Main Risk Factors Research Articles

Increased incidence of ischemic stroke in young: A population-based stroke registry study from 2008 to 2018

BackgroundStudying changing patterns in stroke incidence is essential since strokes represent a burden for public health. The aim of our study was to evaluate the epidemiological trend of strokes from 2008 to 2018 in the population-based Brest Stroke Registry (BSR) focusing on patients under 60. MethodsAll first-ever-stroke, patients aged 15 and older, with imaging, in the Pays-de-Brest from January 1st 2008 to December 31st 2017 were included. Cumulative incidence was calculated, by periods of two years, and temporal trends were evaluated by age group, sex, stroke subtype (ischemic or hemorrhagic) using a Poisson regression. Trends in stroke variables were specifically studied for young people. Ischemic stroke mechanism subtypes were analysed according to TOAST and SSS-TOAST classifications. ResultsOver a 10-year study period, there were 6043 first-ever-strokes: 738 intracerebral hemorrhage (ICH) and 5305 ischemic strokes (IS). Mean age was 73.55±14.25years, 82.2% were older than 60 and 51.8% were women. IS incidence increased in young people from 30.4 [95% CI: 27.4; 33.8] to 37.3 [95% CI: 33.9; 41.0] per 100,000 inhabitants (P=0.0025). IS incidence≥60 decreased except for last studied period. ICH remained stable for older people but decreased in young from 5.6 [4.3; 7.1] to 2.8 [2.0; 4.0] per 100,000 inhabitants (P=0.0250). Under 60, the main risk factors were smoking (68.6%); hypertension (27.8%); high-alcohol intake (24.4%) and dyslipidemia (21%). Most IS were minor. Work-up in the IS young population was for the large majority brain magnetic resonance imaging (MRI) (74.5%); cardiac monitoring (80%): echocardiography (83.5%); and imaging of the neck vessels (89.9%). Among IS, 19.8% were taking antihypertensive drugs and 10.9% statins. According to the TOAST classification, there were 46.7% cryptogenic strokes, which was reduced to 25.5% for other cryptogenic strokes, and 2.3% for cryptogenic embolism according SSS-TOAST classification. In IS, risk profiles, clinical parameters and prior-stroke treatments did not significantly change. Dyslipidemia and use of statins were fluctuant. Diagnostic work-up improved but the frequencies of IS mechanism subtypes remained stable. ConclusionIS incidence increased while ICH incidence declined in young people. Major use of MRI may have contributed to the IS trend. The traditional risk factors studied remained stable and did not explain the increase in IS incidence. Improvement in diagnostic work-up did not lead to any change in subtypes of stroke mechanisms. Using the SSS-TOAST classification reduced the rate of cryptogenic strokes. The role of non-traditional risk factors may be explored in an attempt to explain increased incidence.

Frequency and Risk Factors of Surgical Site Infection with and without Antibiotic Prophylaxis in Adults Undergoing Minor Trauma Surgery

Background: Trauma surgeons are more likely to experience surgical site infections (SSI). Preoperative antibiotic prophylaxis was a common strategy in trauma procedures. This research aimed to determine the frequency and risk factors of surgical site infection with and without antibiotic prophylaxis in adults undergoing minor trauma surgery. Methods: A descriptive cross-sectional investigation was carried out. The surgical emergency and trauma units at Jinnah Hospital and THQ Hospital DGK provided the data for this investigation. Data from 190 patients were gathered and divided into two groups. Before surgery (Group A) took antibiotic prophylaxis while Group B did not. Standard surgical protocols were followed during the surgical operation. Patients were checked for postoperative fever, surgical site infection, and discharge at the incision site. On the third, seventh, and twelfth postoperative days, the wound was checked. The chi-square test was used for analysis and P<0.05 was considered significant. Results: Surgical site infections (SSI) occurred in 18 patients out of 190 patients, with 6 (6.3%) patients from group A and 12 (12.6%) from group B. Two (2.1%) of the patients in Group A who developed SSI were female, whereas no female patients in Group B experienced it. Contaminated wounds, diabetes, and improper surgical site cleaning were the three main risk factors for SSI in minor trauma cases. Conclusion: The study found that the use of prophylactic antibiotics in minor trauma cases performed in adult patients significantly decreases the incidence of SSI.

