High Proportion Of Cases Research Articles

Multiple Sclerosis: Appearance after Covid Vaccination

Background: Multiple sclerosis (MS) is a chronic autoimmune disease that primarily affects the central nervous system, often emerging in young adults. In the context of the global COVID-19 vaccination campaign, concerns have been raised about the potential link between vaccination and autoimmune conditions, including MS. This study aims to assess the incidence of MS post-COVID-19 vaccination across different age groups and vaccine types, with a specific focus on identifying at-risk populations. Methods: A retrospective cohort study was conducted using publicly available registries, case reports, and clinical data. The study included 450 individuals who developed MS after receiving a COVID-19 vaccine, with an analysis performed on incidence rates, relative risk (RR), and demographic factors such as age, sex, and vaccine type. The data was compared with a control group of 3,000 vaccinated individuals without MS onset. Results: The overall incidence of MS among vaccinated individuals was 15 per 100,000. Adults aged 18-40 years had the highest incidence (18 per 100,000), while children under 12 had the lowest (3 per 100,000). Females were disproportionately affected, accounting for 63.3% of MS cases, with an incidence of 18 per 100,000 compared to 12 per 100,000 in males. A higher proportion of cases were linked to mRNA vaccines, particularly Pfizer-BioNTech (54.4% of total cases), though no statistically significant difference was observed among vaccine types. The relative risk of MS in vaccinated adults was 1.35 (95% CI: 1.12-1.60) compared to the general population. Conclusion: While there is a slight increase in the incidence of MS among adults following COVID-19 vaccination, particularly with mRNA vaccines, the overall risk remains low. No significant increase in MS risk was observed in younger populations. The benefits of vaccination against severe COVID-19 far outweigh the potential risks of MS onset. Ongoing surveillance and further research are essential to better understand vaccine-related autoimmune responses.

Global burden and incidence trends of zika virus infection among women aged 15–49 years from 2011 to 2021: A systematic analysis

BackgroundZika virus (ZIKV) infection during pregnancy presents a significant health risk in women of reproductive age and their offspring due to severe neurological complications. It is meaningful to assess its global burden and temporal trends. MethodsThis study extracted annual incidence cases and rates of ZIKV among women of reproductive age (15–49 years) between 2011 and 2021 from Global Burden of Diseases (GBD) 2021, including global level, 21 GBD regions, 5 socio-demographic index (SDI) regions, 7 age groups, and 204 countries and territories. Relative percent change in cases and estimated annual percentage change (EAPC) of incidence rates were used to quantify the temporal trends. ResultsThe incidence rate of ZIKV infection exhibited a pronounced peak in 2016 at 174.27 per 100,000 population, with an EAPC of 158.30 % from 2011 to 2016 and −51.86 % from 2016 to 2021 at 3.06 per 100,000 population. And only 5 out of the 21 GBD regions reported ZIKV infection in 2021, predominantly concentrated in Latin America and Caribbean. The outbreaks were primarily concentrated in low-middle and middle SDI regions. In 2021, at the global level, the incidence rates of ZIKV infection among women of reproductive age were similar across different age groups, ranging from 2.41 to 3.39 per 100,000 population. The proportion of ZIKV infection cases was slightly higher in women aged 25–29 and 30–34 years compared to other age groups in 2021, whereas a higher proportion of cases were observed in younger age groups in 2011 and 2016. ConclusionsWomen of reproductive age in Latin America and Caribbean continue to face the threat of ZIKV. Regions with lower SDI had a disproportionately severe burden. Future public health strategies should focus on high-risk areas and populations of reproductive age, enhancing surveillance, prevention, and education efforts to further mitigate the public health threat posed by ZIKV.

Feasibility of the Non-Window-Type 3D-Printed Porous Titanium Cage in Posterior Lumbar Interbody Fusion: A Randomized Controlled Multicenter Trial.

