Lower Mean Body Mass Index Research Articles

Mid-term results of the Remeex® readjustable sling for female complex stress urinary incontinence and sonographic hypomobile urethra.

We aimed to evaluate the results of a readjustable sling (Remeex® system) among a selected group of women with complex stress urinary incontinence (SUI) with sonographic hypomobile urethra and assessing failure-related risk factors. Observational, longitudinal, prospective cohort study, including patients who underwent surgery with the Remeex® system. The primary outcome was a binary outcome in change of one level or more of the severity of urinary incontinence symptoms according to the intervals of the Incontinence Questionnaire-Short Form (ICIQ-UI-SF) score (mild, moderate, severe and very severe). Secondary outcomes were postsurgical complications, absolute ICIQ-UI-SF, 24-h pad weight test (24-h PT), urodynamic SUI and Patient Global Impression of Improvement (PGI-I) score to evaluate subjective success. Among 120 women included, after surgery we found a 70% subjective success rate, a 76.7% decrease of urinary incontinence severity and a mean reduction of the 24-h PT of 109.6 ± 291.4g. Women with post-surgical decreased severity of incontinence had lower mean body mass index (BMI) and 24-h PT than those without incontinence severity changes with statistically significant differences (p = 0.028 and p = 0.027, respectively). A logistic regression model demonstrated that a 1-point increase of BMI increased the risk of persistence of incontinence severity after surgery by 19% (OR = 1.19; 95% CI: 1.01-1.41; p = 0.040), and an increase of 10g in the pre-surgical 24-h PT represented a 3% rise of the aforementioned risk (OR = 1.03; 95% CI: 1.01-1.06; p = 0.034). In patients with complex SUI and sonographic hypomobile urethra, use of a readjustable sling (Remeex® system) led to improvement of SUI. Patients with a greater BMI and pre-surgical 24-h PT showed worse results after surgery.

Prevalence of Back Pain and Idiopathic Scoliosis in Adolescents From the Semiarid Region of Brazil: A Cross-sectional Study

ObjectiveThe purpose of this study was to estimate the prevalence of adolescent idiopathic scoliosis (AIS), and back pain and its risk factors, in schoolchildren from the semiarid region of Brazil. MethodsA total of 520 adolescents aged 10 to 16 years old were assessed. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument questionnaire. The screening for AIS included measuring the angle of trunk rotation using a scoliometer in the Adams forward-bend test. Participants with an angle of trunk rotation ≥ 7° were referred for radiography. The prevalence ratio was estimated by multivariable analysis using a Poisson regression model (α = 0.05). ResultsAmong the participants, 3.1% (95% confidence interval, 3.2%-6.9%) had a confirmed AIS diagnosis: 1.9% girls and 1.1% boys. There was no difference between boys and girls in AIS prevalence. The prevalence of back pain in the previous 3 months was 63.7% (95% confidence interval, 59.5%-67.7%), at a moderate level (visual analog scale = 3.83; 95% confidence interval, 3.57-4.08). Multivariable analysis showed that back pain is associated with postural variables, sex, and age. ConclusionThe prevalence of AIS in the semiarid region of Brazil was 3.1%, and that of back pain was 63.7%. Only body mass index was different between adolescents with and without AIS, with those with AIS having a lower mean body mass index. Back pain was higher in girls and increased in older adolescents. Furthermore, behavioral and postural habits and hereditary factors were associated with an increased chance of back pain.

Neighbourhood walkability and obesity among adults in rural Japan: results from a Japanese health database.

Walkable neighbourhoods promote physical activity and prevent obesity, but there is limited evidence to inform urban planning strategies for public health within the context of rural Japan. This study describes associations between neighbourhood walkability and obesity in Toyama, a regional municipality in Japan. A cross-sectional analysis of the Toyama Prefecture National Health Insurance data (n=3454) in 2016 using Analysis of Covariance (ANCOVA) and binary logistic regression. Walk Score® was used to estimate neighbourhood walkability. Residents from highly walkable neighbourhoods generally had lower mean body mass index (BMI), but significant associations between neighbourhood walkability and BMI and prevalence of obesity were only observed in women (adjusted OR: 0.46, 95% CI: 0.26-0.80). Men below 65years old had higher obesity prevalence (adjusted OR: 1.76, 95% CI: 1.34-2.30). Daily alcohol consumption was associated with lower odds of being obese among men (adjusted OR: 0.72, 95% CI: 0.55-0.95). Hypertension, diabetes mellitus and dyslipidaemia were associated with higher obesity prevalence among residents, regardless of gender. Walkable environment may improve health outcomes for rural communities in Japan. Further studies are required to create equitable and inclusive living spaces for men and women to access healthier lifestyle choices.

