Height In Meters Research Articles

Hearing Impairment and Allostatic Load in Older Adults

Allostatic load, the cumulative strain that results from the chronic stress response, is associated with poor health outcomes. Increased cognitive load and impaired communication associated with hearing loss could potentially be associated with higher allostatic load, but few studies to date have quantified this association. To investigate if audiometric hearing loss is associated with allostatic load and evaluate if the association varies by demographic factors. This cross-sectional survey used nationally representative data from the National Health and Nutrition Examination Survey. Audiometric testing was conducted from 2003 to 2004 (ages 20-69 years) and 2009 to 2010 (70 years or older). The study was restricted to participants aged 50 years or older, and the analysis was stratified based on cycle. The data were analyzed between October 2021 and October 2022. A 4-frequency (0.5-4.0 kHz) pure tone average was calculated in the better-hearing ear and modeled continuously and categorically (<25 dB hearing level [dB HL], no hearing loss; 26-40 dB HL, mild hearing loss; ≥41 dB HL, moderate or greater hearing loss). Allostatic load score (ALS) was defined using laboratory measurements of 8 biomarkers (systolic/diastolic blood pressure, body mass index [calculated as weight in kilograms divided by height in meters squared], and total serum and high-density lipoprotein cholesterol, glycohemoglobin, albumin, and C-reactive protein levels). Each biomarker was assigned a point if it was in the highest risk quartile based on statistical distribution and then summed to yield the ALS (range, 0-8). Linear regression models adjusted for demographic and clinical covariates. Sensitivity analysis included using clinical cut points for ALS and subgroup stratification. In 1412 participants (mean [SD] age, 59.7 [5.9] years; 293 women [51.9%]; 130 [23.0%] Hispanic, 89 [15.8%] non-Hispanic Black, and 318 [55.3%] non-Hispanic White individuals), a modest association was suggested between hearing loss and ALS (ages 50-69 years: β = 0.19 [95% CI, 0.02-0.36] per 10 dB HL; 70 years or older: β = 0.10 [95% CI, 0.02-0.18] per 10 dB HL) among non-hearing aid users. Results were not clearly reflected in the sensitivity analysis with clinical cut points for ALS or modeling hearing loss categorically. Sex-based stratifications identified a stronger association among male individuals (men 70 years or older: β = 0.22 [95% CI, 0.12-0.32] per 10 dB HL; women: β = 0.08 [95% CI, -0.04 to 0.20] per 10 dB HL). The study findings did not clearly support an association between hearing loss and ALS. While hearing loss has been shown to be associated with increased risk for numerous health comorbidities, its association with the chronic stress response and allostasis may be less than that of other health conditions.

Association between inflammation, body mass index, and long-term outcomes in patients after percutaneous coronary intervention: A large cohort study.

Association between inflammation, body mass index, and long-term outcomes in patients after percutaneous coronary intervention: A large cohort study.

The Obesity Controversy: Does It Impact Treatment Response in Diffuse Large B-Cell Lymphoma?

Background: We aimed to investigate the association of body mass index (BMI) with treatment response in patients with DLBCL. Material and Methods: Seventy-nine DLBCL subjects were included in this study. Data about patient age, sex, serum LDH level, presence of B symptoms, IPI score, ECOG performance score, disease stage, extranodal involvement, and BMI values at diagnosis were retrieved by retrospective patient record review. Patients were staged according to Ann Arbor classification using CT and/or PET/CT findings, and the presence of B symptoms. Body mass index was calculated by dividing weight in kilograms by height in meters squared (kg/m2). Patients were divided into groups according to their BMI as underweight (BMI≤ 18.5 kg/m2), normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI≥ 30 kg/m2), as defined by the World Health Organization. Results: Patients were divided into four groups according to their BMIs, but because there was only one patient in the underweight group, comparisons were performed between normal-weight, overweight, and obese patients. There was no statistically significant difference between these groups in terms of age, sex, serum LDH level, disease stage, presence of B symptoms, extranodal involvement, ECOG performance score, IPI score and treatment response (p= 0.070, 0.704, 0.325, 0.464, 0.254, 0.152, 0.658, 0.620, and 0.947, respectively). Conclusion: In our study, we showed that BMI has no significant impact on treatment response in patients with DLBCL.

Reference Values, Determinants and Regression Equation for the Timed-Up and Go Test (TUG) in Healthy Asian Population Aged 21 to 85 Years.

