Fisher's Test Research Articles

The burden and trend of intestinal parasitosis among women at Berekum, Ghana: a 9-year retrospective study.

Intestinal parasitic infections(IPIs) are serious global public health issues, especially in low and middle-income countries. These parasites can cause high morbidity and mortality, especially in immunocompromised individuals, and can easily be transmitted by consumption of contaminated food or water or by penetration of skin and mucous membranes. We retrospectively analyzed all archived data from stool examination reports at the Parasitology Unit of Precise Health Diagnostic Services, Berekum for the prevalence and trends of parasitic infections spanning a period of 9 years (2013-2021). The data was retrieved and exported to IBM SPSS v.26 for statistical analysis. Descriptive data was summarized as proportions and presented in tables and charts. Pearson Chi-Square test (χ2) or Fisher's exact test was used to test for a statistical association between demographic factors and intestinal parasitic infections. P value was significant at < 0.05. A total of 9,217 records of stool examinations were retrieved. Almost half (48.45%) of the data were from patients aged between 20 and 29 years. An overall prevalence of intestinal parasitic infections of 21.20% was observed in this study. Patients aged 70 to 79 had the highest prevalence of the IPIs (44.44%). The parasites recovered in this study were intestinal flagellates, Entamoeba coli, Hookworm, Entamoeba histolytica/dispar, Ascaris lumbricoides, Enterobius vermicularis, Strongyloides stercoralis and Hymenolepis nana. The intestinal flagellates had the highest prevalence (98.31%) compared to the other intestinal parasites recovered. Intestinal parasitic infections had the highest prevalence in the year 2020 (28.56%) and lowest in 2018 (11.78%). An overall prevalence of 21.20% of intestinal parasitic infection was found. The majority of the parasites reported were intestinal flagellates (98.31%). The trend analysis revealed that the overall prevalence fluctuated across the entire period from 2013 to 2021.

Diffusion-Weighted Imaging Does Not Differentiate Between Bacterial and Fungal Skull Base Osteomyelitis.

Apparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients. Retrospective observational study. Quaternary care referral centre. A retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done. Chi-square or Fisher's exact test was used to compare ADC values of bacterial and fungal SBO. The most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10-3 mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10-3 mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142). This study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.

Clinical characteristics and associated factors of pediatric acute necrotizing encephalopathy: a retrospective study.

In the clinic, pediatric acute necrotizing encephalopathy (ANE) primarily affects children under five years of age and is characterized by severe brain damage and high mortality. However, some challenges remain regarding the diagnosis and treatment of ANE. In the present study, we analyzed the clinical characteristics and related factors of ANE with the aim of providing improved diagnostic and treatment strategies. Thirty-four pediatric ANE patients admitted to Zhejiang University School of Medicine Hospital between February 2019 and December 2023 were included in this study. To identify the factors associated with mortality, clinical, laboratory and imaging data were analyzed with independent-sample t tests, Mann‒Whitney U tests, Fisher's exact probability tests and receiver operating characteristic (ROC) curve analyses. In this cohort of 34 patients, the most common symptoms were fever, seizures, altered consciousness, vomiting, diarrhea and shock. The mortality rate was 55.9%. Laboratory tests revealed that patients who died had higher creatinine, lactate, activated partial thromboplastin time (APTT), thrombin time (TT), interleukin-6 (IL-6), interleukin-10 (IL-10), creatine kinase (CK), and D-dimer than survivors. Imaging examinations predominantly revealed symmetrical lesions in the thalamus. The fatal group displayed lower Glasgow Coma Scale (GCS) scores and severe complications. Other factors related to mortality included the arterial pH, GCS score and hospitalization duration. The most common symptoms of ANE are fever, seizures, altered consciousness, vomiting, diarrhea and shock, and ANE has a high mortality rate. The GCS score and arterial pH are critical biomarkers for assessing the severity of ANE.

Effect of methimazole withdrawl period on the I-131 uptake estimation using Tc-99m thyroid scanning in Graves' disease.

