High Death Research Articles

P-2003. Clinical Outcomes of COVID-19 among Immunocompromised Patients at Siriraj Hospital

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality for patients worldwide. The clinical outcomes of COVID-19 among immunosuppressed patients, who are at presumably risk of more severe disease have not been well characterized. Clinical outcome between immunocompetent and immunocompromised patients hospitalized with COVID-19 Methods We performed a retrospective cohort study including all adult patients hospitalized with COVID-19 during July to December 2021. Primary outcome was a 3-month death among immunocompetent and immunocompromised patients. Secondary outcomes included superimposed infections and intensive care unit (ICU) admission within a 6-month period, and factors associated with death in immunocompromised patients. Comparison between immunocompromised patients hospitalized with COVID-19 who were dead and survived during 3 months after COVID-19 Results 303 patients were enrolled (239 immunocompetent and 64 immunocompromised patients, with mean age of 71 (±14) and 63 (±16) years, respectively). Immunocompromised patients showed more superimposed herpes simplex virus infection (3.1% vs. 0%, P 0.006). There was a trend towards higher ICU admission rate (20.3% vs. 11.%, P 0.058) in the immunocompromised group. However, the 3-month death between both groups did not differ significantly (24.7% immunocompromised vs 20.5% immunocompetent, P 0.437). Interestingly, there was a higher death among immunocompromised patients who had co-infections (61.5% vs. 32.4%, P 0.019) and superimposed infections (56.5% vs. 17.9%, P 0.002). On the other hand, there was a lower death rate in immunocompromised patients receiving immunosuppressive drugs prior to COVID-19 diagnosis (12.9% vs. 59.2%, P < 0.001). Conclusion Three-month mortality rate did not differ between immunocompromised and immunocompetent patients. Superimposed and co-infections increased mortality in immunocompromised COVID-19 patients. Prior use of immunosuppressive agents was associated with less mortality, which may be explained by less detrimental inflammatory response. Disclosures All Authors: No reported disclosures

Missing persons of post-conflict countries: Assessing dental identification through a questionnaire-based study in Syria

Locating and identifying missing persons is crucial to protecting human rights and rebuilding war-torn countries like Syria. Biological identity primarily relies on DNA, fingerprints, or dentition. However, post-conflict countries with high deaths, limited databases, insufficient resources, and a reduced or a lack of forensic expertise make this effort more challenging. Teeth are a practical and cost-effective means to identify human remains, particularly when acceptable dental records are available. Still, the application of comparative dental analysis in conflict scenarios needs to be more explored.A survey study in Syria examined whether post-conflict countries could employ comparative dental identification of missing individuals. The attitudes and perceptions of four groups (the public and dentists, forensic odontologists, dental schools, and the Syrian Dental Association) were determined using questionnaires and analysed for the first two groups. Most respondents (>90 %) indicated that addressing disappearance is crucial for post-conflict reconstruction and considered it unachievable without international support and only 20 % had confidence in this support. Issues hindering human identification reported by a high percentage of dentists and forensic odontologists and included education in Forensic Odontology (92 %), expertise in the field (70 %), awareness (90 %), the availability of antemortem records (92.3 %) and political and security influence (50 %). Responses from over 80 % of the public, 50 % of the dentists and 92 % of the forensic odontologists indicated that comparative dental identification in Syria may not be feasible.The results of this study provide strong evidence of the challenges in identifying missing persons using teeth in developing nations, particularly those affected by conflicts. They include the lack of antemortem records and forensic expertise. The international community is urged to support post-conflict nations including Syria.

Temporal trends of the burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from 1999 to 2019

