Higher Prevalence In Females Research Articles

EFFECT OF MATERNAL BODY MASS INDEX ON THE MODE OF DELIVERY AND NEONATAL OUTCOME: A TERTIARY CARE HOSPITAL BASED STUDY IN SOLAN, HIMACHAL PRADESH.

INTRODUCTION: Obesity is a global health problem characterised as a pandemic issue by the World Health Organization (WHO), with a higher prevalence in females than males. During pregnancy, it is considered a high-risk state because it is associated with maternal complications like preeclampsia, gestational diabetes, obstetric interventions like caesarean delivery, postpartum haemorrhage; and fetal complications like macrosomia, poor apgar scores. BMI is a commonly used indicator which can be used to classify subjects on the basis of weight.AIM: This study aims to find the prevalence of normal weight, overweight and obese pregnant women defined by body mass index (BMI) according to the WHO classification and to study the associations between maternal BMI, the mode of delivery and neonatal outcome.MATERIAL AND METHODS: 200 pregnant women admitted for delivery in the department of Obstetrics & Gynaecology were studied, height and weight were recorded from reliable antenatal records (recorded within two months of gestation). The Body Mass Index was calculated and patients were divided into four categories: Category I: underweight; Category II: normal BMI; Category III: Overweight; Category IV: Obese. The feto-maternal outcomes were studied.RESULTS: On evaluation of 200 nulliparous antenatal women with singleton term gestation, 1.5% were underweight, 33% had normal BMI, 56% were overweight and 9.5% were obese. The prolongation of labour was seen in subjects with BMI more than 25 kg/m2. Overweight patients had more instrumental deliveries and obese patients had a higher tendency for prolonged labour and caesarean deliveries. Neonatal outcomes were poor for obese and overweight patients as compared to normal BMI because more neonates required resuscitation at birth, had low Apgar scores and were small for gestational age. Maternal complications like Hypothyroidism, preeclampsia and gestational diabetes occurred more commonly in the obese category.CONCLUSION: In our institution, majority of patients were found to be overweight. Adverse perinatal outcomes were seen more often in the obese patients. Hence, obesity must be identified as a risk factor for adverse pregnancy outcomes.

Abstract WMP15: Temporal Trends In Medical Complications After Acute Ischemic Strokes In The United States From 2006-2017

Purpose: To evaluate age and sex-specific trends in prevalence of infectious and non-infectious complications (comps) following acute ischemic stroke (AIS) admissions in the United States (US) from 2006 to 2017. Methods: We identified all admissions with a primary AIS diagnosis (weighted n= 5,190,311) in the 2006-2017 National Inpatient Sample. We quantified the prevalence of infectious [pneumonia, sepsis, and urinary tract infection (UTI)] and non-infectious [acute kidney injury (AKI), acute myocardial infarction (AMI), deep venous thrombosis (DVT), pulmonary embolism (PE), gastrointestinal bleeding (GIB) hemorrhage and acute myocardial infarction (AMI)] comps in subgroups categorized by age and sex. Logistic regression models were used to evaluate trends in prevalence over time. Results: Across the study period, 24.3% of all AIS admissions had at least one comp but prevalence increased with age. UTI (12.2%) was the most common comp, but this was driven mainly by its high prevalence in older females (f) 60-79 y (16.0%) and F >=80 y (22.9%). AKI was the second most common comp (8.9%) in all patients, followed by pneumonia (3.3%) and AMI (2.7%). GIB (1.1%), DVT (0.9%), and PE (0.5%) were the least common. Any comp risk increased from 20.8% in 2006 to 25.9% in 2017. Risk of UTI and pneumonia declined over time (p <0.001) but this was more than counterbalanced by increased risk of noninfectious comps such as AKI, AMI, DVT, and PE (figure 1). This was most prominent for AKI where there was a >3-fold increase in risk across the study period (figure 1). After multivariable adjustment, AKI, AMI, PE, pneumonia, sepsis, and GIB were associated with increased odds of in-hospital death while UTI and DVT were inversely associated with mortality (all p-values < 0.01). Conclusion: Infectious comps declined, while noninfectious comps, particularly AKI, increased following AIS admissions from 2006 to 2017. Additional efforts are needed to minimize comp risk following AIS.

