Duration Of Use Research Articles

Airway management in infants with Robin sequence in the United Kingdom and Ireland: A prospective population-based study.

There is currently no consensus about managing upper airway obstruction (UAO) in infants with Robin sequence (RS), in terms of treatment efficacy or clinical outcomes. This study describes UAO management in UK/Ireland, and explores relationships between patient characteristics, UAO management, and clinical outcomes in the first 2 years of life. Active surveillance of RS throughout UK/Ireland via the British Paediatric Surveillance Unit and nationally commissioned cleft services. Clinical data were collected at initial notification and 12-month follow-up. 173 infants with RS were identified, of which 47% had additional congenital anomalies or an underlying syndrome (non-isolated RS). Two-thirds (n = 119) required an airway intervention other than prone positioning: non-surgical in 84% and surgical (tracheostomy) in 16%. Nasopharyngeal airway (NPA) was the most common intervention, used in 83% (n = 99) for median 90 days (IQR 136). Surgical UAO management was associated with prolonged hospital admission, higher prevalence of neurodevelopmental delay (NDD), lower weight-for-age z-scores, and delayed oral feeding. These findings were not attributable to a higher prevalence of non-isolated RS in this group. Although more commonly associated with non-isolated RS, growth faltering was also identified in 48%, and NDD in 18%, of cases of isolated RS. In UK/Ireland, most infants with RS are managed with NPA, and tracheostomy is reserved for refractory severe UAO. Clinical outcomes and duration of use indicate that NPA is a safe and feasible first-line approach to UAO. Longitudinal assessment of neurodevelopment and growth is imperative, including in children with isolated RS. Current variations in practice reinforce the need for evidence-based treatment guidelines.

Biologics in congenital ichthyosis: are they effective?

Congenital ichthyoses (CI) comprise a heterogeneous group of genetic diseases requiring lifelong treatment and having a major effect on quality of life. Conventional treatments reduce scaling and skin discomfort; however, they usually have little or no effect on erythema and pruritus. The identification of cytokine alterations in CI raised the possibility of repurposing available biologics. Several case reports in the literature report successes using different biologics. We aimed to report the effects of biologics in real life. This was a retrospective, observational, international multicenter study of patients with CI treated with at least one biologic for a minimum of 3 months. The effect of the biologics was evaluated using an Investigator Global Assessment-Change (IGA-C) scale. A comprehensive literature search was performed in parallel. A total of 98 patients were included, with a mean age of 19.7 years and both sexes equally represented. Patients with Netherton syndrome (NS) or congenital ichthyosiform erythroderma (CIE) represented the majority of patients (30% and 21.4%, respectively). Most patients (84.7%) had a severe or very severe form of CI. The most frequently used biologics were inhibitors targeting interleukin-17 (IL-17), IL-12/IL-23, or the IL-4 receptor. The mean duration of treatment was 22+20.1 months. There were 45 responders (45.9%), including 18 patients (18.3%) who were good responders; all had an erythrodermic CI subset and received one of the three main biologics. In 2 NS and CIE, IL-12/IL-23 and IL-4 receptor inhibitors tended to be most effective. Review of the literature revealed a shorter mean duration of use of biologics (11.5+8.5 months) and higher percentage of responders (85.7%), suggesting reporter bias. This series identified subsets of CI that may respond to biologics and will aid in designing future clinical trials of biologics for CI.

Electromagnetic fields exposure and neuropsychological effects in young people

Abstract Background In recent years, there has been a large increase in the use of communication/connected devices and technologies. This raises a question about radiofrequency electromagnetic fields (RF-EMF) exposure levels and neuropsychological effects of RF-EMF in young people. The aim of this study was to assess the pattern of use of communication/connected devices and technologies and its impact on cognition and mental health of early school age children in Poland. Methods The study population consists of 293 children from Polish Mother and Child Cohort (REPRO_PL). The study was based on questionnaire data covering type and duration of usage of communication/connected devices and technologies by mothers during pregnancy and children at age of 7 years. The environmental exposure to RF-EMF was also taken into account. Based on such data RF-EMF exposure was assessed. Child emotional and behavioral assessment was done by Strengths and Difficulties Questionnaire whereas IQ and psychomotor development of children was performed by psychologist using Intelligence and Development Scales. Results About 75% of young people used smartphones (2% for voice calls and 7% for Internet browsing at least one hour per day). Tablet or laptop use was declared by 59% and 56% of respondents, respectively. More than 10% declared that they use these devices at least one hour a day. The main factors determining the use of new technology devices were parental age and education (p < 0.05) and the age at which youth started school education (p = 0.06). In multivariable regression model higher level of RF-EMF was associated with total difficulties and emotional problems (p < 0.05). Conclusions This study presents the pattern of use of new technology devices by early school age children in Poland and the association between the exposure to RF-EMF and child mental health. Key messages • The use of communication/connected devices and technologies is common among young people in Poland. • The exposure to RF-EMF can increase mental health problems among young people.

