Excess Incidence Research Articles

Does the timing of surgery affect outcomes in young and middle-aged patients undergoing surgical stabilization of rib fractures? Feedback was based on real data from physicians, patients, and family caregivers.

There is a general clinical consensus that early surgical stabilization of rib fractures (SSRF, ≤ 48-72h after admission) can benefit patients, and this is only regarding the surgeon's opinions. This study assessed the true outcomes of young and middle-aged patients at different surgical timings. This retrospective cohort study was conducted among patients aged 30-55years who were hospitalized with a diagnosis of isolated rib fractures and underwent SSRF between July 2017 and September 2021. The patients were divided into early (≤ 3days), mid- (4-7days) and late (8-14days) groups, according to the interval (days) between surgery and injury date. The impact of different surgical timings on clinical outcomes, patients, and families was assessed by comparing SSRF-related data during hospitalization and follow-up studies of clinicians, patients themselves, and family caregivers 1-2months after surgery. In this study, 155 complete patient data were finally included, including 52, 64, and 39 patients in the early, mid, and late groups, respectively. Length of operation, preoperative closed chest drainage rate, length of hospital stay, intensive care unit length of stay, duration of invasive mechanical ventilation in the early group were lower than those in the intermediate and late groups. Additionally, hemothorax and excess pleural fluid incidence after SSRF was lower in the early group than in the intermediate and late groups. Postoperative follow-up results showed that patients in the early group had higher SF-12 physical component summary scores and shorter duration of absence from work. Family caregivers had lower Zarit Burden Interview scores than those in the mid- and late groups. From the experience of our institution's SSRF, early surgery is safe and offers additional potential benefits for young and middle-aged patients and families with isolated rib fractures.

Risk of male breast cancer after Hodgkin lymphoma

AbstractFemale survivors of Hodgkin lymphoma (HL) treated with chest radiotherapy have a strongly increased risk of breast cancer (BC), but the treatment-specific BC risk in male survivors of HL has not been evaluated. We assessed BC risk in a cohort of 3077 male survivors of 5-year HL treated at age ≤51 years in 20 Dutch hospitals between 1965 and 2013. We estimated standardized incidence ratios (SIRs), absolute excess risks per 10 000 person-years, and cumulative BC incidences. After a 20-year median follow-up, we observed 8 cases of male with BC. Male survivors of HL experienced a 23-fold (95% confidence interval [CI], 10.1-46.0) increased BC risk compared with the general population, representing 1.6 (95% CI, 0.7-3.3) excess BC incidences per 10 000 person-years. The 20- and 40-year cumulative BC incidences after HL treatment were 0.1% (95% CI, 0.02-0.3) and 0.7% (95% CI, 0.3-1.4), respectively. Treatment with chest radiotherapy without alkylating chemotherapy yielded a strongly increased SIR (20.7; 95% CI, 2.5-74.8), which was not significantly different for chest radiotherapy and alkylating chemotherapy (41.1; 95% CI, 13.4-96.0). Males treated with chest radiotherapy and anthracyclines had an SIR of 48.1 (95% CI, 13.1-123.1). Two patients died from BC (median follow-up, 4.7 years). To ensure early diagnosis and treatment, clinicians should be alert to BC symptoms in male survivors of HL.

Attributable risks of varicose veins in the population of a large region of the Central Federal District of the Russian Federation

The article presents the results of a study of the attributable risks of varicose veins in the population of a large region of the Central Federal District of the Russian Federation. A retrospective study of statistical data from medical documents of patients with a diagnosis of lower limb varicose veins who underwent outpatient treatment in the private medical organization Yaroslavl Phlebology Center «Doktor Ven» from 2015 to 2021 was conducted. The homogeneity of the studied population was assessed by age and time criteria, and the analysis of risk factors for the development of varicose veins recorded by experts in patients with an established diagnosis of I83.0, I83.1, I83.2, and I83.9 according to the ICD-10 was carried out. It is known that the prevalence of varicose veins is at the level of 12–26 % among the adult population. This study made it possible to prove that socio-economic, socio-biological, and medical attributable risk factors are the key factors influencing the excessive incidence of varicose disease, its progression and recurrence. Stratification of risks from the perspective of their management capabilities is the first step towards the development of integrated approaches and measures aimed at preventing the varicose veins disease and reducing its prevalence in the population at all levels: from individual to state level. The analysis of attributable risks without taking into account the uncertainty factor and randomness in the data sample and determining the confidence interval in which the true value of the parameter of the general population is located with a certain degree of probability requires reliability correction. In this regard, further study of the pathoepidemiology of varicose veins using sufficiently reliable statistical research methods is of great scientific and practical interest.

