Influence Of Potential Risk Factors Research Articles

Adverse drug reactions in paediatric surgery: prospective study on frequency and risk related factors

BackgroundPaediatric patients are especially prone to experiencing adverse drug reactions (ADRs), and the surgical environment gathers many conditions for such reactions to occur. Additionally, little information exists in the literature on ADRs in the paediatric surgical population. We aimed to quantify the ADR frequency in this population, and to investigate the characteristics and risk factors associated with ADR development.MethodsA prospective observational study was conducted in a cohort of 311 paediatric patients, aged 1–16 years, admitted for surgery at a tertiary referral hospital in Spain (2019–2021). Incidence rates were used to assess ADR frequency. Odds ratios (ORs) were calculated to evaluate the influence of potential risk factors on ADR development.ResultsDistinct ADRs (103) were detected in 80 patients (25.7%). The most frequent being hypotension (N = 32; 35%), nausea (N = 16; 15.5%), and emergence delirium (N = 16; 15.5%). Most ADRs occurred because of drug-drug interactions. The combination of sevoflurane and fentanyl was responsible for most of these events (N = 32; 31.1%). The variable most robustly associated to ADR development, was the number of off-label drugs prescribed per patient (OR = 2.99; 95% CI 1.73 to 5.16), followed by the number of drugs prescribed per patient (OR = 1.26, 95% CI 1.13 to 1.41), and older age (OR = 1.26, 95% CI 1.07 to 1.49). The severity of ADRs was assessed according to the criteria of Venulet and the Spanish Pharmacovigilance System. According to both methods, only four ADRs (3.9%) were considered serious.ConclusionsADRs have a high incidence rate in the paediatric surgical population. The off-label use of drugs is a key risk factor for ADRs development.

Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort

Objective: Evaluation of the influence of potential risk factors (RFs) on glycemic changes at 3 years postpartum. Methods: The glycemic status of 1400 women, in absence of a new pregnancy, was evaluated at 3 months (3 m) and 3 years (3 y) postpartum, after participation in the St. Carlos Gestational Study (2228 normoglycemic pregnant women followed from before gestational week 12 to delivery, from 2015–2017). Abnormal glucose regulation (AGR) was defined as fasting serum glucose ≥ 100 mg/dL and/or HbA1c ≥ 5.7% and/or 2 h 75 g OGTT glucose ≥ 140 mg/dL. In total, 12 modifiable and 3 unmodifiable RFs were analyzed. Results: 3 m postpartum, 110/1400 (7.9%) women had AGR; 3 y postpartum, 137 (9.8%) women exhibited AGR (110 with 3 m normal glucose tolerance [NGT]); 1263 (90.2%) had NGT (83 with 3 m AGR). More women with gestational diabetes mellitus (GDM) progressed to AGR at 3 y (OR: 1.60 [1.33–1.92]) than women without GDM. Yet, most women with 3 m and/or 3 y AGR had no GDM history. Having ≥2 unmodifiable RFs was associated with increased risk for progression to AGR (OR: 1.90 [1.28–2.83]) at 3 y postpartum. Having >5/12 modifiable RFs was associated with increased progression from NGT to AGR (OR: 1.40 [1.00–2.09]) and AGR persistence (OR: 2.57 [1.05–6.31]). Pregestational BMI ≥ 25 kg/m2 (OR: 0.59 [0.41–0.85]), postdelivery weight gain (OR: 0.53 [0.29–0.94]), and waist circumference > 89.5 cm (OR: 0.54 [0.36–0.79]) reduced the likelihood of NGT persisting at 3 y. Conclusions: 3-month and/or 3-year postpartum AGR can be detected if sought in women with no prior GDM. Modifiable and unmodifiable RF predictors of AGR at 3 y postpartum were identified. Universal screening for glycemic alterations should be considered in all women following delivery, regardless of prior GDM. These findings could be useful to design personalized strategies in women with risk factors for 3 y AGR.

Prevalence and knowledge about acute mountain sickness in the Western Alps.