The effect of methimazole withdrawl period (MWP) on the estimation of 24 hour-radioiodine thyroid uptake (131IU24h) from 99mTc-pertechnetate thyroid uptake (99mTcTU) remains unclear for patients with Graves disease (GD) . This study aims to investigate the feasibility and reliability of 99mTcTU-based 131IU24h estimation with different MWPs. We enrolled 116 GD patients scheduled for 131I therapy at our hospital between April 2022 and April 2023. Based on MWP, the patients were categorized: standard (no methimazole or MWP>1 month), MWP1 (MWP≤1 week), MWP2 (MWP>1 week to ≤2 weeks) and MWP3 groups (MWP>2 weeks to <1 month). Fisher's exact test, one-way ANOVA or Kruskal-Wallis test were used to compare variables. Fitted curves of 99mTcTU20min versus 131IU24h were plotted for the standard group. Linear relationships and Bland-Altman plots were used to illustrate the relationship and consistency between estimated and measured 131IU24h. 131IU24h was higher in MWP1 group compared to MWP2 (70.22±7.95% vs 61.92±9.84%, P = 0.001), and thyroid masswas greater in MWP1 group (36.15±22.38g) versus MWP3 (21.25±11.90g, P = 0.005). The relationship between131IU24h and 99mTcTU20min in the standard group is described by the algorithm: estimated 131IU24h=11.3ln (99mTcTU20min)+39.4 (R2=0.62). Based on it, the correlation between estimated and measured 131IU24h was weak in MWP1 and MWP2 groups (both P>0.05) but strong in MWP3 (r=0.66, P=0.002). Additionally, the agreement between estimated and measured 131IU24h was highest in the MWP3 group (95% CI, -15.86 to 15.52%), compared to the MWP1and MWP2 groups. Estimated 131IU24h based on 99mTcTU is not suitable for GD patients with MWP less than 2 weeks at our institution, necessitating further prospective multi-center studies for validation.

Clinical outcomes of chimeric antigen receptor T-cell therapy following autologous hematopoietic stem cell transplantation in 38 patients with refractory/relapsed primary or secondary central nervous system lymphoma.

Several reports have indicated that chimeric antigen receptor (CAR) T-cell therapy following autologous hematopoietic stem cell transplantation (ASCT) is a promising strategy for refractory/relapsed (r/r) central nervous system lymphoma (CNSL), but the number of reported cases is limited. The cohort in this retrospective study consisted of 38 patients with r/r CNSL who received CAR T-cell therapy following ASCT at our center between January 2019 and April 2024. Group comparisons of continuous variables were tested using the unpaired Student's t-test or the Mann-Whitney U-test, while categorical variables were analyzed using Fisher's exact test. The Kaplan-Meier method was employed to estimate survival curves, and group comparisons were performed using the log-rank test. The cohort comprised 38 patients with r/r CNSL, all of whom had active CNS involvement. After therapy, the best overall response rate (ORR) of all patients was 78.9%. Subgroup analysis found that a lower ORR was observed in patients with lactate dehydrogenase levels above the upper limit of normal (60.0% vs. 91.3%, P = 0.039). With a median follow-up of 37.5months, the estimated 1-year overall survival (OS) and progression-free survival (PFS) rates were 72.8% and 57.4%, respectively. The risk factors associated with PFS was no response to current therapy (adjusted hazard ratio: 22.87, P < 0.001). The incidence rates of severe cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome were both 13.2%. Among the 25 patients with secondary CNSL (SCNSL), the best ORRs were 91.7% for those with CNS lesions only and 61.5% for those with CNS and systemic lesions (P = 0.160), while the estimated 1-year PFS rates were 83.3% and 38.5%, respectively (P = 0.030). CAR T-cell therapy following ASCT shows promising efficacy for r/r CNSL patients. Besides, SCNSL patients with CNS and systemic lesions have inferior treatment efficacy compared to those with CNS lesions only.

Comparative Analysis of Surgical Outcomes in Separation Surgery vs. Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.

Retrospectively matched case-control study. To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC). The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods. Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion and complications. The Mann-Whitney U test was used for continuous data, and Fisher's exact test for categorical data. Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss (median 500ml [IQR 300-1,000] vs. 925ml [IQR 500-1,425]; P=0.036) and shorter operating times (median 214 minutes [IQR 164-281] vs. 286 minutes [IQR 220-328]; P=0.028). Intraoperative blood transfusion occurred in seven patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group (P=0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative transfusions, reoperations, or survival (P<0.05). Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control. Treatment benefits, Level IV.