Sex differences in hepatitis A incidence rates-a multi-year pooled-analysis based on national data from nine high-income countries.

Possible sex differences in hepatitis A virus (HAV) incidence rates in different age groups are not well documented. We aimed to obtain stable pooled estimates of such differences based on data from a number of high-income countries. We obtained data on incident cases of HAV by sex and age group over a period of 6-25 years from nine countries: Australia, Canada, Czech Republic, Finland, Germany, Israel, Netherland, New Zealand and Spain. Male to female incidence rate ratios (IRR) were computed for each year, by country and age group. For each age group, we used meta-analytic methods to combine the IRRs. Meta-regression was conducted to estimate the effects of age, country, and time period on the IRR. A male excess in incidence rates was consistently observed in all age groups, although in the youngest and oldest age groups, where the numbers tended to be lower, the lower bounds of the 95% confidence intervals for the IRRs were less than one. In the age groups <1, 1-4, 5-9, 10-14, 15-44, 45-64 and 65+, the pooled IRRs (with 95% CI) over countries and time periods were 1.18 (0.94,1.48), 1.22 (1.16,1.29), 1.07 (1.03,1.11), 1.09 (1.04,1.14), 1.46 (1.30,1.64), 1.32 (1.15,1.51) and 1.10 (0.99,1.23) respectively. The excess HAV incidence rates in young males, pooled over a number of countries, suggest that the sex differences are likely to be due at least in part to physiological and biological differences and not just behavioral factors. At older ages, differential exposure plays an important role. These findings, seen in the context of the excess incidence rates in young males for many other infectious diseases, can provide further keys to the mechanisms of the infection.

Associations between micro-geographic social vulnerability and disparities in cancer incidence.

e18523 Background: Disparities in cancer incidence and diagnosis are the result of complex physical-social-environmental interactions. Geography is one crucial lens for assessment of these disparities. The CDC’s Social Vulnerability Index (SVI) ranks micro-geographies such as Census Tracts based on social factors and can be used to identify health disparities in measures such as cancer incidence. Methods: Actual and age-adjusted expected incidence of common cancers were obtained from the New York State Cancer Registry for 2013-2017 at the Census Tract level. Data were merged with the CDC’s Overall SVI rating for 2016 at the Census Tract level. Analysis included 4,647 Census Tracts, accounting for 97.71% of New York State’s 2016 population (19,078,306 population included). For each cancer, actual and expected incidence were grouped by overall SVI percentile, then percentage deviation from expected cancer incidence was calculated. Pearson correlational test and two-tailed t-test were performed for incidence deviation of each cancer by overall SVI percentile. Results: In New York State, significant correlations between Census Tract Overall Social Vulnerability Index (SVI) percentile and percentage deviation from expected cancer incidence were found for 5 out of 6 cancers reported in the State Cancer Registry. Strong positive relationships between degree of vulnerability and deviation from expected incidence were found for Lung Cancer (R = 0.75, p &lt; 0.001) and Colorectal Cancer (R = 0.67, p &lt; 0.001). Strong negative relationships were found for Female Breast Cancer (R = -0.90, p &lt; 0.001), Urinary Bladder Cancer (R = -0.76, p &lt; 0.001), and Non-Hodgkin Lymphoma (R = -0.73, p &lt; 0.001). A significant correlation was not found for Prostate Cancer, which demonstrated a bimodal relationship with higher excess incidence at low and high vulnerability ratings. Conclusions: There are statistically significant increases in reported incidence of Colorectal and Lung Cancers in more vulnerable Census Tracts in NY State. Paradoxically, there are significant decreases in reported incidence of Breast Cancer, Bladder Cancer, and Non-Hodgkin Lymphoma in more vulnerable Census Tracts. Further exploration of micro-geographic trends is critical to understand the extent to which these disparities are explained by true differences in cancer incidence or by variations in screening access and utilization. [Table: see text]

Vaccination-Associated Myocarditis and Myocardial Injury.