The Multiple Faces of Lung Adenocarcinoma: Challenges in Diagnosis

Abstract Lung cancer dominates the current picture of malignancies worldwide, remaining a tragic first place in mortality statistics. Despite the continuous improvements in lung cancer screening, the refinement of surgical techniques, and innovations in oncological treatments, lung cancer remains the main contributor to fatalities among all forms of neoplastic conditions.(1,2) Lung adenocarcinoma is not just one of the most common histological types of lung cancer but also one of the deadliest high heterogeneity. Smoking worldwide due to its late diagnosis and tobacco is one of the main risk factors for any lung cancer, including adenocarcinoma, but there are also other factors that can increase the risk, such as family history of lung cancer and professional exposure to noxious agents such as silica, asbestos, radon, heavy metals, and diesel fumes . (3) Therefore, through this case series report the authors attempt to present their experience with three cases with a broad range of differences such as past medical history, living and work conditions, and other vicious habits such as smoking. This paper strives to establish the potential faces that lung adenocarcinoma can adopt, disguising itself under the umbrella of many other lung parenchymal syndromes, mimicking non-malignant processes, often displaying features very similar to an infection, and misdiagnosed as pneumonia, thereby delaying the diagnosis. Additionally, we provide a brief synthesis of the best resources available in lung adenocarcinoma-specific literature, including the importance of distinguishing early signs and symptoms, medical imaging, differential diagnosis, and early treatment.

The Role of GABA in the Dorsal Striatum-Raphe Nucleus Circuit Regulating Stress Vulnerability in Male Mice with High Levels of Shati/Nat8l.

Depression is a frequent and serious illness, and stress is considered the main risk factor for its onset. First-line antidepressants increase serotonin (5-hydroxytryptamine; 5-HT) levels in the brain. We previously reported that an N-acetyltransferase, Shati/Nat8l, is upregulated in the dorsal striatum (dSTR) of stress-susceptible mice exposed to repeated social defeat stress (RSDS) and that dSTR Shati/Nat8l overexpression in mice (dSTR-Shati OE) induces stress vulnerability and local reduction in 5-HT content. Male mice were used in this study, and we found that dSTR 5-HT content decreased in stress-susceptible but not in resilient mice. Moreover, vulnerability to stress in dSTR-Shati OE mice was suppressed by the activation of serotonergic neurons projecting from the dorsal raphe nucleus (dRN) to the dSTR, followed by upregulation of 5-HT content in the dSTR using designer receptors exclusively activated by designer drugs (DREADD). We evaluated the role of GABA in modulating the serotonergic system in the dRN. Stress-susceptible after RSDS and dSTR-Shati OE mice exhibited an increase in dRN GABA content. Furthermore, dRN GABA content was correlated with stress sensitivity. We found that the blockade of GABA signaling in the dRN suppressed stress susceptibility in dSTR-Shati OE mice. In conclusion, we propose that dSTR 5-HT and dRN GABA, controlled by striatal Shati/Nat8l via the dSTR-dRN neuronal circuitry, critically regulate stress sensitivity. Our study provides insights into the neural processes that underlie stress and suggests that dSTR Shati/Nat8l could be a novel therapeutic target for drugs against depression, allowing direct control of the dRN serotonergic system.

О необходимости соблюдения индивидуального подхода при маршрутизации пациентов с атеросклерозом брахиоцефальных артерий в рамках проекта «Здоровая Москва».

During the implementation of the program, up-to-date data were obtained on the state of the cardiovascular system, the main risk factors for stroke, especially among middle-aged able-bodied people who had a new coronavirus infection COVID‑19. An assessment was made of the dynamics of populations undergoing preventive examinations in the format of field medical care, the most common diseases, including pathologies of the BCA. A database has been created for long-term monitoring of the incidence of cardiovascular diseases in the population and the prevention of BCA pathologies and stroke. The routing of patients with BCA pathologies was developed based on the analysis of many years of practical experience in providing specialized medical care to patients with pathology of the precerebral arteries in medical organizations of the Moscow public health system. Routing of patients within the framework of this project, based on a specially developed methodology, an integrated approach to treatment with preliminary training of medical personnel in the ultrasound technique for measuring carotid artery stenosis according to the European ECST scale, a clear algorithm and mechanisms for working with patients within the framework of intersectoral activities, allows to reduce the incidence of stroke and mortality. Successful strategies to expand screening of patients with BCA pathology implemented in the «Healthy Moscow» project require further study to evaluate the effectiveness of specific stroke prevention mechanisms.

