Genitourinary Diseases Research Articles

Outcomes of a newly established transitional urology outpatient clinic: a real-world experience.

To evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment. Files of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits. The most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001). Our findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population.

Gender differences in physical morbidity in opioid agonist treatment patients: population-based cohort studies from the Czech Republic and Norway

BackgroundPhysical diseases represent a significant burden for opioid agonist treatment (OAT) patients. This study described physical morbidity in two national cohorts of OAT patients focusing on gender differences.MethodsThis population-based cohort study linking multiple health registers investigated physical diseases (ICD-10) in patients receiving OAT in the Czech Republic (N = 4,280) and Norway (N = 11,389) during 2010–2019. Gender-stratified analysis was performed.ResultsOverall, we found a large burden of physical morbidity across gender groups in OAT patients. In the Czech Republic and Norway, women in OAT had a significantly higher prevalence of physical diseases across most diagnostic chapters, notably genitourinary diseases and neoplasms. Injuries/external causes and infectious/parasitic diseases were among the most common diseases in both women and men. Viral hepatitis accounted for over half of infectious morbidity in women and men in both cohorts.ConclusionsOur findings support the need for early screening, detection, and treatment of diseases and conditions across organ systems and the integration of health promotion activities to reduce physical morbidity in OAT patients. The gender differences underline the need for a tailored approach to address specific medical conditions.

Capturing the Kidney Transcriptome by Urinary Extracellular Vesicles-From Pre-Analytical Obstacles to Biomarker Research.

Urinary extracellular vesicles (uEV) hold non-invasive RNA biomarkers for genitourinary tract diseases. However, missing knowledge about reference genes and effects of preanalytical choices hinder biomarker studies. We aimed to assess how preanalytical variables (urine storage temperature, isolation workflow) affect diabetic kidney disease (DKD)-linked miRNAs or kidney-linked miRNAs and mRNAs (kidney-RNAs) in uEV isolates and to discover stable reference mRNAs across diverse uEV datasets. We studied nine raw and normalized sequencing datasets including healthy controls and individuals with prostate cancer or type 1 diabetes with or without albuminuria. We focused on kidney-RNAs reviewing literature for DKD-linked miRNAs from kidney tissue, cell culture and uEV/urine experiments. RNAs were analyzed by expression heatmaps, hierarchical clustering and selecting stable mRNAs with normalized counts (>200) and minimal coefficient of variation. Kidney-RNAs were decreased after urine storage at -20 °C vs. -80 °C. Isolation workflows captured kidney-RNAs with different efficiencies. Ultracentrifugation captured DKD -linked miRNAs that separated healthy and diabetic macroalbuminuria groups. Eleven mRNAs were stably expressed across the datasets. Hence, pre-analytical choices had variable effects on kidney-RNAs-analyzing kidney-RNAs complemented global correlation, which could fade differences in some relevant RNAs. Replicating prior DKD-marker results and discovery of candidate reference mRNAs encourages further uEV biomarker studies.

The Incidence of Comorbidities in New Adult Tuberculosis Cases

The objective: to determine the potential impact of particular nosologies and their groups on the risk of developing tuberculosis.Subjects and Methods. The incidence of particular nosologies and their groups standardized by gender and age in new tuberculosis cases detected in 2020 was compared to the general incidence of those nosologies among population of RNO-Alania. Relative risk (RR) and statistical significance of differences (p) were determined.Results. RR of type I diabetes mellitus (DM) in tuberculosis patients to the overall incidence of the entire population was 9,5 (p&lt;0,001); RR of viral hepatitis – 6,4 (p&lt;0,001); mental disorders – 3.2 (p&lt;0,001); type II DM – 2,6 (p&lt;0,001); chronic nonspecific lung diseases (CNLD) – 2,3 (p=0,005). There was no excess of RR for digestive diseases (RR=0,9; p=0,9). The role of genitourinary diseases could not be verified due to the lack of observations.

Mortality and cancer incidence in UK military veterans involved in human experiments at Porton Down: 48-year follow-up.