The "Timed-Up-and-Go" test (TUG) is a standard assessment tool for functional mobility as it assesses several functional components, including balance, gait, and lower-extremity strength. It has good reliability and validity and is cost-effective and safe, making it an ideal screening tool for falls in various populations, such as older adults or various conditions. However, TUG interpretation relies on comparisons against local normative reference values (NRV), which few studies established for the Asian or younger population. Hence, this study aims to: (1) establish the normative reference values NRV for the population aged 21 to 85 years; (2) determine demographic and anthropometric variables that influence the TUG results; and (3) establish the regression equation of the TUG. A prospective, convenience sampling cross-sectional study recruited subjects aged 21-85 from the community to complete two TUG trials in various parts of Singapore. Variables collected include gender, age, height (meters, m), weight (kilograms, kg), and hand grip strength (HGS) (kg). The intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) determined test-retest, intra- and inter-rater reliabilities. TUG and variables were analyzed with descriptive statistics and multiple linear regression. p < 0.05 was accepted as statistical significance. Further, 838 subjects (542 females, 296 males) completed the data collection. The mean TUG time was 9.16 s (95% CI 9.01-9.3). Slower TUG was observed with advanced age and female gender. Multiple linear regression analysis demonstrated that age, height, and weight were the best variables to predict TUG scores. The regression formula presented as: TUG (second) = 9.11 + 0.063 (Age, years)-3.19 (Height, meters) + 0.026 (Weight, Kilograms) (R2 = 0.374, p < 0.001). This study provided the TUG NRV and regression formula for healthy Asian adults aged 21 to 85. The information may provide a quick reference for the physical function to interpret assessment findings and guide decision-making in various health and healthcare settings.

Comparison of the 2009 Institute of Medicine and 2021 Chinese guidelines for gestational weight gain: A retrospective population-based cohort study.

To analyze the associations between gestational weight gain (GWG) and perinatal outcomes based on the GWG guidelines of the Chinese Nutrition Society (CNS) and the Institute of Medicine (IOM). This was a retrospective study with 9075 low-risk singleton pregnant women. Logistic regression model was used to analyze associations between GWG categories and perinatal outcomes. Sensitivity analyses were performed based on pre-pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters). Excessive GWG as defined by the two guidelines was associated with a higher risk of adverse perinatal outcomes. Inadequate GWG was associated with higher risks of small for gestational age (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.10-1.64) and preterm birth (aOR 1.70, 95% CI 1.22-2.36), but a lower risk of large for gestational age (LGA) (aOR 0.77, 95% CI 0.63-0.95) according to the IOM guidelines. When using the CNS guidelines, inadequate GWG was associated with only a lower risk of preterm birth (aOR 1.80, 95% CI 1.19-2.70). Sensitivity analyses suggested that excessive GWG was associated with a higher risk of LGA in underweight women. Both guidelines could demonstrate the relationship between GWG and adverse perinatal outcomes. The CNS guidelines were more suitable for the Chinese population with underweight or normal weight before pregnancy, whereas IOM was more suitable for pregnant women with inadequate GWG.

Diagnostic performance using obesity and lipid-related indices and atherogenic index of plasma to predict metabolic syndrome in the adult sudanese population.

Simple and accurate clinical indicators to detect metabolic abnormalities might be helpful for early management and lowering the risk of future consequences like cardiovascular disease and type 2 diabetes mellitus. The visceral adiposity index (VAI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP) have been proposed as reliable, straightforward clinical markers and indications of metabolic syndrome (MetS). This study aimed to see how well these obesity and lipid-related indicators will predict MetS in adult Sudanese patients. This community hospital-based case-control study included 420 middle-aged people (154 men and 266 women). Anthropometric measurements, weight (kilogram), height (meters), and waist circumference (WC) were evaluated, and the body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. Fasting blood samples were collected for glycated hemoglobin (HbA1c) and lipid profile assessment. VAI, LAP, and AIP were calculated. Significantly higher means of BMI, WC, WHtR, HbA1c, triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, LAP, VAI, AIP, and significantly decrease in high-density lipoprotein cholesterol (HDL-C) were seen among MetS when compared with non-MetS group. LAP had a significant proportion with BMI, WC, WHtR, TG, TG/HDL-C, VAI, and AIP, and it is inversely related to HDL-C in the MetS group. On ROC analysis, LAP had the largest operating characteristic curves (AUC) for both gender 0.970 (0.948-0.993) for men and 0.964 (0.945-0.982) for women, followed by WC, and VAI, while BMI showed the lowest AUCs for men and women. In multiple regression analyses, AIP values increased significantly with LDL-C, DBP, HbA1c, LAP, and VAI. The LAP was considerably higher in middle-aged people with MetS in both gender and was considered the best diagnostic performance.