SARS-CoV-2 vaccine-associated myocarditis/myocardial injury should be evaluated in the contexts of COVID-19 infection, other types of viral myocarditis, and other vaccine-associated cardiac disorders. COVID-19 vaccine-associated myocardial injury can be caused by an inflammatory immune cell infiltrate, but other etiologies such as microvascular thrombosis are also possible. The clinical diagnosis is typically based on symptoms and cardiac magnetic resonance imaging. Endomyocardial biopsy is confirmatory for myocarditis, but may not show an inflammatory infiltrate because of rapid resolution or a non-inflammatory etiology. Myocarditis associated with SARS-COVID-19 vaccines occurs primarily with mRNA platform vaccines, which are also the most effective. In persons aged >16 or >12 years the myocarditis estimated crude incidences after the first 2 doses of BNT162b2 and mRNA-1273 are approximately 1.9 and 3.5 per 100 000 individuals, respectively. These rates equate to excess incidences above control populations of approximately 1.2 (BNT162b2) and 1.9 (mRNA-1273) per 100 000 persons, which are lower than the myocarditis rate for smallpox but higher than that for influenza vaccines. In the studies that have included mRNA vaccine and SARS-COVID-19 myocarditis measured by the same methodology, the incidence rate was increased by 3.5-fold over control in COVID-19 compared with 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273. However, mortality and major morbidity are less and recovery is faster with mRNA vaccine-associated myocarditis compared to COVID-19 infection. The reasons for this include vaccine-associated myocarditis having a higher incidence in young adults and adolescents, typically no involvement of other organs in vaccine-associated myocarditis, and based on comparisons to non-COVID viral myocarditis an inherently more benign clinical course.

Non-asbestiform elongate mineral particles and mesothelioma risk: Human and experimental evidence

The presentations in this session of the Monticello II conference were aimed at summarizing what is known about asbestiform and non-asbestiform elongate mineral particles (EMPs) and mesothelioma risks based on evidence from experimental and epidemiology studies. Dr. Case discussed case reports of mesothelioma over the last several decades. Dr. Taioli indicated that the epidemiology evidence concerning non-asbestiform EMPs is weak or lacking, and that progress would be limited unless mesothelioma registries are established. One exception discussed is that of taconite miners, who are exposed to grunerite. Drs. Mandel and Odo noted that studies of taconite miners in Minnesota have revealed an excess rate of mesothelioma, but the role of non-asbestiform EMPs in this excess incidence of mesothelioma is unclear. Dr. Becich discussed the National Mesothelioma Virtual Bank (NMVB), a virtual mesothelioma patient registry that includes mesothelioma patients' lifetime work histories, exposure histories, biospecimens, proteogenomic information, and imaging data that can be used in epidemiology research on mesothelioma. Dr. Bernstein indicated that there is a strong consensus that long, highly durable respirable asbestiform EMPs have the potential to cause mesothelioma, but there is continued debate concerning the biodurability required, and the dimensions (both length and diameter), the shape, and the dose associated with mesothelioma risk. Finally, Dr. Nel discussed how experimental studies of High Aspect Ratio Engineered Nanomaterials have clarified dimensional and durability features that impact disease risk, the impact of inflammation and oxidative stress on the epigenetic regulation of tumor suppressor genes, and the generation of immune suppressive effects in the mesothelioma tumor microenvironment. The session ended with a discussion of future research needs.

How does credit risk affect cost management strategies? Evidence on the initiation of credit default swap and sticky cost behavior

In this paper, we examine the effect of credit defaults swaps (CDS) initiation on reference firms' cost management strategies. CDS contracts provide insurance protection for creditors, inducing a shift in bargaining power from borrowers to creditors and an excessive incidence of bankruptcy. Anticipating more intransigent creditors in debt renegotiations and higher bankruptcy risk, CDS firms are incentivized to mitigate risk through decreasing cost stickiness after CDS initiation, as cost stickiness lowers liquidity and triggers early covenant violations. We find that, on average, CDS initiation is associated with a decline in reference firms' cost stickiness. This association is more pronounced for less liquid, financially distressed, and lower credit quality firms. We also find that CDS firms with a reduction in cost stickiness will exhibit lower future bankruptcy risk than CDS firms without such as reduction in stickiness. Collectively, our findings suggest that the CDS-induced “empty creditor problem” causes reference firms to undertake more conservative cost management practices to alleviate downside risk.