Three-dimensionally printed titanium (3D-Ti) cages can be divided into 2 types: window-type cages, which have a void for bone graft, and non-window-type cages without a void. Few studies have investigated the necessity of a void for bone graft in fusion surgery. Therefore, the present study assessed the clinical and radiographic outcomes of window and non-window-type 3D-Ti cages in single-level posterior lumbar interbody fusion. A total of 70 patients were randomly assigned to receive either a window or non-window cage; 61 patients (87%) completed final follow-up (32 from the window cage group, 29 from the non-window cage group). Radiographic outcomes, including fusion rates, subsidence, and intra-cage osseointegration patterns, were assessed. Intra-cage osseointegration was measured using the intra-cage bridging bone score for the window cage group and the surface osseointegration ratio score for the non-window cage group. Additionally, we looked for the presence of the trabecular bone remodeling (TBR) sign on computed tomography (CT) images. Of the 61 patients, 58 achieved interbody fusion, resulting in a 95.1% fusion rate. The fusion rate in the non-window cage group was comparable to, and not significantly different from, that in the window cage group (96.6% and 93.8%, p > 0.99). The subsidence rate showed no significant difference between the window and non-window cage groups (15.6% and 3.4%, respectively; p = 0.262). The intra-cage osseointegration scores showed a significant difference between the groups (p = 0.007), with the non-window cage group having a higher proportion of cases with a score of 4 compared with the window cage group. The TBR sign was observed in 87.9% of patients who achieved interbody fusion, with a higher rate in the non-window cage group across the entire cohort although the difference was not significant (89.7% versus 78.1%, p = 0.385). Non-window-type 3D-Ti cages showed equivalent clinical outcomes compared with window-type cages and comparable interbody fusion rates. These results suggest that the potential advantages of 3D-Ti cages could be optimized in the absence of a void for bone graft by providing a larger contact surface for osseointegration. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Stage-based recipient and donor outcome in twin-to-twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique.

To evaluate twin survival stratified by Quintero stage in patients with twin-to-twin transfusion syndrome (TTTS) after Solomon laser treatment. This was a single-center study at Johns Hopkins Center for Fetal Therapy, investigating a cohort of consecutive twin pregnancies treated with the Solomon laser technique for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were investigated in relation to neonatal survival of the recipient and donor twins at discharge. Determinants of twin survival were evaluated using univariate logistic regression and cumulative survival probability analyses. Of 402 pregnancies with TTTS that underwent Solomon laser treatment, 80 (19.9%) were diagnosed with Quintero Stage-I TTTS, 126 (31.3%) with Stage II, 169 (42.0%) with Stage III and 27 (6.7%) with Stage IV. Post-laser twin anemia polycythemia sequence or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser surgery. Preterm prelabor rupture of membranes occurred in 150 (37.3%) patients and median gestational age at delivery was 32 + 1 weeks. In 303 (75.4%) patients, both twins were alive at discharge; 67/80 (83.8%) were Stage I, 101/126 (80.2%) were Stage II, 113/169 (66.9%) were Stage III and 22/27 (81.5%) were Stage IV (P = 0.062). Donor twin survival was lower than that of recipients in cases with Stage-III TTTS (118/169 (69.8%) vs 145/169 (85.8%) (χ2 = 26.076, P < 0.0001)). Higher intertwin size discordance and absent or reversed umbilical artery (UA) end-diastolic velocity (EDV) were associated with donor demise (Nagelkerke R2, 0.38; P < 0.001). Overall, spontaneous post-laser donor demise occurred in 53 (39.6%) patients, accounting for the majority of all losses. Cumulative donor survival decreased from 92% to 65% when intertwin size discordance was >30% and to 48% when UA-EDV was absent or reversed (P < 0.001). The Solomon laser technique achieves TTTS resolution and double twin survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant intertwin size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in Stage-III TTTS, is the primary factor preventing double survival due to a higher rate of donor demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Active thymus in adult with lung cancer: preliminary results from the Adult Thymic Project.

