Higher Proportion Of Men Research Articles

International cooperation in cardiogenic shock is key to improving outcomes: Cardiogenic Shock Working Group impacts a single-center in a developing country

Abstract Background Management of cardiogenic shock (CS) poses a formidable challenge in healthcare, necessitating innovative approaches and collaborative efforts, not only local, to improve outcomes. Purpose To demonstrate that CSWG international cooperation and research in CS can lower mortality, change practices, and improve outcomes. Methods From our institutional registry 28,054 patients, we selected 9,430 with CS in SCAI CWSG-score B-E 2022-23 CSWG incorporation (n=1112) against previous years (05-21, n=8318). The primary outcome was in-hospital mortality. Univariate and multivariate analyses were performed, and with PAC use as a a priori subgroup. Adjusted analysis was carried out with age, sex, DM, HTN, previous MI, PCI, CABG, or stroke; CKD, CS etiology, PAC, hemodialysis, number of vasoactives; the presence of MCS, use of mechanical ventilation, and SCAI-CSWG stage. Also, propensity score matching was used to explore differences using the a priori selected variables using K-nearest neighbors (K=2), radius of 1:2, caliper 0.2, and exact SCAI stage matching without replacement (Pre-CSWG n=2198, CSWG era n=1106). Results In the CSWG era, there's a increase in mean age (P=0.049) and a higher proportion of men (72.2 vs. 68%, p=0.005). Clinical risk factors show changes, including increased weight (P=0.037), higher smoking (53.3 vs. 48.6%, P=0.003), diabetes (40.1 vs. 34.8%, P=0.001), and hypertension (46.8 vs. 50%, p=0.043). Prior MI and CABG decreased significantly in the CSWG era. Therapeutic shifts are evident, with increased use of PAC (7.9 vs. 4.2%, P<0.001) and significant changes in mechanical circulatory support (p<0.001). Mortality substantially decreases in the CSWG era (15.3 vs. 22.3%, P<0.001). The unadjusted Cox Pre-CSWG era, the HR 1.41 (1.2-1.65, P< 0.001) a restricted mean survival time (RSMT) of 1.73 days (0.92-2.54, P<0.001). In PAC subgroup, the relationship between PAC use and outcomes appears to be consistent across the levels of the interacting variable (Pint=0.918), with a HR Pre-CSWG era 0.51 (0.44-0.59, P <0.001) and CSWG era HR 0.48 (0.33-0.71,P <0.001)(Fig1C) The adjusted analysis, the Pre-CSWG era had a HR 1.21 (1.03-1.42, P=0.019). PAC outcomes were consistent across eras (Pint= 0.923). In the Pre-CSWG era HR 0.71 (0.59-0.84,P<0.001), and similarly in the CSWG era 0.54 (0.34-0.87,P=0.01). (Fig1D) The PS-cohort had a Pre-CSWG era HR 1.21 (1.01-1.45, P=0.034) of the Pre-CSWG era vs CSWG era and a RSMT at 30 days of 1.07 (0.14-2.01 P=0.025). (Fig2) Conclusion Shifts in patient demographics, clinical risk factors, hemodynamic parameters, and therapeutic strategies were observed. Notably, mortality significantly decreased with the CSWG incorporation, with consistent benefits of PAC use in both eras. The PS cohort underscored the impact of CSWG incorporation on outcomes. Overall, these findings highlight the transformative influence of CSWG on CS management, as international cooperation is key to improving outcomes.Figure 1.Mortality through erasFgure 2.Propensity score cohort

Concurrent intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation for acute coronary syndrome-related cardiogenic shock: A meta-analysis of multivariate studies.