To assess the prevalence of acute mountain sickness (AMS) in 1370 mountaineers at four different altitudes in the Western Alps. We also examined the influence of potential risk factors and the knowledge about AMS on its prevalence. In this observational cross-sectional study AMS was assessed on the day of ascent by the Lake Louise score (LLS, cut-off ≥3, version 2018) and the AMS-Cerebral (AMS-C) score of the environmental symptom questionnaire (cut-off ≥0,70). The latter was also obtained in the next morning. Knowledge regarding AMS and high-altitude cerebral edema (HACE) and the potential risk factors for AMS were evaluated by questionnaires. On the day of ascent, the prevalence of AMS assessed by the LLS and AMS-C score was 5.8 and 3.9% at 2850 m, 2.1 and 3.1% at 3050 m, 14.8 and 10.1% at 3650 m, and 21.9 and 15% at 4559 m, respectively. The AMS prevalence increased overnight from 10.1 to 14.5% and from 15 to 25.2% at 3650 m and 4559 m, respectively, and was unchanged at 2850 m and 3050 m. A history of AMS, higher altitude, lower degree of pre-acclimatization, and younger age were identified as risk factors for developing AMS. Slow ascent was weakly associated with AMS prevalence, and sex and knowledge about AMS and HACE were indistinct. AMS is common at altitudes ≥ 3650 m and better knowledge about AMS and HACE was not associated with less AMS in mountaineers with on average little knowledge.

An analysis of risk factors for ENT diseases: A case study of D. G. Khan and Rajanpur Districts, Punjab, Pakistan.

Objective: To determine the core risk factors of Ear, Nose and Throat (ENT) diseases at D. G. Khan and Rajanpur districts of Punjab, Pakistan. Study Design: Cross Sectional Case Control study. Setting: A sample of 1553 individuals including two categories, ENT Diseased (Case) and ENT diseased free (Control) respondents including both males and females was collected from different hospitals of D. G Khan and Rajanpur Districts. Period: June 2021 to June 2022. Material & Methods: Data for this study have been collected by formulating a questionnaire. That questionnaire was then completed by face to face interviewing. Chi-squared test is used to check the association between the assumed risk factors and ENT diseases. Odds ratios are calculated to measure the strength of association between assumed risk factors and ENT diseases. Looking at the dichotomous nature of the response variable, a binary logistic regression model is also applied to assess the overall influence of potential risk factors on developing the ENT diseases. Results: In our sample of 1553 respondents, 41.47% are females and 58.53% are males. The percentage of clinically diagnosed ENT diseased patients is 54.92% and those of controlled ones is 45.08%. Among the diseased respondents, 57% have ear disease, 19.2% have nose disease and 23.8% have throat disease. Age, education, family status, family system, marital status, slow physical activity, smoking, Naswar, Paan, family history, occupation, work place, water, ventilation, nutrition and tea are found to be the most significant risk factors of developing the ENT diseases. Conclusions: The occurrence of ENT diseases can be reduced by giving the awareness to the people about its risk factors.

Relationship Between Six Insulin Resistance Surrogates and Nonalcoholic Fatty Liver Disease Among Older Adults: A Cross-Sectional Study.

Non-alcoholic fatty liver disease (NAFLD) represents a large and growing public health problem. Insulin resistance (IR) plays a crucial role in the pathogenesis of NAFLD. The aim of this study was to determine the association of triglyceride-glucose (TyG) index, TyG index with body mass index (TyG-BMI), lipid accumulation product (LAP), visceral adiposity index (VAI), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-c) and metabolic score for IR (METS-IR) with NAFLD in older adults and to compare the discriminatory abilities of these six IR surrogates for NAFLD. This cross-sectional study included 72,225 subjects aged ≥60 years living in Xinzheng, Henan Province, from January 2021 to December 2021. The data were collected from the annual health examination dataset. Logistic regression models were used to examine the relationships between the six indicators and NAFLD risk. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different IR surrogates for NAFLD under the influence of potential risk factors. After adjusting for multiple covariates, compared with the first quintile, the odds ratios (ORs) and 95% confidence intervals (CIs) of the highest quintiles of TyG-BMI were the most obvious (OR:43.02, 95% CI:38.89-47.72), followed by the METS-IR (OR:34.49, 95% CI:31.41-37.95). Restricted cubic spline analysis reported that there were non-linear positive association and dose-response relationship between 6 IR surrogates and NAFLD risk. Compared with other IR-related indicators (LAP, TyG, TG/HDL-c and VAI), TyG-BMI showed the highest AUC (AUC:0.8059;95% CI:0.8025-0.8094). Additionally, METS-IR also had a high predictive performance for NAFLD, and the AUC was greater than 0.75 (AUC:0.7959;95% CI:0.7923-0.7994). TyG-BMI and METS-IR had pronounced discrimination ability to NAFLD, which are recommended as complementary markers for the assessment of NAFLD risk both in clinic and in future epidemiological studies.