BackgroundHigh levels of low-density lipoprotein cholesterol (LDL-C) can lead to the occurrence and development of atherosclerosis, which is one of the important risk factors for ischemic stroke (IS). However, details regarding the evolution of the IS burden attributable to high LDL-C in China has not been available. The objective of this study was to examine the changes over time, from 1990 to 2019, in the burden of IS attributed to high levels of LDL-C in China and to estimate the individual impacts of age, period, and cohort on the burden of IS associated with high LDL-C.MethodsDetailed data on IS burden attributable to high LDL-C from 1990 to 2019 in China were extracted from the Global Burden of Disease (GBD) Study 2019. The numbers and age-standardized rates of IS-related mortality and disability-adjusted life years (DALYs) attributable to high LDL-C were assessed by age and sex. The annual percentage change (APC) and average annual percentage change (AAPC) in the burden of IS due to high LDL-C were analyzed using Joinpoint regression model. The age-period-cohort analysis was carried out to assess the individual impacts of age, period, and cohort on the trends over time of mortality and DALY rate.ResultsThe number of IS-related deaths and DALYs due to high LDL-C in China were 182.7 thousand and 4.43 million in 2019, respectively, both more than double the corresponding numbers reported in 1990. However, despite these increased, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) remained unchanged. In 2019, men under 84 years of age had higher death and under 79 years of age had higher DALYs than women. However, above these ages, the gender disparities were reversed. Furthermore, age-specific rates of death, as well as DALY of IS attributable to high LDL-C in 2019 increased with age for both women and men, except for death in adults over 95 years old; and were greater in men than in women. From 1990 to 2019, males consistently had a higher ASMR and ASDR than females in China. During 1990–2019, the ASMR in women slightly decreased before 1997, sharply increased from 1997 to 2004, and then continuously decreased from 2004 to 2019, with an overall AAPC value of -0.4% (95% CI -0.8%, -0.0%). However, for the ASMR of men in China, the overall trend is upward and the AAPC is 0.5%(95% CI 0.1%, 0.8%). The ASDR in women and men had the similar trend as the ASMR over the time, with an AAPC of -0.4% (95% CI -0.7%, -0.1%) and 0.3% (95% CI 0.1%, 0.5%), respectively. The age-period-cohort analysis indicated a rise in period effects and a decline in cohort effects on mortality and DALY rate associated with IS caused by high LDL-C in both genders. Age effect on mortality rates from IS due to high LDL-C showed an exponential increased with age in all women and men except for the 60–69 age group and over 95 age group. The age relative risk of IS DALY rate due to high LDL-C increased with age in both genders except for 65–74 age group and over 95 age group.ConclusionsFrom 1990 to 2019, the burden of IS caused by high LDL-C in China significantly increased among both sexes combined and among men, while significantly decreased among women. Elderly have a substantial burden of IS attributable to high LDL-C. Therefore, effective and tailored strategies based on gender and age for IS primary prevention and management of IS and high LDL-C are urgently needed in China.

PENGARUH ASUPAN KARBOHIDRAT TERHADAP PENDERITA DIABETES MELLITUS (DM)

Diabetes Mellitus (DM) is one of the chronic diseases that causes the highest death after heart disease and hypertension. Diabetes mellitus is caused by the hormone insulin not working properly so that there is a buildup of glucose in the blood. The purpose of this study is the effect of carbohydrate intake on people with diabetes mellitus. The research method used is the literature review method of selected journals. The results of the study showed that there was an influence and relationship between carbohydrate intake consumption on people with diabetes mellitus. The higher the carbohydrate intake, the higher the blood glucose level. Carbohydrate intake can affect blood glucose levels in people with diabetes mellitus. The factors that can control blood glucose levels so that they do not increase are by paying attention to food intake and maintaining a healthy lifestyle and by doing physical activity or exercising.

Molecular Study of (Mycoplasma Pneumoniae, Streptococcus Pneumoniae) in Respiratory Infections Patients in Thiqar Province

The high death and hospitalization rates caused by bacterial respiratory infections make them a major worldwide health problem. Acute otitis media, bacterial rhinosinusitis, pharyngotonsillitis, bronchitis, and community-acquired pneumonia are among the common respiratory tract illnesses caused by common bacterial respiratory infections, which include Streptococcus pneumoniae, Mycobacterium tuberculosis, Haemophilus influenzae, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. The study aimed to detect uncultivated bacteria in respiratory infections patients (Mycoplasma pneumoniae) and Streptococcus pneumoniae that caused respiratory infections and determined if it caused this infection. The study included 140 patients (67males and 73 females) who were suffering from respiratory infections, ages ranging from 10-80 years, in a period from 1 September 2023 to 1 February 2024, all of the 140 samples collected from Nasiriyah Teaching Hospital, Center for Chest Diseases and Respiratory Diseases in Nasiriyah, Souq Al-Shuyoukh General Hospital, Alhussein Teaching Hospital, Private Clinics in Shatrah. Specimens included a sputum sample and oropharyngeal swab for direct detecting by polymerase chain reaction (pcr) Diagnosis is based on the presence of the (16s rRNA) gene to detect (Mycoplasma pneumoniae, Streptococcus pneumoniae) patients had with un-cultivated bacteria where 3\140(2.14%) of patients had infection with Mycoplasma pneumoniae and 6\140(4.28%) with Streptococcus pneumoniae. The present study was conducted that the most detected bacterial in female group 6 (75.0%), while in the male group 2 (25.0%), in addition, the most isolated bacteria in female group were both M. pneumoniae 3 (50.0%), and S. pneumoniae 3 (50%),whil in age groups in first group 3, while non-detected bacteria in both fourth and seventh age group 0, fever and headache are the most abundant symptoms patients, followed by myalgia (90.6%), chill (66%), cough (59%), and dyspnea (36.6%).