Exploring the Possibilities of Incorporating Edible Insects into a Vegetarian Diet: A Survey of Vegetarian Consumer Acceptance.

Due to environmental, health, and ethical concerns, more consumers are reducing their meat consumption or giving it up entirely. Plant protein is most often chosen as a sustainable source of protein. Still, recently, edible insects have been gaining popularity as a source of alternative protein with a better nutritional profile. However, there is no information on whether vegetarians can accept insects. An online survey was conducted with a sample of 790 vegetarians to address this gap. The findings of this survey are crucial in understanding the potential acceptance of insects in vegetarian diets. We found that 13% of the respondents approve of using processed insect protein in vegetarian dishes. Moreover, 9% of the respondents declared that they had knowingly consumed insects before; of these, 42% of them found the taste of the insects to be neutral, 16% found it to be very good, and 25% found it to be good. The level of insect acceptance was influenced by the type of vegetarian diet and its duration of use. Furthermore, pesca-vegetarians and flexi-vegetarians were the most likely to eat insects for ecological reasons (x¯ = 3.54 ± 0.74; x¯ = 3.00 ± 0.67, respectively). These findings do not eliminate the possibility of using edible insects in vegetarian diets but support their partial acceptance.

EVOLUSI BANK KONVENSIONAL DALAM PERSPEKTIF TEORI PUSH PULL MOORING

This study aims to identify differences in customer perceptions of push and pull factors in switching from conventional banking services to digital banking at Bank Mandiri Tanjung Perak Branch in Surabaya. The research methodology involves questionnaires for quantitative data collection and documentation to support the data. Analysis is conducted using the Push Pull Mooring (PPM) theory to evaluate the influence of Service Quality, Perceived Ease of Use, and Lifestyle on customers' Switching Intention. The findings indicate that for customers with less than 5 years of transaction experience, service quality and ease of use of digital services influence their intention to switch. For customers with more than 5 years of experience, service quality and ease of use have different impacts on switching intention. The t-test results show that switching intention is not significantly influenced by the duration of use (P value 0.93), but lifestyle significantly affects preference for digital services (P value 0.003). Perceived ease of use does not show a significant difference between the two groups (P value 0.716), while service quality shows a significant difference (P value 0.014). The application of these research findings to other Mandiri branches needs to consider demographics, strategy adaptation, and continuous evaluation. Bank Mandiri can optimize its services by focusing on customer retention, lifestyle, ease of user experience, and improving service quality. Understanding the interaction effects between these variables helps Bank Mandiri adapt holistic and customer-oriented strategies. Thus, Bank Mandiri can enhance its competitiveness in an increasingly dynamic market.

Alzheimer's Disease and (Phyto) Estrogen Treatment: Modification of Effects by Age, Type of Treatment, and Duration of Use.

There is a continued debate on whether menopausal hormone therapy (MHT) protects women against Alzheimer's disease (AD). It is also unclear whether phytoestrogen could be an alternative treatment for AD. To investigate whether mixed study findings may be due to differences in age at initiation of MHT and duration of prescription of different types of MHT using meta-analyses. After a systematic literature search, meta-analyses were carried out using Cochrane Revman 5.4.1.software including data from large nationwide studies of registered medically diagnosed AD and prescribed MHT. These analyses were stratified for duration and type of treatment, by age at start of prescription of therapy. Insufficient quality data were available for phytoestrogen treatment and AD meta-analyses. A total of 912,157 women were included from five registries, of whom 278,495 had developed AD during follow-up. Meta-analyses suggested a small increased AD risk after 5-10 years prescription of combination MHT regardless of age, and over 10 years only in women younger than 60 years of age. No association was seen for estrogen alone for women younger than 60 years of age, but AD risk did increase for women over 60 years of age for up to 5 years of MHT prescriptions. Combination MHT should probably be prescribed for less than 5 years after menopause to reduce risk for AD, while estrogen alone should not be prescribed to women over 60. For phytoestrogen, small treatment trials suggested some benefit of tempeh (fermented soy), which should be investigated further.