Индивидуализированный подход к формированию групп повышенного онкологического риска на основании оценки иммунологических показателей у хронически облученных людей

Introduction 1. Main risk factors of radiation-induced carcinogenesis 2. Stages of an individualized approach to the formation of high-risk groups for cancer 3. Comprehensive medical examination of a patient 4. Determination of risk of radiation-induced carcinogenesis 5. Measures for prevention and (or) early diagnosis of radiation-induced malignant neoplasms 6. Monitoring of immunity indicators in persons at high risk of radiation-induced carcinogenesis Conclusion

Épidémiologie du cancer du poumon en France: Epidemiology of lung cancer in France

With almost 50,000 new cases and 30,000 deaths per year in France, lung cancer is the 3rd most common cancer and the 1st cause of cancer-related death. While incidence and mortality rates in men have stabilized, they are demonstrating an alarming growth in women, linked to the increase in female tobacco consumption. The 5-year survival rate for lung cancers has increased considerably, from 9% in 1990 to 20% for people diagnosed between 2010 and 2015. While smoking is indeed the main risk factor for lung cancer, responsible for 81% of cases, the risk factors and exposures are numerous, such as a diet low in fruit <300g/day (10% of cases), occupational exposures (16% of cases), and environmental exposures, such as radon (almost 10% of cases) and outdoor air pollution (3.6% of cases). The proportion of environmental exposures being probably underestimated. Combined, close to 90% of lung cancer cases are attributable to modifiable factors, offering numerous levers for prevention policies.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Prevalence, severity, and risk factors of allergic rhinitis among schoolchildren in Saudi Arabia: A national cross-sectional study, 2019

BackgroundAllergic rhinitis is a significant public health concern worldwide, affecting both developed and developing countries, with prevalence rates ranging between 10% and 30% in adults and over 40% in children. However, there are limited studies on allergic rhinitis prevalence in Saudi Arabia. ObjectiveTo explore allergic rhinitis among schoolchildren in Saudi Arabia in terms of prevalence, severity, and risk factors. MethodsThis study was conducted between March and April 2019, covering 20 regions. The study employed a multistage, stratified cluster sampling approach and selected 137 primary and 140 intermediate schools. The research utilized the methodology and questionnaires recommended by the Global Asthma Network (GAN). Data analysis was carried out using IBM SPSS Statistics (Version 23). ResultsThe completed questionnaires in the analysis comprised 3614 children aged 6–7 years old and 4068 adolescents aged 13–14 years old. The study found that 5.6% of children and 14.0% of adolescents reported current rhinoconjunctivitis, with 0.5% of children and 1.3% of adolescents experiencing severe symptoms. Several risk factors were significantly associated with rhinoconjunctivitis. In children 6–7 years old, eating cooked vegetables was inversely associated with rhinoconjunctivitis, while prematurity, wheezing in infancy, and a history of pneumonia were positively associated with the condition. In adolescents, vigorous physical activity, current exposure to cats, and frequent use of paracetamol were found to be the main risk factors associated with rhinoconjunctivitis, while high consumption of pulses and eggs was found to have a protective effect. ConclusionIn Saudi Arabia, the prevalence of rhinoconjunctivitis in children is lower than average globally, but among adolescents, it is within the global average range. However, the prevalence of severe rhinoconjunctivitis among adolescents is twice the global average. Further research is required to examine regional differences, track trends over time, and explore risk factors that contribute to allergic rhinitis.

Risk Factors for Granulomatous Mastitis and Establishment and Validation of a Clinical Prediction Model (Nomogram).