Concurrent intra-aortic balloon pump (IABP) use has been suggested to reduce mortality in patients with acute coronary syndrome (ACS)-related cardiogenic shock (CS) on veno-arterial extracorporeal membrane oxygenation (ECMO). However, this observation is primarily based on small-scale univariate studies. The aim of this meta-analysis was to evaluate whether concurrent IABP and ECMO were independently associated with reduced mortality in patients with ACS-related CS. We searched Medline, Web of Science, and Embase for studies published up to May 28, 2024. The inclusion criteria were longitudinal observational studies comparing concurrent IABP and ECMO to ECMO alone in ACS-related CS patients, reporting all-cause mortality with multivariate adjustments. The primary outcome was the risk ratio (RR) of short-term mortality. A random-effects model incorporating heterogeneity was used to pool the results. Seven cohort studies, involving 5467 patients, were included. Concurrent IABP and ECMO were associated with a significant reduction in short-term mortality (adjusted RR: 0.64; 95% CI: 0.48-0.87, P = 0.005; I² = 83%). Sensitivity analyses confirmed the robustness of these results. Meta-regression indicated that the proportion of men in each study significantly influenced the outcomes, fully explaining the heterogeneity (I² residual = 0%). Subgroup analyses showed consistent results across various study designs, patient ages, observational durations, and study quality scores. In conclusion, concurrent IABP and ECMO are independently associated with reduced short-term mortality in ACS-related CS patients, particularly in studies with higher proportions of men. These findings support the potential benefits of combined mechanical support in this high-risk population.

Characteristics and risk factors associated with developing prediabetes in Saudi Arabia

Objective Prediabetes is prevalent in Saudi Arabia and globally. It is associated with adverse health outcomes and complications. Consequently, this study aimed to determine the risk factors associated with developing prediabetes in Saudi Arabia. Methods This is a case-control study conducted at the Family and Community Medicine Department at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The cases included individuals with prediabetes (prediabetes group), and the control group included individuals with normal HbA1c levels who were not diagnosed with prediabetes or diabetes. The data collected included sociodemographic data, clinical parameters, laboratory tests, and medical conditions. Results The study included 46,201 patients (16,029 patients with prediabetes and 30,173 in the control group). The age of the patients (mean ± SD) with prediabetes was significantly higher than that of the control group (47.22 ± 14.04 versus 36.12 ± 11.83, p < 0.0001). A higher proportion of men was noted in the prediabetes group compared to the control group (36.32% versus 26.54%, p < 0.0001). The body mass index (mean ± SD) was higher in the prediabetes group compared to the control group (33.76 ± 6.75 versus 30.16 ± 7.26, p < 0.0001). The multiple logistic regression analysis showed six independent risk factors associated with prediabetes. These included age (aOR [95% CI] = 1.067 [1.065–1.069]) and gender, with women at a lower risk compared to men (aOR [95% CI] = 0.695 [0.664–0.728]). Other independent risk factors included polycystic ovarian syndrome (aOR [95% CI] = 58.102 (35.731–94.479]), obesity (aOR [95% CI] = 1.265 [1.075–1.487]), cardiac conditions (aOR [95% CI] = 4.870 [1.024–23.154]), and hypertension (aOR [95% CI] = 1.133 [1.031–1.245]). Conclusions The study showed that several risk factors are associated with the development of prediabetes in the Saudi population. Addressing these factors can help prevent prediabetes, and consequently, its burden and further progression to diabetes.

Real-world trends in acute viral hepatitis in Japan: A nationwide questionnaire-based survey.

The actual incidence of acute viral hepatitis in Japan remains unclear. We aimed to investigate trends in the incidence of acute hepatitisB and C infections in Japan. A nationwide, multicenter, retrospective questionnaire-based survey was conducted. Participating hospitals received questionnaires through nationwide geographically distributed regional core centers certified as specialists in hepatitis treatment. The questionnaire included hospital size and the number of patients diagnosed with acute hepatitisB or C during each fiscal year (FY) from 2015 to 2022. The sex distribution in each FY was also documented. Comparisons were made before and during the COVID-19 era (2015-2019 vs. 2020-2022), and between populous and non-populous prefectures. Responses to the questionnaires were obtained from 127 institutions in 29 prefectures covering eight regions in Japan. A median of 127.0 patients with acute hepatitisB (interquartile range [IQR] 106.5-131.8 patients) were reported during each FY, and the incidence significantly decreased during the fiscal years 2020-2022 compared with the fiscal years 2015-2020 (median 96.0 [IQR 91.0-103.0] patients vs. 131.0 [IQR 128.0-134.0] patients; p=0.03). A median of 10.0 (IQR, 7.8-13.5) patients were reported with acute hepatitisC during each FY. The proportions of men in acute hepatitis B and C were significantly higher in populous prefectures. Populous prefectures had a higher proportion of men among viral hepatitis patients than non-populous prefectures. Estimating the high-risk populations in each area could provide insights to advance the elimination of viral hepatitis.