Effective doses and risks from medical diagnostic x-ray examinations for male and female patients from childhood to old age

The consideration of risks from medical diagnostic x-ray examinations and their justification commonly relies on estimates of effective dose, although the quantity is actually a health-detriment-weighted summation of organ/tissue-absorbed doses rather than a measure of risk. In its 2007 Recommendations, the International Commission on Radiological Protection (ICRP) defines effective dose in relation to a nominal value of stochastic detriment following low-level exposure of 5.7 × 10−2 Sv−1, as an average over both sexes, all ages, and two fixed composite populations (Asian and Euro-American). Effective dose represents the overall (whole-body) dose received by a person from a particular exposure, which can be used for the purposes of radiological protection as set out by ICRP, but it does not provide a measure that is specific to the characteristics of the exposed individual. However, the cancer incidence risk models used by ICRP can be used to provide estimates of risk separately for males and females, as a function of age-at-exposure, and for the two composite populations. Here, these organ/tissue-specific risk models are applied to estimates of organ/tissue-specific absorbed doses from a range of diagnostic procedures to derive lifetime excess cancer incidence risk estimates; the degree of heterogeneity in the distribution of absorbed doses between organs/tissues will depend on the procedure. Depending on the organs/tissues exposed, risks are generally higher in females and notably higher for younger ages-at-exposure. Comparing lifetime cancer incidence risks per Sv effective dose from the different procedures shows that overall risks are higher by about a factor of two to three for the youngest age-at-exposure group, 0–9 yr, than for 30–39 yr adults, and lower by a similar factor for an age-at-exposure of 60–69 yr. Taking into account these differences in risk per Sv, and noting the substantial uncertainties associated with risk estimates, effective dose as currently formulated provides a reasonable basis for assessing the potential risks from medical diagnostic examinations.

Patient and Fetal Radiation-Induced Malignancy Risk From Imaging For Evaluation of Pulmonary Embolism in Pregnancy

BackgroundImaging for diagnosis of suspected pulmonary embolism in pregnancy presents radiation concerns for patient and fetus. ObjectivesEstimate the risks of radiation-induced breast cancer and childhood leukemia from common imaging techniques for the evaluation of suspected pulmonary embolism in pregnancy. MethodsBreast and uterine absorbed doses for various imaging techniques were input into the National Cancer Institute Radiation Risk Assessment Tool to calculate risk of breast cancer for the patient and childhood leukemia for the fetus. Absorbed doses were obtained by synthesizing data from a recent systematic review and the International Commission on Radiological Protection. Primary outcomes were the estimated excess incidences of breast cancer and childhood leukemia per 100,000 exposures. ResultsBaseline incidences of breast cancer for a 30-year-old woman and childhood leukemia for a male fetus were 13,341 and 939, respectively. Excess incidences of breast cancer were 0.003 and 0.275 for a single and two-view chest radiograph, respectively, 9.53 and 20.6 for low- and full-dose computed tomography pulmonary angiography (CTPA), respectively, 0.616 and 2.54 for low- and full-dose perfusion scan, respectively, and 0.732 and 2.66 for low- and full-dose ventilation perfusion scan, respectively. Excess incidences of childhood leukemia were 0.004 and 0.007 for a single and two-view chest radiograph, respectively, 0.069 and 0.490 for low- and full-dose CTPA, respectively, 0.359 and 1.47 for low- and full-dose perfusion scan, respectively, and 0.856 and 1.97 for low- and full-dose ventilation perfusion scan, respectively. ConclusionExcess cancer risks for all techniques were small relative to baseline cancer risks, with CTPA techniques carrying slightly higher risk of breast cancer for the patient and ventilation perfusion techniques a higher risk of childhood leukemia.

Workers in Australian prebake aluminium smelters: update on risk of mortality and cancer incidence in the Healthwise cohort

ObjectivesTo investigate mortality and the rates of incident cancer among a cohort of aluminium industry workers.MethodsAmong 4507 male employees who worked in either of two Australian prebake smelters for at...

Increased breast cancer incidence among nurses in a tertiary university hospital in South Korea.