Antiphospholipid Antibodies Increase the Risk of Fetal Growth Restriction: A Systematic Meta-Analysis.

Objective Antiphospholipid syndrome (APS) is a chronic autoimmune disease with a high prevalence in females. Published data have identified pregnant women with APS may suffer from recurrent miscarriage, fetal death. However, the association between antiphospholipid antibody (aPL) and fetal growth restriction (FGR) remains controversial. This study aims to systematically review the literature on population-based studies investigating an association between aPL and FGR. Methods The literature was searched on 1 November, 2021, using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), following the MOOSE checklist. Study inclusion criteria focused on peer-reviewed published articles that reported an association between aPL and FGR. Quality assessment was performed based on the Newcastle-Ottawa scale. The between-study heterogeneity was assessed by the Q test. Publication bias was assessed by funnel plots. Results Twenty-two studies (with 11745 pregnant women) were included in the final analysis. Pooled odds ratio for association of aPL, anticardiolipin antibodies (ACA), anti-beta2 glycoprotein 1 antibodies (β2GP1), and FGR was 1.26 (95%CI 1.12, 1.40), 2.25 (95%CI 1.55, 2.94), and 1.31 (95% CI 1.12, 1.49), respectively. Lupus anticoagulant (LA) did not increase the chance of FGR (OR 0.82, 95%CI 0.54, 1.10). Conclusions Our meta-analysis showed that aPL increased the risk of FGR. The risk of FGR varies with the aPL types. ACA and β2GP1 are strongly associated with FGR. There are currently insufficient data to support a significant relationship between LA and FGR.

Sex differences in chronic kidney disease prevalence in Asia: a systematic review and meta-analysis.

ABSTRACTBackgroundPrevious reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesize available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region.MethodsWe systematically searched MEDLINE and Embase for observational studies involving ≥500 adults who reported sex-disaggregated CKD prevalence data in any of the 26 countries in East, Southeast and South Asia. For each study we calculated the female:male prevalence ratio (PR), with a ratio >1 indicating a higher female prevalence. For each country, log-transformed PRs were pooled using random effects meta-analysis. These were then combined using a fixed effects model, weighting by population size, to estimate a pooled PR for each of East, Southeast and South Asia and Asia overall.ResultsSex-disaggregated data were available from 171 cohorts, spanning 15 countries and comprising 2 550 169 females and 2 595 299 males. Most studies (75.4%) came from East Asia (China, Taiwan, Japan and South Korea). Across Asia, CKD prevalence was higher in females {pooled prevalence 13.0% [95% confidence interval (CI) 11.3–14.9]} compared with males [pooled prevalence 12.1% (95% CI 10.3–14.1)], with a pooled PR of 1.07 (95% CI 0.99–1.17). Substantial heterogeneity was observed between countries. The pooled PRs for East, Southeast and South Asia were 1.11 (95% CI 1.02–1.21), 1.09 (0.88–1.36) and 1.03 (0.87–1.22), respectively.ConclusionsCurrent evidence suggests considerable between-country and -region heterogeneity in the female:male PR of CKD. However, there remains a large part of the region where data on sex-specific CKD prevalence are absent or limited. Country-level assessment of the differential burden of CKD in females and males is needed to define locally relevant policies that address the needs of both sexes.

Age and gender based study of urine microscopy in children and adolescents: a retrospective study

Background: Urinary tract infection (UTI) is a common reason for accessing health care services in all age groups. Women are more susceptible to UTI across age groups. Among males, the prevalence decreases in adolescence. Socio-economic and behavioural factors may play a significant role in the higher prevalence of UTI among adolescent girls. A study on UTI among children and adolescents will give a better insight in to the gravity of the problem and suggest appropriate interventions. Aim of the current study was to investigate the prevalence of urinary tract infection in males and females in the age group 0 to 20 based on the urine routine examination.Methods: This retrospective study included patients who had urine routine examination (URE) done based on clinical symptoms, during the period from January to December 2018 in a tertiary care teaching hospital. Data was obtained from the laboratory records and medical records department.Results: 1574 (3.43%) out of 45896 patients had a URE. This included 716 males (46%) and 858 females (54%). Among those with positive URE results, females were more affected than their male counterparts and this was statistically significant (male 21.8%, female 78.2%, p< 0.0001). As age advances, the prevalence decreases in males.Conclusions: Urinary tract infection is more prevalent in females across the pre- adolescent and adolescent age group. It decreases with age in males. Understanding the factors responsible for the persistent higher prevalence in females may decrease the prevalence of urinary infection in adolescent females.