Physical Activity, Kinesiophobia, Pain Catastrophizing, Body Awareness, Depression and Disease Activity in Patients With Ankylosing Spondylitis and Rheumatoid Arthritis: A Cross-Sectional Explorative Study.

The aim was to compare the levels of physical activity, kinesiophobia, pain catastrophizing, body awareness, and depression in patients with Ankylosing Spondylitis (AS) and Rheumatoid Arthritis (RA) and to explore the associations between these outcomes and disease activity. Seventy-eight patients with AS (n=30) and RA (n=48) were included. Outcomes were assessed using the International Physical Activity Questionnaire-Short Form, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, the Body Awareness Questionnaire, and the Beck Depression Inventory. Disease activity levels were determined using the Bath Ankylosing Spondylitis Disease Activity Index for AS and the Disease Activity Score 28 score for RA. AS patients were younger, had a higher proportion of men, and were more physically active than RA patients (p<0.05). Both groups exhibited high levels of kinesiophobia but low levels of pain catastrophizing, similar body awareness and mild depression scores. Moderate correlations (r≥0.5) were observed between kinesiophobia and depression, body awareness and pain catastrophizing and depression, and pain catastrophizing and disease activity in AS patients. In RA patients, moderate correlations (r≥0.5) were found between kinesiophobia and pain catastrophizing. Addressing physical activity, kinesiophobia, pain catastrophizing, body awareness, and depression is important in managing AS and RA patients. Notably, correlations among outcomes differed between groups, with more significant correlations in AS. Further studies are needed to explore these in greater detail.

Elevated risk of pre-diabetes and diabetes in people with past history of COVID-19 in northeastern Nigeria

BackgroundAn increased risk of diabetes mellitus (DM) after COVID-19 has been reported in the United States, Europe, and Asia. The burden of COVID-related DM has yet to be described in Africa, where the overall risk of DM has been increasing rapidly. Our objective was to compare the prevalence of pre-DM and DM in Nigerian individuals with a history of COVID-19 to individuals without known COVID-19 infection.MethodsWe undertook a retrospective cohort study with 256 individuals with a past medical history of COVID-19 with no history of pre-DM or DM and 256 individuals without a history of COVID-19 or pre-DM/DM. Participants were categorized as pre-DM (fasting capillary glucose 100–125 mg/dL) or DM (fasting capillary glucose ≥ 126 mg/dL). We employed univariate and multivariable logistic regression to identify key predictors and adjust for confounders related to hyperglycaemia risk factors. Additionally, we used multinomial logistic regression to analyze the relationship between COVID-19 history and diabetes status, distinguishing between normal, pre-diabetic, and diabetic glucose levels. All models were adjusted for age, gender, hypertension, physical activity, central adiposity, and family history of DM.ResultsCompared to the control group, those with a history of COVID-19 had a similar median age (38 vs. 40 years, p = 0.84), had a higher proportion of men (63% vs. 49%), and had a lower prevalence of central adiposity (waist: hip ratio ≥ 0.90 for males and WHR ≥ 0.85 for females) (48% vs. 56.3%, p = 0.06). Of the 256 with a history of COVID-19, 44 (17%) required in-patient care. The median (interquartile range) time interval between COVID-19 diagnosis and the glycaemic assessment was 19 (IQR: 14, 24) months. Pre-DM prevalence was 27% in the post-COVID-19 group and 4% in the control group, whereas the prevalence of DM was 7% in the post-COVID-19 group and 2% in the control group. After multivariable adjustment, the odds of pre-DM were 8.12 (95% confidence interval (CI): 3.98, 16.58; p < 0.001) higher, and the odds of DM were 3.97 (95% CI: 1.16, 13.63) higher in those with a history of COVID-19 compared to controls. In the adjusted multinomial logistic regression analysis, individuals with a history of COVID-19 exhibited significantly elevated risks for pre-diabetes (RRR = 7.55, 95% CI: 3.76–15.17) and diabetes (RRR = 3.44, 95% CI: 1.01–11.71) compared to those without COVID-19.ConclusionPrevious COVID-19 was found to be a risk factor for prevalent pre-diabetes and diabetes mellitus in Nigeria. More intensive screening for DM in those with a history of COVID-19 should be considered.