Higher body mass index and disease duration are associated with increased risk of left ventricular diastolic dysfunction in women with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have an increased cardiovascular (CV) risk. Insulin resistance (IR), which is higher in patients with SLE, adversely impacts left ventricular (LV) remodeling and function. The aims were to determine LV dysfunction and evaluate the influence of potential risk factors on subclinical LV dysfunction in women with SLE, including IR. This cross-sectional study included adult women with SLE without diabetes mellitus (DM), hypertension or severe obesity. Diastolic dysfunction (DD) was verified according to current guidelines. Insulin resistance was estimated using the Quantose score. We included 77 women. The frequency of IR was 65%. All participants had a normal ejection fraction (EF), and 11 (15.7%) had abnormal LV global longitudinal strain (GLS). Twenty-three (32.8%) had DD. The GLS% and global circumferential strain (GCS)% did not differ in patients with and without IR (-20.8 ± 3.1 vs -20.5 ± 2.1; p = 0.61 and -27.9 ± 4.4 vs -27.4 ± 3.7; p = 0.57, respectively). The prevalence of DD was 38.1% in patients with IR versus 25% in those without (p = 0.30). E/e' and E/A ratios did not differ between groups (6.6 ± 1.9 vs 6.6 ± 1.5; p = 0.98 and 1.3 ± 0.3 vs 1.3 ± 0.2; p = 0.27). Higher BMI (OR: 1.2, 95% CI 1.1-1.5) and disease duration (OR: 1.2, 95% CI 1.1-1.4) were associated with DD. Patients with overweight/obesity may be at higher risk of LV dysfunction. Although IR was high in our patients with SLE was not associated with systolic dysfunction or DD. Body mass index and disease duration were associated with an increased risk of DD.

Prevalence of asthma and asthma symptoms among rural and urban pre-school children in Mpumalanga Province, South Africa

Background and Aim: Asthma is the most common chronic illness in South African children and its prevalence is increasing in both urban and rural areas. Little is known about the prevalence of asthma amongst pre-school children living in Mpumalanga province, South Africa, which forms part of the Highveld region, a priority area in terms of air pollution. The area is known for poor air quality and elevated concentrations of criteria pollutants. The aim of the study was to investigate the prevalence of asthma and asthma symptoms among rural and urban pre-school children and the association with environmental risk factors. Methods: This analytical cross-sectional study that included 3145 pre-school children from Mpumalanga Province, South Africa. Parents of the children were requested to complete a modified ISAAC questionnaire. We analyzed the influence of potential risk factors on dependent variables using bivariate analysis. Significant risk factors identified in the bivariate analysis were included in a multiple logistic regression to develop a final model. Results: Self-reported prevalence of asthma was 2.3% (66/2810), with pre-school children in rural areas reporting a higher rate than pre-school children in urban areas (1.3% vs 1%), χ2=10.86, P <0.001). The prevalence of asthma symptoms was 15.1% (467/3084), with rural pre-school children reporting a higher prevalence of symptoms than urban pre-school children (10% vs 5%), χ2 = 24.45, P < 0.001). Risk factors for asthma and asthma symptoms were vigorous physical activity (odds ratio (OR) 2.31, 95% CI 1.14-4.66), home smoking exposure (OR 2.94, 95% CI 1.40-6.19) and male parent smoking (OR 1.46, 95% CI 1.01-2.12). Conclusions: Pre-school children in rural areas reported a higher prevalence of asthma compared to pre-school children in urban areas. Risk factors for asthma included physical activity and smoking exposure in the home. Key words: asthma, pre-school children, risk factors

A 3-Year Clinical Evaluation of Endodontically Treated Posterior Teeth Restored with Resin Nanoceramic Computer-Aided Design/Computer-Aided Manufacture (CAD/CAM)-Fabricated Partial Crowns.