Sociocultural overview and predisposing factors of body art in a health promotion perspective: survey on a sample of Italian young adults.

The body art (tattoos, body piercing and other aesthetic practices) is increasing at global level and involves different aspects of public health, from epidemiological feature to cultural and psychosocial determinants and regulatory issues. The study is aimed at estimating the prevalence of tattooed and pierced in youth, focusing on emerging profiles. A cross-sectional study has been conducted on 575 students at the first year of degree courses of an Italian University. Students were asked to fill an online questionnaire. Logistic regression models were evaluated in order to identify predictive factors and determinants of practice (tattoos, piercing, body art). The 41.9% of participants underwent at least one body art intervention, with a higher prevalence in females. Multivariate logistic regression suggested an association of body art practice with type of school and university course, as well as lifestyle characteristics (smoking, alcohol abuse). In addition, the intention to undergo to body art intervention in the future appeared significantly higher in women and more frequent in apparently 'protected' categories such as medical students and non-problematic alcohol users. The study confirmed the importance of the surveillance and social and behavioural research on body art practice and suggested different health promotion perspectives, such as early intervention towards adolescents and late intervention towards young adults belonging to lesser risky population groups.

A systematic review on the prevalence and management of subclinical hypothyroidism in patients with Type 2 Diabetes Mellitus

Background: Subclinical hypothyroidism (SCH) remains one of the most common biochemical manifestations of thyroid dysfunction.1 Similarly, type 2 diabetes mellitus (T2DM) is considered the most common metabolic disorder in clinical practice.2Methods: This is a systematic review to ascertain the prevalence and optimum management approach for thyroid dysfunction in patients with T2DM. We conducted a search on PubMed and Google scholar (Figure 1) for articles published between 2010-2020 using the following keywords: subclinical hypothyroidism, type 2 diabetes mellitus, thyroid diseases, diabetic retinopathy, diabetic nephropathy, and diabetic complications. Results: The prevalence of SCH in T2DM patients ranges from 7.8% to 23 % (average around 13.4%). In comparison, the prevalence of SCH in the general population ranges from 6% to 10%. SCH has a higher prevalence in females, older age >60 years old, long duration of T2DM, positive thyroid autoantibodies, glycated hemoglobin (Hba1c) 8%, and obese patients (risk factors).3 The prevalence of SCH in patients with diabetic retinopathy (DR) ranges from 17.3% to 43.3%. Also, the prevalence of SCH among patients with diabetic nephropathy (DN) ranges from 18.1% to 36%. Screening for thyroid dysfunction in T2DM at diagnosis is recommended and justified (Table 1). If patients with SCH have a risk of cardiovascular disease (CVD), DR, DN, symptomatic, presence of goiter, pregnant women, and continuous sustained increases of thyroid-stimulating hormone (TSH) on follow-up, it is recommended to start low dose levothyroxine which improves morbidity. Conclusion: The prevalence of SCH is relatively high in T2DM patients. This supports routine screening of such patients for thyroid dysfunction especially in patients with risk factors and diabetic complications (DR, DN), and consideration of thyroxine replacement wherever warranted although more evidence from randomized controlled trials is needed to explore the possible causal relationships.

Sexual Dimorphism in the Brain Correlates of Adult-Onset Depression: A Pilot Structural and Functional 3T MRI Study.