Autologous stem cell transplantation in T-cell/histiocyte-rich large B-cell lymphoma: EBMT Lymphoma Working Party study

AbstractAlthough broadly used, consolidative autologous hematopoietic stem cell transplantation (auto-HCT) for relapsed/refractory (R/R) T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) has never been specifically investigated. Here, we have analyzed outcomes of auto-HCT for THRLBCL compared with diffuse large cell B-cell lymphoma not otherwise specified (DLBCL). Eligible for this retrospective registry study were adult patients with R/R THRLBCL and DLBCL, respectively, who underwent a first auto-HCT in a salvage-sensitive disease status as assessed by positron emission tomography–computed tomography between 2016 and 2021 and were registered with the European Society for Blood and Marrow Transplantation database. The primary end point was progression-free survival (PFS) 2 years after transplantation. A total of 201 patients with THRLBCL and 5543 with DLBCL were included. There were no significant differences in terms of disease status at HCT, pretreatment lines, and interval from diagnosis to transplant between the cohorts, but patients with THRLBCL were significantly younger, contained a higher proportion of men, and had a better performance status. Compared with DLBCL, THRLBCL was associated with significantly better 2-year PFS (78% vs 59%; P < .001) and overall survival (OS, 81% vs 74%; P = .02) because of a significantly lower 2-year relapse incidence (16% vs 35%; P < .001). On multivariate analysis, favorable relapse risk (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.31-0.7) and PFS (HR, 0.58; 95% CI, 0.41-0.82) of patients with THRLBCL remained significant, whereas OS benefits (HR, 0.78; 95% CI, 0.54-1.12) did not. These results were validated in a propensity score–matched analysis. These data prove auto-HCT as an effective treatment option for salvage-sensitive R/R THRLBCL.

Impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy loss: A cross-sectional study.

Recurrent pregnancy loss (RPL) has a multifactorial etiology, with a majority of cases remaining unexplained. To account for these unexplained cases, possible male factors are being explored. Conventional semen analysis lacks a qualitative assessment of sperms and information regarding sperm DNA integrity. Sperm DNA fragmentation (SDF) has diagnostic value in unexplained RPL, and it may account for a number of unexplained cases. Hence, we planned a study to explore and evaluate the impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy losses. Analytical cross-sectional study was conducted at a tertiary-level referral facility in India between August 2021 and July 2023. Participants (n = 70) were divided into two groups-male partners of couples with unexplained RPL (following spontaneous conceptions) (n = 35) and men with at least one previous live birth (spontaneous or following fertility treatments for female factor infertility such as ovulation induction or intrauterine insemination) as controls (n = 35). Neither of the two groups of couples recruited for this study had undergone ART as fertility treatment. Primary outcome assessed was mean DNA fragmentation index (DFI). Secondary outcomes included differences in semen parameters such as sperm concentration, progressive sperm motility and morphology, proportion of men with high (≥30%) and low DFI in the two groups, and the association between various semen parameters and DFI. Univariate logistic regression revealed that sperm DNA fragmentation was higher in men with unexplained RPL (30.0; IQR (interquartile range) 19.0, 46.0) as compared to controls (22.0; IQR 14.0, 30.0) although it was not statistically significant (OR, odds ratio, 1.02; 95% CI 1.0-1.1, p = 0.08). A higher proportion of men with unexplained RPL had DFI ≥30% compared to controls (54.2% vs. 25.7%; OR 3.43 (95% CI 1.2-9.4); p = 0.02). No statistically significant differences were observed in semen volume, sperm concentration, progressive motility, and morphology between the two groups. Sperm DNA fragmentation index also showed a weak but significant inverse relationship with sperm morphology (r = -0.336, p = 0.004). The current study did not show any significant difference in the mean sperm DNA fragmentation levels in male partners of couples with unexplained RPL compared to controls. However, a higher proportion of men with DFI ≥30% were observed in unexplained RPL population when compared to controls.

Clinical analysis of progressive destroyed lung after lung cancer surgery.