The Impact of Different Shear Wall Structure Position on Symmetric and Unsymmetric Tall Buildings

Abstract: The shear wall is a structural component used to withstand lateral stresses. These walls will absorb shear stresses and avoid construction site relocation and subsequently devastation. For instance, if the shear walls are not constructed, we cannot expect the structure to exhibit acceptable tensional behavior. The contribution of the remaining structural elements to the bending moment, shear force, torsion, and axial force, as well as the final design of all structural components, are also impacted by shear wall. Over the last two decades, there has been an almost exponential increase in the building of towering skyscrapers above 150 meters in height. Numerous identical buildings have been constructed across the Middle East and Asia, and many more are now being planned or constructed. Buildings taller than 300 meters provide significant engineering challenges, particularly in terms of structural and geotechnical design. Wind analysis is crucial for tall constructions. Numerous studies have explored the structural behavior of tall buildings with SSI by considering a range of criteria, including foundation type, soil conditions, lateral loads. The current study presents G+18-story rectangular building and a asymmetric building with a 3 m floor-to-floor height was evaluated in ETABS in zone III. The structure's resistance to static and dynamic wind and seismic forces has been studied using shear walls in various locations, such as without shear walls, shear walls in the outer center, and shear walls at the corners. The results obtained are compared in the form of storey drift, joint displacement and storey drift. The research indicates that the shear wall at outer Centre with firm soil has the best response compared to without shear wall and shear wall at corner condition for symmetrical building. And for asymmetrical building shear wall at corner condition has best response compared to without shear wall and shear wall at outer centre condition.

Fibrosis Progression Rate in Biopsy-Proven Nonalcoholic Fatty Liver Disease Among People With Diabetes Versus People Without Diabetes: A Multicenter Study

There are limited data regarding fibrosis progression in biopsy-proven nonalcoholic fatty liver disease (NAFLD) in people with type 2 diabetes mellitus (T2DM) compared with people without T2DM. We assessed the time to fibrosis progression in people with T2DM compared with people without T2DM in a large, multicenter, study of people with NAFLD who had paired liver biopsies. This study included 447 adult participants (64% were female) with NAFLD who had paired liver biopsies more than 1 year apart. Liver histology was systematically assessed by a central pathology committee blinded to clinical data. The primary outcome was the cumulative incidence of a ≥1-stage increase in fibrosis in participants with T2DM compared with participants without T2DM. The mean (SD) age and body mass index (calculated as weight in kilograms divided by the square of the height in meters) were 50.9 (11.5) years and 34.7 (6.3), respectively. The median time between biopsies was 3.3 years (interquartile range, 1.8-6.1 years). Participants with T2DM had a significantly higher cumulative incidence of fibrosis progression at 4 years (24% vs 20%), 8 years (60% vs 50%), and 12 years (93% vs 76%) (P= .005). Using a multivariable Cox proportional hazards model adjusted for multiple confounders, T2DM remained an independent predictor of fibrosis progression (adjusted hazard ratio, 1.69; 95% CI, 1.17-2.43; P= .005). The cumulative incidence of fibrosis regression by ≥1 stage was similar in participants with T2DM compared with participants without T2DM (P= .24). In this large, multicenter cohort study of well-characterized participants with NAFLD and paired liver biopsies, we found that fibrosis progressed faster in participants with T2DM compared with participants without T2DM. These data have important implications for clinical practice and trial design.

The role of vitamin D in women with Hashimoto's thyroiditis.