Major Depressive Disorder (MDD) is a disabling illness affecting more than 5% of the elderly population. Higher female prevalence and sex-specific symptomatology have been observed, suggesting that biologically-determined dimensions might affect the disease onset and outcome. Rumination and executive dysfunction characterize adult-onset MDD, but sex differences in these domains and in the related brain mechanisms are still largely unexplored. The present pilot study aimed to explore any interactions between adult-onset MDD and sex on brain morphology and brain function during a Go/No-Go paradigm. We hypothesized to detect diagnosis by sex effects on brain regions involved in self-referential processes and cognitive control. Twenty-four subjects, 12 healthy (HC) (mean age 68.7 y, 7 females and 5 males) and 12 affected by adult-onset MDD (mean age 66.5 y, 5 females and 7 males), underwent clinical evaluations and a 3T magnetic resonance imaging (MRI) session. Diagnosis and diagnosis by sex effects were assessed on regional gray matter (GM) volumes and task-related functional MRI (fMRI) activations. The GM volume analyses showed diagnosis effects in left mid frontal cortex (p < 0.01), and diagnosis by sex effects in orbitofrontal, olfactory, and calcarine regions (p < 0.05). The Go/No-Go fMRI analyses showed MDD effects on fMRI activations in left precuneus and right lingual gyrus, and diagnosis by sex effects on fMRI activations in right parahippocampal gyrus and right calcarine cortex (p < 0.001, ≥ 40 voxels). Our exploratory results suggest the presence of sex-specific brain correlates of adult-onset MDD–especially in regions involved in attention processing and in the brain default mode–potentially supporting cognitive and symptom differences between sexes.

A Review on Vyangavis a vis Melasma

Ayurvedais one of the oldest comprehensive health care system worldwide. Ayurvedicscience being ancient and traditional still correlate with day to day medical conditions and their treatment. Melasma being a non communicable and non deteriorated condition is still a mental trauma in human life especially for the younger age group. Melasma is a common acquired condition of symmetrical hyper pigmentation typically occurring on the face with higher prevalence in females and darker skin types. It is is characterized by more or less dark brownish maculae with irregular contour , but clear limits on photo exposed areas especially on the face, forehead, temples and more rarely on the nose, eyelids, chin and upper lips. In Ayurveda, vyanga has been elaborated as one of the kshudra rogas(minor ailments). VYANGA, a type of kshudra Roga, characterized by niruja(painless), shayavvarna mandala(bluish black patches) occurring specially on the face. The clinical features correlate with melasma which is acquired and symmetrical hypermelanosis . Vyangais a disease which belongs toswalpavariety of kshudra Roga. Vayuaggravated by Krodh and ayasa, get associated with pittaand suddenly produces a thin grey coloured circular patch which reaches the face. As per medical science melasma, cutaneous pigmentation is the outcome of two important events, the synthesis of melanin by melanocyte and the transfer of melanosomes to surrounding Keratinocytes. Both modern andayurvedicsciences have considered the use of topical as well asoral medications and their combinations for the treatment of vyanga. In Ayurveda,vyangahas been treated both by antah parimarjanand bahya parimarjan chikitsa. Several ayurvedic text such as Sushruta Samhitaand AshtangaHridayaand Sangrahaetc, have elaborated the pathophysiology and treatment of vyanga, the available references are scattered. So, there is a need of in-depth review and compilation of ayurvedictext and literatures which are effective for the management of vyanga

Variations of the circle of willis determined via magnetic resonance angiography: A single-center analysis of the serbian population

Introduction: The circle of Willis (CoW) represents the collateral pathway between large brain-feeding arteries, the knowledge of which is important in interventional and neurosurgical procedures, in the diagnosis and planning of procedures in acute stroke and subarachnoid hemorrhage. Aim: The study aims to determine the prevalence of variations of the CoW in patients from Serbia via magnetic resonance angiography (MRA). Material and Methods: The study was conducted as a retrospective study at the Center for Imaging Diagnostics, Oncology Institute of Vojvodina. Magnetic resonance imaging was analyzed in 665 patients of both sexes (471 females and 194 males), who underwent MRA during 2018 and 2019. Results: Complete CoW was found in 48.42% of cases, mostly in females (68.01%). Partially complete CoW and incomplete CoW were encountered in 38.05% and 13.55% of patients, mostly in females (73.52% and 73.33%). Anterior circulation variations were seen in 27.41% of cases, higher in females (63.83%), most commonly A1 anterior cerebral artery hypoplasia (9.32%). Posterior circulation variations were seen in 46.36% of cases, higher in females (79.25%), most commonly posterior communicating (PCom) artery hypoplasia (25.56%). Combined variations were seen in 26.24% of patients, with higher prevalence in females (73.33%). The prevalence of variations of posterior circulation between male and female patients was statistically significant (P = 0.007) and was higher in females. Discussion and Conclusion: This study showed that the most common variations were that of the posterior circulation, most commonly PCom artery hypoplasia. Complete CoW was found in <50% of cases (48.42%).