We investigated whether military personnel involved in chemical warfare agent research at Porton Down had increased rates of mortality or cancer incidence. This was a historical cohort study comprising male UK veterans who participated in the 'Service Volunteer Programme', 1941-89, identified from Porton Down experiment books, and a comparison group of similar 'non-Porton Down' veterans identified from military personnel files. Of 19 233 records retrieved for each group, 18 133 (94%) Porton Down and 17 591 (92%) non-Porton Down were included in our analytical sample. Mortality and cancer incidence data were obtained from national registries up to December 2019. Over a median follow-up of 48.1 years, 10 935 Porton Down veterans (60.3%) and 10 658 non-Porton Down veterans (60.6%) had died. After adjustment for age, year of birth and military service characteristics, overall, Porton Down veterans had a 6% higher rate of all-cause mortality compared with non-Porton Down veterans [hazard ratio (HR) = 1.06, 95% confidence interval (CI) 1.03-1.09]. For cause-specific mortality, Porton Down veterans had higher rates of death from genitourinary diseases (HR = 1.34, 95% CI 1.05-1.70) and deaths attributable to alcohol (HR = 1.44, 95% CI 1.07-1.94), with weaker associations observed for deaths from infectious and parasitic diseases (HR = 1.32, 95% CI 0.99-1.78), lung cancer (HR = 1.10, 95% CI 1.01-1.20) and external causes (HR = 1.15, 95% CI 1.00-1.32). Associations with all-cause mortality were stronger for veterans who attended Porton Down between 1960 and 1964 (HR = 1.34, 95% CI 1.19-1.50); likelihood-ratio test, P = 0.006. There was no association between attendance at Porton Down and overall cancer incidence (HR = 1.00, 95% CI 0.95-1.03). Overall, mortality rates were slightly higher in Porton Down veterans, but there was no difference in cancer incidence. Associations for mortality were stronger in Porton Down veterans who attended in the early 1960s.

Position paper of the working group Urological Acute Medicine

Emergency patients with acute genitourinary system diseases are frequently encountered in both outpatient and clinical emergency structures. It is estimated that one-third of all inpatients in a urology clinic initially present as an emergency. In addition to general emergency medicine knowledge, specialized urologic expertise is a prerequisite for the care of these patients, which is needed early and specifically for optimal treatment outcomes. It must be taken into account that, on the one hand, the current structures of emergency care still lead to delays in patient care despite positive developments in recent years. On the other hand, most hospital emergency facilities need urologic expertise on site. In addition, politically intended changes in our health care system, which drive an increasing ambulantization of medicine and condition a further centralization of emergency clinics, become effective. The aim of the newly established working group "Urological Acute Medicine" is to ensure and further improve the quality of care for emergency patients with acute genitourinary system diseases and, in consensus with the German Society of Interdisciplinary Emergency and Acute Medicine, to define precise task distributions and interfaces of both specialities.

Interconnections between urolithiasis and oral health: a cross-sectional and bidirectional Mendelian randomization study.

Urolithiasis is one of the most common diseases for urologists and it is a heavy burden for stone formers and society. The theory of the oral-genitourinary axis casts novel light on the pathological process of genitourinary system diseases. Hence, we performed this study to characterize the crosstalk between oral health conditions and urolithiasis to provide evidence for prevention measures and mechanisms of stone formation. This population-based cross-sectional study included 86,548 Chinese individuals who had undergone a comprehensive examination in 2017. Urolithiasis was diagnosed depending on the results of ultrasonographic imaging. Logistic models were utilized to characterize the association between oral health conditions and urolithiasis. We further applied bidirectional Mendelian randomization to explore the causality between oral health conditions and urolithiasis. We observed that presenting caries indicated a negative correlation with the risk for urolithiasis while presenting gingivitis [OR (95% CI), 2.021 (1.866-2.187)] and impacted tooth [OR (95% CI), 1.312 (1.219-1.411)] shown to be positively associated with urolithiasis. Furthermore, we discovered that genetically predicted gingivitis was associated with a higher risk of urolithiasis [OR (95% CI), 1.174 (1.009-1.366)] and causality from urolithiasis to impacted teeth [OR(95% CI), 1.207 (1.027-1.418)] through bidirectional Mendelian randomization. The results cast new light on the risk factor and pathogenesis of kidney stone formation and could provide novel evidence for the oral-genitourinary axis and the systematic inflammatory network. Our findings could also offer suggestions for tailored clinical prevention strategies against stone diseases.

Pilates and multiple health outcomes: An umbrella review.