Effect of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction

BACKGROUND The aging of the population has become increasingly obvious in recent years, and the incidence of cerebral infarction has shown an increasing trend annually, with high death and disability rates. AIM To analyze the effects of infarct location and volume on cognitive dysfunction in elderly patients with acute insular cerebral infarction. METHODS Between January 2020 and December 2023, we treated 98 cases of elderly acute insula, patients with cerebral infarction in the cerebral infarction acute phase (3-4 weeks) and for the course of 6 months in Montreal Cognitive Assessment Scale (MoCA) for screening of cognition. Notably, 58 and 40 patients were placed in the cognitive impairment group and without-cognitive impairment group, respectively. In patients with cerebral infarction, magnetic resonance imaging was used to screen and clearly analyze the MoCA scores of two groups of patients with different infarctions, the relationship between the parts of the infarction volume, and analysis of acute insula cognitive disorder in elderly patients with cerebral infarction and the relationship between the two. RESULTS The number of patients with cognitive impairment in the basal ganglia and thalamus was significantly higher than that without cognitive impairment (P < 0.05). The total infarct volume in the cognitive impairment group was higher than that in the non-cognitive impairment group, and the difference was statistically significant (P < 0.05). The infarct volumes at different sites in the cognitive impairment group was higher than in the non-cognitive impairment group (P < 0.05). In the cognitive impairment group, the infarct volumes in the basal ganglia, thalamus, and mixed lesions were negatively correlated with the total MoCA score, with correlation coefficients of -0.67, -0.73, and -0.77, respectively. CONCLUSION In elderly patients with acute insular infarction, infarction in the basal ganglia, thalamus, and mixed lesions were more likely to lead to cognitive dysfunction than in other areas, and patients with large infarct volumes were more likely to develop cognitive dysfunction. The infarct volume in the basal ganglia, thalamus, and mixed lesions was significantly negatively correlated with the MoCA score.

Association of Life's Essential 8 with depression among adults: A cross-sectional study of NHANES.

The prevalence of depression continues to rise, and it has a high death and disability rate. Life's Essential 8 (LE8) is an updated measurement of cardiovascular health (CVH), and a higher score of LE8 represents healthier CVH. Our study aimed to investigate the association between the LE8 and depression among adults. This cross-sectional study used data from the National Health and Nutrition Examination Survey. CVH was measured by using LE8 according to American Heart Association definitions. Depression was assessed by the 9-item Patient Health Questionnaire (PHQ-9). Weighted univariable and multivariable logistic analyses were performed to investigate the association of LE8 with depression. Subgroup analyses were also conducted in different groups based on age, gender, race, body mass index (BMI), smoking, arthritis, cardiovascular disease, and chronic kidney disease. A total of 22,149 participants were included in the database, with a mean LE8 score of 71.27. The prevalence of depression was 7.32%. The mean scores of LE8 in health behaviors and health factors were 73.28 and 69.26, respectively. After adjustment of potential confounders, a higher LE8 score was associated with lower odds of depression (odds ratio = 0.27, 95% confidence interval: 0.20-0.37). A similar association was observed in the subgroup analyses. Higher overall LE8 scores and higher scores for each component (diet, physical activity, nicotine exposure, sleep duration, BMI, blood lipids, blood glucose, and blood pressure) were associated with lower odds of depression. LE8 score might be a useful tool for both cardiologists and psychiatrists in screening for and monitoring physical and mental health. Primary care physicians also could better tailor care and interventions to address both physical and mental health needs.

Enhancing stroke risk and prognostic timeframe assessment with deep learning and a broad range of retinal biomarkers

Stroke stands as a major global health issue, causing high death and disability rates and significant social and economic burdens. The effectiveness of existing stroke risk assessment methods is questionable due to their use of inconsistent and varying biomarkers, which may lead to unpredictable risk evaluations. This study introduces an automatic deep learning-based system for predicting stroke risk (both ischemic and hemorrhagic) and estimating the time frame of its occurrence, utilizing a comprehensive set of known retinal biomarkers from fundus images. Our system, tested on the UK Biobank and DRSSW datasets, achieved AUROC scores of 0.83 (95% CI: 0.79–0.85) and 0.93 (95% CI: 0.9–0.95), respectively. These results not only highlight our system’s advantage over established benchmarks but also underscore the predictive power of retinal biomarkers in assessing stroke risk and the unique effectiveness of each biomarker. Additionally, the correlation between retinal biomarkers and cardiovascular diseases broadens the potential application of our system, making it a versatile tool for predicting a wide range of cardiovascular conditions.