Voice-related quality of life and emotional symptoms before and after thyroidectomy.

To correlate voice-related quality of life, anxiety, and depression symptoms pre- and post-thyroidectomy. Observational, longitudinal, prospective, and quantitative study. Twenty patients participated in the study, with a mean age of 54 years, who underwent thyroidectomy, laryngeal visual examination, and the Voice-Related Quality of Life and Hospital Anxiety and Depression Scale questionnaires at different times: preoperative, 1 week and 3 months post-thyroidectomy, with a higher prevalence of females (85%; n=17) and partial thyroidectomy (70%; n=14). There was no statistical difference in voice quality of life between the moments, but lower preoperative scores were observed, especially in the physical domain. We observed a slight trace of anxiety in the preoperative period, with a reduction after 1 week and an increase after 3 months. There was a moderate negative correlation between the physical domain of QVV and the anxiety subscale and the total HADS score after 1 week and between the total domain of QVV with the total HADS score after 1 week, weak negative correlation between the total domain of QVV and the HADS anxiety subscale after 1 week and the total HADS score after 3 months. The patients evaluated in this study self-perceived their voice-related quality of life as positive. Mild anxiety traits were identified, with a reduction after one week postoperatively and an increase after three months. The self-perception of better voice-related quality of life in the postoperative period is weakly related to the reduction of anxiety levels.

The effect of topical nano vitamin-C iontophoresis versus the effect of trichloroacetic acid 20% peel in treatment of melasma

BackgroundMelasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies, including hydroquinone, tretinoin, corticosteroids, and triple-combination creams.ObjectiveThis study was designed to assess the efficacy of topical nano vitamin C enhanced with iontophoresis and to compare its effect with topically applied trichloroacetic acid 20% chemical peeling in the treatment of melasma.Patients and methodsA right–left comparative study included 30 female patients with their age ranging from 20 to 52 years, who participated for treatment of facial melasma, with melasma duration ranging from 1 to 12 years selected from the cosmetology outpatient clinic of Dermatology Department, Menoufia University Hospitals during the period from September 2020 to March 2021. History and clinical examinations were done for each patient.ResultsThere was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on right sides and age, disease duration, number of pregnancies, and duration from the last pregnancy. There was a significant positive correlation between Melasma Area and Severity Index score in the sixth session on the left sides and the amount of pregnancy and mean percentage of improvement was more on the right than the left side, 58.9 ± 18.8 versus 51.2 ± 18.8, but did not reach the significance level (P > 0.05).ConclusionNanosomal vitamin C with iontophoresis is an easy, safe, effective, painless, and noninvasive method in the treatment of melasma and trichloroacetic acid 20% peel was found as effective in the treatment of melasma.

Impact of routine footwear on foot health: A study on plantar fasciitis.