To summarize the evidence of associations between Pilates and multiple health outcomes, and evaluate the strength and validity of these associations. Unbrella review. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February, 2023. The methodological quality of included studies was assessed using A Measurement Tool to Assess Systematic Reviews, version 2 and the certainty of evidence was graded by the Grading of Recommendation, Assessment, Development and Evaluations. We recalculated each outcome using random-effects models with standardized mean difference. We identified 27 systematic reviews with meta-analyses in this umbrella review. 1 was rated as high quality, 1 as moderate quality, 15 as low quality, and 10 as critically low quality. These studies focused on the populations with diseases of the circulatory system, endocrine, nutritional or metabolic diseases, genitourinary system diseases, mental, behavioral, or neurodevelopmental disorder, musculoskeletal system diseases, neoplasms, nervous system diseases, sleep-wake function disorder and others. Compared with inactive/active intervention, Pilates can reduce body mass index and body fat percentage, relieve pain and disability, and improve sleep quality and balance. The certainty of evidence was very low to moderate for these outcomes. Pilates showed benefits on several health outcomes related with low back pain, neck pain and scoliosis. However, the certainty of the evidence was mostly low; further high quality randomized controlled trials are needed to elucidate and support these promising findings.

HF01-07 FROM BERLIN TO BRADY: TRACING THE ORIGINS OF UROLOGY RESIDENCY

You have accessJournal of UrologyCME1 Apr 2023HF01-07 FROM BERLIN TO BRADY: TRACING THE ORIGINS OF UROLOGY RESIDENCY Trevor C. Hunt and Ronald Rabinowitz Trevor C. HuntTrevor C. Hunt More articles by this author and Ronald RabinowitzRonald Rabinowitz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology was one of the first specialties in medicine to employ the training model known today as residency. These events are rarely taught in formal urologic curricula, yet it is imperative that tomorrow’s urologists understand how today’s system came to be. METHODS: We performed a review of the literature, including journal articles, book chapters, and transcribed talks, to compile sufficient evidence to inform this historical review. RESULTS: The residency training model first appeared in the mid-1800s, when German surgeon Bernhard von Langenbeck devised a system where medical graduates would live at the hospital and undertake graduated responsibility in the care of surgical patients. One of his residents—known then as house officers—was Theodor Billroth, who later mentored American surgeon William Halsted in Vienna while he trained throughout Europe from 1878-1880. In 1889, Johns Hopkins Hospital opened and Halsted became one of the founding “Big Four” doctors alongside Welch, Osler, and Kelly. As Chief of Surgery, he drew on Billroth’s methods and established the earliest form of surgical residency as we now know it. Halsted’s model was “pyramidal”, with only one of eight residents advancing each year, and aimed to produce a single outstanding surgeon at the unintentional expense of the others. This remained the gold standard until 1931, when Edward Churchill at Massachusetts General Hospital introduced the more balanced “rectangular” structure which remains the backbone of residency programs today. Halsted hired 25-year-old Hugh Hampton Young to his surgical staff in 1895 and quickly made him Chair of the Department of Genitourinary Diseases in 1897, which he helmed through 1941. In response to the appointment, Young is noted to have said, “This is a great surprise. I know nothing about genitourinary surgery,” to which Halsted replied, “We believe you could learn.” He did indeed learn, and is now widely regarded as the Father of Modern Urology. From 1897-1915, Young was allowed to recommend aspiring urologists to Halsted for appointment in the surgical residency, spawning the beginnings of the urologic specialty as we know it today. In 1915, thanks to a donation from his patient James Buchanan Brady, the Brady Urological Institute opened at Hopkins, and Young designed a 7-year training program to begin alongside it. With this, the first formal urology residency in the country was born. CONCLUSIONS: Urology residency shares deep roots with the history of surgery itself. Recognizing where this model originated is critical context for all who seek to improve how the urologists of tomorrow are trained. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e258 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trevor C. Hunt More articles by this author Ronald Rabinowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

Age-Period-Cohort Analysis on Long-Term Mortality Trend of Genitourinary Diseases - China, 1987-2021.

There has been a lack of attention to genitourinary diseases for an extended period, resulting in limited research on the mortality trends of genitourinary diseases in China. This study examines the long-term trend of genitourinary diseases' mortality across Chinese individuals of all genders and in various urban and rural regions. Additionally, it investigates the impact of age-period-cohort effects on this trend. It is imperative to address genitourinary diseases, particularly among vulnerable populations such as rural older men. Policymakers should prioritize these individuals by providing necessary policy interventions and healthcare support.