VITAMIN D SERUM LEVELS IN HOSPITALIZED NON-ICU PATIENTS WITH SARS-COV-2 INFECTION

ObjectiveLow vitamin D blood levels have been linked to an increased risk of acute respiratory infections (ARIs). Taking a vitamin D supplement reduced the risk of having ARI. Non-ICU in-patients in our hospital with a vitamin D deficiency were supplemented with vitamin D.Methods and proceduresFrom March to May 2020, data of non-ICU patients with Covid-19 infection were collected at discharge. Vitamin D serum levels were assessed at admission and correlated to age, sex, Body Mass Index (BMI), length of stay (LOS) and discharge outcome. Mean and standard deviation or percentage were calculated for all data.ResultsVitamin D serum level was assessed at admission in n. 97 non-ICU patients. Most of them (80%) have a deficiency of vitamin D (< 20 ng/mL), median age is 63,7 years, 71% are men, mean BMI is 26,5, median LOS is 13,6 days (Table 1) and above 25% have a worse discharge outcome (sub-ICU, ICU or death) as shown in Table 2. Patients with a sub-obtimal vitamin D level are 14%, mostly female (64%), with a lower mean BMI (24,8), mean LOS of 15,4 days and a worse discharge outcome in 14% of cases. Only 5 patients have a sufficient vitamin D serum level, mean age of 61,2 years, mean BMI of 24,6, mean LOS of 9,2 and home discharge outcome for all of them.ConclusionLow vitamin D levels seem to correlate with a higher risk of developing the disease; supplementation of vitamin D may help in reducing the risk of ARI and improving outcome.

Return to Play After Open Calcaneoplasty for Insertional Achilles Tendinopathy With Haglund Deformity in Competitive Professional Athletes.

Background:Surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes has not been previously investigated.Purpose:To assess clinical outcomes, including return to play (RTP), after surgical treatment of insertional Achilles tendinopathy in professional athletes.Study Design:Case-control study; Level of evidence, 3.Methods:This retrospective study included 20 professional athletes who were surgically treated for insertional Achilles tendinopathy and had at least 2 years of follow-up. An open longitudinal lateral approach was used for the operation, without violation of the Achilles tendon. Outcome evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, subjective patient satisfaction, mean time of return to competition (RTC), and rate of RTP. We defined RTC as return to an official match for at least 1 minute and RTP rate as the percentage of patients who were able to participate in at least 2 full seasons. A subgroup analysis was performed to compare the RTP and no-RTP groups.Results:The AOFAS score improved significantly from preoperatively to the final follow-up (from 65.1 to 88.4; P < .001), and 75% of the patients reported good to excellent satisfaction. The mean time of RTC was 7.45 months (range, 4-18 months), and the rate of RTP was 60%. The RTP group had a significantly lower mean body mass index than did the no-RTP group (22.03 vs 23.86, respectively; P = .005) and faster mean RTC (5.0 vs 11.1 months, respectively; P < .001).Conclusion:Open calcaneoplasty for surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes should be approached cautiously. Our patients had a 7.5-month recovery period before return to their first official match, and only 60% of the patients returned to their sports activity and participated in at least 2 full seasons. Lower body mass index and a faster RTC after surgery were related to longer functional maintenance.

Exploring perioperative outcomes in metabolic and bariatric surgery amongst the elderly: an analysis of the 2015-2017 MBSAQIP database.