This study aimed to explore the risk factors and clinical characteristics of granulomatous mastitis (GM) using a case-control study and establish and validate a clinical prediction model (nomogram). This retrospective case-control study was conducted in three hospitals in China from June 2017 to December 2021. A total of 1634 GM patients and 186 healthy women during the same period were included and randomly divided into the modeling and validation groups in a 7:3 ratio. To identify the independent risk factors of GM, univariate and multivariate logistic analyses were conducted and used to develop a nomogram. The prediction model was internally and externally validated using the Bootstrap technique and validation cohort. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the prediction model. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical significance of the model. The average age of GM patients was 33.14 years (mainly 20-40). The incidence was high within five years from delivery and mainly occurred in the unilateral breast. The majority of the patients exhibited local skin alterations, while some also presented with systemic symptoms. On multivariate logistic analysis, age, high prolactin level, sex hormone intake, breast trauma, nipple discharge or invagination, and depression were independent risk factors for GM. The mean area under the curve (AUC) in the modeling and validation groups were 0.899 and 0.889. The internal and external validation demonstrated the model's predictive ability and clinical value. Lactation-related factors are the main risk factors of GM, leading to milk stasis or increased ductal secretion. Meanwhile, hormone disorders could affect the secretion and expansion of mammary ducts. All these factors can obstruct or injure the duct, inducing inflammatory reactions and immune responses. Additionally, blunt trauma, depressed mood, and diet preference can accelerate the process. The nomogram can effectively predict the risk of GM.

Risk Factors of Acute Coronary Syndrome: The Experience from Iran

Aims: This study was conducted with the aim of identifying the risk factors of coronary artery disease in patients referred to Imam Khomeini Hospital in Jiroft. Background: Acute coronary syndrome (ACS) is a spectrum of symptoms compatible with acute myocardial ischemia. Understanding these factors can have an effective impact on the prevention, diagnosis, and management of ACS. Methods: This is a descriptive study. Participants in this study were all patients diagnosed with acute coronary syndrome and acute myocardial infarction in 2020. Data collection was done by reviewing patients' clinical records. Data analysis was performed by SPSS version 21. Results: Out of a total of 228 patients, 149 (65%) were male and 79 (35%) were female. 88% of patients complained of heart pain upon arrival, 43% had a history of drug abuse, 98.2% had retrosternal pain, 48.1% had an average length of hospitalization of four days, 32% were under ischemic treatment, and 68% were under ischemic treatment. They were on thrombolytic therapy. The majority of patients (65.1%) had an EF greater than 40%. 13.9% mortality, 18.9% discharge with survival and recovery, 62.7% recovery and referral to a higher center to complete treatment and angiography, and 4.5% leaving the hospital with It was personal satisfaction. Conclusion: The main risk factors related to chest pains in the Jiroft region and the reason for more patients going to the hospital include hypertension, high blood sugar on arrival, low WMR, high BMI, drug abuse, leukocytosis, and non-compliance with post-treatment recommendations.

Schistosoma haematobium infection and morbidity risk factors for pre-school age children in western Angola: A knowledge, attitudes and practices survey.

Urogenital schistosomiasis is one of the most prevalent parasitic diseases in sub-Saharan Africa. It is a poverty-related disease conditioned by behavioural practices. Our objective is to evaluate the awareness, mindset and habits about urogenital schistosomiasis in the community of Cubal (Angola), as well as its association with infection and urinary tract morbidity in pre-school age children. A cross-sectional study of knowledge, attitudes and practices at home was conducted between February and May 2022 with 250 participants. Overall, 93.6% of those surveyed had some prior knowledge about schistosomiasis and, among all the symptoms associated with this disease, blood in the urine was the best known (54.4%). Nevertheless, 57.6% obtained a medium knowledge score. Regarding attitude, the majority of respondents had a high attitude score (79.2%) with 96.0% willing to participate in mass drug administration campaigns. Laundry in the river was the most common risk practice (61.2%) and 55.2% out of the total were classified with a low practice score. Low knowledge about symptoms and transmission by caregivers was the outstanding risk factor for infection in pre-school age children (OR = 16.93, 95%CI: 3.93-72.82), and lack of knowledge that avoiding entering the river prevents schistosomiasis was the main risk factor for morbidity in PSAC (OR = 8.14, 95%CI: 1.14-58.25).