Morbimortalidade e fatores associados ao óbito em internados por efeitos do álcool e outras drogas

Abstract Objective To describe the hospitalizations resulting from the impacts of alcohol and other drug abuse and factors associated with death. Methods Cross-sectional, observational, and retrospective study, with secondary data from 3,562 admissions recorded at the Center for Information and Toxicological Assistance of a teaching hospital in northwest Paraná, using epidemiological surveillance of active search, from 2009 to 2018. Data were processed using univariate analysis (Pearson’s Chi-square test and Fisher’s exact test). Results Most were males (89.6%), and the mean age was 43.62 years (±16 years). Most hospitalizations resulted from traumatic events and other external causes (52.1%) associated with the use/abuse of alcoholic beverages (85.8%). The mean length of hospital stay was 34.6 days, and 6.0% died. There was an association between risk of death and endocrine/metabolic, cardiovascular, gastrointestinal, and genitourinary diseases. Conclusion Hospitalizations with greater severity increase the incidence of deaths, and evidencing the associated factors directs interventions to decrease hospitalizations, reducing complications and deaths. Implications for practice The studies serve as a support for the development of prevention strategies, encouragement for improvement actions in the assistance network for users, strengthening and increasing public policies.

Utilization of remote e-prescription (Anat) in Saudi Arabia during COVID-19: Factors associated with primary adherence and antibiotic prescription.

The COVID-19 pandemic has affected healthcare systems globally. Various health care technologies have been used to mitigate the risk of disease transmission. Telemedicine is one such technology, and remote consulting and prescribing comprise one of its key aspects. In Saudi Arabia, telephone health services have been widely used through the free Medical Consultation Call Center (937). This platform facilitates medical consultations for all citizens, residents, and visitors. After consultations, healthcare providers are able to issue authenticated e-prescriptions using the Anat platform. To explore the utilization of the Anat remote prescription system in Saudi Arabia during the COVID-19 pandemic and to identify the factors associated with antibiotic prescription and primary medication adherence. This retrospective analysis included data from the Anat e‑prescription system using a stratified random sample of 25000 prescriptions issued in Saudi Arabia in 2020. Predictive factors related to the patients, practitioners, and prescriptions were identified through bivariate and multivariate logistic regression analyses. Out of 25,000 e-prescriptions, 8885 were dispensed, resulting in a 35.5% primary medication adherence rate. The significant predictors of primary adherence were children, respiratory diseases, and antibacterial drugs. In addition, antibiotics made up 32.1% of the e-prescriptions. The prescription of antibiotics was significantly associated with male sex, children, genitourinary system diseases, and being treated by radiologists. Almost two thirds 62.2% of e-prescriptions were undispensed, with antibiotic eprescriptions at 32.1%. Findings emphasize the need to enhance primary medication adherence and antibiotic prescription interventions. These findings could aid decision-makers in improving patient-centered e-prescribing practices.

THE MORBIDITY RATE OF GENITOURINARY DISEASES ACCORDING TO THE DATA ON POPULATION RECEIVING MEDICAL CARE IN A MULTIFUNCTIONAL HEALTH CARE FACILITY.

The aim: Establishing the characteristic features and morbidity rate of genitourinary diseases in order to substantiate the need for health care services. Materials and methods: The article uses bibliographic, medical, statistical and content analysis, as well as analytical methods. We have analyzed the sex-age characteristics of the morbidity rate of genitourinary diseases, with the morbidity rates among different sex-age groups of the population in 2015-2022 evaluated. Results: Diseases of the genitourinary system constitute a significant share in the overall structure of the morbidity rate (7.3%-10.6%) and disease prevalence (6.1%-7.3%) among adults. In 2015-2022, the dynamics of the morbidity rate of genitourinary diseases and their prevalence were characterized by a constant increase until 2019, with a subsequent decrease until 2022. Such trends in the morbidity rate and prevalence of genitourinary diseases among people may be related to the impact of the COVID-19 pandemic, which led to the restricted access to health care services as a result of taking measures to prevent the spread of infection, excessive load on the network of health care facilities within the pandemic period, etc. The features of prevalence and dynamics of the incidence of genitourinary diseases in adolescents, adults, and persons of older age groups are determined. Conclusions: The identified sex-age characteristics of the morbidity rate of genitourinary diseases, prevailing nosologies in certain age and sex groups will become the basis for substantiating measures to improve the quality of medical care, taking into account the principle of patient centricity and integration of care.