Thymus is considered a non-functional remnant in adults, but some evidence suggest that it may harbor residual activity. Lung cancer patients represent the ideal model to study thymic residual activity, as their thymus can be easily harvested during surgery. This study was designed to confirm the presence of residual thymic activity both in adult mice (step 1) and in humans (step 2). In step 1, lung cancer was induced by activating k-ras mutation in a cohort of 20 young and adult mice. After killing, thymus and lungs were analyzed. Thymus was considered active when medullary was evident, cortico-medullary ratio was 50:50 or higher and adipose involution was present. In step 2, a cohort of 20 patients, undergoing surgery for lung cancer, had biopsy of pericardial fat pad, site of ectopic thymus. Thymus was considered present if Hassall's bodies were detected. In mice, active thymus was detected in a high proportion of cases, without significant difference between adult and young (70% vs 44.4% respectively). Two cases without evidence of lung tumor had a fully functional thymus. In humans, ectopic thymus was detected in the pericardial fat pad in 2 cases (10.5%), confirmed by immunohistochemistry. Signs of previous thymic activity were detected in 8 additional patients. Results confirmed thymus activity in animal models and humans with lung cancer, providing the rationale for future systematic mediastinal thymic biopsy. The comprehension of interactions between thymus, lymphocytes and tumor may open a new potentially targetable perspective in lung cancer.

Linking epidemiological and genomic data in cases of enteric fever in England to inform clinical management and public health action.

To explore the feasibility of linking data from enhanced surveillance patient questionnaires from each enteric fever case in England with genome sequencing data, including antimicrobial resistance (AMR) profiles, from the corresponding isolate of typhoidal salmonellae. After linking data we interrogated the merged dataset and assessed the utility of passive surveillance data to match and monitor antimicrobial treatment regimens in enteric fever patients with the AMR profiles of the infectious agent. A high proportion of cases were given antibiotics (n = 1230/1415; 86.9%); half of the cases stated the class of antibiotic they were given (n = 630/1239) and half were prescribed cephalosporins (n = 316/630). Reported treatment with a combination of antibiotics increased with symptom severity. Nearly half of isolates (n = 644/1415; 45.5%) had mutations conferring resistance to ciprofloxacin. Based on genome-derived AMR profiles, typhoidal salmonellae isolates inferred to be susceptible to the recommended first-line antimicrobials were twice as likely to be isolated from individuals residing in the least deprived areas compared with the most deprived (n = 26/169; 15.4% versus n = 32/442; 7.2%). Due to the high proportion of missing data obtained from patient interviews, we recommend a more transparent and systematic approach to recording the antibiotic prescription details by healthcare professionals in primary and secondary care. A more robust approach to data capture at this point in the care pathway would enable us to audit inconsistencies in the prescribing algorithms across England and ensure equitable treatment across all sections of society. Integrating prescribing data with the genome-derived AMR profiles of the causative agent at the individual patient level provides an opportunity to monitor the impact of treatment on clinical outcomes, and to promote best practice in real time.

Long-term trends in incidence and outcomes of rib fractures: A population-based data linkage study from New South Wales, Australia.

Determine long-term trends in population-based incidence and outcomes of rib fracture hospitalisations. This was a data linkage study of rib fracture cases identified between 2015 and 2022 in New South Wales, Australia. Routinely collected health data were linked between ED, admitted patient and death registry data collection. The primary outcomes were age-specific incidence of rib fracture hospitalisation cases and risk-adjusted 30 days mortality. Other outcomes of interest were hospital length of stay (LOS), admission rate and ICU admissions. A total of 70 609 cases were analysed. Overall, the number of rib fracture hospitalisations increased by 25% between 2015 and 2022. The highest proportion of cases was in the 45-65 years (28%) and 65-85 years (31%) age groups. On a per population basis, the incidence rate increased by 2% per annum. After adjusting for age, comorbidity and injury severity, there was no significant trend in 30 days mortality observed between 2015 and 2022. The median inpatient LOS was 4 days with 38% of patients staying 1-2 days. Regional and rural areas were associated with more severe chest injuries. Rib fracture hospitalisations have increased with older patients driving this trend.

Radiomic Gradient in Peritumoural Tissue of Liver Metastases: A Biomarker for Clinical Practice? Analysing Density, Entropy, and Uniformity Variations with Distance from the Tumour.