BackgroundWe aimed to investigate the clinical effects of resin nanoceramic (RNC) computer-aided design/computer-aided manufacture (CAD/CAM) partial crowns on posterior teeth after root canal treatment over a 3-year period.Material/MethodsA total of 132 posterior teeth restored with CAD/CAM partial crowns were placed in 128 patients. The observation group (n=66) was restored with RNC restorations, while the control group received lithium disilicate-based glass ceramic (LDGC) CAD restorations. Using Fédération dentaire internationale (FDI) World Dental Federation clinical criteria, 2 calibrated evaluators examined the performance of the restorations at baseline, 6, 12, 18, 24, and 36 months. The Kaplan-Meier method and the log-rank test were adopted to analyze the survival rate. The influence of potential risk factors on the main pattern of failure was studied by univariate Cox regression analysis (α=0.05).ResultsAt the 3-year followup, the survival rate of the partial crowns was 83.1% in the RNC group, and 93.5% in the LDGC group (P=0.061). Failures were caused by debonding (66.7%), restoration fracture (26.6%), and tooth fracture (6.7%). No significant differences were found between the 2 materials at 36 months, except for the parameters of “surface luster” (P=0.002) and “occlusal contour and wear” (P=0.009). The RNC group was significantly more likely to debond than the LDGC group (hazard ratio=9.22 [1.17,72.74], P=0.01).ConclusionsRNC CAD/CAM-fabricated partial crowns are a potential clinical alternative for endodontically treated posterior teeth, with a survival rate of 83.1% at the 3-year followup. The main pattern of failure was debonding, which might be influenced by surface pretreatment of the RNC material.

Factors affecting the formation of bone block in patients with isthmic spondylolisthesis

Objective. To analyze significance of the influence of various factors on the fusion rate in patients with isthmic spondylolisthesis.Material and Methods. A retrospective monocenter study included data from 41 patients aged 18 years and older with isthmic spondylolisthesis who underwent transforaminal interbody fusion with cage using a four-screw rigid transpedicular fixation system. The influence of potential risk factors on the fusion rate was studied.Results. A univariate analysis showed that obesity (p = 0.037) and the use of non-steroidal anti-inflammatory drugs (NSAIDs) for more than three months (p = 0.007) significantly affect the formation of a bone block. When compiling a logistic regression model, it was found that a combination of obesity, smoking, and the use of NSAIDs for more than three months significantly worsens the prognosis of bone block formation (p = 0.007; R2N = 0.405; AUC = 0.850).Conclusion. The study showed that the absence of bone block formation in patients with isthmic spondylolisthesis may be associated with smoking, obesity, and the use of NSAIDs for more than three months. Keeping these factors in mind and trying to minimize their presence can help ensure better radiographic outcomes after surgery.

Using Geographically Weighted Regression to Study the Seasonal Influence of Potential Risk Factors on the Incidence of HFMD on the Chinese Mainland

Hand, foot, and mouth disease (HFMD) is an epidemic infectious disease in China. Its incidence is affected by a variety of natural environmental and socioeconomic factors, and its transmission has strong seasonal and spatial heterogeneity. To quantify the spatial relationship between the incidence of HFMD (I-HFMD) and eight potential risk factors (temperature, humidity, precipitation, wind speed, air pressure, altitude, child population density, and per capita GDP) on the Chinese mainland, we established a geographically weighted regression (GWR) model to analyze their impacts in different seasons and provinces. The GWR model successfully describes the spatial changes of the influence of potential risks, and shows greatly improved estimation performance compared with the ordinary linear regression (OLR) method. Our findings help to understand the seasonally and spatially relevant effects of natural environmental and socioeconomic factors on the I-HFMD, and can provide information to be used to develop effective prevention strategies against HFMD at different locations and in different seasons.