Metabolic and bariatric surgery (MBS) is increasingly performed in patients >65 years. Studies of perioperative outcomes have shown equivocal results. Our study objective was to explore perioperative outcomes in elderly MBS patients compared with those <65 years. Academic Hospital. Primary sleeve (SG) and gastric bypass (RYGB) cases were identified from the 2015-2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Selected cases were stratified by age (≥65 yr versus <65 yr). Univariate and multivariate logistic regression analyses were performed comparing outcomes in the elderly with the general MBS cohort. 26,557 (5.6%) of MBS cases were performed in elderly patients, who were more likely to be white, male, have a lower mean body mass index (BMI), receive a gastric bypass, and robotic-assisted surgery. Elderly patients had a significantly higher disease burden, and most outcome measures were significantly higher in elderly patients, including mortality and morbidity. On multivariate regression analyses, elderly patients undergoing SG have significantly less risk of mortality and morbidity compared with RYGB. In general, co-morbidities were in most cases more strongly predictive of complications than age alone. The number needed to harm (NNH) for overall and related morbidity were 59 and 232, respectively. Elderly MBS patients have higher disease burden and higher adverse outcomes following MBS; however, complications in this cohort remain overall rare. When performing bariatric surgery on elderly patients, procedure consideration should favor SG as RYGB is independently associated with worse outcomes.

Evolution of Cardiovascular Risk Factors in a Worker Cohort: A Cluster Analysis.

The identification of the cardiovascular risk factor (CVRF) profile of individual patients is key to the prevention of cardiovascular disease (CVD), and the development of personalized preventive approaches. Using data from annual medical examinations in a cohort of workers, the aim of the study was to characterize the evolution of CVRFs and the CVD risk score (SCORE) over three time points between 2009 and 2017. For descriptive analyses, mean, standard deviation, and quartile values were used for quantitative variables, and percentages for categorical ones. Cluster analysis was performed using the Kml3D package in R software. This algorithm, which creates distinct groups based on similarities in the evolution of variables of interest measured at different time points, divided the cohort into 2 clusters. Cluster 1 comprised younger workers with lower mean body mass index, waist circumference, blood glucose values, and SCORE, and higher mean HDL cholesterol values. Cluster 2 had the opposite characteristics. In conclusion, it was found that, over time, subjects in cluster 1 showed a higher improvement in CVRF control and a lower increase in their SCORE, compared with cluster 2. The identification of subjects included in these profiles could facilitate the development of better personalized medical approaches to CVD preventive measures.

Comparison of transversus abdominis plane catheters with thoracic epidurals for cost and length of stay in open colorectal surgeries: a cohort study

BackgroundThoracic epidural analgesia has long been a common method of postoperative analgesia for major open abdominal surgeries and is frequently used within enhanced recovery after surgery programs. An alternative postoperative analgesia method is the single shot transversus abdominis plane block, which has shown promising outcomes with respect to total length of stay, cost, pain scores, and decreased opioid usage. However, far less is known regarding continuous transversus abdominis plane analgesia using catheters. We evaluated the total cost-effectiveness of transversus abdominis plane catheter analgesia compared to thoracic epidural analgesia for patients undergoing open colorectal surgeries within the enhanced recovery after surgery program at our institution.MethodsThis cohort study included patients booked under the colorectal surgery enhanced recovery after surgery program from November 2016 through March 2018 who received either bilateral transversus abdominis plane catheters (n = 52) or thoracic epidural analgesia (n = 24).ResultsThere was no difference in total direct cost (p = 0.660) and indirect cost (p = 0.220), and median length of stay (p = 0.664) in the transversus abdominis plane catheter group compared to the thoracic epidural group. Additionally, the transversus abdominis plane catheter group received significantly less morphine equivalents compared to the thoracic epidural group (p = 0.008) and had a lower mean body mass index (p = 0.019). There was no significant difference between the two groups for age (p = 0.820), or sex (p = 0.330).ConclusionsTransversus abdominis plane catheter analgesia is not associated with increased cost or longer hospital stays when compared to thoracic epidural analgesia in patients undergoing open colorectal surgery within an enhanced recovery after surgery program. Furthermore, transversus abdominis plane catheter analgesia led to decreased opioid consumption while maintaining similar pain scores, suggesting similar pain control between the two modalities.