The prescribing of opioids for chronic noncancer pain in the menopausal and postmenopausal population: a drug utilisation study in the United Kingdom.

Opioid use for chronic noncancer pain (CNCP) is consistently higher in menopausal/postmenopausal women than in younger women or men, elevating their risk of opioid-related adverse health outcomes. Since pain severity increases with hormonal changes accompanying menopause, these women should be a focus of opioid stewardship efforts. To examine opioid prescribing trends for CNCP in menopausal/postmenopausal women diagnosed with a musculoskeletal condition. Population-based drug utilisation study using IQVIA Medical Research Data UK. Annual opioid prescribing incidence, prevalence, and average duration of use were calculated for a cohort of women aged 50-79 with musculoskeletal conditions newly diagnosed between 2010-2021. Specific results were stratified by age, pain indication, and Townsend score. From 2010 to 2021, incident prescribing rates of opioids increased in women aged 50-54 (161.4 [95% CI 149.7-174.0] per 1000 PYAR in 2010 to 239.6 [95% CI 211.7-271.2] per 1000 PYAR in 2021); these women discontinued opioid use faster (~1 year) than older age groups (~2 years). Overall, opioid prescribing prevalence decreased from 23% in 2010 to 14% in 2021, and average opioid use duration decreased from 3 years to 1 year (2010 - post-2017) in women aged 50-79. The overall observed decrease in prevalence and average duration of opioid use is encouraging. Incident prescriptions are rising in women aged 50-54 and those with fibromyalgia while remaining steady in women aged 55-79. Understanding the impact of menopause/post-menopause on opioid use trends is important for effective opioid stewardship.

The Impact of Pre-biopsy Corticosteroids Use on CD20 Staining Pattern in B-cell Lymphomas

Abstract Introduction/Objective Diffuse large B-cell lymphomas, the most common Non-Hodgkin’s lymphoma are heterogeneous in terms of varied clinical presentation. The pathological work up these lymphomas is usually initiated with a CD20/CD3 immunohistochemical panel. Due to the aggressive nature of these lymphomas, pre-diagnosis corticosteroids are necessitated in some cases. However, the corticosteroids treatment can significantly alter the antigen staining of the lymphoma delaying the pathological diagnosis and subsequent treatment. This study investigates how pre-biopsy corticosteroids administration affects CD20 staining in B-cell lymphoma cells along with CD3 and PAX5, aiming to provide insights to the practicing pathologist for prompter diagnosis in these challenging cases. Methods/Case Report 14 biopsy cases of B-cell lymphoma pretreated with corticosteroids were included in this study. Clinicopathological parameters including corticosteroids usage are collected. H&E and immunohistochemistry slides were reviewed to analyze CD20, CD3 and PAX5 staining patterns. Results (if a Case Study enter NA) Of 14 cases, 10 cases showed cytoplasmic and granular staining with CD20, with extracellular spilling instead of the typical membranous pattern. This change was more frequent with intravenous dexamethasone (7/9) compared to oral prednisone (3/5), high dose (80%) compared to moderate and low dose (67%), short-term corticosteroids usage (86%) compared to intermediate-term and long-term (57%) usage and shorter dosing interval (100% in Q6H). The impact of prebiopsy corticosteroids was seen more on lymph node (5/7) compared to bone marrow (3/5). This cytoplasmic granularity was also observed in CD3 in the background non-neoplastic T lymphocytes in 25% of the cases. Though nuclear stains such as PAX5, Ki67, MUM1 and BCL6 also showed granularity in a significant number of cases, it was limited to the nucleus. Conclusion Pre-biopsy corticosteroids leads to alteration in CD20 staining pattern of the lymphoma cells leading to cytoplasmic granularity with extracellular spillage, which causes diagnostic challenge. This effect varies according to the type, route, dose, and duration of corticosteroids usage.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