Determinants of transitions in water and sanitation services in two urban slums of Nairobi: A multi-state modeling approach

Access to improved water, sanitation, and hygiene (WASH) services at the household level remains a good strategy to improve the health and well-being of individuals. Informal settlements, such as urban slums, are at risk of the spread of diseases due to the relative lack of access to safe, clean drinking water and basic sanitation, as well as poor hygiene. Global initiatives, such as the Sustainable Development Goals (SDGs) adopted by the United Nations, are aimed at transitioning households and communities from unimproved to sustained improved states of WASH services. To deepen understanding of the time dynamics between states of WASH services in the Nairobi Urban and Demographic Surveillance System (NUHDSS), this study employs the multi-state transition model to assess the influence of potential risk factors on these transitions. Results indicated that study sites, wealth tertile, age of household head, poverty status, the ethnicity of household head, household ownership, and food security were associated with household transitions of WASH services. There was a lower probability for households to transition from unimproved to improved toilet services than the reverse transition, but a higher chance for households to transition from unimproved to improved water and garbage services. The estimated average time that households spent in the unimproved and improved states before transitioning were, respectively, 35 months and 9 months for toilet services, 7 months and 66 months for water services, and 16 months and 19 months for garbage services. Thus, households tend to remain longer in the unimproved state of toilet and garbage services, and when in the improved states, they transition back relatively faster compared to water services. In conclusion, sanitation services in Nairobi informal settings remain largely unsatisfactory as transitions to improved services are not sustained. It is therefore important for governments, policy-makers, and stakeholders to put in place policies and interventions targeting vulnerable households for improved and sustained WASH services.

A cohort study on risk factors of high-density lipoprotein cholesterol hypolipidemia among urban Chinese adults

BackgroundHigh-density lipoprotein cholesterol (HDL-C) hypolipidemia, a major type of dyslipidemia, has been associated with many kinds of diseases, such as stroke, coronary heart disease, obesity and diabetes, and has displayed an increasing prevalence in China. This study explores the risk factors of HDL-C hypolipidemia and makes recommendations for controlling and preventing HDL-C hypolipidemia and the diseases caused by it.MethodsUsing a retrospective cohort study design, 26,863 urban adults without dyslipidemia, diabetes, cardiovascular and cerebrovascular diseases, hepatosis, renal insufficiency and thyroid diseases were enrolled in the study between 2010 and 2015. Data on each individual were collected at the 2010 baseline year and at a follow-up medical check. A Cox regression model was constructed to evaluate the influence of potential risk factors on the outcome event- HDL-C hypolipidemia.ResultsThe incidence of HDL-C hypolipidemia was 5.7% (1531/26863). Sex, age, body mass index (BMI), HDL-C, triglyceride (TG) and urea nitrogen (UN) were significant risk factors of HDL-C hypolipidemia. Men were more likely to develop HDL-C hypolipidemia than women during follow-up medical checks (HR = 1.258, P = 0.014). The incidence of HDL-C hypolipidemia in the over 65 years old group was higher than that of the ≤65 age group (HR = 1.276, P = 0.009). The incidence of HDL-C hypolipidemia increased with increasing BMI (HR = 1.030, P = 0.002), TG (HR = 1.321, P = 0.001) and UN (HR = 1.054, P = 0.019), while falling with increasing HDL-C in the baseline year (HR = 0.002, P < 0.001).ConclusionsMen, aged over 65, with high BMI were at the highest risk of developing HDL-C hypolipidemia. Measures should be taken to prevent HDL-C hypolipidemia even for healthy urban adults whose blood biochemical indicators were in the normal range when their level of TG, UN and HDL-C are closed to the border of the normal value range.