119 A Descriptive Epidemiological Study of Clinical Trials, Comparing Trials Targeted At Older People to Adults of All Ages

Abstract Introduction Fewer clinical trials are carried out in older people. It is unclear how representative and applicable clinical trials carried out exclusively in older people are. We compared clinical trials recruiting older people exclusively “older trials” to those recruiting adults of all ages “all age trials”, using anti-hypertensives acting on the renin-angiotensin aldosterone system (RAAS drugs) as an exemplar. Method We searched the US clinical trials register 1, to identify all trials carried out exclusively in those aged over 60. From these we selected trials of RAAS drugs. These were matched in a 2:1 ratio to trials carried out in adults of all ages. Data regarding baseline characteristics, adverse events and eligibility criteria were collected from clinical trial reports and clinicaltrials.gov. Estimated associations were calculated for age, sex and adverse events. Eligibility criteria were described and ICD- 10 coded, as appropriate. Results 71 clinical trials were carried out exclusively in older people.13 related to RAAS drugs. Participants in “Older trials” had higher mean age (73.1 and 55.9 respectively), mean difference 16.17 (CI 15.31–17.02). Older trials had fewer male participants. Participants in older trials had lower mean body mass index (BMI). A higher rate of participants in older trials experienced serious adverse events. (2.07, CI 1.55–2.75.) Few older trials had upper age limits (23.1% V 27% all age trials). All trials had exclusion criteria in multiple ICD blocks. Concurrent medications were a more common exclusion criterion in older trials (61.5% v 40.9%). Conclusions Clinical trials carried out exclusively in older people are representative in terms of age, serious adverse events and eligibility. Although there are multiple exclusion criteria for clinical trial participation in both groups, this is not prohibitive. This supports carrying out more trials exclusively in older people.

Menstrual pattern and contraceptive choices of Portuguese athletes

Objectives Menstrual symptoms are commonly cited barriers to physical activity in women. Delay or avoidance of menstruation through hormonal contraceptives may mitigate those barriers. Our purpose is to identify the uterine bleeding patterns of Portuguese athletes, their contraceptive choices and the impact of contraceptive methods in sports performance. We aim also to compare the outcomes between users and non-users of contraception. Methods Observational, descriptive and comparative study based on a customised self-assessment online survey aimed at Portuguese athletes. Athletes had to be at least 16 years old and competing at a national, international or professional level. Results A total of 256 athletes from 18 modalities were eligible. The mean age was 29 years and the mean age of menarche was 12.8 years. Monthly bleeding pattern was prevailing and 50% presented dysmenorrhoea. More than 85% experience fluctuations in sports performance throughout the month. The majority (71.5%) used contraceptive methods. Only 16% believed that contraception decreased sports performance. Contraceptive users exhibit a lower mean body mass index, blood loss and percentage of dysmenorrhoea than the non-users. Conclusion Most athletes had the perception that performance varies throughout the month. The majority of participants do not report amenorrhoea and have monthly menses. The use of contraceptive methods is reportedly high, benefit cycle control and apparently without any physical inconvenience.

895 Maternal and neonatal outcomes associated with preimplantation genetic testing in IVF twin pregnancies

The impact of preimplantation genetic testing (PGT) on pregnancy outcomes with twin gestations is not well known. The objective of this study was to determine whether PGT is associated with adverse maternal and neonatal outcomes in twin pregnancies conceived using vitro fertilization (IVF). Retrospective cohort of multiple gestations conceived via IVF and delivered within a university health system between January 2014 and August 2019. Higher-order multiple gestations (triplet or higher) and cases with missing outcome data were excluded. Adverse maternal outcomes, i.e. hypertensive disorders of pregnancy, abnormal placentation, preterm birth, and adverse neonatal outcomes were compared between twin pregnancies conceived after transfer of one or two PGT screened euploid embryos versus untested embryos. Statistical analysis included use of Chi-square and Wilcoxon rank sum tests, as well as multivariate backwards-stepwise logistic regression, with significance defined as P value < 0.05. Data was presented as adjusted Odds Ratios (OR) with 95% confidence intervals (95% CI). Of 145 twin pregnancies, 43 (29.7%) were conceived following euploid embryo transfer and 102 (70.3%) were conceived following untested embryo transfer. Women who underwent PGT had a significantly lower mean body mass index compared to those that did not (Table 1). Use of donor egg and IVF cycle type (fresh vs. frozen) also differed between the two groups (Table 1). After adjusting for potential confounders, there was no significant difference between the two groups with respect to adverse maternal outcomes or in adverse neonatal outcomes (Table 2). Our data suggest no increase in adverse maternal or neonatal outcomes associated with PGT in twin IVF pregnancies. While our findings are reassuring, future studies utilizing larger cohorts of twin pregnancies are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