"Progressive destroyed lung (PDL)" refers to a state in which the normal structure and function of the lung are permanently disrupted owing to repeated inflammation. After lung cancer surgery, the remaining lung tissue can experience progressive destruction; however, the exact cause remains unclear. In this study, we retrospectively analyzed cases in which the remaining lung deteriorated after lung cancer surgery and investigated the associated risk factors. A case-control study was conducted on 31 cases of PDL and 247 cases of non-PDL among 1,234 patients who underwent surgery for primary lung cancer from 2006 to 2021. The following factors were analyzed: age, sex, medical history, smoking status, surgical procedure, lung cancer histology, surgical approach, postoperative complications, chemotherapy, radiation therapy, and lung cancer recurrence. Patients were matched 1:1 based on preoperative factors, and postoperative risk factors were evaluated using multivariate logistic regression analysis. A higher proportion of men and higher prevalence of chronic lung diseases, smokers, squamous cell carcinoma (SCC), postoperative acute pneumonia, chronic pneumonia, air leak, and history of radiation therapy were noted in the PDL group than in the non-PDL group. In the analysis following propensity score matching, chronic pneumonia [odds ratio (OR): 10.1, 95% confidence interval (CI): 2.9 to 35.8] was identified as an independent risk factor for PDL. In this study, PDL after lung cancer surgery was associated with postoperative chronic pneumonia, including Aspergillus infection and aspiration pneumonia.

Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital

Background and AimNutritional screening is essential for addressing malnutrition and its consequences. However, routine implementation in large hospitals faces several challenges. To overcome these obstacles, the Clinical Nutrition Service of a tertiary hospital developed a technology-assisted nutritional screening system. This study evaluates the system's efficiency in detecting and assessing patients at nutritional risk upon hospital admission. It also examines the association between nutritional risk, clinical outcomes, and sociodemographic characteristics. MethodsThis retrospective, analytical, observational study examined 11,722 hospital admissions of adult patients in 2019, each with a minimum hospital stay of 48 hours in a tertiary hospital. Rates and timing for the detection, referral, and assessment of patients at nutritional risk were calculated. Participants were divided into low (Malnutrition Screening Tool [MST] < 2 points) and moderate/high (MST ≥ 2) nutritional risk groups to evaluate the relationship between nutritional risk and clinical and demographic variables. ResultsWe found that 91% of patients underwent nutritional screening within the first hours of admission, with a median time of 9 hours from admission to screening (interquartile range [IQR] 3-19). The prevalence of nutritional risk (MST ≥ 2) was 21%. All patients identified as being at nutritional risk were immediately referred for a nutritional assessment once identified, with a median referral time of 0 hours (IQR 0-0). This assessment was carried out by a nutritionist for 98% of these patients, with a median time of 19 hours from referral to assessment (IQR 6-24). Compared to the low-risk group, patients with nutritional risk were older, had higher rates of mortality and admission to the intensive care unit (ICU), longer hospital stays, and a higher proportion of men and cancer diagnoses (p=0.00 for all comparisons). After adjusting for age and sex, nutritional risk was significantly associated with a higher probability of ICU admission (Odds Ratio [OR] 1.13; 95% CI 1.02-1.24) and in-hospital mortality (OR 2.32; 95% CI 1.97-2.73). ConclusionThe integration of technology into nutritional screening was highly efficient for early detection and assessment of at-risk patients upon hospital admission. Features of this system could guide other hospitals. The association found between nutritional risk and clinical outcomes emphasizes the importance of prompt and appropriate nutritional interventions.

Routine Data Analysis of HIV Pre-Exposure Prophylaxis Use and Rates of Sexually Transmitted Infections Since Coverage of HIV Pre-Exposure Prophylaxis by the Statutory Health Insurance in Germany