The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense CRLMs >10 mm and high-quality computed tomography (CT). In the portal phase, we segmented (1) the tumour, (2) a series of concentric rims at a progressively increasing distance from CRLM (from one to ten millimetres), and (3) a cylinder of normal parenchyma (Liver-VOI). Sixty-three CRLMs in 51 patients were analysed. Median peritumoural HU values were similar to Liver-VOI, except for the first millimetre around the CRLM. Entropy progressively decreased (from 3.11 of CRLM to 2.54 of Liver-VOI), while uniformity increased (from 0.135 to 0.199, p < 0.001). At 10 mm from CRLM, entropy was similar to the Liver-VOI in 62% of cases and uniformity in 46%. In small CRLMs (≤30 mm) and responders to chemotherapy, normalisation of entropy and uniformity values occurred in a higher proportion of cases and at a shorter distance. The radiomic analysis of the parenchyma surrounding CRLMs unveiled a wide halo of progressively decreasing entropy and increasing uniformity despite a normal radiological aspect. Underlying pathology data should be investigated.

Assessment of Interobserver Agreement Among Gynecologic Pathologists Between Three-Tier Versus Binary Pattern-based Classification Systems for HPV-associated Endocervical Adenocarcinoma.

The three-tier (A vs. B vs. C) pattern-based (Silva) classification system is a strong and fairly reproducible predictor of the risk of lymph node involvement and recurrence of human papillomavirus (HPV)-associated endocervical adenocarcinoma (EA). Recently, a binary pattern-based classification system has been proposed which incorporates the Silva pattern and lymphovascular invasion (LVI) to assign tumors as "low risk" or "high risk" and this may have superior prognostic significance compared with the three-tier system as well as current International Federation of Gynecology and Obstetrics (FIGO) staging of cervix-confined disease. The interobserver reproducibility of this binary system, however, is unknown. Representative slides from 59 HPV-associated EAs (1-3 slides/case) were independently reviewed by 5 gynecologic pathologists who participated in an online training module before the study. In the first review, a pattern was assigned using the three-tier system. On the second review, a "low risk" or "high risk" designation was assigned and the presence or absence of LVI was specifically documented. Interobserver agreement was assessed using Fleiss' kappa. The binary system showed improved interobserver agreement (kappa=0.634) compared with the three-tier system (kappa=0.564), with a higher proportion of cases having agreement between at least 4/5 reviewers (86% vs. 73%). Nineteen and 8 cases showed improved and worse interobserver agreement using the binary system, respectively; the remainder showed no change. 3/5 reviewers showed no intraobserver discrepancy while the remaining 2 did in a small subset of cases (n=2 and 4, respectively). In this study, a binary pattern-based classification system showed improved interobserver agreement compared with the traditional three-tier system.

Epidemiological profile and spatial analysis of probable cases of dengue registered from 2010 to 2021 in the state of Maranhão

Dengue is a disease of viral etiology transmitted by mosquitoes, with a high incidence in tropical countries. Dengue has great epidemiological importance in the Americas and in Brazil. The goal of this study was to analyze the spatial distribution and to describe the epidemiological profile of probable cases of dengue in the State of Maranhão from 2010 to 2021. Statistical analysis through non-parametric tests and spatial analysis were performed using the Moran’s Global Index and Local Indicators of Spatial Association (LISA) and Space-time Scan statistic. Data were collected from the Department of Informatics of the Unified Health System in Brazil (DATASUS) between 2010 and 2021. The highest number of probable cases occurred in 2016 (23,938) and they were concentrated in the first half of each year. The female gender had the highest proportion of cases (54.9%). The cases predominated in the group of people aged between 20 and 39 years old (35.5%). People with incomplete elementary school degree were the most affected (43.0%). The brown race had more registered cases (80.7%). The municipality that had the highest incidence was Barra do Corda (7,418.5 per 100.000 inhabitants in 2016). In the local spatial analysis, 55.8% of the clusters of municipalities High- High occurred in the South region from the State of Maranhão. The municipality of Barra do Corda presented the highest relative risk (55.91) in the Space-time Scan statistic. People of the brown race, with incomplete schooling and young adults were the most affected by the dengue disease. The South region of the State showed greater epidemiological importance because it has representative clusters High-High. KEY WORDS: Dengue; incidence; spatial analysis; State of Maranhao.