690 Are participants in obstetrical randomized clinical trials representative of the United States pregnant population?

Since the obstetric outcomes vary among different racial-ethnic groups, we sought to ascertain, how demographics of individuals enrolled in randomized clinical trials (RCT) vary from that of the US. The objective of this study was to determine if the demographic data of participants in obstetrical RCTs reflects the demographics of pregnant women in the United States. This was a review of demographic data in obstetric RCTs published between January 1, 2018, and December 31, 2019, in six journals (American Journal of Obstetrics and Gynecology, American Journal of Perinatology, JAMA, the Lancet, New England Journal of Medicine, Obstetrics and Gynecology). Results were compared to U.S. population data from the National Vital Statistics Databases, 2018. Standardized differences (SD) were calculated and an absolute SD of ≥ 15% was considered clinically significant. 35,880 studies were screened in the six selected journals. Of the 100 RCTs identified in this study, 76 reported, at least in part, demographic data of participants. White women were overrepresented with an SD of 19.4% compared to the national average, while those of Hispanic Ethnicity were underrepresented (SD -43.6%). Participants in RCTs had a lower mean body mass index and a lower proportion were complicated by obesity. Less than 50 studies reported comorbidities of smoking, hypertensive disorders, or diabetes; all were more prevalent among study participants than the baseline population (Table 1). Geographically, 13 states encompassing 26.9 million people did not have any clinical sites participating in RCTs in obstetrics. In the United States, the study participants in obstetric RCTs differ significantly from the demographics of pregnant women in the United States.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Trends of biomarkers of cardiovascular disease in the United States by income: Disparities between the richest 20% and the poorest 80%,1999-2018.

IntroductionIncome inequality between the richest 20% and the poorest 80% in the United States has been increasing over the past two decades. Emerging evidence indicates widening disparities between the two groups in cardiovascular disease prevalence as well. However, the mechanisms behind this trend remains unclear. This analysis examines whether a similar trend exists in the levels of biomarkers and risk factors of cardiovascular disease in the United States.MethodsWe conducted a serial cross-sectional analysis of a nationally representative data from the National Health and Nutrition Examination Survey (NHANES) for participants age 20 or older between 1999 and 2018. We calculated trends in age-standardized means of body mass index (BMI), systolic blood pressure (SBP), and high-density lipoproteins (HDL) and the trend in prevalence of obesity, high SBP, and low HDL by income group.ResultsThis analysis included 49,764 participants. Age-standardized mean BMI increased every two years by an average of 0.15 kg/m 2 among the richest 20% and by an average of 0.21 kg/m 2 among the poorest 80%. Age-standardized mean SBP decreased every two years by an average of 0.13 mm Hg among the richest 20% and by an average of 0.10 mm Hg among the poorest 80%. Age-standardized mean HDL increased every two years by an average of 0.39 mg/dL among the richest 20% and by an average of 0.19 mg/dL among the poorest 80%. When adjusted for demographic factors and time, the richest 20% had lower mean BMI (OR = −0.67, 95% CI: −0.89, - 0.44), lower mean SBP (OR = −0.72, 95% CI: −1.24, −0.20), and higher mean HDL (OR = 3.04, 95% CI: 2.46, 3.62) compared to the poorest 80%ConclusionThere are increasing disparities in cardiovascular disease biomarkers by income in the US. Between 1999 and 2018, improvement in biomarkers overwhelmingly occurred among the richest 20%

A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients

BackgroundDifferences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI.MethodsA total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression.ResultsWomen represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE.ConclusionOur study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.