Therapeutic effect of proprioceptive neuromuscular facilitation combined with muscle energy technique on post-stroke dysphagia.

According to the Global Burden of Disease Study the prevalence of stroke worldwide has significantly increased from 1990 to 2019, making it the second leading cause of death worldwide. Approximately 70%-80% of stroke patients are unable to live independently due to disability. To explore the therapeutic effect of proprioceptive neuromuscular facilitation (PNF) combined with muscle energy technique (MET) on post-stroke dysphagia. A total of 122 stroke patients with dysphagia admitted to our hospital from January 2017 to December 2020 were divided into the control group (n= 61) and the study group (n= 61). Patients in the control group received conventional rehabilitation plans, while those in the study group were given a combined therapy of MET and PNF. Standard Swallowing Function Assessment Scale (SSA), Videofluoroscopic Swallow Study (VFSS), Swallowing Quality of Life (SWAL-QOL) scores, Water Swallow Test (WST) grading, and efficacy indicators were compared between two group with t-tests, Wilcoxon signed-rank test, χ2 test or Fisher's exact probability test. After treatment, the study group showed lower SSA score (P= 0.036), and VFSS, P= 0.013 than the control group. The changes in SSA score (P= 0.013) and VFSS score (P< 0.001) in the study group were greater than the control group. Furthermore, after treatment, both the study group and the control group showed a decrease in WST grading (P< 0.001); and the degree of post-treatment WST grading decline in the study group was higher (P= 0.009). Besides, after treatment, the SWAL-QOL score of the study group was higher than the control group (P< 0.001); and the effective rate of patients in the study group was higher than that in the control group (P= 0.021). Compared with traditional rehabilitative training strategies, PNF combined with MET can effectively improve swallowing function, and enhance the quality of life in patients with post-stroke dysphagia.

Seasonal Variation in ATP-Induced Retinal Damage in the Cone-Dominant 13-Lined Ground Squirrel.

To examine whether time of year (relative to hibernation emergence) influences the retinal degenerative effects of intravitreal injection of adenosine triphosphate (ATP) in the 13-lined ground squirrel (13-LGS). Eighteen (9 male, 9 female) 13-LGS in three experimental cohorts (early season, mid-season, late season) (n = 6 each) underwent baseline imaging using scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT). Animals then received a 10-µL intravitreal injection of 0.723 M ATP, followed by OCT and SLO imaging at 3, 10, and 21 days. Adaptive optics SLO (AOSLO) was performed in animals without retinal damage after the 21-day follow-up. Retinal thickness, choroidal thickness, and cone density measures were compared to values from wild-type controls (n = 12). Five animals (four early season, one late season) showed retinal damage post-ATP injection (Fisher's exact test, P = 0.065). Animals with retinal damage displayed areas of disrupted retinal lamination on OCT. Any changes in OCT thickness were generally present on initial follow-up and resolved at later time points. Follow-up imaging with AOSLO on animals without retinal damage showed no significant differences in the cone mosaic topography from control eyes. Axial length was increased in mid-/late-season cohorts relative to early season (P = 0.0025 and P = 0.0007). In this pilot study, the 13-LGS appears more susceptible to ATP-induced retinal damage during the early season. Future studies adjusting dose based on ocular biometry may help elucidate the impact of time of year on chemical response. Consideration of ocular biometry in this and other animal models is merited when using intravitreal methods of chemical administration.

Exploring the real-world management of catheter-associated urinary tract infections by Swiss general practitioners and urologists: insights from an online survey.