Measles outbreak in 2019: a warning for the post-COVID-19 pandemic period.

Introduction. At the end of 2019 and the year before, there was a significant spread of measles in the World Health Organization (WHO) European Region.Gap statement. Among the countries that reported, a measles outbreak was Bosnia and Herzegovina (BiH).Aim. To describe the measles outbreak in BiH (an entity of the Federation of BiH, FBiH) in 2019.Methodology. Confirmatory IgM serology, measles nucleic acid detection by real-time RT-PCR and virus genotyping were done in the WHO-accredited laboratory for measles and rubella at the Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology. Genotype was determined in all measles-RNA-positive cases by sequence analysis of the 450 nt fragment coding the C-terminal of measles virus nucleoprotein (N).Results. From 1 January to 31 December 2019, 1332 measles cases were reported, with the peak observed in April 2019 (413/1332, 31.01 %). Sarajevo Canton had the highest incidence, number of cases and percentage (206.4; 868/1332; 65.17 %) of measles cases. Around four-fifths of infected persons were unvaccinated (1086/1332, 81.53 %), while 4.58 % of the patients (61/1332) were immunized with one dose of measles-containing vaccine. The highest proportion of cases was found in children 0-6 years of age (738/1332, 55.41 %). Measles IgM positivity was determined in 75.88 % (346/456), while virus RNA was detected in 82.46 % (47/57) of the swab samples. All measles virus sequences belonged to genotype B3. SNP (position 216: C=>T) was detected in 1 of the 40 sequences obtained during this outbreak.Conclusion. Due to suboptimal immunization coverage, BiH belongs to countries at a high risk for measles outbreaks. Post-COVID-19 (coronavirus disease 2019) pandemic, targeted and tailored strategies are required to ensure routine vaccination demand and acceptance and broad partner and stakeholder group participation.

Medication errors involving intravenous paracetamol in children: experience from enquiries to the National Poisons Information Service

IntroductionChildren are at higher risk of medication errors due to the complexity of drug prescribing and administration in this patient group. Intravenous (IV) paracetamol overdose differs from overdose by ingestion...

Characterizing Utilization and Outcomes of Digoxin Immune Fab for Digoxin Toxicity.

Digoxin is a widely prescribed drug for congestive heart failure and atrial fibrillation. Digoxin has a narrow therapeutic index and toxicity can develop quite easily. Digoxin immune fab (DIF) is an effective treatment for toxicity, however there are limited studies characterizing its impact on clinical outcomes in real-world clinical practice. The aim of this study was to identify factors and healthcare outcomes associated with digoxin immune fab (DIF) treatment in patients with confirmed/suspected digoxin toxicity. An IRB-approved retrospective chart review of digoxin toxic patients (2011-2020) presenting at an academic healthcare system was conducted. Demographic and clinical data were collected. Patients were stratified by DIF treatment versus non-DIF treatment. DIF utilization patterns (appropriate, use when not indicated, or underutilized) were determined using pre-defined criteria. Severe digoxin toxicity was defined as having one or more of the following: mental status disturbances, antiarrhythmic therapy, acute renal impairment or dehydration, serum digoxin concentration (SDC) > 4ng/mL, or serum K+ > 5mEq/mL. Logistic multivariable regression analysis evaluated factors associated with DIF use. All statistical analyses were performed in R version 4.1. Data from 96 patients (non-DIF treated group = 49; DIF treated group = 47) were analyzed. DIF was used appropriately in 70 patients (73%), underutilized in 19 (20%), and administered to 7 (7%) patients when it was not indicated. Several clinical parameters differentiated the DIF from the non-DIF group (p<0.05) including higher mean SDC (3.41±1.63 vs 2.87±1.17), higher mean potassium (5.33±1.48 vs 4.55±0.87), more toxicity severity (85% vs 49%), and more likely to require cardiac pacing (26% vs 4%). Digoxin toxicity resolved sooner in the DIF group (coefficient - 0.702, 95% CI - 1.137 to - 0.267) (p<0.01) and they had shorter intensive care unit lengths of stay (12.4±20.3 vs 24.4±28.7 days; p=0.018). The all-cause mortality rate in patients appropriately managed with DIF therapy versus those patients where DIF was underutilized was 11% and 21%, respectively. Based on our study population, DIF therapy appears to be beneficial in limiting duration of toxicity and intensive care unit lengths of stay in digoxin toxic patients. Although DIF was appropriately utilized in most cases, there was a relatively high proportion of cases in which DIF treatment was either underutilized or not indicated.