Risk factors for extremely preterm and very preterm birth

Aim. To evaluate the prevalence of preterm birth and risk factors for extremely preterm, very preterm, and moderate to late preterm birth.Materials and Methods. We retrospectively assessed case histories of 11,500 pregnant women delivered in Kuzbass Regional Children's Clinical Hospital during 2019-2021 and their newborns. Among the studied factors were gestational age, birth weight, sex, 5-minute Apgar score, maternal age (&lt; 20 years, 20-35 years, ≥ 35 years), parity (primiparity or multiparity), active smoking, maternal diseases during pregnancy (gestational hypertension, intrahepatic cholestasis of pregnancy, gestational diabetes mellitus, anemia, gastrointestinal and genitourinary diseases), chorioamnionitis, and pregnancy complications (placental abruption, placenta previa, vaginal bleeding, polyhydramnios), fetal distress, and fetal growth restriction.Results. Prevalence of preterm birth was 8.4%. The potential risk factors for preterm birth were placental abruption, placenta previa, short (&lt; 25 mm) cervix, intrahepatic cholestasis of pregnancy, gestational hypertension, chorioamnionitis, anemia, young (&lt; 20 years) and advanced (≥ 35 years) maternal age, primiparity, active smoking, and fetal distress. Among them, placental abruption, placenta previa, short (&lt; 25 mm) cervix, gestational hypertension, and chorioamnionitis were specific risk factors of extremely preterm and very preterm birth whilst intrahepatic cholestasis of pregnancy was the risk factor of moderate to late preterm birth.Conclusion. Extremely preterm, very preterm, and moderate to late preterm birth have distinct risk factor profiles, highlighting the need for differential pregnancy management strategies.

StrokeViT with AutoML for brain stroke classification

Stroke, categorized under cardiovascular and circulatory diseases, is considered the second foremost cause of death worldwide, causing approximately 11% of deaths annually. Stroke diagnosis using a Computed Tomography (CT) scan is considered ideal for identifying whether the stroke is hemorrhagic or ischemic. However, most methods for stroke classification are based on a single slice-level prediction mechanism, meaning that the most imperative CT slice has to be manually selected by the radiologist from the original CT volume. This paper proposes an integration of Convolutional Neural Network (CNN), Vision Transformers (ViT), and AutoML to obtain slice-level predictions as well as patient-wise prediction results. While the CNN with inductive bias captures local features, the transformer captures long-range dependencies between sequences. This collaborative local-global feature extractor improves upon the slice-wise predictions of the CT volume. We propose stroke-specific feature extraction from each slice-wise prediction to obtain the patient-wise prediction using AutoML. While the slice-wise predictions helps the radiologist to verify close and corner cases, the patient-wise predictions makes the outcome clinically relevant and closer to real-world scenario. The proposed architecture has achieved an accuracy of 87% for single slice-level prediction and an accuracy of 92% for patient-wise prediction. For comparative analysis of slice-level predictions, standalone architectures of VGG-16, VGG-19, ResNet50, and ViT were considered. The proposed architecture has outperformed the standalone architectures by 9% in terms of accuracy. For patient-wise predictions, AutoML considers 13 different ML algorithms, of which 3 achieve an accuracy of more than 90%. The proposed architecture helps in reducing the manual effort by the radiologist to manually select the most imperative CT from the original CT volume and shows improvement over other standalone architectures for classification tasks. The proposed architecture can be generalized for volumetric scans aiding in the patient diagnosis of head and neck, lungs, diseases of hepatobiliary tract, genitourinary diseases, women’s imaging including breast cancer and various musculoskeletal diseases. Code for proposed stroke-specific feature extraction with the pre-trained weights of the trained model is available at: https://github.com/rishiraj-cs/StrokeViT_With_AutoML.