Human immunodeficiency virus pre-exposure prophylaxis (PrEP) is considered as an effective protection against a human immunodeficiency virus (HIV) infection. However, it is still unclear, how PrEP use is associated with the incidence of sexually transmitted infections (STI) other than HIV. PrEP became reimbursable in Germany from September 1, 2019 for persons with statutory health insurance (SHI). With the EvE-PrEP study, the Federal Ministry of Health commissioned the evaluation of the effects of the new reimbursement situation in Germany. In the presented module of the EvE-PrEP study, routine data from three large German SHI funds were analyzed in anonymized form for the period January 1, 2019 to March 31, 2020. Data were analyzed regarding: Characteristics and adherence of PrEP users, treatment success of PrEP, and changes in STI incidence rates before and since PrEP use. The cooperating SHI funds collectively covered about 52% of the overall population in Germany in 2019. A total of 7102 persons with PrEP use were included into the analysis. These were predominantly male (99%), on average 37.4 years old and a high proportion of persons lived in large cities. The average quotient of PrEP daily defined doses and assumed days on PrEP was 87%. The average STI rates normalized per 100 person-years at individual level pre PrEP did not statistically significant differ compared to since PrEP (chlamydia: 17.5 vs. 17.6, gonococcal infection: 29.1 vs. 30.7, and syphilis: 14.6 vs.13.6). A large data set was used to evaluate the introduction of PrEP as a SHI benefit in Germany. A potentially suspected increase in bacterial STI incidence rates was not found. A rather high average adherence rate was observed. The very high proportion of men and people from the largest German cities among PrEP users is striking. These results could indicate barriers to PrEP access for people at risk of HIV, especially if they are women or people living in less urban areas.

Racial Disparities in Clinical Outcomes of Takotsubo Cardiomyopathy: An Analysis of the National Inpatient Sample 2006 to 2018.

This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample. We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups. The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.

Sex differences in early-onset atrial fibrillation in Norwegian primary care: a retrospective national database analysis

BackgroundIndividual variation in the need for healthcare constitutes knowledge gaps for young atrial fibrillation (AF) patients. We aimed to estimate the prevalence and primary care burden of early-onset AF in...

Association of back pain with all-cause and cause-specific mortality among older men: a cohort study.

We evaluated whether more severe back pain phenotypes-persistent, frequent, or disabling back pain-are associated with higher mortality rate among older men. In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95%CI = 1.11-1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95%CI = 0.86-1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death.

Unveiling the hidden pathologies: preoperative endoscopic findings in patients with obesity undergoing bariatric surgery

BackgroundObesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery.MethodsRetrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023.ResultsA total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001).ConclusionsPreoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.

Association of body image perception and (dis)satisfaction with adiposity in adults: The Pró-Saúde study.

Body image distortion and/or dissatisfaction may occur primarily due to body fat accumulation and/or distribution. The aim of this study was to evaluate the frequency of body image perception and (dis)satisfaction categories in adult men and women according to the adiposity classification. This is a cross-sectional study (n = 514; 33-79 years; 265 women) that is part of a prospective cohort (Pró-Saúde study). Adiposity measurements were determined by two methods: anthropometry, used to calculate the body mass index (BMI) and dual-energy X-ray absorptiometry (DXA), to estimate body fat percentage. Participants were grouped as "no excess adiposity" and "excess adiposity", considering BMI and body fat percentage (>30% for men, >40% for women). Perception and (dis)satisfaction with body image were evaluated using the Kakeshita scale, composed by 15 silhouettes, developed for the Brazilian population. Degree of distortion (perceived BMI - real BMI) and dissatisfaction (perceived BMI - desired BMI) were calculated. A high proportion of men (58.6%; 74.3%), and especially of women (82.6%; 86.8%), presented body size overestimation and dissatisfaction due to excess weight, respectively. A relevant fraction of the women (32.6%) and men (30.8%) who were dissatisfied due to excess weight did not present excess adiposity, especially if classified by DXA. Variability in degree of distortion was hardly explained by anthropometric and DXA variables in women (<5%) and men (∼22%). Both anthropometric and DXA measurements accounted for ∼30% and ∼50% of the variability in degree of dissatisfaction among women and men, respectively. Our results suggest a high frequency of body image distortion in Brazilian adult individuals, as well as dissatisfaction with excess weight, especially among women with excess adiposity. The findings indicate that anthropometric measurements explain much of the variability in degree of body image dissatisfaction in men, with no apparent advantage of the use of more refined DXA measurements.