Autoimmune thyroid diseases (AITD), including Hashimoto's thyroiditis (HT), are the most common organ specific autoimmune disorders. Vitamin D (vit-D) is a steroid molecule, mainly produced in the skin, which regulates the expression of many genes. The vitamin D receptor (VDR) is found in most tissues and cells in the body. Many studies suggests that vit-D deficiency, which is common worldwide, could also play an important role in autoimmune diseases, including HT. The aim of our study was to show the potential differences in vit-D levels between healthy women and individuals with hypothyroidism and HT. Additionally, we assessed the correlation between vit-D concentration and the level of TSH and anti-thyroid antibodies in females diagnosed with HT. The study group included 370 subjects. The group was divided into 3 subgroups: (125 - healthy individuals, 111 - hypothyreosis, 134 - HT). Anthropometric measurements including height and weight were obtained in all participants. Body mass index (BMI) was calculated as body weight (in kilograms) divided by the square of body height (in metres). The measurement of the thyroid gland was performed using an ultrasound scan with a 10-MHz linear probe by one endocrinologist (Vivid S60N). We noticed that a lower level of vit-D was connected with a higher level of TSH in each subgroup. There was also strong, negative correlation between TSH and vit-D levels in all the study groups. Moreover, there was a weak, negative correlation between antithyroid peroxidase antibody (anti-TPO) and antithyroglobulin antibody (anti-TG) and vit-D levels in females with HT regardless of vit-D status: < 20 ng/mL, 20-30 ng/mL, and > 30 ng/mL. To our knowledge, the current study is the first in Poland to compare vit-D status in healthy patients and patients with hypothyroidism, taking into account the level of antibodies (anti-TPO and anti-TG). The results of our study suggest that vit-D supplementation in patients with hypothyroidism, especially in the course of AITD, although determining its optimal, safe dose requires further research.

Serum leptin, estradiol and testasterone concentrations in normal healthy fertile women with different weights

Background: Leptin, the product of the ob gene, is a hormone secreted by adipocytes. Animals with mutations in the ob gene are obese, leptin affects not only nutritional homeostasis but also reproductive events. A prospective study was done to investigate serum leptin ,estradiol and testosterone levels in 100 fertile healthy women with regular cycle aged(18-45) years with different weights and to see the influence of obesity on these parameters , the correlation of leptin with body mass index ,waist hip ratio , estradiol and testosterone level was determined. Methods fasting blood samples were obtained for the measurement of all studied parameters. serum concentrations of leptin was measured using ( ELISA) , estradiol and testosterone concentrations measured by ( ELFA ) technique (enzyme linked fluorescent assay)by mividus, the body-mass index was defined as the weight in kilo-grams divided by the square of the height in meters. Results: according to the body mass index (BMI), the women were divided in to 3 groups: Group (1) normal weight(30 women) with BMI≤24.9 kgm2 , group( 2) Overweight(30 women) with BMI=25-29.9 kgm2 , group ( 3) obese (40 women) with BMI≥ 30 kgm2. The mean value ±SD of the weight in normal weight group was (53±5)kg , of overweight group was(65.8 ± 4.7) and of obese group was(91.6±16) so there was a highly significant difference between the 3 groups (p-value=0.000) , the Mean ± SD of waisthip ratio in normal, over weight and obese groups were (0.79 ± 0.06, 0.81 ± 0.03 and 0.84 ± 0.05) respectively and there was significant difference between the 3 groups(p-value=0.04), the leptin mean ± SD of normal ,overweight and obese groups were(12.4±6.7, 18.2±5.8 and 24.4±16.4) respectively, and p-value =0.000. Estradiol mean±SD of normal ,overweight and obese groups were (46.2±30.2 ,54.6±25 and79.9 ±52.7)respectively ,p-value =0.03,Testosterone mean±SD of normal, overweight and obese groups were (0.14±0.06, 0.16±0.07 and 0.2±0.09)respectively, p-value =0.00. Conclusions. Leptin correlate significantly with BMI, WH ratio and estradiol level, the women with higher BMI(obese) has higher level of leptin, estradiol and testosterone so the leptin clearly appears to be linked to the reproductive system .