EVALUATION OF CNS DEPRESSANT AND BEHAVIORAL ACTIVITY OF AN ETHANOL EXTRACT OF ZIZIPHUS JUJUBA (BER) IN MOUSE MODEL

Objective: Ziziphus jujuba, known as Ber (Hindi), is an indigenous herb found in India. Z. jujuba has been used to treat various diseases such as respiratory system diseases (asthma, cough, and laryngitis), gastrointestinal problems (constipation, colitis, and liver diseases), as well as cardiovascular and genitourinary system diseases. Seeds and fruit have been also reported to have central nervous system (CNS) depressant effect. Hence, in this study, neuropharmacological effects of leaves are studied which are not reported previously. Z. jujuba extract’s potential to depress the CNS and affect behavior was examined in this study, along with the phytochemicals that may be responsible for these effects. Methods: 400 mg/kg of the extract was administered intraperitoneally. As a benchmark, diazepam (2 mg/kg body weight i.p.) was used. ANOVA and Dunnett’s tests were used to evaluate the data. The results were all presented as Mean (SEM) values. p&gt;0.05 was regarded as meaningful. Result: The outcome of the study demonstrated that ethanol extract of Z. jujuba (400 mg/kg i.p.) reduced locomotion, caused muscle relaxation, and had anti-anxiety effects. Conclusions: Ethanols extract of Z. jujuba leaves exhibits CNS depressant action and significant anxiolytic activity comparable to diazepam.

Vitamin D and Healthcare Service Utilization in Children: Insights from a Machine Learning Approach.

Vitamin D deficiency and insufficiency is a global health issue: an association has been demonstrated between vitamin D deficiency and a myriad of acute and chronic illnesses. Data regarding vitamin D status among children hospitalized with non-critical illnesses are scanty. We aimed to: (1) identify profiles of children hospitalized due to non-critical illnesses, using vitamin D levels as the driving outcome; (2) assess the association between patient profiles and length of stay. The study included 854 patients (1−17 years old) who underwent blood tests for detecting vitamin D levels. A regression tree was used to stratify patients. The relationship between vitamin D levels and length of stay was explored using Poisson regression. The regression tree identified three subgroups. Group A (16%): African, North African, Hispanic, and Indian patients. Group B (62%): Caucasian and Asian patients hospitalized for respiratory, metabolic, ill-defined, infective, and genitourinary diseases. Group C (22%): Caucasian and Asian patients hospitalized for digestive, nervous, and musculoskeletal diseases, blood and skin diseases, and injuries. Mean serum vitamin D level (ng/mL) was 13.7 (SD = 9.4) in Group A, 20.5 (10.0) in Group B, and 26.2 (12.6) in Group C. Group B was associated with the highest BMI z-score (p < 0.001) and the highest frequency of preterm births (p = 0.041). Mean length of stay was longer in Group A than in the other groups (p < 0.001) and decreased significantly by 9.8% (p = 0.024) in Group A and by 5% (p = 0.029) in Group B per 10 ng/mL increase in vitamin D level. We identified three subgroups of hospitalized children, defined according to ethnicity and discharge diagnosis, and characterized by increasing vitamin D levels. Vitamin D levels were associated with length of hospitalization.

Circulating lipoprotein(a) levels and health outcomes: Phenome-wide Mendelian randomization and disease-trajectory analyses

BackgroundLipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic and valvular diseases, but its possible role in other diseases has not yet been established. We conducted phenome-wide Mendelian randomization and disease-trajectory analyses to assess any associations of circulating Lp(a) levels with a broad range of diseases. MethodsA weighted polygenic risk score was constructed using independent genetic variants in the LPA gene and with an established effect on Lp(a) levels. The PheWAS analysis included 1081 phenotype outcomes ascertained among 385,917 White participants of the UK Biobank. Novel findings were investigated in MR analysis using data from the FinnGen consortium. Disease-trajectory and comorbidity analyses were further conducted to explore the sequential patterns of multiple morbidities related to high circulating Lp(a) levels. ResultsPheWAS revealed statistically significant associations of higher circulating Lp(a) levels with increased risk of a large number of circulatory system diseases (including various cardiac diseases, peripheral vascular disease, hypertension, and valvular and cerebrovascular diseases) as well as some endocrine/metabolic diseases (including hyperlipidemia, hypercholesterolemia, disorders of lipoid metabolism, and type 2 diabetes), genitourinary system diseases (renal failure), and hematologic diseases (including different types of anemia). Two-sample MR analysis supported the association between Lp(a) and risk of anemia, showed a suggestive association with type 2 diabetes, but found no association with renal failure. Disease-trajectory and comorbidity analyses identified 3 major sequential patterns of multiple morbidities, mainly in the cardiovascular, metabolic, and mental disorders, related to high circulating Lp(a) levels. ConclusionsGenetically predicted higher circulating Lp(a) levels were associated with increased risk of many circulatory system diseases and anemia. Additionally, this study identified three major sequential patterns of multiple morbidities related to high Lp(a).