INTERCULTURAL NURSING IN CHAOS ENVIRONMENT: CASE REPORT

The epidemic caused by the Covid-19 virus released in December 2019 was declared as a pandemic by the World Health Organization. The rapid spread of the virus unexpectedly and causing high deaths has led to a difficult process in the field of health. Societies, which are a social and cultural phenomenon, have also been affected by this epidemic in different ways. The phenomenon of health is not only a stable state of medical procedures, but also a dynamic concept where different cultures come together. Defending that if nurses do not take into account the cultural differences in the individual or society, the care to be given will not be effective, Leninger says that care should have the universal characteristics of the human structure under all conditions. In this sense, the aim of intercultural nursing is to provide culturally appropriate care. In this case, there are problems in health caused by the communication problem encountered in an Angolan patient who was hospitalized in the burn service when the coronavirus disease 2019 (COVID-19) was pandemic.

Nutrition Knowledge and Food Frequency Among People with Diabetes Mellitus

Diabetes Mellitus is one of the chronic diseases that causes the highest death in Indonesia. In fact, the number of cases of pain continues to increase. Riskesdas 2018 data shows that the total number of diabetes cases in Indonesia is 8.5%. Complications include heart attacks and strokes, severe leg infections (causing gangrene, which may result in amputation), end-stage renal failure, and sexual dysfunction. After 10-15 years from the time of diagnosis, the prevalence of all complications of diabetes increases markedly. Efforts that can be made to prevent diabetes mellitus are managing lifestyle, regular physical activity, maintaining diet, and conducting early examinations. The purpose of this study was to determine the relationship between nutrition knowledge and food frequency with the incidence of diabetes mellitus. This was an observational analytic study with a cross-sectional study design conducted in Malang. A sample of 54 people was selected by purposive sampling technique. The dependent variable is the incidence of diabetes mellitus. Independent variables include nutrition knowledge and food frequency. The data were collected by questionnaire and analyzed using Pearson correlation. Nutrition knowledge (r = 0.40; p = 0.003) and food frequency (r = 0.33; p = 0.017) related to diabetes mellitus and statistically significant. Good nutritional knowledge and regular food frequency can prevent diabetes mellitus.

Global Epidemiology and Geographic Variations of Pediatric-Onset Inflammatory Bowel Disease: A Comprehensive Analysis of the Global Burden of Disease Study 1990 to 2019.

An increasing incidence of pediatric-onset inflammatory bowel disease (PIBD) has been reported in many countries. However, the global burden and distribution of this disease remain less understood. We aimed to examine the global epidemiology and trends of PIBD from 1990 to 2019. Data from the 2019 Global Burden of Disease Study, covering 204 countries, were analyzed. We assessed key measures like incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using linear regression to calculate annual percentage changes and assess trends. Between 1990 and 2019, the PIBD incidence rate increased and the DALY rate and mortality rate declined. The incidence rate was notably elevated in the high Socio-demographic Index (SDI) quintile, reaching 6.3 per 100 000 person-years, corresponding to 13 914 new cases in 2019. Incidence and prevalence of PIBD positively correlated with the SDI, while higher death and DALY burdens were observed in lower-SDI countries. In 2019, the top 5 countries with the highest PIBD incidence rates were Canada (19.9 per 100 000 population), Denmark (12.4 per 100 000 population), Hungary (8.5 per 100 000 population), Austria (8.1 per 100 000 population), and the United States (7.4 per 100 000 population). Several countries experienced significant increases in incidence rates from 1990 to 2019, led by Taiwan (annual percent change 4.2%), followed by China (2.8%), Japan (2.1%), Australia (1.8%), and Hungary (1.6%). PIBD incidence has significantly increased since 1990. High-SDI countries face higher incidence, while lower-SDI countries experience higher mortality and DALY burdens. The study underscores the need for ongoing monitoring and research to address this emerging public health issue.

Global burden of diseases attributable to intimate partner violence: findings from the Global Burden of Disease Study 2019.

Our study aims to evaluate the global burden of disease attributable to IPV from 1990 to 2019 at global, regional, national, and socio-demographic index (SDI) levels. Our research question is: What is the global burden of disease attributable to intimate partner violence (IPV) from 1990 to 2019, and how does it vary at global, regional, national, and socio-demographic index (SDI) levels? Data parameters for the number of deaths, disability-adjusted life years (DALYs), and age-standardized rate were obtained from the Global Burden of Disease Study 2019. We calculated the percentage change and population attributable fraction with 95% uncertainty intervals. IPV directly accounted for 0.14% [95% UI 0.09%, 0.21%] and 0.32% [95% UI 0.17%, 0.49%] of global all-cause deaths and DALYs in 2019, respectively. The age-standardized deaths and DALYs rates of IPV increased by 12.83% and 4.00% respectively from 1990 to 2019. Women aged 35-39 and 30-34 had the highest deaths and DALYs rate respectively. The highest age-standardized rates of IPV-related deaths and DALYs were observed in Southern Sub-Saharan. Both of deaths and DALYs were high in low-socio-demographic Index (SDI) quintile in 2019. A higher level of deaths and DALYs attributable to IPV were reported in younger women, in the early 2000s, in Southern Sub-Saharan regions and in low SDI regions. Our study provides policymakers with up-to-date and comprehensive information.