Avaliação antropométrica e sintomas gastrointestinais de pacientes em tratamento oncológico em uma cidade do interior de São Paulo

Introduction: Cancer and its treatment modalities have a negative impact on the nutritional status of patients. The purpose of this study is to evaluate anthropometric measurements and the presence of gastrointestinal symptoms in patients undergoing cancer treatment. Methods: This is a study carried out with 50 patients over 18 years of age undergoing cancer treatment. For anthropometric assessment, weight and height measurements were performed to calculate the body mass index (BMI) and the measurements of the adductor pollicis muscle thickness (APMT), arm (AC) and calf (CC) circumference, in addition to the triceps skin fold (TSF). Gastrointestinal symptoms were questioned in an interview. Results: Most participants were female (72%), aged 60 years or over. According to the BMI, 46% of the patients were overweight. The lowest mean BMI was found in individuals with colon and rectal neoplasia (23.2 ± 3.9 kg/m²) and this measure was correlated to the other anthropometric measures: AC (r = 0.84; p = 0.001); CC (r = 0.75; p = 0.009) and TSF (r = 0.72; p = 0.012). APMT revealed 92% of inadequacy, while AC and CC measurements indicated 40% and 24% of inadequacy, respectively. The most prevalent gastrointestinal symptoms were: hyporexia, nausea, vomiting, diarrhea and constipation. Conclusion: The present study identified a high prevalence of nutritional risk, characterized by excess weight and muscle depletion, in patients undergoing cancer treatment. Patients with colorectal cancer had their nutritional status even more impaired and a higher frequency of gastrointestinal symptoms.

Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study

BackgroundMalnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.MethodsThis was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software.ResultsOf the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%).Long-term haemodialysis (> 4 years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p < 0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01–0.97), p < 0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS.ConclusionMalnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

Incidence of Unintentional Intraoperative Hypothermia in Pediatric Scoliosis Surgery and Associated Preoperative Risk Factors.

Introduction Intraoperative hypothermia is associated with perioperative complications such as blood loss and wound infection. Thus, perioperative heat retention methods to prevent perioperative hypothermia such as providing a warmed blanket and active patients' warming are important. Although major surgery and pediatric patient age are noted as risk factors, only a few studies focus on hypothermia as an intraoperative complication in pediatric scoliosis surgery. The aim of this study is to investigate the incidence of intraoperative hypothermia in pediatric scoliosis surgery and the associated preoperative risk factors. Methods We retrospectively reviewed the records of pediatric patients who underwent posterior spinal fusion at a single institution between 2015 and 2019. We recorded the background data, perioperative data, lowest recorded core temperature, and perioperative complications. Patients were divided into those whose temperature decreased below 36°C (Group H) and those who maintained a temperature of 36°C or greater (Group N) during surgery. We compared the two groups and performed multivariate analysis to identify preoperative risk factors for intraoperative hypothermia. Results A total of 103 patients underwent posterior spinal fusion; 56 for adolescent idiopathic scoliosis and 47 for neuromuscular scoliosis. Hypothermia was observed in 40 patients (38.8%). Group H had more non-adolescent idiopathic scoliosis (AIS) patients, lower mean body mass index, greater mean blood loss, greater number of fused vertebrae, larger preoperative Cobb angle, and lower initial core body temperature (immediately after induction of anesthesia). On multivariate analysis, a diagnosis of neuromuscular scoliosis, a lower body mass index, and a lower initial core body temperature were identified as independent risk factors for intraoperative hypothermia. Conclusions The incidence of hypothermia in pediatric posterior scoliosis surgery is 38.8%. Diagnosis of non-AIS, lower body mass index, and lower core body temperature at the time of anesthesia induction are preoperative risk factors for intraoperative hypothermia.

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

SummaryBackgroundComparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents.MethodsFor this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence.FindingsWe pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls.InterpretationThe height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks.FundingWellcome Trust, AstraZeneca Young Health Programme, EU.