To assess and compare the real-world management of catheters and catheter-associated urinary tract infections (CAUTI) among Swiss general practitioners and urologists, encompassing diagnosis, treatment and prophylaxis. An anonymised online questionnaire was distributed among Swiss general practitioners and urologists between January and October 2023 via the networks of Sentinella and the Swiss Association of Urology. The questionnaire consisted of questions on catheter management, including diagnosis, treatment and prophylaxis of CAUTI. Analysis was performed by discipline. Fisher's exact test was applied for comparisons (statistical significance with p <0.05). Out of 175 participating physicians, the majority were involved in catheter management. Urologists exhibited significantly higher levels of competence as compared to general practitioners (67.1% vs 20.9%). Although no significant differences were observed regarding diagnostic approaches between disciplines, unrecommended diagnostic methods were frequently applied. general practitioners reported that they treated non-febrile CAUTI for longer durations, while urologists indicated that they treated febrile CAUTI longer. Additionally, the use of fluoroquinolones was more prevalent among general practitioners compared to urologists, while prophylactic measures were more frequently applied by urologists. Catheter and CAUTI management entail significant uncertainty for general practitioners. CAUTI management varied notably between general practitioners and urologists in terms of treatment and prophylaxis. The use of non-recommended diagnostic approaches and drugs was common. This trend, along with inappropriate diagnostic methods and prophylaxis, may increase antimicrobial resistance and CAUTI morbidity. The study emphasises the necessity for diagnostic and antimicrobial stewardship interventions, and proper training in CAUTI management for general practitioners and urologists.

A rare complication after ureterorenoscopy lithotripsy: Subcapsular renal hematoma.

To evaluate the prevalence, risk factors, clinical manifestations, and outcomes of subcapsular renal hematoma (SRH) following ureterolithotripsy. Between January 2014 and December 2023, patients who underwent ureterorenoscopy lithotripsy (URL) at our hospital were retrospectively reviewed. Clinical data including basic information, calculi-related indicators, and perioperative period data were collected. A Student's t-test was used for continuous data, while a Chi-square test or Fisher's exact test was utilized for categorical data. A total of 2098 patients treated with URL for ureteric stones were included in this study. The incidence of SRH after URL was 0.52% (11 cases). All SRH cases were confirmed by non-contrast computed tomography, with an average patient age of 55.54 years (range 34-84). The mean stone size in patients with SRH was 10.54 cm (range 0.8-1.5). Patients with SRH had a higher proportion of severe hydronephrosis caused by ureteral stones (54.55% vs 26.07%, p = 0.032) and narrow ureters (45.45% vs 8.04%, p < 0.001) compared to those without SRH. Patients with SRH experienced a longer length of stay, with a significant difference between the two groups (11.64 ± 5.05 vs 3.87 ± 8.12, p < 0.001). Nine patients were managed conservatively without further intervention, while embolization was required in one patient and percutaneous drainage was performed in another. All SRH cases resolved completely during a 4-month follow-up. The incidence of SRH following URL is low, with severe hydronephrosis and narrow ureters identified as risk factors. Most SRH cases can be successfully managed conservatively, although patients with SRH may experience a significant prolongation of their length of stay.

Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.

Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia. An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05. In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality. The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.

Incidence and Risk Factors for Amputations in Persons with Diabetes Mellitus: A Retrospective Cohort Study.

The aim of this study was to identify and analyze the incidence rate of amputations and their risk factors in people with Diabetes Mellitus (DM) in two specialized outpatient clinics in Brazil. This is an epidemiological, retrospective cohort study using data collected from electronic health records of 281 adult diabetic patient types 1 or 2; attended in specialized outpatient service between 2015 and 2020. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the risk factors for amputation was carried out through logistic regression. The study was approved by ethical committee. The sample mean age was 65.6 years (SD 13.05), predominating male gender n = 211 (75%), type 2 DM n = 223 (86.7%), with cardiovascular disease n = 143 (63.2%), and about 68.7% (n = 156) with peripheral arterial disease (PAD). Seventy-seven had lower limb amputation (LLA), with a rate incidence of 31.9% during five years. Logistic regression analysis showed the following associations with amputation: Diabetic peripheral neuropathy increased the rate of amputation by 3.6 times (OR = 3.631, 95% CI = 1.214-11.353; P = .022), and peripheral arterial disease increased by 10 times (OR = 10.631; 95% CI = 2.969-57.029; P = .001). The LLA in individuals with DM in two specialized outpatient services was higher compared to international literature; DPN and PAD were confirmed as risk factors for amputation, according to literature. This finding suggests that the study population faces an increased risk of amputation, highlighting the urgent need for targeted interventions and implementing robust preventive strategies to transform the current scenario and mitigate these severe outcomes. A comprehensive approach is essential to proactively address the underlying issues and reduce the prevalence and impact of amputations in Brazil.