Plantar fasciitis is the most common cause of heel pain requiring medical attention. The clear understanding of the long-term impact routine footwear has on plantar fasciitis is essential as any slight changes in shoe selection could possibly prevent the wearer from substantial discomfort and disability. Thus this study was planned to investigate impact of routine footwear on foot health by highlighting different features of the shoes worn daily by the people having plantar fasciitis. A cross-sectional study was conducted in the orthopedics' outpatient department of a tertiary-care hospital in Pakistan. Data was collected using non-probability convenient sampling from 101 people diagnosed with plantar fasciitis. Their routine footwear was categorized as appropriate or inappropriate on basis of heel height, sole thickness, and insole type (hard/cushioned/arched). Data were collected using a self-designed questionnaire and analysed by applying descriptive statistics and non-parametric tests. The majority (83.2%) of the people wear inappropriate shoes, whereas only 16.8% wear the recommended shoes, i.e., with heel height between 0.5-4 cm, thick soles, and arched or cushioned insoles. About 82.2% of plantar fasciitis patients reported wearing shoes of minimal heel height and 55.5% wore shoes with hard, non-cushioned insole without built-in arch support. Participants who wear inappropriate shoes experience more severe heel pain (P 0.013) which limits their daily activities. Footwear plays an important role in causing plantar fasciitis as the majority of the diagnosed cases wear inappropriate shoes with minimal heel height, thin sole, and hard insole without any built-in arch support.

Prevalence of urinary incontinence in a cohort of women with obesity

INTRODUCTION: Urinary incontinence (UI) is frequently associated with obesity. The prevalence of the different UI types in women with obesity remains scarcely investigated and controversial. OBJECTIVE: The goal of this study was to investigate the prevalence of the different types of UI (stress urinary incontinence, SUI, urge, UUI, or mixed, MUI) in a large sample of female patients with obesity by means of a specific questionnaire and non-invasive tests. METHODS: In this observational study, 248 obese female patients (BMI≥30 Kg/m2, age: 62.8 + 10.9 years) admitted to hospital from April 2019 to September 2019 for a multidisciplinary rehabilitation program were recruited for this study. The International Consultation on Incontinence Questionnaire - short form (ICIQ-sf) was used to screen the presence of symptoms of UI and to differentiate the different UI types. Patients with ICIQ-sf score≥4, were asked to undertake the Pad Test for quantifying urine leaks under stress. RESULTS: 61.69% of our sample presented UI symptoms. The prevalence of UI appears to be lower in younger age groups (57% in 31–46 years of age and 52% in 47–62 years of age) and higher (69%) between 63 and 79 years of age. MUI was the most frequent form (57.5%), followed by UUI (21.5%) and SUI (20.9%). SUI was most prevalent in younger participants (31–46 years old). CONCLUSION: This study demonstrated that UI has a high prevalence in females with obesity and it is not an exclusive concern of older women. This high prevalence calls for specific rehabilitation interventions within multidisciplinary programs.

Spatial and temporal patterns in the sex ratio of American lobsters (Homarus americanus) in southwestern Nova Scotia, Canada

An approximate 1:1 sex ratio of American lobsters can be skewed due to environmental factors or fisheries management. Substantial skewness can impact mating behaviour and lower reproduction which could have far-reaching ecological and economic consequences. The aim was to investigate the sex ratio patterns of lobsters in two lobster fishing areas (LFAs) in southwestern Nova Scotia, Canada and identify factors associated with skewed sex ratios. This study analyzed biological data from more than 270,000 lobsters sampled over ten years (2010–2019) by the Fishermen and Scientists Research Society. A mixed effect logistic regression model evaluated the effect of spatial, temporal and environmental factors as well as size on the sex ratio of lobsters. There were significant temporal patterns in sex ratios that differed by LFA. After the effects of sampling month, year and LFA were accounted for, lower bottom temperature and deeper water depth were associated with a higher prevalence of females, especially in larger lobsters. We present the first long term analyses of sex ratio patterns in H. americanus in Atlantic Canada’s most commercially important region for this species and provide evidence that these patterns are influenced by environmental factors and fisheries. In view of future climate change scenarios, monitoring the population dynamics of this iconic fishery species is crucial to ensure sustainable fisheries and healthy lobster stocks.

Epidemiology of Treatment-Resistant Depression in the United States.