Characteristics and long-term mortality of individuals with MASLD, MetALD, and ALD, and the utility of SAFE score

Background and AimsThe new nomenclature of steatotic liver disease (SLD) was recently launched with sub-classifications of metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and Alcohol-related liver disease (ALD). We aim to evaluate the characteristics, long-term outcomes of these subgroups and the utility of noninvasive biomarkers. MethodsUsing the National Health and Nutrition Examination Survey (NHANES) III and their linked mortality data, all adult participants with available ultrasonographic liver steatosis status were included. Those with viral hepatitis, incomplete data on alcohol consumption, cardiometabolic risk, and for SAFE score calculation were excluded. The characteristics of those without SLD (no steatosis on ultrasound), MASLD, MetALD, and ALD were compared. The overall survivals (OS) were determined and SAFE score strata were applied to SLD subgroups. ResultsA total of 9,939 participants were eligible, 64% had no SLD, while 30%, 2.3%, and 1% had MASLD, MetALD, and ALD, respectively. A higher proportion of men was observed in MetALD and ALD than in MASLD as well as active smoker. Diabetes was more prevalent in MASLD than in MetALD and ALD. ALD subgroup demonstrated significantly lower OS than MASLD (p=0.004), but the MetALD did not (p=0.165). SAFE score strata meaningfully differentiated OS of all SLD subgroups. ConclusionsThe largest proportion of SLD was MASLD. MetALD shared the characteristics of both MASLD and ALD. ALD subgroup had a significantly lower OS than MASLD but no difference between MetALD and MASLD. SAFE score can be used to stratify long-term outcomes in all SLD subgroups. Impact and implications“Steatotic Liver Disease (SLD)” is a recently introduced term covering 3 subgroups 1) metabolic dysfunction-associated SLD (MASLD), 2) MASLD and increased alcohol intake (MetALD), and 3) Alcohol-related liver disease (ALD). We explored the characteristics and outcomes of these subgroups among US population. We found that MASLD was far more common than MetALD and ALD but all subgroups shared cardiometabolic risk factors. ALD subgroup has the worst survival, pointing out the synergistic effect of alcohol and metabolic dysfunction. In addition, SAFE score might be a useful noninvasive test to stratify long-term risk in all 3 SLD subgroups.

Predictive values of relative fat mass and body mass index on cardiovascular health in community-dwelling older adults: Results from the Longevity Check-up (Lookup) 7+

ObjectivesTo assess the predictive value of relative fat mass compared to body mass index for hypertension, diabetes, hyperlipidemia, and heightened cardiovascular risk in a cohort of community-dwelling older adults from the Longevity Check-up 7+ cohort. Study designRetrospective cross-sectional study. Main outcome measuresHyperlipidemia was defined as total cholesterol ≥200 mg/dL or ongoing lipid-lowering treatment. Diabetes was defined either as self-reported diagnosis or fasting blood glucose >126 mg/dL or a random blood glucose >200 mg/dL. Hypertension was defined as blood pressure ≥ 140/90 mmHg or requiring daily antihypertensive medications. Heightened cardiovascular risk was operationalized as having at least two of these conditions. ResultsAnalyses were conducted in 1990 participants (mean age 73.2 ± 6.0 years; 54.1 % women). Higher proportions of men than women had hypertension and diabetes, while hyperlipidemia was more prevalent in women. Receiver operating curve analysis indicated relative fat mass was a better predictor of hypertension in women and diabetes in both sexes. Body mass index performed better in predicting hyperlipidemia in women. Relative fat mass thresholds of ≥27 % for men and ≥40 % for women were identified as optimal indicators of heightened cardiovascular risk and so were used to defined high adiposity. Moderate correlations were found between high adiposity or body mass index ≥25 kg/m2 and the presence of hypertension, hyperlipidemia and heightened cardiovascular risk, while a strong correlation was found with diabetes. Logistic regression analysis highlighted significant associations between high adiposity and increased odds of hypertension, diabetes, and heightened cardiovascular risk. ConclusionsProposed cut-offs for relative fat mass were more reliable indices than the usual cut-offs for body mass index for identifying individuals at heightened cardiovascular risk. Our findings support the role of anthropometric measures in evaluating body composition and the associated metabolic and cardiovascular conditions in older adults.

Ocular Trauma Characterization in a Reference Emergency Eye Centre in Colombia (FOSCAL).