Exposing telomere length's impact on malnutrition risk among older adults residing in the community: Insights from cross-sectional data analysis.

Successful aging is associated with an increase in life expectancy. For a better understanding of the aging process, recognize the relationship between telomere length and nutritional status is a novel approach in geriatric science. Telomers shortening coincides with a decrease in life expectancy, and an increased risk of malnutrition-related diseases. The goal of this study was to investigate whether a shorter telomere length is associated with a greater likelihood of malnutrition in community-dwelling older adults. A cross-sectional study with a probabilistic sample of 448 older people aged 60 years old or over, and living in the urban area of an inland Brazilian municipality was conducted. The information was gathered in two stages: a) a personal interview was conducted to obtain sociodemographic, cognitive, and functional autonomy data. The Mini Nutritional Assessment was used to assess the risk of malnutrition. b) a blood sample was taken to proceed with the relative quantitative study of telomere length using real-time qPCR method. The differences between the groups were estimated using Pearson's v2 and Fisher's exact tests. In the data analysis, descriptive statistics and multiple logistic regression were applied. In 34.15% of the total sample, malnutrition was recognized as a risk factor. Older people with the shortest telomere length had more chances of getting malnutrition (OR = 1.63; IC:95% = 1.04-2.55) compared to those with longer telomeres, independent of age groups, family income, multimorbidity, cognitive decline, and depressive symptoms. The creation of clinical trials and the implementation of therapies to reduce the risk of malnutrition will be aided using the telomere length as an aging innovative biomarker, connected with nutritional status.

Economic and Efficient: Introducing the Bifurcation-Invisible Sign in Endovascular Thrombectomy for Middle Cerebral Artery Occlusions.

Introduction Selecting thrombectomy techniques for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) significantly affects outcomes and costs. This study introduces the Bifurcation-Invisible (BI) sign identified on initial microcatheter angiogram in acute middle cerebral artery occlusions before endovascular thrombectomy. We aimed to evaluate whether this sign is associated with better angiographic outcomes using contact aspiration (CA) versus stent retriever (SR). Methods In this study, we reviewed 285 cases of acute M1-segment middle cerebral artery (M1-MCA) occlusions treated with stent retriever (SR) or contact aspiration (CA). Angiographic success was evaluated using modified Thrombolysis In Cerebral Infarction (mTICI) scores after the first attempt, clinical outcomes by 90-day modified Rankin Scale (mRS) scores, and procedural costs were analyzed. Categorical variables were analyzed using χ2 or Fisher's exact test, and continuous variables using Student's t-test or Mann-Whitney U test. Subgroup multivariate logistic analysis and interaction tests were conducted, with post-hoc analysis applying Bonferroni correction. Results BI-positive patients treated with CA had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 41.3%, p = 0.005; Bonferroni-corrected p = 0.030) and 19.8% lower device costs (p < 0.05) than those treated with SR. BI-positive CA patients had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 32.1%; p < 0.001; Bonferroni-corrected p = 0.002) and a 39.9% reduction in device costs (p < 0.05) than BI-negative patients. The interaction tests showed significant interactions between the presence of BI and contact aspiration for first-pass reperfusion rates (p = 0.007) and device costs (p ˂ 0.001). Conclusion The BI sign, a refined version of the BSO sign identified via microcatheter angiography, could guide the selection of contact aspiration, improving recanalization rates and reducing costs in MCA occlusions.