Background: The prevalence of treatment-resistant depression (TRD) among patients with pharmaceutically treated depression (PTD) varies greatly in publications. The aim of this study is to estimate the prevalence of TRD using 2 large claims databases in the US.Methods: This cross-sectional study used data from the Humana and Optum databases. Patients aged ≥ 18 years who had at least 1 diagnosis of major depressive disorder (ICD-10-CM codes: F32.xx, F33.xx) and 1 antidepressant prescription filled in 2018 were identified as having PTD. Among patients with PTD, TRD was defined as experiencing failure of treatment with at least 2 antidepressants with ≥ 4 weeks of adequate treatment. We estimated the age- and gender-standardized prevalence of TRD and then used logistic regression to investigate if TRD risk varies by age, sex, race, and geographic region. Finally, we described the timeline of TRD development in incident PTD patients.Results: We identified 296,055 and 277,941 patients with PTD in the Humana and Optum databases, among whom 17,640 (6.0%) and 16,131 (5.8%) had TRD. After age and sex standardization, TRD prevalence among PTD patients was 6.8% in Humana vs 5.8% in Optum. Females, middle-aged adults, and White patients had higher risk of TRD. The median time from index antidepressant use to TRD was about 6 months in incident PTD patients.Conclusions: The prevalence of TRD among patients with PTD was similar in the 2 databases. TRD prevalence varies by sex, race, and age, with a higher prevalence in females, White patients, and those in the age group of 45-64 years. However, the absolute differences were small.

Complex Regional Pain Syndrome in Athletes: Scoping Review.

Background and Objectives: Complex regional pain syndrome (CRPS) is a chronic condition characterized by disproportionate regional pain, usually affecting distal limbs, that follows trauma or surgery. Athletes may develop CRPS because of exposure to traumatic or overuse injuries. The aim of the present study is to review the available literature about CRPS type 1 in athletes. Materials and Methods: We searched two online databases (PubMed and Web of Science), selecting papers aiming at investigating CRPS type 1 (algodystrophy) in athletes. The analysis of databases was made considering original articles published until 30 June 2021, written in English. Results: Fifteen papers (12 case reports, 3 case series) were selected for a total of 20 clinical cases (15 females, 5 males), aged between 10 and 46 years (mean age 18.4 ± 9.8 standard deviation years). Patients included practiced different types of sport (soccer, athletics, gymnastics, basketball). The most involved anatomical sites were lower limbs, and time to diagnosis ranged from 2 days to 4 years. The most used treatments were pharmacological and physical therapies, but sometimes invasive approaches, as regional nerve, or lumbar sympathetic blocks, were provided. The main assessed outcomes were return to activity and pain. Conclusions: Our review suggests a higher prevalence of CRPS type 1 in younger people and in lower limbs than in general population but confirms the higher prevalence in females. However, the number of studies addressing CRPS in athletes is limited, as well as the number of involved patients, considering that only few and heterogeneous case reports were published about this topic. Moreover, the high prevalence of old studies (only 5 available studies in the last 10 years) might have influenced the choice of both assessment tools and management strategies. Despite these limitations, athletes showing disproportionate pain after sport-related injury should be promptly evaluated and treated through a multidimensional approach to avoid long-term consequences of algodystrophy.

Abstract 13697: Predictors of Prolonged Hospitalization (&gt;48 Hours) and In-Hospital Mortality Among the Patients Admitted With Acute Pulmonary Embolism

Introduction: Prolonged hospitalization leads to worse outcomes in patients admitted with acute pulmonary embolism (PE). However, there is a scarcity of data regarding the factors predisposing to prolonged hospitalization in such patients. Hypothesis: We aimed to identify the factors associated with the prolonged hospitalization and in-hospital mortality among patients admitted with acute PE. Methods: We identified all adults admitted with the primary diagnosis of acute PE from the National Inpatient Sample database (2017). We divided all the admissions into three cohorts based on their hospital length of stay (LOS) — short (sLOS) within 48 hours, medium (mLOS) 3-5 days, and extended (eLOS) &gt;5 days. More than 48 hours of stay was considered prolonged hospitalization. Variables related to patient and hospital-related characteristics were analyzed using logistic regression. Results: A total of 1,87,770 patients (71,215 with sLOS, 72,755 with mLOS, and 43,800 with eLOS) with mean age of 60, 64 and 65 years respectively (p&lt;0.001) were included in the study. Cohorts with mLOS and eLOS had a higher prevalence of females (53% both vs 49%, p&lt;0.001). In multivariate analysis, patients with increasing age, non-white race, tobacco smoking, obesity, associated upper limb and lower limb deep vein thrombosis (DVT), insulin-dependent diabetes, systemic steroids use, recent falls, dementia, and prior chronic respiratory diseases were found to be associated with prolonged hospitalization. Similar factors were also the independent predictors of in-hospital mortality. Interestingly, in-hospital mortality was higher among sLOS (3.8%) and eLOS (4%) compared to mLOS (1.6%). Conclusions: Our study identifies factors independently associated with prolonged hospitalization and in-hospital mortality among patients admitted with acute PE. Knowledge of these factors could aid in treatment strategies and discharge planning.