Trends of inequality in DPT3 immunization services utilization in Ethiopia and its determinant factors: Evidence from Ethiopian demographic and health surveys, 2000-2019.

Low levels of diphtheria, tetanus toxoid, pertussis (DPT3) immunization services utilization and high deaths among under five children are concentrated in economically and socially disadvantaged groups, especially in low and middle-income countries, including Ethiopia. Hence, the aim of this study is to assess levels and trends in DPT3 immunization services utilization in Ethiopia and identify inequalities. This study used data from 2000, 2005, 2011, 2016, and 2019 Ethiopian Demographic Health Surveys (EDHSs). The 2019 updated version of the world health organization (WHO's) Health Equity Assessment Toolkit (HEAT) software was used to analyze the data. Six measure of inequality was calculated: ratio (R), differences (D), relative index of inequality (RII), slope index of inequality (SII), population attributable fraction (PAF) and population attributable risk (PAR). The findings were disaggregated by the five equity stratifiers: economic status, education, place of residence, regions and sex of the child. This study showed an erratic distribution of DPT3 immunization services utilization in Ethiopia. The trends in national DPT3 immunization coverage increased from 21% in (2000) to 62% in (2019) (by 41 percentage points). Regarding economic inequality, DPT3 immunization coverages for the poorest quintiles over 20 years were 15.3% (2000), and 47.7% (2019), for the richest quintiles coverage were 43.1 (2000), and 83.4% (2019). However, the service utilization among the poorest groups were increased three fold compared to the richest groups. Regarding educational status, inequality (RII) show decreasing pattern from 7.2% (2000) to 1.5% in(2019). Concerning DPT3 immunization inequality related to sex, (PAR) show that, sex related inequality is zero in 2000, 2005 and in 2019. However, based on the subnational region level, significance difference (PAR) was found in all surveys: 59.7 (2000), 51.1 (2005), 52.2 (2011), 42.5 (2016) and 30.7 (2019). The interesting point of this finding was that, the value of absolute inequality measures (PAR) and (PAF), are shown a decreasing trends from 2000 to 2019, and the gap among the better of regions and poor regions becoming narrowed over the last 20 years. Concerning individual and community level factors, household wealth index, education of the mother, age of respondent, antenatal care, and place of delivery show statically significant with outcome variable. Keeping the other variables constant the odds of an average child in Amhara Region getting DPT3 immunization was 54% less than for a child who lived in Addis Ababa (OR: 0.46, 95% CI: 0.34 - 0.63). Respondents from households with the richest and richer wealth status had 1.21, and 1.26 times higher odds of DPT3 immunization services utilization compared to their counterpart (OR: 1.21, 95% CI: 1.04 -1.41) and (OR: 1.26, 95% CI: 1.13 - 1.40) respectively. We conclude that DPT3 immunization coverage shows a growing trend over 20 years in Ethiopia. But inequalities in utilization of DPT3 immunization services among five equality stratifies studied persisted. Reasons for this could be complex and multifactorial and depending on economic, social, maternal education, place of residence, and healthcare context. Therefore, policy has to be structured and be implemented in a ways that address context specific barriers to achieving equality among population sub-groups and regions.

Assessing the Global, Regional, and National Impact of High Body Mass Index on Alzheimer's Disease and Other Dementias Between 1990 and 2019.

Obesity significantly increases Alzheimer's disease (AD) and dementia risk. Understanding the link between a high body mass index (BMI) and these conditions is crucial for effective management and prevention. We aimed to estimate the burden of AD and other dementias attributed to high BMI from 1990 to 2019 based on sex, age, and socio-demographic indicators (SDI) at global, regional, and national levels. We collected data on deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) from the 2019 Global Burden of Disease study for AD and dementia attributed to high BMI. We explored the correlation between SDI levels and ASDR. In 2019, there were 198,476.2 deaths (95% UI: 32,695.4-593,366.4) and 3,159,912.4 DALYs (848,330.5-8,042,531) attributed to high BMI. Numbers of deaths, DALYs, ASMR, and ASDR increased since 1990. Females had higher deaths, ASMR, and ASDR than males. Mortality and DALYs rates increased with age. ASMR and ASDR increased across five SDI levels, with the highest rise in Low-middle SDI. High-income North America had the most deaths [30,993.9 (5,101.7-89,912.9)], while North Africa and the Middle East had the highest ASMR [4.61 (0.79-13.64)] and ASDR [72.56 (20.98-181.16)] in 2019. The burden of AD and other dementias attributed to high BMI increased since 1990 globally and is still heaviest in developed regions. Females accounted predominantly for the burden than males. Timely measures are needed to against high BMI.

