of 26 months was 8.5% (95% CI=3.0%-21%) and 1.9% (95% CI=0.8%-4.3%). The pooled bridging’s stent instability was 3.9% (95% CI=1.1%-12.9%) in zone 0 and 3.2% (95% CI=1.8%-5.8%) in zones 1 to 2. Conclusions: Endovascular repair of aortic arch pathologies using PMEGs seems to present a satisfactory level of technical success and a low mortality rate. To attain clearer conclusions, further research employing randomized controlled trials, longer-term follow-up, and consistent reporting of results is warranted. Clinical Impact This systematic review and meta-analysis of observational studies analyzed the short- and mid-term outcomes of aortic arch aneurysm and/or dissection using physician-modified endografts. It separately examined the outcomes from zones 0 and 1-2 of the aortic arch. Fourteen studies (n=777 patients) were included. Overall technical success rates were 96.6% for zone 0 and 95.9% for zone 1-2. Regarding early mortality and stroke rates, no significant differences were observed, while late mortality was higher in patients in zone 0. The late reintervention rate favored patients treated with PMEGs in zone 1-2. The physician-modified technique appears to be an excellent and rapidly available alternative for the treatment of aortic arch diseases.

Deep vein thrombosis in response to stress induced by earthquakes in Japan: a meta-analysis of possible exacerbating factors

The principal goal of this study was to assess factors associated with deep vein thrombosis (DVT) in the aftermath of earthquakes in Japan. We searched PubMed, Google Scholar, Web of Science, and Cochrane Library for articles published in English or Japanese regarding indicators for DVT associated with Japanese earthquakes. We calculated pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs) for patients with DVT (the DVT group) as compared with the non-DVT group for potential predictors. Ultimately, 7 articles were included in the analysis, comprising 6,637 subjects (DVT, 895; and non-DVT, 5,742). The following factors proved statistically significant: female gender (OR = 1.48, 95% CI; 1.20–1.81, p = 0.0002), greater age (MD = 4.44, 95% CI; 1.62–7.25, p = 0.002), hypertension (OR = 1.44, 95% CI; 1.18–1.75, p = 0.0003), heart disease (OR = 1.45, 95% CI; 1.07–1.97, p = 0.02), previous history of DVT (OR = 9.23, 95% CI; 2.94–28.91, p = 0.0001), sleeping pill use (OR = 1.81, 95% CI; 1.37–2.38, p = 0.0001), lower leg varix (OR = 1.63, 95% CI; 1.17–2.28, p = 0.004), and soleal vein dilatation ≥ 8 mm (OR = 2.13, 95% CI; 1.32–3.42, p = 0.002). Our findings furnish insights that can aid in making informed choices about healthcare and policy in the context of earthquake-induced stress.

Completion of maternal and child health continuum of care and associated factors in West Gondar Zone, North West Ethiopia, 2023: a community based cross sectional study

BackgroundThe maternal and child health continuum of care integrates services from pre-pregnancy through childhood to enhance maternal and child outcomes. It is crucial for reducing maternal and child mortality by focusing on comprehensive health interventions. Despite its significance, comprehensive studies on the continuum remain limited. This study aimed to assess the completion of the maternal and child health continuum of care and associated factors among mothers with index children aged 12–23 months in the West Gondar Zone, Northwest Ethiopia, in 2023.MethodsA community-based cross-sectional study was conducted from May 1–30, 2023, by interviewing mothers of 12-23-month-old children in West Gondar zone. A simple random sampling method was used to select 1,019 mothers. Data were collected via KoboCollect and analyzed in Stata version 14.0. Binary logistic regression was used to examine associations between independent variables and the continuum of care. Variables with a p value < 0.2 in bi-variable analysis were included in the multivariable model. Finally, adjusted odds ratios (AOR) with 95% confidence intervals (CI) and p values < 0.05 were used to determine statistical significance. The Hosmer and Lemeshow goodness-of-fit test was computed.ResultsThe overall rate of completion of the maternal and child health continuum of care was 6.19% (95% CI: 4.69–7.68). The factors associated were having the first ANC visit before 16 weeks of pregnancy [AOR: 4.25 (CI: 2.14–8.47)], birth preparedness and complication readiness [AOR: 3.02 (CI: 1.41–6.46)], history of modern contraceptive use [AOR: 2.34 (CI: 1.16–4.73)], intended pregnancy [AOR: 3.25 (CI: 1.63–6.48)], receiving maternal services during ANC visits [AOR: 2.69 (CI: 1.07–6.80)], and the health facility being less than an hour away from home [AOR: 2.53 (CI: 1.06–6.03)].ConclusionsThe maternal and child health (MCH) continuum of care in West Gondar was low. Key factors affecting completion included birth preparedness and complication readiness, early ANC initiation, planned pregnancy, family planning use, proximity to health facilities, and maternal health services provided during ANC. Efforts should target these factors and ensure services at each stage of the continuum to stay mothers along the path of the MCH continuum of care.