Long-term hospitalisations in survivors of paediatric solid tumours in France

The late effects of treatments for childhood cancers may lead to severe and multiple health conditions requiring hospitalisation. We aimed to estimate the hospitalisation rate among childhood cancer survivors (CCS) in France, to compare them with the general population and to investigate the associated factors. We matched total of 5439 5-year solid CCS diagnosed before the age of 21 between 1945 and 2000 by sex, birth year and region of residence to 386,073 individuals of the French general population. After linkage with the national hospital discharge database, we estimated the relative hospitalisation rate (RHR), the absolute excess risks (AERs) and the relative bed-day ratio (RBDR) during 2006–2018. We used generalised linear models to estimate associations between hospitalisation and survivor characteristics. Overall, the RHR was 2.49 (95% confidence interval [CI] 2.46–2.52) and the RBDR was 3.49 (95% CI 3.46–3.51). We found that neoplasm-related hospitalisations had the highest AER (105.8 per 1000 person-years), followed by genitourinary system diseases (34.4 per 1000 person-years) and cardiovascular diseases (19.2 per 1000 person-years). In adjusted analysis, CCS treated with chemotherapy (risk ratio [RR] 1.62, 95% CI 1.53–1.70), radiotherapy (RR 2.11, 95% CI 1.99–2.24) or both (RR 2.59, 95% CI 2.46–2.73) had a higher risk of hospitalisation than the ones who had not received any of these treatments. CCS treated during the past decades by chemotherapy and/or radiotherapy now had a higher hospitalisation risk for all main categories of diagnosis than the general population. Prevention strategies and medical surveillance programmes may promote a long-term decrease in the hospitalisation rate among CSS.

New insights into smoking and urinary tract infections during pregnancy using pregnancy-pair design: A population-based register study.

Pregnancy itself predisposes to urinary tract infections (UTI). There appears to be a higher prevalence of infections and genitourinary diseases among pregnant smokers than among non-smokers. The present study is a retrospective observational register study aiming to investigate whether maternal smoking is associated with the prevalence of UTIs during pregnancy by utilizing a pregnancy-pair analysis. Information about pregnancies and maternal smoking was obtained from the Finnish Medical Birth Register. The study sample consisted of all singleton pregnancies (n=723 433) of women giving birth between January 2006 and December 2018 in Finland. Information on maternal smoking was collected in three categories: (1) non-smoking; (2) quit smoking during the first trimester; and (3) continued smoking throughout the pregnancy. Information about maternal UTI diagnoses during pregnancy was received from the Hospital Discharge Register and the Medical Birth Register. UTIs were categorized as lower and upper UTIs according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 diagnosis codes. Risks were calculated as odds ratios (OR) by logistic regression with 95% confidence intervals (CI) further adjusted for maternal characteristics (aOR). Finally, pregnancy-pair analyses were performed: mothers who had changed smoking status (no smoking/any smoking) between consecutive pregnancies (n=27 246 pregnancy-pairs) were analyzed as one cluster and compared with non-smokers. Smokers had UTIs more often compared with the non-smokers. The association was even stronger among those who continued to smoke (aOR 1.60, 95% CI 1.51-1.70) than among those who smoked only during the first trimester (aOR 1.27, 95% CI 1.18-1.37) compared with non-smokers. In pregnancy-pair analysis, smoking was associated with upper UTIs during pregnancy (OR 1.49, 95% CI 1.05-2.12) compared with non-smokers, but after the adjustments this association was attenuated (aOR 1.27, 95% CI 0.88-1.82). No association in lower UTIs was observed in the pregnancy-pair design. Maternal smoking was associated with a higher prevalence of UTIs during pregnancy in the standard comparison. The observed association was fully attenuated in the pregnancy-pair analysis, in which smoking was dichotomized. This study suggests that the association between maternal smoking during pregnancy and adverse maternal health effects might be more complex than previously thought.