An Observational Study of Glycemic Status in New Onset Acute Stroke and Their Clinical Outcome in a Tertiary Care Teaching Hospital

Abstract Objective The study was aimed to test the blood glucose level in acute stroke patients to find out any correlation with types and prognosis of different glycaemic groups. Method It was a prospective observational study of patients admitted to hospital in Nizamabad due to an acute ischemic or hemorrhagic stroke (<24Hrs after the onset). Clinical parameters including history and clinical examination findings were recorded. CT scan of brain, blood glucose level, HbA1c, and other laboratory tests were taken in all the patients. 2D echocardiography (2D-ECHO) and X-Ray chest picture were also performed. According to glycaemia, the patients were classified into four groups such as Nondiabetic/euglycemic, known Diabetics on glycemic control therapy with or without glycemic control, Newly detected diabetics, and Stress hyperglycemia patients. On the day 1 and 15 National Institutes of Health Stroke Scale (NIHSS) was calculated to evaluate the severity of stroke and its outcome. Good prognosis was considered when NIHSS 5, moderate prognosis when NIHSS was 6–15, and poor prognosis when NIHSS was 16–20. Patients with NIHSS 20 died within 3 days of admission. Results Finally, 158 patients with acute stroke were included. Hemorrhagic stroke was seen in 43 (27.2%) and ischaemic stroke in 115 (72.8%) patients. Maximum cases were found in 51–60 years age group (37.9%) followed by 41–50 (20.3%) and 61–70 years age group (20.3%). Majority of study subjects were males, 65.8 % (n=104). Maximum cases were Euglycemics (44.3%), followed by stress hyperglycemic (27.8%), known diabetes (15.9%), and newly diagnosed diabetes (12%) presenting with acute stroke. Higher NIHSS score was found in stress hyperglycemic patients (19.4%) followed by known diabetics (17.3%), newly detected diabetics (16.3%), and euglycemics (9.5%). Maximum proportion (81.8%) of ischaemic stroke cases were found with stress hyperglycemia compared to other glycemic conditions but in hemorrhagic stroke maximum proportion (47.3%) were newly diagnosed diabetics. Maximum proportion of large size of lesion (47.4%) was found in newly diagnosed diabetes followed by stress hyperglycemia (45.55). Medium size of the lesions was found more in newly diagnosed diabetes (52.6%) followed by known diabetes cases (52%). Good outcome was found in 51 cases (32.2%), moderate outcome in 34 (21.5%), and poor outcome was in 30 (18.9%). 43 patients with NIHSS score >20 died within 3 days of admission (27.2%). Maximum proportion of death cases in ischemic group those belongs to newly diagnosed diabetes cases (8/9=88.8%). Higher deaths were found in blood sugar <110 mg/dl and blood sugar >199 mg/dl with an incidence rates of 41.2% and 53.4%. Conclusion Hyperglycaemia in non-diabetic patients after acute stroke is a stress response reflecting more severe neurological damage. Elevated HbA1c presenting stroke glycaemia status has a significant trend in increasing the risk of cause mortality. The management of hyperglycaemia in patients with diabetes and non-diabetes is an important aspect of the emergency management of stroke.

Gender differences in the burden of multiple sclerosis in China from 1990 to 2019 and its 25-year projection: An analysis of the Global Burden of Diseases Study.

Multiple sclerosis (MS) is a crippling, chronic, gender-related disease that causes burdens to individuals and society. China has a considerable and increasing population of MS. We aim to analyze the gender disparities in the burden of MS in China and predict the trends. The study was conducted based on the Global Burden of Disease Study 2019. Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of MS in China from 1990 to 2019 was descriptively analyzed by year, gender, and age group. The Nordpred package in R (version 4.2.2) was used for age-period-cohort analysis to predict the all-ages numbers and age-standardized rates of incidence, prevalence, deaths, and DALYs in China from 2020 to 2044. The number of prevalent cases of MS in 2019 reached 18,143.56 (95% uncertainty intervals [UI]: 13,997.71-22,658.60) in males and 24,427.11 (95% UI: 18,906.02-30,530.21) in females in China. The peak age of prevalence was shifted from 40-44 years in 1990 to 45-49 years in 2019 in females but remained unchanged in males. In contrast to the increased age-standardized prevalence rate, the age-standardized death rate (ASDR) and age-standardized DALYs rate showed downward trends, which were more significant in females. Different from the global, Chinese males showed lower prevalence but higher deaths and DALYs than females for age-standardized rates and numbers. In the next 25 years, the patient population will remain large and peak around 44,599.78 in 2025-2029. The ASDR, age-standardized DALYs rate, and DALYs number were expected to decrease. The improvements in deaths and DALYs will be more significant in females. Males with MS had a lower prevalence but higher deaths and DALYs than females in China. The ASDR and age-standardized DALYs rate have reduced over the past 30 years and were expected to continue decreasing, especially in females. The burden of MS will remain notable in the next 25 years.