Ocular trauma is one of the most important causes of ocular morbidity and inadequate visual acuity in developed and developing countries. In some countries, eye trauma is the leading cause of monocular blindness. Studies conducted in developing countries like Colombia suggest that there is a lack of awareness of preventive measures. In Colombia, there is no countrywide ocular trauma registry. The purpose of the present study is to describe and analyse characteristics of ocular trauma at a tertiary ophthalmology emergency department in Colombia. Patients who consulted or were referred to the ophthalmologic emergency department of FOSCAL due to eye injuries between March 1, 2022, and January 10, 2023, were included in this cross-sectional study. Of 1 957 patients, 2 088 eyes were included. Men comprised 78.5% of the patients, the median age was 36 years, and 75.0% lived in urban areas. The median latency between trauma and ophthalmology consultation was 21.8 hours. Of the eyes, 1 805 (88.4%) had suffered mechanical or mixed (mechanical plus burn) trauma. Of the injuries, 87.5% were unilateral. In terms of the circumstances, 45.9% of injuries occurred during working or educational activities (in 85.6% of these cases, without eye protection), 28.2% in home accidents, and 14.0% in transportation situations. According to the Birmingham Eye Trauma Terminology System (BETT), 1 735 eyes (91.1%) were closed globe injuries, and 49 eyes (2.7%) were open globe injuries. Fifty eyes (2.8%) could not be categorised according to BETT at the initial consultation and were classified as "still to be determined". In the Ocular Trauma Score (OTS), 85.8% were category 5. Of the ocular burn cases, 93.0% were categorised as grade I according to the Roper Hall classification. In line with global literature, a much higher proportion of men than women sought consultation for ocular trauma. The findings suggest a need for improvement in the referral process from institutions with the lowest level of care. Lack of awareness about eye protection is an issue. Surgical exploration or additional tests may be necessary for precise injury classification. We therefore propose adding a "still to be determined" category to the BETT initial classification. These cases may be reclassified later, thus improving the accuracy of OTS calculation.

Abstract 4799: Hidden epidemics: The gender divide in HCV and cancer screenings among the unhoused

Abstract Background &amp; Methodology: In the United States, the unhoused population experiences disproportionately higher rates of cancer incidence and mortality—double that of the general populace. Despite these startling statistics, there is a notable dearth of research on this topic within medical literature. Our medical student-led pilot study aimed to bridge this knowledge gap by evaluating the uptake of cancer screenings and identifying the barriers faced by the unhoused in Southwest Michigan. Our objective was to enhance the understanding of cancer care disparities and identify factors that hinder access to cancer screenings for this marginalized group. Utilizing questionnaires distributed in homeless shelters, we collected data on the prevalence and impediments to screenings for hepatitis C virus (HCV), and lung, breast, colon, and cervical cancers in a local community. Results: The study encompassed 143 participants, revealing that women reported a shorter median duration of homelessness (5 months) than men (18 months). The primary barriers to cancer screening were access to services and lack of awareness, rather than insurance coverage. Gender disparities were evident in HCV screening, with an overall rate of 55%; however, willingness to screen was higher among women (83%) compared to men (49%). Colon cancer screening showed no significant gender disparity, standing at 45% uptake. The prevalence of smoking was high at 78%, yet a higher proportion of men were amenable to lung cancer screening. Interestingly, Pap smear uptake surpassed national averages, while mammogram rates were below expected at 40%. Discussion &amp; Conclusion: While the discrepancies between genders may not be immediately apparent, our data shows that developing targeted interventions and tailoring the delivery of adequate cancer screenings to the unhoused require consideration of gender as a key factor. Women’s perceived barriers differ slightly from men’s, and generally-speaking, they undergo more cancer screenings per year compared with men. The reluctance among male participants to engage in HCV screening has been observed in other studies as well and as our study demonstrates, it may be related to informational barriers. Although preliminary, our findings shed light on the critical health care issues faced by the unhoused and serves as a steppingstone towards improving our understanding on their challenges in hopes of improving their health outcomes. Comprehensive research is imperative to unravel the complex causes of these gender-based discrepancies. In the interim, the implementation of a navigator social worker system could prove beneficial in facilitating the unhoused with the logistics of screening processes, overcoming transportation hurdles, and reinforcing the importance of ongoing health management. Citation Format: Talal Al-Assil, Claire Kalina, Madison Laird, Nataly Dawood, Raven Riordan, Neya Suresh Kumar, Ryan Olivier, Cheryl Dickson, Gitonga Munene. Hidden epidemics: The gender divide in HCV and cancer screenings among the unhoused [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4799.