A series of breast cancer cases were recently reported in a tertiary university hospital in South Korea. Nurses are generally exposed to risk factors for breast cancer such as night shift work, antineoplastic agents, and job strain. However, the epidemiological evidence of excess incidence among nurses remains lacking. This study aims to investigate the excess incidence of breast cancer among nurses in a tertiary university hospital and provide epidemiological evidence of occupational risk factors. A retrospective cohort was developed using personnel records of female workers in the nursing department who worked from January 2011 to June 2021 in a tertiary university hospital in South Korea. Sick leave records were used to identify cases of breast cancer. The standardized incidence ratio of breast cancer among nurses was compared to the general population. A total of 5,509 nurses were followed up for 30,404 person-years, and 26 breast cancer cases were identified. This study revealed a significantly increased breast cancer incidence among all included nurses, with a standardized incidence ratio of 1.65 (95% confidence interval [CI]: 1.08-2.41), compared to the general population. Workers, who handle antineoplastic agents in their representative department and current and/or former department, had significantly elevated breast cancer standardized incidence ratios of 2.73 (95% CI: 1.008-5.94) and 3.39 (95% CI: 1.46-6.68), respectively. This study provides significant evidence of increased breast cancer risk among nursing staff in a hospital setting, particularly those who handle antineoplastic drugs. Measures that reduce exposure to risk factors should be implemented, especially anticancer drugs, to protect healthcare professionals. Further research at a national level that focuses on healthcare workers is necessary to validate breast cancer incidence and its contributing factors.

Incidence of Post-Anesthesia Complications in the Recovery of Tertiary Care Hospital

Background: The Post- Anesthesia care unit to recover and wakeup after having anesthesia for an operation or procedure. It is a critical care unit where the patient's vital signs are closely observed, pain management begins, and fluids are given. Post-anesthesia complications are common in high-risk surgical populations and are associated with poor short-term and long-term outcomes. Morbidity can be identified using prospective assessment of pathological criteria, or deviations from the ideal postoperative course requiring clinical intervention. Objectives: The aim of this study is to assess the Incidence of post-anesthesia complications in the recovery of tertiary care hospital. Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of anesthesiology, MH Samorita Hospital &amp; Medical College, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2020 to January 2021. The duration of the period from Data was entered in MS Excel and Statistical analysis was done using SPSS trial version. Results: This study shows that the according to age of 100 Patients aged 40 to 69 years. Here according to Age distribution, 18(18.0%) were 20-29 years, 15(15.0%) were 30-39, 48(48.0%) were 40-49, 12(12.0%) were 50-59 years and 7(7.0%) &gt;60 years. And according to gender (76%) males and (24%) females. Conclusion: The especially excessive incidence of issues in healing suggests the significance of using expert personnel and additionally the usage of sufficient monitoring equipment in order to minimize mortality and morbidity of the patients and additionally store on hospital charges.

Healthcare system engagement and algorithm-identified cancer incidence following initiation of a new medication.

Implausibly high algorithm-identified cancer incidence within a new user study after medication initiation may result from increased healthcare utilization (HU) around initiation ("catch-up care") that increases diagnostic opportunity. Understanding the relationships between HU prior to and around initiation and subsequent cancer rates and timing is important to avoiding protopathic bias. We identified a cohort of 417 458 Medicare beneficiaries (2007-2014) aged ≥66 initiating an antihypertensive (AHT) after ≥180 days of non-use. Initiators were stratified into groups of 0, 1, 2-3, and ≥4 outpatient visits (OV) 60-360 days before initiation. We calculated algorithm-identified colorectal cancer (aiCRC) rates stratified by OVs and time since AHT initiation: (0-90, 91-180, 181-365, 366-730, and 731+ days). We summarized HU -360/+60 days around AHT initiation by aiCRC timing: (0-29, 30-89, 90-179, and ≥180 days). AiCRC incidence (311 per 100 000 overall) peaked in the first 0-90 days, was inversely associated with HU before initiation, and stabilized ≥180 days after AHT initiation. Catch-up care was greatest among persons with aiCRCs identified <30 days in follow-up. Catch-up care magnitude decreased as time to the aiCRC date increased, with aiCRCs identified ≥180 days after AHT initiation exhibiting similar HU compared with the full cohort. Lower HU before-and increased HU around AHT initiation-seem to drive excess short-term aiCRC incidence. Person-time and case accrual should only begin when incidence stabilizes. When comparison groups within a study differ by HU, outcome-detection bias may exist. Similar observations may exist in other settings when typical HU is delayed (e.g., cancer screening during SARS-CoV-2).