Risk Analysis and Study of Post-marketing Adverse Events for Absorbable Sutures

Objective To investigate, analyze, and evaluate the risk data associated with the clinical use of absorbable sutures by retrieving and summarizing information from the databases of the US FDA and CNKI, as well as the adverse event reports related to absorbable sutures from January 2019 to October 2022 within Zhejiang province. The adverse event reports are obtained from both incident locations and monitoring organizations affiliated with the registrant. The aim is to identify the main risk factors associated with the clinical use of absorbable sutures. The key risk factors are potential product quality defects, product design and material selection, clinical selection and application, and postoperative recovery care including patient's self-care. Risk control strategies are further proposed to reduce or minimize the risk of adverse events caused by this product.

The role of folate in the management of insulin resistance in adults : a systematic review

Insulin resistance (IR) is one of the main risk factors for type 2 diabetes. IR employs a heavy economic burden, and the prevalence rate of IR in Indonesia is high. Homeostasis model of assessment-insulin resistance (HOMA-IR) is proven to be a great clinical tool to assess IR. Nutrition intervention should be the primary focus in treating IR. Folate is proven to be effective in lowering homocysteine concentrations, which is one of the risk factors for IR. This study aimed to summarize the role of folate in the management of IR in adults.

Delirium and subsyndromal delirium in the intensive care unit: In-hospital outcomes and prognosis at discharge

Background and objectiveThe characteristics and outcomes of patients with subsyndromatic delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirum and SSD in the intensive care unit care (ICU), to analyze the association with risk factors and to explore outcomes of delirium and subsyndromal delirium (SSD) at hospitalization and three months after discharge. Patients and methodsA prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU. Results22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age≥75 years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (0.017), ARM (P=.001) and fast (P=.028) and with the development of SSD were low schooling (P=.014), charlson>5 (P=.028), AIVD<8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1−2) days in the group without delirium, 3 (IQR, 2−4) days in SSD (P=.0001), and 3 (IQR, 2−7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005). ConclusionsThe SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification.

К ВОПРОСУ О РОЛИ ПСИХОСОЦИАЛЬНЫХ ФАКТОРОВ НА ЗДОРОВЬЕ РАБОТАЮЩЕГО НАСЕЛЕНИЯ С ПОЗИЦИЙ ПРОМЫШЛЕННОЙ И ВОССТАНОВИТЕЛЬНОЙ МЕДИЦИНЫ

The article contains data from a review of foreign literature on the prevention of diseases of the working population from the perspective of industrial and restorative medicine. Scientists have identified the most significant measures as: impact on the social determinants of mental health (standard of living and working conditions; measures to prevent and promote health and mental health, including measures to reduce stigma and discrimination; increasing access to evidence-based care through the development of services occupational health and safety, including access to industrial and restorative medicine services. Work intensity is most often considered the main risk factor for constant stress in the workplace/production place, as it correlates with the body's reactions to the adverse effects of production factors. Analysis of the combination of high production demands with social vulnerability at work/work with symptoms of depression and/or anxiety showed a high risk of mental disorder depending on psychosocial factors, regardless of the social status, health status, verbal intelligence and personal qualities of the employee. There is a need for closer attention to issues of gender selection in various professions as part of the study of the gender aspect as a social determinant of health in the context of maintaining/restoring the health of workers. The discrepancy between the efforts made and the rewards received at work is another psychosocial factor that negatively affects the mental health of the population, which also contributes to the abuse of alcohol and various medications that affect cognitive abilities, and reduces the quality of sleep. High personal self-esteem is thought to be a protective resource that reduces the risk of psychological distress, but there is a paucity of research linking self-esteem to neurobiological adaptability.

Risk factors for Microtia and preventive approaches

Microtia is a congenital anomaly that directly affects the external ear. Although the etiology of this pathology is not fully elucidated, there are several factors that are associated with its occurrence, such as genetics, perinatal and maternal conditions. During organogenesis of the outer ear it is important to mention that as anomalies occur before the sixth week of pregnancy, the chances of severe defects or total absence of the outer ear increase. At the genetic level, the etiology of microtia has been related to multiple causes, as well as the identification of genes involved in allelic expression pathways and transcription factors. Furthermore, this anomaly does not always occur alone, but associated with other pathologies such as cleft palate (12.8%), cleft lip and palate (11.5%), anophthalmia/microphthalmia (11.5%), facial asymmetry (10.6%), as well as oculoauriculovertebral spectrum syndromes, Goldenhar syndrome, craniofacial microsomia, Treacher Collins syndrome, Nager, DiGeorge or 22q deletion, Townes-Brock syndrome and branchi oto-renal syndrome. Treatments are based on the aesthetic management of the patient, but also related to the improvement of the patient's hearing ability. Epidemiologically, the prevalence ranges from 0.8 to 17.5 per 10,000 live births. One of the main risk factors for variation in case identification is altitude, genetics and maternal-perinatal factors. This literature review provides a thorough analysis of information for the better understanding, analysis and clinical management of this congenital anomaly.