Consumption of Dried Fruits Is Associated with Greater Intakes of Underconsumed Nutrients, Higher Total Energy Intakes, and Better Diet Quality in US Adults: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey, 2007-2016

BackgroundDried fruits are shelf-stable alternatives to fresh fruit that avert common barriers to consuming fruit. Consumption of dried fruits may facilitate greater fruit consumption and contribute to better diet quality and nutrient intakes. ObjectiveOur aims were to assess differences in diet quality and cardiometabolic health between dried fruit consumers and nonconsumers, and evaluate differences in nutrient intakes on days when dried fruits were consumed vs not consumed. DesignThis is a cross-sectional analysis of data from the National Health and Nutrition Examination Survey 2007-2016. Participants/settingMean dried fruit intakes were estimated in adults 20 years and older (n = 25,590) who completed a dietary recall. Dried fruit consumers (one-quarter cup-equivalent/day or more) were defined in respondents with 2 complete dietary recalls (n = 22,311). Within-person differences in nutrient intakes were assessed in respondents who consumed dried fruit on 1 of 2 dietary recalls (n = 1,233). Main outcome measuresCardiometabolic risk factors, diet quality scored using the Healthy Eating Index 2015, and nutrient intakes were assessed. Statistical analysesDiet quality and cardiometabolic health were compared in consumers vs nonconsumers using multivariate linear regression, adjusted for demographic and lifestyle factors. Within-person differences in nutrient intakes on days when dried fruits were consumed vs not were assessed using multivariate linear regression. ResultsMean ± standard error dried fruit intake was 0.04 ± 0.001 cup-equivalents and represented 3.7% of total fruit consumed. Consumers (7.2% of adults) had higher quality diets than nonconsumers (mean ± standard error Healthy Eating Index 2015 score = 60.6 ± 0.5 vs 52.6 ± 0.3; P < 0.001) and lower mean body mass index, waist circumference, and systolic blood pressure (P < 0.01). Total carbohydrate, dietary fiber, potassium, and polyunsaturated fat intakes were greater on days when dried fruits were consumed vs not consumed (P < 0.001). Total calorie intakes were also greater (208-215 kcal; P ≤ 0.002) when dried fruits were consumed. ConclusionsDried fruit consumption is associated with higher diet quality and greater intakes of underconsumed nutrients. However, dried fruits do not appear to displace other calorie sources on days when consumed.

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series.

The use of spinal anesthesia (SA) as opposed to general anesthesia (GA) during elective lumbar spine surgery is an emerging technique and represents a potentially modifiable factor to limit perioperative complications. Few studies, however, have compared these anesthetic techniques in an elderly population. The aim of this study is to determine if SA is a safe alternative to GA for lumbar spine surgery in elderly patients. A retrospective, consecutive case series study was performed. All patients aged 70 years and older who underwent lumbar spine decompression or combined decompression and fusion using either SA or GA during a 2-year period at a single institution were identified. Demographics and perioperative outcomes were compared. Of all patients meeting the inclusion criteria, 56 patients (19%) received SA and 239 (81%) received GA. Patients receiving SA were slightly older (median age, 77 years versus 75 years, P = .002), consisted of more men (57% versus 36%, P = .01), and had a lower mean body mass index (28.3 versus 30.1, P = .03). Indications for surgery and type of surgery were similar between groups. On average, operative times with SA were 101 minutes versus 103 minutes with GA (P = .71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (β = -75 mL; 95% confidence interval [CI], -140.6, -9.4; P = .025) and intraoperative intravenous fluid requirements (β = -205 mL; 95% CI, -389.4, -21.0; P = .029), shorter postanesthesia care unit stays (β = -41 minutes; 95% CI, -64.6, -16.9; P = .001), lower maximum visual analog scale pain scores (β = -0.89 points; 95% CI, -1.6, -0.1; P = .020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P = .45); there were no significant differences in operative time, length of stay, nausea, or oral morphine equivalents consumed per day. Complication rates were similar between groups. Spinal anesthesia is a reasonable, safe alternative to general anesthesia for lumbar spine surgery in elderly patients with degenerative conditions.