Zinc Deficiency and Impact on Lipid Profiles in Malnourished Children in Senegal

Aims: Zinc is an important element for the body because of the role it plays in the structure but also in the catalytic activity of several metabolic enzymes. The aim of this study is to evaluate the zinc status in malnourished children and its association with lipid profile parameters. Study Design: This is a cross-sectional and prospective analytical study. Place and Duration of Study: This is a fifteen-month study, conducted at the Diamniadio Children's Hospital. Children under five years of age, malnourished according to the weight/height ratio were selected after parental. Methodology: The study population comprised 176 children with a sex ratio of 1, of whom 49% with severe acute malnutrition, 41% moderately malnourished and 10% undernourished. Zinc was determined using Biosystem's® 5 Br PAPS colorimetric method. To compare the groups, we used the Chi-squared test (X2) or the Fisher's exact test. For the comparison of quantitative variables between the targeted groups, we used the ANOVA test. Zinc, total cholesterol (TC), HDL cholesterol (HDLc) and LDL cholesterol (LDLc) were significantly lower in the malnourished. Hypozincemia was found in 66% of children. TC, HDLc and triglycerides (TG) are significantly lower in malnourished patients with hypozincemia with a mean average of 2.99 ± 1.31 mmol/L (p&lt; 0.001), 0.56 ± 0.36 mmol/L (p=0.007) and 1.73 ± 0.85 mmol/L (p=0.004), respectively. There is a positive correlation between zinc and the various lipid profile parameters. TC (r=0.314; &lt; 0.001), HDLc (r=0.326; p&lt; 0.001), LDLc (r=0.200; p=0.008) and TG (r= 0.229; p=0.002). Conclusion: The management of hypozincemia is essential within the follow-up of malnourished children. Zinc supplementation can prevent dyslipidemia, which is secondary to malnutrition and serve as a preventive measure against dyslipidemia in malnourished children.

Development of a Dual-Plane MRI-Based Deep Learning Model to Assess the 1-Year Postoperative Outcomes in Lumbar Disc Herniation After Tubular Microdiscectomy.

Tubular microdiscectomy (TMD) is a treatment for lumbar disc herniation (LDH). Although the combination of MRI and deep learning (DL) has shown promise, its application in evaluating postoperative outcomes in TMD has not been fully explored. To evaluate whether integrating preoperative dual-plane MRI-based DL features with clinical features can assess 1-year outcomes in TMD for LDH. Retrospective. The study involved 548 patients who underwent TMD between January 2016 and January 2021. Training set (N = 305, mean age 51.85 ± 13.84 years, 56.4% male). Internal validation set (N = 131, mean age 51.85 ± 13.84 years, 54.2% male). External validation set (N = 112, mean age 51.54 ± 14.43 years, 50.9% male). 3 T MRI with sagittal and transverse T2-weighted sequences (Fast Spin Echo). Ground truth labels were based on improvement rate in 1-year Japanese Orthopaedic Association (JOA) scores. Information on 42 preoperative clinical features was collected. The largest protrusions were identified from T2 MRI by three clinicians and were used to train deep learning models (ResNet50, ResNet101, and ResNet152) to extract DL features. After feature selection, three models were built, namely, clinical, DL, and combined models. Chi-square or Fisher's exact tests was used for group comparisons. Quantitative differences were analyzed using the t-test or Mann-Whitney U test. P-values <0.05 were considered significant. Models were validated on internal and external datasets using metrics such as the area under the curve (AUC). The AUCs of the clinical models achieved 0.806 (internal) and 0.779 (external). ResNet152 performed best in three DL models, with AUCs of 0.858 (internal) and 0.834 (external). The combined model achieved AUCs of 0.889 (internal) and 0.857 (external). A model combining preoperative dual-plane MRI DL features and clinical features can assess 1-year outcomes of TMD for LDH. 4 TECHNICAL EFFICACY: Stage 2.

Oral health status, self-perceptions, and risk awareness among young adult users of electronic cigarettes in Pakistan.