Association of RAAS inhibitors on osteoporosis and fracture risk in the hypertensive population–A prospective population-based cohort study in Lanzhou, China

BackgroundRenin-angiotensin-aldosterone system (RAAS) inhibitors appear to benefit bone tissue in antihypertensive treatment. However, the association between RAAS inhibitors and bone metabolism was inconsistent.Methods and study designBased on the study of Risk Evaluation of Cancers in Chinese Diabetic Individuals(REACTION) conducted in 2011, We followed 6,252 Lanzhou residents aged 40–75 years from 2014 to 2016. Finally, 1,625 hypertension cases with complete data were included in the analysis. The study subjects were divided into four groups according to the type of antihypertensive drugs. We employed logistic or multivariate Cox proportional hazards regression to estimate the association between different antihypertensive drug use and osteoporosis, the risk of fracture, and the change in bone mineral density (BMD) level. The association of osteoporosis or the fracture risk by cumulative duration of use of these medications (< 3 years.) and (> 3 years.) was also estimated.ResultsThe cross-sectional study showed that there was no significant association between baseline antihypertensive drugs (angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB)) use and osteoporosis and fracture. During a mean follow-up of 3.4 years in the longitudinal study, there were 478 new osteoporosis cases and 76 fractures. Compared with patients without antihypertensive drug use, the hazard ratios (HRs) [95% confidence interval (CI)] for the risk of osteoporosis were 1.005(0.651,1.552) and 1.077(0.793,1.462) in ACEI or ARB use (p > 0.05). ACEI or ARB use was also not significantly associated with fracture risk (HR 1.102(0.326,3.726), 0.735(0.251,2.148), p > 0.05). Further analysis showed that the use of ACEI (HR 1.078(0.146,7.950)) or ARB (HR 1.169(0.347,3.939)) was not significantly associated with the improvement of osteoporosis (p > 0.05). In addition, the duration of RAAS inhibitors used showed no apparent correlation with the risk of osteoporosis (≤ 3 years: HR 0.872 (0.516, 1.474), > 3 years: HR 1.151 (0.574, 2.308)), nor with the improvement of osteoporosis and the risk of fracture. Meanwhile, the association mentioned above did not change compared to different RAAS inhibitors.ConclusionsThe use of RAAS inhibitors, including ACEIs and ARBs, was not significantly associated with osteoporosis, risk of fracture, or BMD change.

8716 Late Onset of Temozolomide in Aggressive Pituitary Tumors: Insights From a Leading Oncology Center in Latin America

Abstract Disclosure: C.R. de Macedo: None. I.P. de Magalhães: None. A. Glezer: None. M. Berardo Carneiro da Cunha Neto: None. N.R. de Castro Musolino: None. O. Feher: None. R.L. Batista: None. Introduction: Temozolomide (TMZ) is an oral alkylating agent used in management of glioblastoma multiforme. Since 2006, TMZ is used in patients with pituitary tumors (PITNets) with yielded promising outcomes as an alternative for aggressive PITNets. Objective: To evaluate the response to TMZ in patients with aggressive or metastatic PITNets within the largest tertiary oncology service in Latin America. Patients and Methods: We screened all cases that received TMZ at our institution between 2008-2023 (n=661, primarily glioblastoma cases). We identified 7 cases that TMZ was employed for treating PITNets. We assessed for PITNet characteristics, functionality, timelines of treatment initiation, correlation with radiotherapy, duration of TMZ usage and treatment response utilizing the RECIST criteria. Results: At the time of diagnosis, all patients presented with macro-PITNets and 6 were giant (size greater than 4 cm). In terms of hormonal production, 4 cases were prolactinomas and 3 were non-functioning PITNets. Over the follow-up period, these tumors exhibited an aggressive behavior, manifesting rapid tumor growth despite optimized treatments and one case was recategorized as metastatic PitNET. All cases demonstrated a Ki-67 index greater than or equal to 3%. The initiation of TMZ occurred on average 9.48 years after diagnosis and subsequent to multiple surgical interventions (average of 1.8 surgeries). In 5 cases, TMZ followed radiotherapy. Among the cohort, 3 of 7 patients underwent 6 cycles of TMZ, one underwent 5 cycles, another had an extended treatment of 10 cycles and 2 patients received only 3 cycles due to adverse effects. In terms of treatment response, 4 patients exhibited stable disease, one achieved a partial response (PR) and 2 had disease progression. The most commonly side effect was mild nausea and vomiting and one patient required dose adjustment due to thrombocytopenia. A second course of TMZ was warranted in 2 cases that previously demonstrated a PR (on average one year after the initial treatment). While one case sustained the PR, the other experienced disease progression. Conclusion: The administration of this treatment was often postponed, potentially attributed to the significant disparities in opinions regarding the optimal timing of treatment initiation and the most suitable duration of usage. However, TMZ demonstrated its efficacy in maintaining disease stability for the majority of cases, with good tolerability and safety, even when used later, after multiple surgical procedures, and in patients with high Ki67 levels. Presentation: 6/2/2024