Understanding wealth transitions among households in urban slums of Nairobi: A multi-state transition modelling approach

Disparities in wealth are socially undesirable and may result in economic inequalities that have destabilizing effects on communities. Globally, more than 700 million people who live in extreme poverty still struggle for the most basic human needs. It is important to note that poverty is not static as households and individuals may transition from one wealth state to another with the passage of time. As such, the examination of poverty levels at one point does not offer a sufficiently complete picture of the dynamics in states of wealth through the dimension of time. In this paper, we study transitions in wealth status of households in two informal settlements (slums) in Nairobi, Kenya from 2006 to 2015. We employed the multistate transition model to assess the influence of potential risk factors on wealth transitions for households in urban slums. The results of the analysis indicate that slum areas, age of the household head, ethnicity, gender, household ownership type, food security, and household size have an effect on at least one transition between wealth states. A considerable proportion of households still remain in the lowest and middle wealth states. Households were found to easily transition forward, from the lowest to the highest wealth state than the reverse transition. The estimated mean sojourn times for the lowest, middle and highest wealth tertile were approximately 10, 7, and 14 months, respectively. These highlights the need for interventions that reduce the time spent in the lowest and middle wealth tertile while ensuring retention of households in the highest tertile. Our findings underscore the need for policy options around the provision of economic opportunities with targeted attention to households in vulnerable settings.

Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis.

The lateral closing and medial opening wedge high tibial osteotomy can correct a varus malalignment of the knee caused by medial compartment osteoarthritis. These procedures have produced great short-term and mid-term results. As no systematic review has examined their long-term results yet, the goal of this article was to compare the results of all articles about lateral closing and medial opening wedge high tibial osteotomies, published after the year 2000, with a mean follow-up of more than 10 years. A systematic search of the Medline, Web of Science and Cochrane databases resulted in the inclusion of 30 articles. All these studies combined examined the results of 7087 high tibial osteotomies in a total of 6636 patients after a mean follow-up of more than 10 years. Primary outcome measures were the survival rate of the osteotomy, functional scores, patient satisfaction and pain scores. Secondary outcome measures were alignment correction and the identification of factors influencing the survival of the osteotomy. The 5-year, 10-year, 15-year and 20-year survival rates, respectively, ranged from 86 to 100%, 64-97.6%, 44-93.2% and 46-85.1%. The subjective scoring systems showed an improvement postoperatively that was maintained until final follow-up. The anatomical and mechanical tibiofemoral axis were, respectively, corrected to a mean of 7.3°-13.8° of valgus and 0.6°-4° of valgus. The results of the articles evaluating the influence of potential risk factors were contradictory. Despite the low quality of the available evidence, the lateral closing and medial opening wedge high tibial osteotomy seem to remain valid long-term treatment options for patients with painful varus malalignment caused by isolated medial compartment osteoarthritis of the knee. The available results indicate that the need for arthroplasty could be delayed for more than 15years in the majority of patients. However, higher-quality studies are needed to confirm these findings. As a systematic review is assigned a level of evidence equivalent to the lowest level of evidence used from the analyzed manuscripts, the level of evidence of this systematic review is IV.

Emergency surgeries for rectal cancer complicated by intestinal obstruction: long-term outcomes and prognostic factors

The aim of the study: to examine the indicators of relapse-free survival and evaluate prognostic factors that had the greatest impact on relapse- free survival in patients with rectal cancer complicated by obstructive obstruction and undergoing emergency surgery.Materials and methods. The analysis of the immediate and long-term results of treatment – relapse-free survival of patients undergoing emergency surgery for rectal cancer complicated by obstructive obstruction in general surgical and specialized hospitals in Smolensk from 2001 to 2017 is presented. Relapse-free survival was analyzed by the Kaplan–Meier method. To determine the influence of potential risk factors on the rate of occurrence of the studied event, Cox regression was used.Results. Postoperative complications of the III–IV degree according to Clavien–Dindo were more common in patients undergoing emergency surgery for complicated rectal cancer in general surgical hospitals (p = 0.0056). In specialized hospitals, anastomosis leakage in 5.3 % (1 of 19 cases), in general surgical hospitals – 16.3 % (9 of 55 cases). Five-year relapse-free survival in general surgical hospitals at the IIB stage was 18.3 %, median survival – 32 months; in specialized hospitals at stage IIB 5‑year relapse-free was 45.8 %, median survival – 52 months (p = 0.028 and 0.011, respectively). A multivariate analysis confirmed the influence of the following factors on the performance of a 5‑year relapse-free survival: hospital specialization (risk ratio (RR) 1.35; 95 % confidence interval (CI) 1.18–1.55; p &lt;0.001), type of surgery – one-stage operations (RR 1.13; 95 % CI 1.05–1.22; p = 0.001), the presence of metastases in the lymph nodes (RR 0.77; 95 % CI 0.71–0.84; p &lt;0.0001), the number of examined lymph nodes (RR 0.79; 95 % CI 0.72–0.87; p &lt;0.001).Conclusions. It is advisable to carry out two-stage surgical treatment with the formation of a colostomy at the first stage; the main stage of radical intervention should be performed in a specialized hospital.