The Prophylactic Effect of Eucheuma spinosum on Total Blood Cholesterol Levels in Rattus norvegicus Dexamethasone-Induced

Hyperlipidemia is one of the main risk factors for heart disease caused by the formation of atherosclerosis. Eucheuma spinosum contains a natural antioxidant flavonoid, which has an antiatherogenic effect that can inhibit the formation of cholesterol in the liver so that it can prevent the development of atherosclerosis. This study aims to determine the effect of prophylactic administration of Eucheuma spinosum on the total cholesterol levels of Rattus novergicus induced by dexamethasone. This study was an experimental design with a post-test-only control group design. This study would use 24 white male Rattus norvegicus divided into three groups; a negative control group (K-) without treatment, a positive control group (K+) induced dexamethasone 8 mg/Kg BW on day 14 until day 20, treatment group (KP) given Eucheuma spinosum extract 200 mg/Kg BW on day 8 until day 20 as Prophylactic and on day 14 until day 20 induced dexamethasone 8 mg/Kg BW. After completing the treatment period, all groups were terminated and taken total calculation of cholesterol levels through the aorta of rats. Data was analyzed statistically computerized. The results of the study of total cholesterol levels that used Kruskal-Wallis test showed differences between groups (p&lt;0.001). There was a decrease in total cholesterol levels in the treatment group (p&lt;0.024) compared with the positive control group. The administration of Eucheuma spinosum extract as a prophylactic dose of 200 mg/Kg BW for 14 days could reduce the total cholesterol level of Rattus norvegicus induced by dexamethasone compared to those not given Eucheuma spinosum extract.

Risk factors for coagulation inhibitor development in children with severe hemophilia A

Aim of the study: to examine the role of potential risk factors in inhibitor development in previously untreated patients (PUPs) (or minimally treated patients) with severe hemophilia A. The study was approved by the Independent Ethics Committee and the Scientific Council of the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology (the Republic of Belarus). The study included 89 boys who underwent regular follow-up for severe hemophilia A at the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology (the Republic of Belarus) from 1998 to 2022. The median age (10th–90th percentile) at diagnosis of hemophilia was 8.0 (1.0–21.0) months, the baseline factor VIII activity was 0.7% (0.4–0.95%). Age at first exposure to factor VIII concentrate was 11.0 (1.0–31.0) months. Out of 89 patients, 23 children had severe hemophilia A with inhibitors. The cumulative incidence of inhibitors in the whole group of PUPs was 31.0 ± 5.6%. The cumulative incidence of hemophilia A with inhibitors was higher in the patients with null mutations (37.0 ± 6.9%) than in the patients with non-null mutations (6.5 ± 6.0%) (the log-rank test, p = 0.041). The use of plasma-derived FVIII concentrate (approved for use in neonates and for prophylaxis) from one manufacturer was associated (c2 = 8.53; p = 0.004) with a lower incidence of factor VIII inhibitors (up to 21.3 ± 8.5%) compared with the incidence in the group of patients treated with FVIII concentrates from different manufacturers (45.2 ± 7.8%). Age (&gt; 1 year old or &lt; 1 year old) at first exposure to FVIII had no effect on the formation of inhibitors (the log-rank test, p = 0.746). Such factors as age at diagnosis of hemophilia (odds ratio (OR) 0.99; 95% confidence interval (CI) 0.93–1.024; p = 0.991) and baseline factor VIII activity (OR 0.99; 95% CI 0.8–1.06; p = 0.09) were not associated with inhibitor development. The first measurements of activated partial thromboplastin time (APTT) ratio (patient APTT value over the APTT reference value) (OR 1.89; 95% CI 0.72–5.09; p = 0.21) and FVIII recovery in vivo (OR 0.74; 95% CI 0.27–2.01; p = 0.55) were not associated with inhibitor development either. We have confirmed that one of the main risk factors for FVIII inhibitor development is F8 gene mutations. The incidence of inhibitors among the patients who received plasma-derived FVIII concentrates (recommended for use in PUPs in the neonatal period) from one manufacturer was lower than among those who received FVIII from different manufacturers.