Treatment-Related Circulatory Diseases and Mortality in Hodgkin Lymphoma Patients Using Multi-State Modelling and Relative Survival

Introduction Diseases of the circulatory system (DCS) are some of the most common late effects of Hodgkin lymphoma (HL), primarily due to mediastinal radiotherapy and/or anthracycline-containing chemotherapy (e.g., ABVD and BEACOPP). As DCS is very common in the general population, modelling DCS attributable to HL therapy versus that expected in the general population is relevant to understand the magnitude of DCS reduction that could be achieved with less cardiotoxic therapies. This real-world data study used multi-state modelling and relative survival to estimate treatment-related DCS risk in HL survivors. Material and methods All HL patients registered in the Swedish Lymphoma Register 2000-2018, aged 18-80 years at diagnosis, and treated with anthracycline-containing therapy were included. DCS events were identified in the Swedish National Inpatient Register (ICD-10 codes I00-I99) and defined as the first admission for DCS after HL diagnosis. Sex-, year-, and age-specific DCS incidence rates in the general population were retrieved from public records. Patients were followed from treatment initiation through a series of states: alive and DCS-free, alive and with (excess or expected) DCS, dead without DCS, and dead after DCS. Follow-up ended on date of death, emigration, or December 31st, 2019, whichever came first. All state transitions were modelled separately using flexible parametric survival models, yielding hazard ratios (HR) with 95% confidence intervals (CI). A relative survival model incorporating the expected DCS rates was fitted to allow for estimation of excess DCS, which was then interpreted as treatment-related. Transition probabilities (i.e., the likelihood of being in a state) were predicted for specific patient groups, by sex and low/high (≤200/>200 mg/m2) cumulative anthracycline dose. Results In a total of 1,929 HL patients, the mean age at diagnosis was 42 years, 54% were males, and 49% were treated with high dose anthracycline (Table 1). The distribution of treatments was 66% ABVD, 20% CHOP-like, and 14% BEACOPP. During a median follow-up of 7.6 years (IQR: 4.5-11.0), 145 (7.5%) died without DCS, 377 patients (20%) were diagnosed with DCS, and 87 (5%) died after DCS. Figure 1a shows the sex-specific transition probabilities for a patient with advanced stage disease, diagnosed in 2000, at age 50, and treated with a cumulative anthracycline dose of >200mg/m2 in a ABVD regimen. The probability of being in the treatment-related (excess) DCS state at 10 years after first line treatment was 0.35 (95% CI: 0.09-0.75) for males and 0.41 (95% CI: 0.10-0.81) for females in this patient group. Figure 1b shows the probabilities for limited stage male patients diagnosed in 2000 at age 50, treated with ABVD, by low/high anthracycline dose. Here, the probability of being in the treatment-related (excess) DCS state at 10 years was 0.44 (95% CI: 0.16-0.76) and 0.53 (95% CI: 0.25-0.80) for low and high dose anthracycline patients, respectively. There were no significant differences in treatment-related (excess) DCS incidence rates or post DCS all-cause mortality rates (Table 1). Females had a significantly lower non-DCS mortality rate than males (adj. HR=0.69, 95% CI: 0.49-0.97), as did patients treated with high compared to low anthracycline dose (adj. HR=0.28, 95% CI: 0.18-0.44). Conclusion After 10 years, females had higher risks of treatment-related (excess) DCS compared to males, although not statistically significant and likely due to superior survival. The same was seen for high compared to low cumulative doses of anthracycline. Female sex and high dose anthracycline reduced the non-DCS mortality rate, but not the excess DCS incidence rate. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 15307: Change in Cardiovascular Health, Cardiovascular Disease, and Mortality in Patients With Diabetes

Aim: To describe patterns of change in cardiovascular health (CVH) measured by the Life’s Simple 7 (LS7) over 6 years in participants with diabetes, and assess the association of these patterns of change with subsequent CVD and all-cause mortality. Methods: We conducted a long-term prospective cohort analysis (median follow-up 19 years) using the ARIC study, a community-based, biracial cohort with participants aged 45-64 years at baseline in 1987-1989. Seven markers of LS7 were collected at baseline and 6 years later: smoking, body mass index, physical activity, diet, total cholesterol, blood glucose, and blood pressure. At both time points, participants were classified as low, moderate, and favorable CVH, corresponding to presenting 0-2, 3-4, and 5-7 metrics at ideal levels. Results: The majority (62.2%) of participants with diabetes at baseline had a stable low CVH at both visits, whereas 12.1% had stable moderate and 0.4% stable favorable, 14.9% improved, and 10.5% worsened. Compared to those with stable low LS7, CVD and mortality risk was lower for those who showed improvement 6 years later, or started moderate and remained so, or even who deteriorated to low CVH. This was driven by favorable changes in blood pressure, cholesterol, physical activity and smoking. Compared to participants free of diabetes with a stable favorable CVH trajectory, participants with diabetes had a higher CVD and mortality risk regardless of their CVH trajectory. However, those with a favorable LS7 trajectory displayed the same excess risk as participants without diabetes with constantly low CVH. Conclusions: Among individuals with diabetes, maintaining or reaching ideal levels of LS7 metrics can help reduce the excess CVD incidence and mortality. A favorable CVH trajectory in people with diabetes carried approximately the same excess CVD and mortality risk than an unfavorable CVH trajectory in people free of diabetes.