P.035 Health System Utilization and Medication Use among Adults with Migraine in Alberta: An observational cohort study using Alberta administrative health data

Background: Migraine is costly to governments. Despite significant burden, Canada lacks population data regarding migraine prevalence, resource and medication utilization. We sought to characterize the demographics, health resource utilization, and medication use in an adult migraine cohort in Alberta. Methods: Migraine cohort: previously validated case definition of migraine (ICD 10 + dispensation of abortive and/or preventative migraine drug (04/2010-03/2016). Patients over 18 years, followed three years from index date [first dispensation of migraine medication]. Health resource utilization (HRU) assessed by emergency department (ED) visits, hospital admission and physician claims. Medication assessed province-wide dispensation database linkage. Patient demographics and Charlson Comorbidity Index (CCI) included. Results: Over 5 years: 53,333 migraine cases identified (mean age 40.5 years, 79% female). Common comorbidities: hypertension, COPD, diabetes mellitus, cancer, cerebrovascular disease. Mean CCI 0.55 (SD 1.06). Metropolitan patients: 48%, urban 34.6%, rural 17.4%. Initial migraine diagnosis: 46% by GP, 31% in ED. Rural patients present more to ED/hospital for care in 3-year follow-up (IRR 2.95 [2.83, 3.08]). Conclusions: Our migraine case definition is more specific than sensitive and underestimates Alberta’s migraine prevalence. Higher female prevalence as expected. Rurally, migraine care largely occurs in ED/hospital. Study of prevalence, HRU and medications may help inform health policy in Alberta and Canada.

Predictive Ability of the Estimate of Fat Mass to Detect Early-Onset Metabolic Syndrome in Prepubertal Children with Obesity.

Body mass index (BMI), usually used as a body fatness marker, does not accurately discriminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using the following formula: FM = weight − exp(0.3073 × height2 − 10.0155 ×d-growth-standards/standards/body-mass-index-for-age-bmi-for-age weight− 1 + 0.004571 × weight − 0.9180 × ln(age) + 0.6488 × age0.5 + 0.04723×male + 2.8055) (exp = exponential function, score 1 if child was of black (BA), south Asian (SA), other Asian (AO), or other (other) ethnic origin and score 0 if not, ln = natural logarithmic transformation, male = 1, female = 0), to detect MS in 185 prepubertal obese children compared to other adiposity parameters. The eFM, BMI, waist circumference (WC), body shape index (ABSI), tri-ponderal mass index, and conicity index (C-Index) were calculated. Patients were classified as having MS if they met ≥ 3/5 of the following criteria: WC ≥ 95th percentile; triglycerides ≥ 95th percentile; HDL-cholesterol ≤ 5th percentile; blood pressure ≥ 95th percentile; fasting blood glucose ≥ 100 mg/dL; and/or HOMA-IR ≥ 97.5th percentile. MS occurred in 18.9% of obese subjects (p < 0.001), with a higher prevalence in females vs. males (p = 0.005). The eFM was correlated with BMI, WC, ABSI, and Con-I (p < 0.001). Higher eFM values were present in the MS vs. non-MS group (p < 0.001); the eFM was higher in patients with hypertension and insulin resistance (p < 0.01). The eFM shows a good predictive ability for MS. Additional to BMI, the identification of new parameters determinable with simple anthropometric measures and with a good ability for the early detection of MS, such as the eFM, may be useful in clinical practice, particularly when instrumentation to estimate the body composition is not available.