8620 Prevalence of Osteopenia of Prematurity and Risk Factors in Neonatal of Maternity Hospital

Abstract Disclosure: D.M. Bastos: None. J.G. Bastos: None. A.C. Bastos: None. Introduction: The osteometabolic disease of prematurity (ODP), formerly known as osteopenia of prematurity, corresponds to a disorder of bone mineralization in the neonatal period in very low birth weight premature newborns. The estimated prevalence is about 30% when the birth weight is less than 1,500 grams and around 60% when it is less than 1,000 grams. There is no specific clinical picture, and it can present with mild manifestations, growth deficit, or even evolve with severe rickets and fractures. To qualify the care of premature newborns (NB) in our Service, we question what is the local prevalence of ODP and what are the clinical, biochemical, or imaging risk factors that are potentially related to a greater predisposition to this condition. Objective: Evaluate the prevalence of ODP and recognize potential risk factors in NBs in a neonatal ICU of a reference maternity hospital in Curitiba/ PR. Method: Retrospective longitudinal study, with analysis of medical records of patients born with a gestational age less than 34 weeks and birth weight less than 1,500 grams, born between January/2013 to August/2016. Discussion: Prematurity is the significant factor, followed by low birth weight, for osteopenia. Newborns (NB) with a birth weight below 1500g should receive 40mg/Kg of calcium and 50 mg/Kg of phosphorus. Supplementation of human milk should be started from 15 days of life or when oral intake reaches 100ml/Kg per day (1g/20 ml of milk). In this study, the classification of the growth curve and prevalence by sex were divergent with the literature. The most vulnerable are those with parenteral nutrition or prolonged fasting, as the adequate diet is the basis of prevention and treatment, similar data being found, as well as association with prolonged use of diuretic, presence of sepsis diagnosis and bronchopulmonary dysplasia. However, there is still a lack of specific and sensitive markers for early diagnosis and treatment. Conclusion: The prevalence of Osteopenia of Prematurity was lower than that found in the literature. The risk factors bronchopulmonary dysplasia and use of diuretics were statistically significant when evaluated in patients with osteopenia. However, no relationship was found between ODP and sepsis, as well as a relationship between ODP and Necrotizing Enterocolitis. Regarding the days kept fasting, use of TPN and Use of antibiotics, a longer duration of use was obtained when compared with the group that did not develop the disease. Presentation: 6/3/2024

An experiment on the installation of small calming spaces in childcare rooms - Frequency of use with internal sound absorption

In this study, a field experiment was carried out in a kindergarten classroom for 5-year-olds where a small spaces for calming down were installed. The small space has a box shape for one person with a width, depth, and height of 42, 57, and 74 cm, and two units were installed with different inside sound-absorbing conditions. The noise attenuation due to the small space was about 6 to 7 dB above 500 Hz bands with additional internal sound absorption. The experiment was performed for two months in a room with short and long reverberation, respectively, during which the use of the space was automatically observed using a mat sensor and the room sound was recorded at the same time. As a result, the frequency and duration of use of the spaces increased in the room with longer reverberation. Also, the duration of use of spaces with internal sound absorption tended to be longer.

A quality improvement initiative to reduce excess inhaled therapy use in the neonatal intensive care unit.