Clinical Presentation and Histological Types of Ovarian Tumor in Patients Admitted in Tertiary Care Center

Background: Ovarian cancer is the eighth most frequent cancer among women worldwide, accounting for 4% of all cancers in the female population. When compared to other reproductive system cancers, ovarian cancer has a high death and morbidity rate. Objectives: The aim of the study was to assess the clinical presentation and histological types of ovarian tumor in patients admitted in tertiary care center. Methods: A descriptive cross-sectional study was conducted to determine the clinical presentation and histopathological types of ovarian tumour diagnosed at Medical college for women, Uttara and Nightingale medical college, Ashulia. The study was approved by the Institutional Review Board (IRB) and 600 patients diagnosed with ovarian tumors were consecutively included in the study from July 2009 to August 2016. The cases were diagnosed and subclassified in accordance with the WHO Classification of Female Genital Tumours, Fourth Edition. Statistical Package for Social Sciences (SPSS) application, version 25, was used for data analysis. Results: Out of Total Gynaecological admission of 4800 patients during the study period, 600 patients were admitted with diagnosis of ovarian Tumor, So occurance was 12.5%. the mean age of the patients was 35 ± 2.09. About 8.6% of the patients had less than 20 years old. 56.6% were within the age group of 21-40, 29.8% were within the age group of 41-60 and only 5% had more than 60 years. The mean Menarche in years was 14.6 ± 1.02 and Menopause in years was 48.7 ± 2.46. Regarding clinical presentation 37.40% had abdominal pain, 55.50% had abdominal mass, 3% had abdominal distension,2% had ascites, 0.50% had menstrual irregularities and 2.50% were asymptomatic. Regarding surgical procedure, 35% undergone Total abdominal hysterectomy and bilateral salpingo-oophorectomy, 18.33% Bilateral salpingo-oophorectomy, 15% Right salpingo-oophorectomy and Left salpingo-oophorectomy recommendation, 13.33% Right cystectomy, 3.33% Left cystectomy. Regarding consistency of tumour 57.33% were cystic, 37% were solid, 5.33% were complex and 0.33% were Diffuse pattern (metastatic tumor). Benign tumors were 77%, borderline 16.67% and malignant 6.33% cases. Out of 462 benign tumors, Serous cystadenoma (230/49.78%), Mucinous cystadenoma (60/12.98%), benign Brenner tumor (10/2.16%), Mature cystic teratoma (110/23.80%), stroma ovarii (10/2.16%), Fibroma (10/2.16%), Fibro-thecoma (12/ 2.59%), leiomyoma (20/4.34%). Out of 38 malignant tumour, Serous cystadenocarcinoma (11/28.94%), mucinous cystadenocarcinoma (6/15.78%), clear cell carcinoma (1/2.63%), Malignant Brenner tumor (1/2.63%), endometroid adenocarcinoma (4/10.52%), squamous cell carcinoma arising in mature teratoma (1/2.63%), Dysgerminoma (7/18.4%), Immature teratoma (1/2.63%), malignant mixed germ cell tumor (1/2.63%), Adult granulosa cell tumor (4/10.52%), Krukenburg tumor (1/2.63%). Survival status was satisfactory; 99.67% patients was alive. Conclusion: The study found that ovarian neoplasms had ambiguous signs and symptoms, were mostly seen in reproductive age groups, and were mostly benign. The proportion of malignant ovarian neoplasms was significantly lower than that of benign ovarian neoplasms. Although incidence of malignant tumor is less common but gynocologists should be more careful in diagnosis of malignancy as ovaries are pelvic organs and definite screening methods are not available and malignancy can occur in any age.