Primary phenotypic features associated with caudal neck pathology in warmblood horses.

Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. A total of 223 Warmblood horses. Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. The frequency of occurrence of each clinical feature was compared between cases and controls and relative risk (RR) were calculated. Ninety-six cases and 127 controls were included. Forty-seven (49%) of the cases were classified as neurologic, 31 (32.3%) had thoracic limb lameness, and 18 (18.7%) had neck stiffness or pain or both. Focal caudal cervical muscle atrophy (46, 47.9%), hypoesthesia (38, 39.6%), patchy sweating (16, 16.7%), hyperesthesia (11, 11.5%), and pain upon firm pressure applied over the caudal cervical articular process joints and transverse processes (58, 60.4%) were only observed in cases (P < .001). Sideways flexion of the neck was restricted in a higher proportion of cases (47/96, 49%) compared with controls (40/127, 31.8%; P = .009, RR 1.5). Hopping-type thoracic limb lameness was only observed in cases, (30, 31.6%). Deterioration in lameness after diagnostic anesthesia occurred in 13/31 (41.9%) cases. Systematic clinical evaluation using the methods described should enable clinical differentiation between horses with caudal cervical lesions and horses with other causes of gait abnormalities.

Racial disparities in incidence and survival in renal cell carcinoma in adolescents and young adults (AYA).

e23153 Background: Renal cell carcinoma (RCC) has doubled in incidence over the past 50 years. Most cases are incidentally discovered. AYA cancer is defined as cancer in individuals 15 to 39 years. There is paucity of data in the literature on racial disparities in the incidence and survival outcomes of RCC in AYA. We aim to determine the influence of race on incidence and survival outcomes in AYA. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 17 program were utilized to obtain annual percentage change (APC) of RCC from 2000-2020 for patients aged 15-39 years. Patient characteristics were expressed in proportions. Relative survival rate (RSR) was used to determine survival outcomes. The 5-year RSR was defined as the percentage of patients alive 5 years after the diagnosis of cancer. SEER*Stat software was used to determine the RSR. Results: We identified 8751 patients with RCC. A higher proportion of cases were males (57.9%) vs females (52.1%). Patients were predominantly non-hispanic whites (NHW, 54.7%), hispanics (24.9%), non-hispanic blacks (NHB, 11.4%), non-hispanic asian or pacific islander (NHAPI, 0.06%) &amp; non-hispanic american indian/alaska native (NHAIAN, 0.01%). There was significant increase in RCC incidence (APC: 4.0%, CI: 3.0, 4.9). Incidence was higher in males (APC: 4.0, CI: 3.1, 5.0) vs females (APC: 3.9, CI: 2.8, 5.0). Incidence was highest in Hispanics (APC: 5.6%, CI: 4.4, 6.8), followed by NHW (APC: 4.1 % CI: 3.1, 5.2, -2.3), NHAPI (APC: 3.3%, CI: 1.2, 5.5) and NHB (APC: 1.5%, CI: 1.1, 2.0). The 5-year RSR was 79.7% (CI: 77.7, 81.6). Survival was greatest in females (RSR: 82.8, CI: 79.8, 85.4) vs males (RSR: 77.3%, CI: 74.4, 79.9). NHB had the lowest survival (RSR: 65.9%, CI: 60.2, 71.0) compared to NHW (RSR: 83.9%, CI: 81.3-86.2). Conclusions: In AYA, RCC incidence has increased; consistent with global trends. Significant racial disparity in incidence and survival exists. Survival in NHB remained poorer than other racial groups despite minimal increase in incidence. More studies are needed to explore the reasons for these racial differences to improve the outcomes among AYA patients. [Table: see text]