Inhaled medications are commonly used at our single-center, Level IV neonatal intensive care unit (NICU). We lacked a standardized process for measuring efficacy of these medications to guide optimal duration of use, potentially leading to their overuse. We utilized quality improvement methodology to reduce the length of inhaled hypertonic saline (HTS) course durations and high frequency albuterol use. Interventions included education, data sharing, and implementation of a respiratory therapy assessment tool. The average inhaled HTS course duration decreased from 8.7 to 4.2 days. The percentage of q4 albuterol administrations per total albuterol doses administered monthly decreased from 39 to 20%. Developing a shared mental model between interprofessional providers for the indication and effect of inhaled agents and standardizing assessment of these medications' efficacy can reduce their overuse.

Synergistic and antagonistic interaction between ZDDP and TiO2 nanoparticles under boundary lubrication

Lubricants are complex mixtures of additives that serve multiple purposes, and these additives must work synergistically at best and at worst, not interfere with each other. In previous research, nanoparticles of TiO2 have demonstrated excellent tribological outcomes when used singularly as an additive in lubricants. In this study, we have shown that when nanoparticles of TiO2 and ZDDP are used together they act antagonistically by resulting in very high wear rates wherein nanoparticles of TiO2 remove the protective tribofilms from ZDDP as they form on the surface. To further investigate this behavior, we used these additives in alternating sequential order and introduced them at different time points (15 & 30 min) during the one-hour testing. Very synergistic interaction is seen when TiO2 is used first followed by ZDDP wherein the TiO2 reacts with the Fe substrate to form FeTiO3. This layer then serves as a superior surface for Zn-polyphosphates and Ti-phospate tribofilms formed due to the decomposition of ZDDP under tribological conditions. On the other hand, when use of ZDDP is followed by TiO2 we see outcomes that favor the shorter duration of use of ZDDP, however, results are not as effective as former case where TiO2 is followed by ZDDP. The addition of TiO2 earlier in the tribological process assists in the development of more robust complex polyphosphate tribofilms leading to much desirable tribological properties.

Hormonal Contraception and Breast Cancer Risk for Carriers of Germline Mutations in BRCA1 and BRCA2.

It is uncertain whether, and to what extent, hormonal contraceptives increase breast cancer (BC) risk for germline BRCA1 or BRCA2 mutation carriers. Using pooled observational data from four prospective cohort studies, associations between hormonal contraceptive use and BC risk for unaffected female BRCA1 and BRCA2 mutation carriers were assessed using Cox regression. Of 3,882 BRCA1 and 1,509 BRCA2 mutation carriers, 53% and 71%, respectively, had ever used hormonal contraceptives for at least 1 year (median cumulative duration of use, 4.8 and 5.7 years, respectively). Overall, 488 BRCA1 and 191 BRCA2 mutation carriers developed BC during median follow-up of 5.9 and 5.6 years, respectively. Although for BRCA1 mutation carriers, neither current nor past use of hormonal contraceptives for at least 1 year was statistically significantly associated with BC risk (hazard ratio [HR], 1.40 [95% CI, 0.94 to 2.08], P = .10 for current use; 1.16 [0.80 to 1.69], P = .4, 1.40 [0.99 to 1.97], P = .05, and 1.27 [0.98 to 1.63], P = .07 for past use 1-5, 6-10, and >10 years before, respectively), ever use was associated with increased risk (HR, 1.29 [95% CI, 1.04 to 1.60], P = .02). Furthermore, BC risk increased with longer cumulative duration of use, with an estimated proportional increase in risk of 3% (1%-5%, P = .002) for each additional year of use. For BRCA2 mutation carriers, there was no evidence that current or ever use was associated with increased BC risk (HR, 0.70 [95% CI, 0.33 to 1.47], P = .3 and 1.07 [0.73 to 1.57], P = .7, respectively). Hormonal contraceptives were associated with increased BC risk for BRCA1 mutation carriers, especially if used for longer durations. Decisions about their use in women with BRCA1 mutations should carefully weigh the risks and benefits for each individual.