Incidence of Ventilator-Associated Pneumonia and its Bacterial Characterization – Intervention Based Prospective Study

Objectives: Ventilator-associated pneumonia (VAP) is a widely recognized and potentially fatal healthcare-related infection that occurs in all high-dependency units. Mechanically ventilated patients are at an elevated risk of developing VAP, which has a high death and morbidity rate. The prevalence of VAP varies greatly depending on the location and diagnostic approach. Radiological and clinical markers impact VAP diagnosis accuracy. Reliable sampling and confirmation of microbes are highly recommended. The purpose of this study was to document the incidence, patient distribution, bacteriological profile, and antibiotic susceptibility pattern of VAP patients. Material and Methods: A prospective observational study was done between January 2016 and December 2019. Critically, ill patients on mechanical ventilation for more than 48 hours were included in the study. Based on the initial baseline, positive end-expiratory pressure, and fraction of inspired oxygen were followed by three-tier VAP criteria as per NSHN guidelines. Results: Out of 1220 VAP-suspected patients (mechanically ventilated), 49 patients developed hospital-acquired VAP. The incidence of VAP significantly reduced from 10.7 to 1.4 VAP/1000 ventilator days with continuous intervention and auditing over some time. Elderly males aged 51–66 years were found to be in higher risk groups. Klebsiella pneumoniae and Pseudomonas aeruginosa were found to be the most common pathogen. The majority of Enterobacterales (79%) were found to be resistant to third-generation cephalosporin, 69% were resistant toward fluoroquinolone and cotrimoxazole, followed by 55% resistance to beta-lactam and beta-lactamase inhibitor combination. Conclusion: Targeted strategies with implementable policies, such as the care bundle approach, will reduce the in-patient days. It might improve patient outcomes and reduce the incidence of VAP.

The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype

Abstract There is growing evidence that higher body mass index (BMI) is associated with lower survival in breast cancer patients. The aim of this study was to investigate whether there is an association between body mass index (BMI) at breast cancer diagnosis and breast cancer prognosis and whether this association is dependent on menopausal status and tumor subtype in a less developed population in northern China. We collected 1,225 patients with primary invasive cancer in stage I-IIIC for retrospective analysis from October 2010 to December 2020. We used Kaplan–Meier and Cox regression analyses and estimated the relationship between baseline BMI and breast cancer-specific survival (BCSS). Next, we further evaluated whether the effect of BMI on breast cancer prognosis differed by menopausal status and tumor subtype. We found that death rate and prognosis were worse for patients with BMI ≥ 24, more than four positive lymph nodes, and triple negative status. Interestingly, BMI played a different prognostic role depending on tumor subtype and menopausal status. For premenopausal women, patients with BMI ≥ 24 had significantly lower BCSS compared to those with BMI < 24 in human epidermal growth factor receptor 2 (HER2) overexpression (HR: 4.305, p = 0.004) and triple negative subtypes (HR: 1.775, p = 0.048). By contrast, there was no association between BMI ≥ 24 and higher death regardless of tumor subtype in post-menopausal patients (p > 0.05). BMI influences breast cancer outcome depending on tumor subtype and menopause. BMI ≥ 24 might be a risk factor for BCSS, particularly in premenopausal women with HER2 overexpression or triple negative subtype. In contrast, BMI ≥ 24 was not associated with higher death regardless of tumor subtype in post-menopausal patients.

Severity of vehicle-to-vehicle accidents in the UAE: An exploratory analysis using machine learning algorithms

The World Health Organization (WHO) identifies road traffic injuries as a global health problem. The Eastern-Mediterranean region is particularly suffering from low traffic safety levels, recording the third highest death per capita ratio in the world. It is critical to evaluate and understand the causes of crashes and their severity levels as a first step to devising policies that aim to reduce these causes. Previous studies examining the frequency or severity of crashes present important limitations that motivate the need for the current work. While these studies have investigated the relation of contributing factors to severity of crashes, not until recently the importance of these factors are bring investigated. Even then, less research have explored various Machine Learning models and none in the middle-eastern region. This is critical because the WHO report concludes that the chances of dying in a traffic crash in this region are second only to Africa per 100000 population.This is a first study analyzing the severity of vehicle-to-vehicle crashes among drivers in the United Arab Emirates. Traffic Crash Data was obtained from the Abu Dhabi Police, which consisted of 11,400 observations during the period 2014–2017. Machine learning algorithms, including gradient boosting (GB), support vector machines (SVM), and random forest (RF), were trained and tested to predict crash severity and extract (using feature analysis) its determinants. The models were evaluated using two performance metrics: prediction accuracy and F1-scores.The RF model outperformed both GB and SVM, with the confusion matrix of RF reporting a better prediction for all four crash severity classes. The feature importance analysis indicates that the age of car, age of the injured, and the age of the initiator have the highest effect on severity, which is an important finding as the listed factors were rarely considered in previous studies. Vehicle and road characteristics such as vehicle class, crash type, and lighting are slightly associated with the severity. Consistent with other studies, gender was the least essential predictor of severity. Recommendations are finally provided to the Abu Dhabi Department of Municipalities and Transport (AD-DMT) authority to guide the development of road safety policies and countermeasures to mitigate the occurrence and severity of crashes.