2022 SONQO-CALCHAQUÍ Program: Evaluation of Cardiovascular Variables in a Mid- and High Mountain Calchaquí Population of Tucumán

Background: The community of Quilmes (Tucumán) encompasses 2400 mid- and high mountain inhabitants (1800 to 4000 meters above sea level). In 2018, a study was carried out on their cardiovascular health status (2018 SONQO-CALCHAQUÍ Program). Objective: The aim of this study is to update and expand the survey carried out in 2018, to obtain a broader panorama of the cardiovascular health of this community. Methods: A descriptive cross-sectional study was carried out in the Quilmes community, in people who voluntarily attended specially established clinics in September 2022. Questionnaires, laboratory tests, ECG, echocardiogram, anthropometric measurements, muscular resistance and strength tests were carried out. Results: A total of 186 patients (119 women and 67 men) aged 45.0±1.3 years attended the study. The prevalence of cardiovascular risk factors (hypertension 17.8%, smoking 14.1%, diabetes 4.9% and dyslipidemia 30.6%) was acceptable, but a high proportion of cases had not been examined in the last year. The diet consisted mainly of flour products, with little fresh fruit and vegetables. The prevalence of overweight (34.3%) and obesity (35.4%) was high. Forty percent of respondents had secondary or higher education. Good quality of life (69.5±1.1% of the maximum possible value of satisfaction on the self-perception scale) was reported. The Minimental Test average was 15.7±0.2 points. Prehensile strength in 55.8% of cases was below the normal range. Conclusions: The Quilmes population presents an acceptable physical condition, but with a high rate of overweight and obesity, due to the diet, a condition that should be considered in future health programs.

Hospital admissions following emergency medical services in Germany: analysis of 2million hospital cases in 2022.

The use of emergency medical services (EMS) in Germany has increased substantially over the last few decades. While current reform efforts aim to increase effectiveness and efficiency of the German hospital and EMS systems, there is lack of data on characteristics of hospital cases using EMS. To analyze and compare the characteristics of cases hospitalized with and without the use of EMS. The BARMER health insurance data on more than 2million hospital cases admitted in 2022 were analyzed. The distributions of age, clinical complexity (measured by patient clinical complexity levels, PCCL), main diagnoses, costs for EMS and hospital treatment, and multiple severity indicators were described. The overall severity of hospital cases was classified as "low or moderate" or "high" based on acombined severity indicator. All analyses were stratified by use of EMS and EMS type. A total of 28% of all included hospital cases used EMS. Relative to hospital cases without use of EMS, hospital cases with use of EMS were older (physician-staffed ambulance: 75years, interquartile range [IQR]59-84, double-crewed ambulance: 78years, IQR64-85) and had ahigher clinical complexity. The severity of more than 30% of the cases using EMS (except for patient transport service ambulance) was classified as "low or moderate". The distributions of main diagnoses differed by severity and use of EMS. The high proportion of cases with low or moderate severity using EMS may indicate asubstantial potential to avoid the use of EMS in the context of hospital admissions in Germany. Further investigation is required to explore whether the proportion of cases using EMS could be reduced by optimizing preclinical service.

Does Paging Clinicians about Tick-Borne Disease Serological Results Impact Clinical Care? A Retrospective Analysis of 70 Cases in North Carolina.

Delayed treatment of Rocky Mountain spotted fever is associated with increased morbidity and mortality. Because the diagnosis cannot be established from a single serological test, guidelines recommend empirical antibiotic initiation in suspect patients. We evaluated a policy used by UNC Health of paging clinicians when acute testing for Rickettsia returned with a titer ≥1:256. Our objective was to assess the potential effect of paging on routine treatment practices. Notably, we found that a high proportion of cases (N = 28, 40%) were not prescribed antibiotics until the results were available. The vast majority of these cases did not have evidence of compatible symptoms or disease progression. These findings suggest that paging may have prompted unnecessary treatment. Overall, the policy, which has now been discontinued, appears to have had limited benefit. Efforts are urgently needed to improve adherence to testing and treatment guidelines.