Effect of Omega-3 on lipid profile in type 2 diabetic patients

Diabetic complication is a major health concern , especially uncontrolled lipid profile, contributing to cardiac, renal and multisystem disorders. To evaluate the effect of 2 months supplementation of Omega-3 on lipid profile in type 2 diabetic patients and in comparison with the control. This non-randomized clinical trial was conducted at Al-Wafa'a Center for Diabetes Management and Research in Mosul City in the period from 1st of February 2012 to the 1st of July 2012. A total number of 84 patients (42 males and 42 females) diagnosed with type 2 diabetes mellitus (T2DM) for 2-5 years and were treated with metformin (dose of 500 mg twice daily) + glibenclamide (dose of 2.5 mg once daily) with no other liver or renal disorders, the patients were divided into two groups: First group included 50 patients with age ranged from 37 to 61 years, the patients were given Omega-3 capsules (1000 mg twice daily) for two months (Omega-3 group). The second group included the remaining 34 diagnosed diabetic patients, matched with the first group by age, sex , and BMI and considered as (control group). Fasting blood samples were taken from the first group at the beginning then after two months of Omega-3 use and from the control group once. The sera obtained from all participants in this study were used to measure lipid profile parameters by using the commercial kits, serum low-density lipoprotein cholesterol (LDL-c) was calculated using Friedewald equation. Atherogenic index (AI) was recognized by simple equation and BMI measured by dividing weight in (kg) by square of height in (meter). There was a significant reduction of serum triglycarides (TG) level and atherogenic index but no significant changes in total cholesterol (TC), high density lipoprotein-cholesterol HDL-c, nor in LDL-c level after 2 months therapy with Omega-3 and in comparison with the control group. The use of Omega-3 supplementation for two months in type 2 diabetic patients resulted in significant reduction in the serum TG level and atherogenic index but there was no effect on the other lipid profile parameters. This may be of therapeutic importance in lowering of the cardiovascular risk factors in patients with T2DM.

The Effect of 6 Weeks of Body weight Exercises on the Respiratory Function of overweight Women

The prevalence of obesity and overweight all over the world due to the mechanization of lifestyle and people’s use of ready-made foods is increasing and affecting health and is closely related to major problems. One of the diseases that has a positive and frequent relationship with obesity is a respiratory disease. Obesity weakens people’s lung function and respiratory tract through two mechanisms, mechanical and inflammatory. The mechanical effect of obesity is such that it can affect the respiratory mechanics of the lungs and chest wall and cause asthma or pseudo-asthmatic shortness of breath and increase the response of the respiratory tract. In this study, we investigated the effect of 6 weeks of bodyweight training on the respiratory function of overweight women. For this purpose, in this research, 30 obese women aged 25 to 40 years were randomly divided into two control and training groups. The height meter and weight were calibrated with a digital scale and the body mass index was calculated by calculating the height and weight and the corresponding formula. The training program of the experimental group was for 6 weeks, 3 sessions per week and 60 minutes in each session. The training session included a 10-minute warm-up at the beginning of the workout and a 10-minute cool-down at the end of the workout. According to the present study, the percentage of fat in the training group was significantly reduced compared to the control. Also, there was a significant difference between the two groups in the FVC respiratory indices and the FEV1/FVC ratio. This was even though no significant difference was observed in the FEV1 index between the training and control groups. . Resistance training improves body composition by increasing metabolism and energy consumption and reducing fat mass. Research has shown that resistance training is effective in improving body composition due to increasing muscle volume and reducing fat percentage. In the present study, it was observed that resistance training with bodyweight could improve FVC. Resistance training is effective in improving the pulmonary indices of people by improving the skeletal muscle system and posture. The final result of this research showed us that resistance training with body weight in overweight women can improve body composition and respiratory function.

Cardiovascular Outcomes and Mortality After Bariatric Surgery in Patients With Nonalcoholic Fatty Liver Disease and Obesity

Bariatric surgery (BS) is associated with significantly reduced incidence of cardiovascular diseases and mortality in patients with obesity. However, whether BS can decrease major adverse cardiovascular events in patients with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. To investigate the association of BS with the incidence of adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity. This was a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 35 or greater and NAFLD (without cirrhosis) who underwent BS between January 1, 2005, and December 31, 2021, were included. Patients in the BS group were matched with patients who did not undergo surgery (non-BS group) according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. Patient follow-up ended on August 31, 2022, and data were analyzed in September 2022. Bariatric surgery vs nonsurgical care. The primary outcomes were defined as the first incidence of new-onset heart failure (HF), composite cardiovascular events (unstable angina, myocardial infarction, or revascularization, including percutaneous coronary intervention or coronary artery bypass graft), composite cerebrovascular disease (ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and a composite of coronary artery procedures or surgeries (coronary stenting, percutaneous coronary intervention, or coronary artery bypass). Cox proportional hazards models were used to estimate hazard ratios (HRs). Of 152 394 eligible adults, 4693 individuals underwent BS; 4687 patients who underwent BS (mean [SD] age, 44.8 [11.6] years; 3822 [81.5%] female) were matched with 4687 individuals (mean [SD] age, 44.7 [13.2] years; 3883 [82.8%] years) who did not undergo BS. The BS group had significantly lower risk of new-onset of HF (HR, 0.60; 95% CI, 0.51-0.70), cardiovascular events (HR, 0.53; 95% CI, 0.44-0.65), cerebrovascular events (HR, 0.59; 95% CI, 0.51-0.69), and coronary artery interventions (HR, 0.47; 95% CI, 0.35-0.63) compared with the non-BS group. Similarly, all-cause mortality was substantially lower in the BS group (HR, 0.56; 95% CI, 0.42-0.74). These outcomes were consistent at follow-up duration of 1, 3, 5, and 7 years. These findings suggest that BS was significantly associated with lower risk of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity.