Excess Incidence of Home Dialysis Attrition During the COVID-19 Pandemic

Excess Incidence of Home Dialysis Attrition During the COVID-19 Pandemic

Guidance of Ultrasound in Critical Illness to Direct Euvolemia Trial: A Cluster-Randomized, Crossover, Comparative Effectiveness Trial

INTRODUCTION: Acute kidney injury (AKI) after trauma is common and associated with poor outcomes. Both inadequate resuscitation and excess fluid administration increase incidence and duration of AKI. We hypothesized that adding ultrasound (US) assessments of inferior vena cava diameter and collapsibility index to usual care would result in shorter AKI duration. METHODS: The Guidance of Ultrasound in Critical Illness to Direct Euvolemia (GUIDE) trial was a sequential, cluster-randomized, crossover comparative effectiveness trial designed to account for care team clusters. ICU teams were randomized to usual care with or without the addition of 24 hours of serial inferior vena cava diameter and inferior vena cava diameter and collapsibility index measurements from September 2019 to June 2020. The primary outcome was AKI duration. Univariate and multivariate analyses were performed. RESULTS: Of 411 patients, 222 were randomized to the US group. Demographics were similar between groups. Patients had a median Injury Severity Score of 26 (interquartile range 16 to 34) and a median age of 38 (interquartile range 26 to 60). The incidence of AKI was similar between groups (US 54% vs usual care 58%, p = 0.46), and the median duration of AKI was 1 day in both groups (interquartile range 0 to 2, p = 0.34). Fluid balances were similar at 24 hours; however, at 48 hours, patients in the US group had a higher fluid balance (Figure). Other complications and mortality were similar between groups.FigureCONCLUSION: This comparative effectiveness trial demonstrated that addition of inferior vena cava diameter and inferior vena cava diameter and collapsibility index assessments to routine care did not affect the duration of AKI but increased patients’ fluid balance at 48 hours. Routine application of US assessments of fluid status in severely injured trauma patients is not recommended.

Incidence of Accommodative Excess Reported at Binocular Vision Therapy Clinic of a Tertiary Eye Care Centre Among School Children During Pandemic Lockdown

Purpose: This study aimed to find out the aspects of incidence of accommodative excess among school-going children due to excessive near work during pandemic period in relation to various parameters like indoor-outdoor activity &amp; screen time. Methodology: A retrospective study was conducted among 176 individual children between 5-17 years of age reported with ocular or non-ocular asthenopic symptoms. A detailed test had performed to check various accommodative parameters like NPA, MEM, NRA, PRA, MAF, BAF, as well as vergence parameters like NPC, NFV and PFV. One monthly follow up had been performed all these necessary binocular vision assessments tests &amp; checked the status. Results: Out of 267 patients, 51 of them had accommodative excess (28.97%). It was found that 29% children with less screen exposure &amp; 46% of children with excessive screen exposure had developed accommodative excess which became significant (fisher’s exact 0.027). The percentage of children with less indoor activity &amp; excessive indoor activity with accommodative excess were 17% &amp; 48% respectively (p value 0.052). Among all the Accommodation parameters, Accommodative facility (100%) becomes an excellent marker followed by poor NPA (33%), NRA/PRA (27%) &amp; MEM (10%). Also children with long screen &amp; indoor exposure developed with poor NRA more easily.(18% short exposure &amp; 54% long exposure). Conclusion: Children with prolonged near work &amp; indoor activities suffered more compared to children with some outdoor activities &amp; less screen exposure. Secondary convergence insufficiency can be there along with accommodative excess. A proper vision therapy and appropriate counselling about the visual hygiene &amp; environmental modifications should always be advocated to save our future shapers of this beautiful world.

Bronchiectasis: A pulmonary disease with systemic consequences.

Bronchiectasis: A pulmonary disease with systemic consequences.