Medium-term clinical and radiographic outcomes of a cementless prosthesis with a 140° neck–shaft angle in reverse total shoulder arthroplasty

The design of humeral implants has evolved from the initial Grammont design, notably regarding the neck-shaft angle (NSA) and through the use of cementless prostheses. Stress shielding was frequently reported with cementless implants, the 2 main risk factors being humeral stem misalignment and high filling ratios. Our hypothesis was that standard length cementless stems with an NSA of 140° would facilitate good alignment with moderate filling ratios, thereby limiting stress shielding and ensuring good clinical outcomes. A single-center retrospective study was conducted of patients who underwent reverse total shoulder arthroplasty between January 2015 and August 2017, with at least 2 years' follow-up. Clinical evaluations included range of motion measurements and Constant and subjective shoulder values scores. Frontal alignment was assessed in terms of the angle (α) between axes of the stem and of the humerus. Filling ratios were measured in the metaphysis of the humerus, in the diaphysis, and at the distal end of the stem and considered excessive above 0.7. Stress shielding was evidenced radiographically by the observation of medial cortical narrowing, medial metaphysis thinning, lateral metaphysis thinning or under-the-baseplate osteolysis. Eighty-two shoulders were included and 70 had radiographic follow-up data available. The mean patient age was 78years and 63/81 patients (78%) were female. The mean follow-up time was 39±7months. The mean α angle was 1.4°±0.9° and was less than 5° in all cases. The mean metaphyseal, diaphyseal, and distal filling ratios were 0.61±0.06, 0.70±0.08, and 0.64±0.09, respectively. The mean Constant score improved from 28±11 preoperatively to 64±14 at last follow-up. The mean subjective shoulder values score at last follow-up was 81±12. Seventy-nine percent of patients (55/70) had at least 1 form of stress-shielding related, which were not associated with clinical outcomes, apart from lateral metaphysis thinning, which was associated with lower active anterior elevation (mean, 106°±30° vs. 126°±28°; P=.01) and lower Constant scores (mean, 56±17 vs. 65±14; P=.06). The use of cementless reverse shoulder prostheses with a NSA of 140° was associated with good clinical outcomes at 2 years' follow-up. The prosthesis stem was correctly aligned with the humeral axis and the filling ratios were <0.7 in all cases. Stress-shielding was common but, apart from lateral metaphysis thinning, this had no impact on clinical outcomes.

Possible dose-dependent effect of eplerenone on intraocular pressure.

Intraocular pressure (IOP) is the main modifiable risk factor for glaucoma. Current therapies target the anterior outflow of aqueous humor or its production. This study aims to demonstrate eplerenone could reduce IOP through a possible posterior outflow path via retinal pigment epithelium (RPE). In this retrospective study, IOP changes in patients undergoing eplerenone treatment were investigated. Inclusion criteria were IOP data immediately before and during treatment. Exclusion criteria included ophthalmic procedures, changes in topical glaucoma treatment, or taking systemic medications affecting IOP. After reviewing 162 charts, 41 subjects were eligible. Pearson correlation test was used to investigate the correlation between continuous IOP and eplerenone dosage. The mean ± SD IOP before eplerenone treatment was 14.31 ± 3.73 mmHg and decreased to 13.50 ± 4.04 mmHg; however, this was not statistically significant (P = 0.39). In subset of patients with eplerenone dose of more than 25 mg/day and baseline IOP equal to or less than 15 mmHg, the mean IOP before eplerenone treatment was 12.33 ± 2.59 mmHg and decreased to 10.33 ± 2.99, which is a trend toward IOP reduction with a 16% reduction in IOP (P = 0.055). A possible dose-dependent decrease in IOP with eplerenone provides indirect evidence for the posterior flow model and suggests the mineralocorticoid receptors (MRs) in RPE play a role in the posterior flow of aqueous humor. It can be deduced that the RPE pumps responsible for the posterior flow of aqueous humor are MR-regulated and their function can be enhanced with MR antagonists.