Targeted Hypoglossal Nerve Stimulation for Patients With Obstructive Sleep Apnea

Evidence is lacking from randomized clinical trials of hypoglossal nerve stimulation in obstructive sleep apnea (OSA). To evaluate the safety and effectiveness of targeted hypoglossal nerve stimulation (THN) of the proximal hypoglossal nerve in patients with OSA. This randomized clinical trial (THN3) was conducted at 20 centers and included 138 patients with moderate to severe OSA with an apnea-hypopnea index (AHI) of 20 to 65 events per hour and body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or less. The trial was conducted from May 2015 through June 2018. Data were analyzed from January 2022 through January 2023. Implant with THN system; randomized 2:1 to activation at month 1 (treatment) or month 4 (control). All received 11 months of THN with follow-up at months 12 and 15, respectively. Primary effectiveness end points comprised AHI and oxygen desaturation index (ODI) responder rates (RRs). Treatment responses at months 4 and 12/15 were defined as a 50% or greater reduction in AHI to 20 or less per hour and an ODI decrease of 25% or greater. Coprimary end points comprised (1) month 4 AHI and ODI RR in the treatment greater than the control group and (2) month 12/15 AHI and ODI RR in the entire cohort exceeding 50%. Secondary end points included sleep apnea severity (AHI and ODI) and patient-reported outcomes (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale). Among 138 participants, the mean (SD) age was 56 (9) years, and 19 (13.8%) were women. Month 4 THN RRs were substantially greater in those in the treatment vs control group (AHI, 52.3% vs 19.6%; ODI, 62.5% vs 41.3%, respectively) with treatment-control standardized mean differences of 0.725 (95% CI, 0.360-1.163) and 0.434 (95% CI, 0.070-0.843) for AHI and ODI RRs, respectively. Months 12/15 RRs were 42.5% and 60.4% for AHI and ODI, respectively. Improvements in AHI, ODI, Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale scores were all clinically meaningful (medium to large effect size). Two serious adverse events and 100 nonserious related adverse events were observed from the implant procedure or study protocol. This randomized clinical trial found that THN demonstrated improvements in sleep apnea, sleepiness, and quality of life in patients with OSAs over an extended AHI and body mass index range without prior knowledge of pharyngeal collapse pattern. Clinically meaningful improvements in AHI and patient-reported responses compared favorably with those of distal hypoglossal nerve stimulation trials, although clinically meaningful differences were not definitive for ODI. ClinicalTrials.gov Identifier: NCT02263859.

Development and validation of a new antenatal warning score system (DRRiP) for neonatal complications of gestational diabetes.

To evaluate the DRRiP (Diabetes Related Risk in Pregnancy) score warning system as a tool for predicting neonatal morbidity in gestational diabetes. A retrospective observational cohort study. By applying nine parameters from an antenatal trichotomy of glycemic, ultrasound, and clinical characteristics, DRRiP scores were calculated and assigned to each patient using a checklist tool. Logistic regression models were used to evaluate the association between DRRiP score and adverse fetal outcomes, after adjusting for maternal age and body mass index (calculated as weight in kilograms divided by the square of height in meters). In all, 627 women were studied. DRRiP score was an excellent predictor of macrosomia and shoulder dystocia (both areas under the receiver operating characteristics curves [AUROC]=0.86), and a modest predictor of preterm delivery, hyperbilirubinemia, neonatal intensive care unit admission and a composite of either of the studied events (AUROC range 0.63-0.69). For the composite outcome, the sensitivity of an amber trigger score of 1 was 68.7% (95% confidence interval [CI] 62.27%-74.63%) and specificity was 48.87% (95% CI 43.85%-53.9%). Specificity at a red trigger score of 3 (89.7%) and a graded increase in post-test probability (90.7% risk at a score of 5) were highly encouraging. DRRiP score offers reasonable discriminative performance that could be clinically useful for meaningful risk stratification when making delivery plans.