Defining postoperative ileus and associated risk factors in patients undergoing radical cystectomy with an Enhanced Recovery After Surgery (ERAS) program.

Postoperative ileus (POI) is a common complication of radical cystectomy (RC), occurring in 1.6-23.5% of cases. It is defined heterogeneously in the literature. POI increases hospital length of stay and postoperative morbidity. Factors such as age, epidural use, length of procedure, and blood loss may impact POI. In this study, we aimed to evaluate risk factors that contribute to POI in a cohort of patients managed with a comprehensive Enhanced Recovery After Surgery (ERAS) protocol. A retrospective review of consecutive patients who underwent RC from March 2015 to December 2016 at Vancouver General Hospital was performed. POI was defined a priori as insertion of nasogastric tube for nausea or vomiting, or failure to advance to a solid diet by the seventh postoperative day. To illustrate heterogeneity in previous studies, we also evaluated POI using other previously reported definitions in the RC literature. The influence of potential risk factors for POI, including patient comorbidities, American Society of Anesthesiologists score, gender, age, prior abdominal surgery or radiation, length of operation, diversion type, extent of lymph node dissection, removal date of analgesic catheter, blood loss, and fluid administration volume was analyzed. Thirty-six (27%) of 136 patients developed POI. Using other previously reported definitions for POI, the incidence ranged from <1-51%. Node-positive status and age at surgery were associated with POI on univariate analysis but not multivariable analysis. A large range of POI incidence was observed using previously published definitions of POI. We advocate for a standardized definition of POI when evaluating RC outcomes. POI occurs frequently even with a comprehensive ERAS protocol, suggesting that additional measures are needed to reduce the rate of POI.

Artificial Neural Network Modeling of Novel Coronavirus (COVID-19) Incidence Rates across the Continental United States.

Prediction of the COVID-19 incidence rate is a matter of global importance, particularly in the United States. As of 4 June 2020, more than 1.8 million confirmed cases and over 108 thousand deaths have been reported in this country. Few studies have examined nationwide modeling of COVID-19 incidence in the United States particularly using machine-learning algorithms. Thus, we collected and prepared a database of 57 candidate explanatory variables to examine the performance of multilayer perceptron (MLP) neural network in predicting the cumulative COVID-19 incidence rates across the continental United States. Our results indicated that a single-hidden-layer MLP could explain almost 65% of the correlation with ground truth for the holdout samples. Sensitivity analysis conducted on this model showed that the age-adjusted mortality rates of ischemic heart disease, pancreatic cancer, and leukemia, together with two socioeconomic and environmental factors (median household income and total precipitation), are among the most substantial factors for predicting COVID-19 incidence rates. Moreover, results of the logistic regression model indicated that these variables could explain the presence/absence of the hotspots of disease incidence that were identified by Getis-Ord Gi* (p < 0.05) in a geographic information system environment. The findings may provide useful insights for public health decision makers regarding the influence of potential risk factors associated with the COVID-19 incidence at the county level.

Факторы риска центральной серозной хориоретинопатии: исследование «случай-контроль»