The use of electronic cigarettes (ECs) has surged globally, particularly among young individuals. This study aimed to assess the perceptions of vaping-related oral health risks, clinical oral health status, and self-perceived dental and periodontal conditions among young adult users of ECs in Pakistan. A cross-sectional study was conducted from June 2023 to March 2024, recruiting 142 young users of ECs. Intraoral examinations assessed Decayed, Missing, and Filled Teeth (DMFT) index, Oral Hygiene Index Simplified (OHI-S), Gingival Bleeding Index (GBI), Plaque Index (PI), and dental stain. Data on sociodemographic characteristics, oral health behaviors, vaping habits, and perceptions of impact of vaping on oral health were gathered through a self-administered questionnaire. Associations between EC use and various oral health variables were analyzed using the chi-squared and Fisher's exact tests. Mean DMFT was 5.66 (SD=2.20). Poor oral hygiene (29.6%) and severe dental staining were prevalent. Most participants (76.1%) brushed once daily, while only 34.5% attended regular dental check-ups. Gingival bleeding and plaque accumulation were observed in 47.2% and 35.3% of participants. Around 66% reported daily EC use, with 80.3% initiating vaping before the age of 18 years. Most common reason for vaping was perception that ECs are safer than traditional smoking (31.7%). Participants' perceptions of vaping-related oral health risks were relatively low, with 45% associating vaping with tooth decay, 48% with gum disease, and 58.5% with tooth staining. Tooth brushing frequency, vaping frequency (per day), and time since vaping started, were significantly associated with oral clinical indicators (p<0.05). The education level was the only variable significantly associated with vaping-related risk perception (p<0.05). The study reveals that oral health awareness among young vapers is low, with many starting EC use at a young age and exhibiting poor oral health behaviors. Misconceptions about the safety of ECs compared to conventional cigarettes may contribute to increased vaping.

Complications of total knee arthroplasty in patients with prior anterior cruciate ligament reconstruction compared to a matched cohort

BackgroundCurrent literature reports a 500 % increase in reoperation in total knee arthroplasty (TKA) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study is to determine the effect of ACLR on subsequent TKA. MethodsThis retrospective case control study included 30 patients that underwent TKA following an ACLR who were matched 3:1 to a control cohort at a single tertiary academic center between January 1, 2011 and January 1, 2021. The electronic medical records were queried for demographics, complications, history of ACLR, and range of motion (ROM) preoperatively and postoperatively at 3 months and 1 year. Student's t-tests and Fisher's exact tests were used for analysis (α = 0.05). ResultsThe mean ROM between the ACLR and control groups preoperatively, at 3 months and at 1 year postoperatively were 108.2° v 104.8° (p = 0.42), 114.0° v 111.8° (p = 0.51), and 115.3° v 115.8° (p = 0.88). At 1 year, 9 of 30 (30 %) ACLR patients decreased ROM versus 14 of 90 (15.6 %) control patients (mean loss of 21.4° v 11.9°, p = 0.076). No difference in complication rate was found (10 % v 11.1 %, p = 1). Complications in the ACLR group included open debridement and capsular release for stiffness after 2 failed manipulations under anesthesia (MUA), lysis of adhesions for patellar clunk, and revision surgery for flexion instability. No control patients required MUA. ConclusionThis study demonstrated that TKA following ACLR is without an increased risk of complications. However, ACLR patients should be followed closely since loss of ROM can be large.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Mutation Screening of ATXN1, ATXN2, and ATXN3 in Amyotrophic Lateral Sclerosis.

Emerging evidence suggests potential disease modifying roles of ATXN1, ATXN2, and ATXN3 in amyotrophic lateral sclerosis (ALS). We aimed to provide a comprehensive variants profile of the ATXN1, ATXN2, and ATXN3 genes and examine the association of these variants with the risk and clinical characteristics of ALS. We screened and analyzed the rare variants in a cohort of 2220 ALS patients from Southwest China, using controls from the Genome Aggregation Database (gnomAD) and the China Metabolic Analytics Project (ChinaMAP). The over-representation of rare variants and their association with disease risk in ALS patients were assessed using Fisher's exact test with Bonferroni correction at both allele and gene levels. Kaplan-Meier analysis was employed to explore the relationship between the distribution of variants and survival. A total of 62 eligible rare missense variants were identified, comprising 32 from ATXN1, 21 from ATXN2, and 9 from ATXN3. Allelic association testing revealed a significant enrichment of the ATXN1 (c.2122C > G, p.Leu708Val) variant and the ATXN2 (c.3778C > G, p.Pro1260Ala) variant in ALS. Gene burden analysis indicated that variants in the ATXN1 and ATXN3 genes had a higher burden in ALS. Substantial heterogeneity in survival time was observed among patients carrying different variants within the same gene. However, there were no significant differences in survival between ALS patients grouped by N-terminal or C-terminal distribution. Our results provided a genetic variation profile of ATXN1, ATXN2, and ATXN3 in ALS patients, along with the clinical characteristics of individuals carrying these variations. This information might offer valuable insights for the ongoing ALS disease-modifying treatments.