Serum melatonin levels and in a sample of Iranian patients with migraine

Migraine, a complex disorder, is characterized by recurrent headache episodes. The production of melatonin in the pineal gland, which is crucial for controlling circadian rhythms and sleep–wake cycles, is altered in various conditions, including neurological disorders such as migraine. Recent studies underscore the significance of serum melatonin levels in patients with chronic and episodic migraine, the focus of this study. This case‒control study, conducted from September 2017 to June 2020 in Tehran, Iran, selected potential participants aged 18–65 years from a headache clinic at Sina Hospital (affiliated with Tehran University of Medical Sciences). Both episodic migraine and chronic migraine were diagnosed following the diagnostic criteria in the International Classification of Headache Disorders’ third edition. Melatonin levels were measured according to the instructions of the ELISA kits. There were significant differences in the frequency of headache days and the duration of abortive medication usage between the two groups (P value < 0.001). Besides, analysis revealed significantly lower serum melatonin levels in patients with episodic ((80.45–45.06) 72.83) and chronic migraine ((154.34–63.34) 70.38, P value < 0.001) than in healthy controls (281.25–160.86) 280). Although no considerable differences were found between episodic and chronic migraine patients, the current study demonstrated that serum melatonin levels were substantially greater in healthy controls than in patients with migraine.

Risk of infections among persons treated with opioids for chronic pain: a systematic review and meta-analysis protocol

IntroductionMillions of persons with chronic pain across North America and Europe use opioids. While the immunosuppressive properties of opioids are associated with risks of infections, these outcomes could be mitigated...

Utilization Patterns of Glucagon Like Peptide-1 Receptor Agonists Prior to Bariatric and Metabolic Surgery: A Multicenter Study

BackgroundGlucagon-like-peptide-1 receptor agonists (G1RA) have gained popularity as a treatment for weight loss in patients who are overweight or obese, but their utilization patterns and impact on candidates for metabolic and bariatric surgery (MBS) remain understudied. ObjectiveWe aimed to investigate the prevalence, characteristics, and outcomes of patients with a history of G1RA utilization among MBS candidates. SettingFive high-volume MBS centers in Israel. MethodsData were collected retrospectively from February 1st, 2023, to September 30th, 2023. Demographic, clinical, and treatment data were analyzed to assess a history of G1RA use, associated factors, adverse events, and treatment outcomes. Results434 MBS candidates were included in the study. A history of G1RA utilization was obtained in 275 (63%) MBS candidates, with Liraglutide and Semaglutide being the most commonly used agents. Younger age, type 2 diabetes mellitus, dyslipidemia, and no previous MBS history were associated with a higher rate of G1RA utilization. With these medications, median maximal weight loss was 5.38 kg, and mean duration of use was 19 weeks. Patients using G1RA for ≥6 weeks experienced significantly greater weight loss compared to those using it for shorter periods (6.3±6.43 vs 1.65±1.69 ;p<0.001). GI-related adverse events were reported in 57.8% of patients. Over 95% of patients discontinued G1RA due to insufficient weight loss and/or adverse effects. Patients reaching the maximal recommended dose exhibited significantly greater weight loss vs patients who did not reach it for both Liraglutide (5.9±4.98 kg vs. 3.9±5.53 kg; p=0.03) and Semaglutide (6.5±7.8 kg vs. 2.5±3.8 kg; p=0.016). ConclusionPre-MBS G1RA utilization and failure are prevalent among MBS candidates. Our study underscores the need for further research to understand the role of G1RA therapy in obesity management and the development of guidelines for its appropriate use in MBS candidates.

The Influence of Personal Listening Devices on Hearing in Egyptian University Students: A Cross-Sectional Study

Background: Improper use of personal listening devices (PLDs) is associated with an increased risk of hearing loss. The purpose is to investigate the use of PLDs among university students and their impact on hearing. Methodology: A study involved 310 University students, surveyed on their PLDs habits. They shared their daily PLD use, volume level, and duration of use. Participants also discussed PLD-related hearing issues and other risk factors for hearing loss. Screening used the Five-minute hearing test (FMHT) and the “Hear WHO” app. Positive cases in both tests received diagnostic pure-tone audiometry (PTA). Results: About 70% used in-earpiece PLDs for studying, 53% used them for over 5 years. Also 83% used PLDs for over 60 mins daily, and 72% used them above volume level 6. Most (74%) were low-risk users. 10.6% tested positive for hearing loss in both screenings, with 1.6% confirmed by PTA. A shift in the 4 kHz average hearing threshold was noted. Tinnitus was reported by 49%, and ear pain by 42% of students. Higher risk PLD use predicted tinnitus, ear pain and excessive ear wax in multivariable analysis. Conclusions: Students' high-volume PLD use is linked to auditory problems like tinnitus and ear pain. Regular hearing screenings are recommended.