Aim of the study: Assessment of the influence of potential risk factors on the development of central serous chorioretinopathy in a large industrial city. Materials and Methods: Case-control study of persons aged 18 years and older. The study group included 100 patients with central serous chorioretinopathy, confirmed by optical coherence tomography, and controls – 100 patients without central serous chorioretinopathy. The groups are comparable in gender and age. Interviewing of patients was carried out according to the developed questionnaire, including 33 questions. One-way and multivariate analysis of the results using logistic regression was carried out. Statistical data processing was carried out using Microsoft Office Excel 2010, Jamovi programs, R – Studio statistical package, OpenEpi online calculators (http://www.openepi.com). Results: The following risk factors for CSC were identified: taking corticosteroid drugs in the last year – OR 13.5; 95% CI 3.4-53.2 and the presence of arterial hypertension – OR 8.3; 95% CI 1.3-54.1. Intake of antihypertensive drugs and psychotropic drugs from the group of anxiolytics were statistically significant factors in the "prevention" of the development of CSC (OR 0.1; 95% CI 0.02-0.9 and OR 0.01; 95% CI 0.0003− 0.5), respectively. The presence of myopia also proved to be a protective factor for CSC –OR 0.3; 95% CI 0.14-0.8. Conclusion: In a case-control study, significant risk factors for CSC for the population of a large industrial city were arterial hypertension and the use of corticosteroid drugs. The presence of myopia is associated with a lower incidence of CSC.

Prediabetes defined by HbA1c and by fasting glucose: differences in risk factors and prevalence.

To investigate, in a sample of nondiabetic adults from a Spanish community, the differences between prediabetes as defined by HbA1c ("H-prediabetes") and by fasting plasma glucose (FPG) ("F-prediabetes") in regard to prevalence and the influence of potential risk factors, adjusting the latter for confounders. A total of 1328 nondiabetic participants aged ≥ 18years were classified as normoglycemic, H-prediabetic [HbA1c 5.7-6.4% (39-47mmol/mol)] or F-prediabetic (FPG 5.6-6.9mmol/L). Multivariable analyses were used to compare the impacts of risk factors on the prevalence of H-prediabetes, F-prediabetes and their conjunctive and disjunctive combinations ("HaF-prediabetes" and "HoF-prediabetes," respectively). Some 29.9% of participants were HoF-prediabetic, 21.7% H-prediabetic, 16.3% F-prediabetic and only 8.1% HaF-prediabetic. Whatever the definition of prediabetes, increasing age, fasting insulin and LDL cholesterol were each a risk factor after adjustment for all other variables. Increasing BMI and decreasing mean corpuscular hemoglobin (MCH) were additional risk factors for H-prediabetes; male sex and increasing uric acid for F-prediabetes and increasing BMI for HaF-prediabetes. The participants satisfying the compound condition "hypertension or hyperlipidemia or obesity or hyperuricemia" (59.9% of the whole study group) included 83.1% of all subjects with HoF-prediabetes. In this population, the most sensitive risk factor for detection of prediabetes was age, followed by fasting insulin, LDL cholesterol, BMI, MCH, male sex and uric acid, with differences depending on the definition of prediabetes. MCH, an indirect measure of erythrocyte survival, significantly influences the prevalence of HbA1c-defined prediabetes. This study suggests that screening of individuals with selected risk factors may identify a high proportion of prediabetic persons.

First mortality analysis in the French cohort of uranium millers (F-Millers), period 1968-2013.

Epidemiological studies in cohorts of uranium millers can be informative to improve knowledge of the health effects of uranium, but are very rare. The aim of this study was to analyze, for the first time, mortality in a French cohort of uranium millers. The F-Millers cohort includes permanent contract workers employed at least 6months at French uranium milling plants. Vital status and causes of death were obtained from national registries between 1968 and 2013, in order to perform comparisons with French national and local mortality rates by computing standardized mortality ratios (SMRs) with 95% confidence intervals (95% CI). The cohort includes 1291 workers. The average duration of follow-up is 32.1years. At the end of follow-up, 448 workers were deceased and 13 lost to follow-up. We observed a significant deficit of mortality for all causes combined when the national reference was considered (SMR 0.81; 95% CI [0.74;0.89]), but no significant difference when the local reference was considered (SMR 0.97; 95% CI [0.88;1.07]). Significant excesses were observed only in a subgroup of 552 workers hired at the manufacturing unit, mainly when the local reference was considered. No significant excess of mortality was observed at the scale of the full cohort. The cause-specific excesses of mortality observed in the subgroup of workers hired at the manufacturing unit were based on small number of cases, but would warrant further investigations. Undertaking analytical studies and combined analyses of cohorts of uranium millers would help to study the influence of potential risk factors and obtain more precise results.