Gamma activity in Autism Spectrum Disorder: Enhanced response to visual input

IntroductionAutism spectrum disorder (ASD) is a childhood onset neurodevelopmental condition, that leads to permanent disability in a high proportion of cases. ASD is associated with a heterogeneous symptom presentation, which - besides social interaction and communication difficulties - encompasses altered sensory reactivity, including excessive hyper-sensitivity to stimuli, especially in the visual domain. Meta-analyses of fMRI studies revealed increased reactivity in visual task conditions in the temporal and occipital brain regions. Neural oscillations in the EEG gamma band are viewed as a candidate neurobiological marker for higher order sensory and perceptual processes, and social interactions.ObjectivesWe investigated changes in gamma activity in the EEG in the eyes open (EO) vs. eyes closed (EC) condition in order to identify the neurobiological underpinning of the enhanced sensitivity to visual input in ASD as compared to typically developing (TD) subjects.MethodsEEGs were obtained in EC and EO condition in ASD (N=23) and TD subjects (N=24) in an ongoing study. For EEG recording we used a high-density 128-channel BioSemi system, with 0.5 Hz frequency resolution. The spectral power in the gamma band (30-100Hz) was quantified by the power spectral density. To investigate whether changes in the gamma band were linked to changes in arousal instead of enhanced visual processing, we also examined alterations in the alpha band (8-13Hz) in the EO condition. Spectral power changes were determined for each EEG channel by computing the difference between the EC and EO conditions (EO-EC).ResultsSpectral power in the gamma band showed changes in the opposite direction in the two study groups: ASD subjects manifested significant (p&lt;0.05) increase, while TD subjects had a decrease in the EO vs. EC condition in the temporal and occipital brain regions. By contrast, the changes in the alpha band were similar, with both groups exhibiting a spectral power decrease in the EO compared to the EC condition.ConclusionsIn ASD, an enhancement of gamma activity is present in the EO as compared to the EC condition in the posterior brain areas. These brain areas are involved in the processing of visual information, and gamma activity is considered as a measure of perceptual processes. Thus, the gamma alterations in the EO vs. EC condition may underlie the hyper-sensitivity symptoms to visual stimuli in ASD, and EEG can offer a simple to use tool to delineate the neurobiological foundation of the symptom presentation.Funding statement: Hungarian Brain Research program,#NAP2022-I-4/2022Disclosure of InterestNone Declared

Factores de riesgo asociados en el desarrollo de Síndrome de Hellp en gestantes atendidas en el Instituto Nacional Materno PerinataL, Lima, 2018-2021.

ABSTRACT Objectives: To determine the risk factors associated with the development of Hellp Syndrome (HS) in pregnant women attended at the Instituto Nacional Materno Perinatal, 2018-2021. Materials and methods: The study is a retrospective cross-sectional analysis using a case-control design. Twenty-five hundred medical records were collected and 196 cases and controls with Hellp syndrome (HS) were selected following eligibility criteria. A data collection form including variables and study dimensions was used. For the analysis, SPSS software was used, applying frequency techniques and Pearson's Chi-square tests to evaluate associations. Results: In cases of Hellp syndrome (HS), higher frequencies were observed in single and cohabiting women, representing 16.8% (p = 0.583); with primary education level in 20.4% (p = 0.195). Regarding age, 12.2% of SH cases were women between 30 and 32 years of age (p = 0.640). A higher proportion of cases were found with a history of arterial hypertension, with 29.1% (OR: 1.230), and in those with malnutrition, with 27.6% (OR: 1.780). There was no significant association with parity, but a higher frequency of cases was observed in nulliparous women, with 17.9% (OR: 1.538), and in pregnant women with a gestational age of 40 weeks, with 6.1%. Conclusions: Malnutrition is the statistically significant risk factor associated with the development of SH.