Nutritional Status of School-Going Children Visiting Outdoor Patient Department of a Tertiary Care Hospital

Aim: To evaluate the nutritional status of school-going children visiting the outdoor patient department of a tertiary care hospital. Study Design: Cross-sectional study Place and duration: Pediatric OPD of POF hospitalWah Cantt/ NUMS University from 1 June 2021 to 30 August 2021 Methodology: The age of each child was verified from the hospital HMIS data after which weight and height were recorded. Weight in kilograms (Kg) divided by the square of height in meters was used to determine body mass index. Using WHO AnthroCalc v 2.10, Z score values for weight for age, height for age, and BMI for age were determined. Results: In the present study, 51.6% were of male gender out of 519 children. Mean age was 9.2 (SD = ±2.2) years, 56.6% were of age less than 10 years old, mean height was 131.4 (SD=±14.8) cm and mean weight was 28.4 kg (SD=±10.9). 46.8% studied in government schools, 52.8% in private schools and just 0.4% in Madrasa. The majority i.e. 325 (62.5%) children were found with normal body mass index, 66(12.7%) were thin, 49 (9.4%) were of severe thinness, 48 (9.2%) were overweight and 31 (6%) were found obese according to the WHO BMI criteria for children. Conclusion: WHO BMI criteria is a valuable tool for the screening of malnutrition in children. Our study showed a double burden of malnutrition in school going children with high prevalence of obesity and severe thinness in boys. Keywords: Thinness, body mass index, double burden of malnutrition, obesity

Risk Factors Associated With Post−COVID-19 Condition

Post-COVID-19 condition (PCC) is a complex heterogeneous disorder that has affected the lives of millions of people globally. Identification of potential risk factors to better understand who is at risk of developing PCC is important because it would allow for early and appropriate clinical support. To evaluate the demographic characteristics and comorbidities that have been found to be associated with an increased risk of developing PCC. Medline and Embase databases were systematically searched from inception to December 5, 2022. The meta-analysis included all published studies that investigated the risk factors and/or predictors of PCC in adult (≥18 years) patients. Odds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, the random-effects model was used to compare the risk of developing PCC between individuals with and without the risk factor. Data analyses were performed from December 5, 2022, to February 10, 2023. The risk factors for PCC included patient age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared; smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; previous hospitalization or ICU (intensive care unit) admission with COVID-19; and previous vaccination against COVID-19. The initial search yielded 5334 records of which 255 articles underwent full-text evaluation, which identified 41 articles and a total of 860 783 patients that were included. The findings of the meta-analysis showed that female sex (OR, 1.56; 95% CI, 1.41-1.73), age (OR, 1.21; 95% CI, 1.11-1.33), high BMI (OR, 1.15; 95% CI, 1.08-1.23), and smoking (OR, 1.10; 95% CI, 1.07-1.13) were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC (OR, 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated (OR, 0.57; 95% CI, 0.43-0.76). This systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination. PROSPERO Identifier: CRD42022381002.

Obesity increases the odds of multiple pregnancies: A nationwide register-based cohort study in Finland.

To investigate the effects of increased pre-pregnancy body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) on the risk of having spontaneous multiple pregnancies using a nationwide register-based study sample. Data from the National Medical Birth Register (MBR) (2004-2018) were used to evaluate the effects of a higher pre-pregnancy BMI on the risk of multiple pregnancies. Lower and higher pre-pregnancy BMI classes, using the WHO classification, were compared with a normal weight class. A logistic regression model was used to assess the primary outcomes. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) between the groups were compared. The model was adjusted by maternal age, maternal height, and maternal smoking status. The odds of multiple pregnancies were higher among women in the overweight group (aOR 1.07, 95% CI 1.02-1.12), obesity class I group (aOR 1.11, 95% CI 1.04-1.18), and obesity class II group (aOR 1.15, 95% CI 1.03-1.28) compared with women in the non-overweight BMI class. Women in the underweight group had lower odds for multiple pregnancies (aOR 0.82, 95% CI 0.73-0.93). The odds of multiple pregnancies slightly increase with pre-pregnancy obesity, and this should be acknowledged as a minor risk factor for multiple pregnancies.

Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018

Improved understanding of trends in the proportion of individuals with metabolically healthy obesity (MHO) may facilitate stratification and management of obesity and inform policy efforts. To characterize trends in the prevalence of MHO among US adults with obesity, overall and by sociodemographic subgroups. This survey study included 20 430 adult participants from 10 National Health and Nutrition Examination Survey (NHANES) cycles between 1999-2000 and 2017-2018. The NHANES is a series of cross-sectional and nationally representative surveys of the US population conducted continuously in 2-year cycles. Data were analyzed from November 2021 to August 2022. National Health and Nutrition Examination Survey cycles from 1999-2000 to 2017-2018. Metabolically healthy obesity was defined as a body mass index of 30.0 (calculated as weight in kilograms divided by height in meters squared) without any metabolic disorders in blood pressure, fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), or triglycerides based on established cutoffs. Trends in the age-standardized prevalence of MHO were estimated using logistic regression analysis. This study included 20 430 participants. Their weighted mean (SE) age was 47.1 (0.2) years; 50.8% were women, and 68.8% self-reported their race and ethnicity as non-Hispanic White. The age-standardized prevalence (95% CI) of MHO increased from 3.2% (2.6%-3.8%) in the 1999-2002 cycles to 6.6% (5.3%-7.9%) in the 2015-2018 cycles (P < .001 for trend). There were 7386 adults with obesity. Their weighted mean (SE) age was 48.0 (0.3) years, and 53.5% were women. The age-standardized proportion (95% CI) of MHO among these 7386 adults increased from 10.6% (8.8%-12.5%) in the 1999-2002 cycles to 15.0% (12.4%-17.6%) in the 2015-2018 cycles (P = .02 for trend). Substantial increases in the proportion of MHO were observed for adults aged 60 years or older, men, non-Hispanic White individuals, and those with higher income, private insurance, or class I obesity. In addition, there were significant decreases in the age-standardized prevalence (95% CI) of elevated triglycerides (from 44.9% [40.9%-48.9%] to 29.0% [25.7%-32.4%]; P < .001 for trend) and reduced HDL-C (from 51.1% [47.6%-54.6%] to 39.6% [36.3%-43.0%]; P = .006 for trend). There was also a significant increase in elevated FPG (from 49.7% [95% CI, 46.3%-53.0%] to 58.0% [54.8%-61.3%]; P < .001 for trend) but no significant change in elevated blood pressure (from 57.3% [53.9%-60.7%] to 54.0% [50.9%-57.1%]; P = .28 for trend). The findings of this cross-sectional study suggest that the age-standardized proportion of MHO increased among US adults from 1999 to 2018, but differences in trends existed across sociodemographic subgroups. Effective strategies are needed to improve metabolic health status and prevent obesity-related complications in adults with obesity.

Defensive Buildings of the Bakalskaya Culture (The Staro-Lybaevskoe-1 Settlement in the Forest-Steppe Trans-Urals)

Purpose. The purpose of this article is to evaluate defensive potentialities of the Middle Age population in the Trans-Urals. The main task is to reconstruct the exterior of the fortified areas and the necessary amount of work.Results. The defensive buildings of the Staro-Libayevskoye-1 fortified settlement were used. It has been established on the terrace of the Middle Tobol river and had the 5-angle form, size 65 × 75 m and a simple rampart-and-ditch line with two approach gates. This square was used for habitation twice in Middle age epoch. Apparently, large earthworks were not carried out due to the features of the relief, which had a height difference of 2 meters; considering the wooden wall and the ditch depth. Based on the analysis of the archaeological finds and the cultural layer, we established that in the early period of the Bakalskaya culture (4th – 5th centuries) the settlement was encircled with timber-framed wall and the terrace slope possibly played a role of a berm. The inhabitants created a defense line minimum of 5.5–6 meters in height. We assume that there was exacerbation of social and local conflicts, and the population sought to prevent these conflicts by strengthening defense. The Ustyug-1 synchronous cemetery testifies to the existence of a constant military threat, such as attacks by migrants and conflicts with the use of weapons. Later, in 8th – 10th centuries the settlers used traditional methods and created a new earthen wall. It was built two times wider, then earlier, using pre-existing land cultural layer. The settlers abandoned the laborious movement of soil from the ditch to the height of the wall. For greater protection, they equipped the earthen rampart with timber-frame structures and created a barrier 5.5 meters high.Conclusion. Concluding, we suggest that a dangerous military situation persisted during this period, as evidenced by samples of weapons and a cemetery in the settlement. The study also revealed a trend towards increasing labor costs for fortifications construction.