Main Risk Research Articles

Vitamin D Status, VDR, and TLR Polymorphisms and Pulmonary Tuberculosis Epidemiology in Kazakhstan.

Tuberculosis (TB) and vitamin D deficiency remain major public health problems in Kazakhstan. Due to the high incidence of pulmonary tuberculosis in the country and based on the importance of vitamin D in the modulation of the immune response and the association of its deficiency with many health conditions, the aim of our research was to study the vitamin D status, VDR and TLR gene polymorphisms, and pulmonary tuberculosis epidemiology in Kazakhstan. A case-control study included 411 individuals diagnosed with pulmonary TB and 686 controls with no family history of pulmonary tuberculosis. Concentrations of serum vitamin D (25-(OH)D) levels were measured by electrochemiluminescence immunoassay. The gene polymorphisms were determined by real-time polymerase chain reaction (PCR) allelic discrimination assay using TaqMan probes. The association between the risk of pulmonary TB and polymorphisms was evaluated using multimodal logistic regression and assessed with the ORs, corresponding to 95% Cis, and the significance level was determined as p < 0.05. 1097 individuals were recruited from 3 different regions of Kazakhstan. Biochemical data showed vitamin D deficiency (25-(OH)D < 20 ng/mL) was present in both groups, with the case group accounting for almost 95% and 43.7% in controls. Epidemiological data revealed that socioeconomic factors such as BMI < 25 kg/m2 (p < 0.001), employment (p < 0.001), diabetes (p < 0.001), and vitamin D deficiency (p < 0.001) were statistically different between case and control groups. Logistic regression analysis, adjusted by sex, age, BMI, residence, employment, smoking, alcohol consumption, and diabetes, showed that T/T polymorphism of the VDR gene (rs1544410, OR = 1.97, 95% CI: 1.04-3.72, p = 0.03) and A/A polymorphism of the TLR8 gene (rs3764880, OR = 2.44, 95% CI: 1.20-4.98, p = 0.01) were associated with a high risk of developing pulmonary tuberculosis. Vitamin D deficiency remains prevalent in our study cohort and is associated with TB progression. Socioeconomic determinants such as unemployment, BMI under 25 kg/m2, and diabetes are the main risk factors for the development of pulmonary TB in our study. A/A polymorphism of TLR8 (rs3764880) and T/T polymorphism (BsmI, rs1544410) of VDR genes may act as biomarkers for pulmonary tuberculosis in the Kazakh population.

Cybersecurity Challenges In The Era Of Digital Transformation A Comprehensive Analysis Of Information Systems

Increased digitalization in business transformation has provided significant benefits, but has also created new challenges for information security. This research aims to analyze the cyber security challenges faced in the era of digital transformation, with a focus on Information Systems. The research method used is a comprehensive analysis of literature and case studies to gain an in-depth understanding of these issues. In this research, we found that there are a number of significant challenges related to cyber security in implementing digital transformation, including malware attacks, phishing, insufficient network security, and privacy violations. Causal analysis concluded that insufficient training and security awareness, as well as weak design in information systems, were the main risk factors. The implication of this research is the need for proactive steps in implementing strong security practices in information systems, including adequate training for employees, careful security monitoring, and early warning of security threats. In addition, the importance of collaboration between organizations, governments and related entities in facing increasingly global threats was also highlighted.

Predicting coal workers' pneumoconiosis trends: Leveraging historical data with the GARCH model in a Chinese Miner Cohort.

Coal workers' pneumoconiosis (CWP) is one of the most common and severe occupational diseases worldwide. The main risk factor of CWP is exposure to respirable mine dust. Prediction theory was widely applied in the prediction of the epidemic. Here, it was used to identify the characteristics of CWP today and the incidence trends of CWP in the future. Eight thousand nine hundred twenty-eight coal workers from a state-owned coal mine were included during the observation period from 1963 to 2014. In observations, the dust concentration gradually decreased over time, and the incidence of tunnels and mine, transportation, and assistance workers showed an overall downward trend. We choose a better prediction model by comparing the prediction effect of the Auto Regression Integrate Moving Average model and Generalized Autoregressive Conditional Heteroskedasticity model. Compared with the Auto Regression Integrate Moving Average model, the Generalized Autoregressive Conditional Heteroskedasticity model has a better prediction effect. Furthermore, the status quo and future trend of coal miners' CWP are still at a high level.

Epidemiology of substance and opium use among adult residents of Tehran; a comprehensive report from Tehran cohort study (TeCS)

BackgroundThe prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran.MethodFrom March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use.ResultWe analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P < 0.001), alcohol intake (OR: 1.3, P = 0.016), and smoking (OR: 8.5, P < 0.001) were independently associated with opium use.ConclusionsWe found that the prevalence of substance use in Tehran was 5.6%, and opium was the most frequently used substance. In addition, male gender, lower levels of education, alcohol, and tobacco consumption are the main risk factors for substance use in Tehran. Healthcare providers and policymakers can utilize our results to implement preventive strategies to minimize substance use in Tehran.

Childhood obesity - risk factors and prevention strategies

Introduction and purpose: Obesity is one of the most serious health challenges in modern society. Over the last 40 years, the number of obese school-age children has increased tenfold. This not only has significant consequences for physical health, but also affects psychosocial aspects and the quality of life of the young generation. The aim of this study is to conduct a comprehensive review of the literature on obesity among children and adolescents, focused on identifying the main risk factors and analyzing effective forms of prevention. Materials and methods: A review of the literature available in the "PubMed" database and books was conducted. The search was performed by using the following keywords: "childhood obesity", "childhood obesity risk factors", “childhood obesity prevention” State of knowledge: The risk factors for obesity in children and adolescents include genetic factors, endocrine diseases, improper diet, low physical activity, low socioeconomic status, stress, psychological factors, short sleep time, medications, hypothalamic obesity and H. pylori. As part of the prevention of obesity in children and adolescents, it is recommended to develop appropriate habits in children and adolescents. The influence of parents on health behaviors in children is important. Top-down activities such as health campaigns and legal regulations also have a significant impact. Summary: Due to research conducted over the years, awareness of obesity risk factors has increased. To effectively prevent this disease, an integrated approach is necessary, taking into account both education and changes in the social environment. Implementing these strategies requires cooperation at local, regional, national and international levels.

Educational intervention on oral cancer in high-risk patients between 35-59 years

Introduction: mortality from oropharyngeal cancer ranked tenth among cancer types in Cuba in 2020 and 2021. Objective: to implement an educational intervention on oral cancer in high-risk patients between 35-59 years old. Method: an educational intervention with a quasi-experimental design, before-after type, was carried out in consulting room 19, La Demajagua, Isla de la Juventud between April-September 2023. The population was 126 patients, the sample being made up of 80 at high risk of oral cancer. Theoretical, empirical and mathematical-statistical methods were used and the variables were used: risk to predict oral cancer, risk factors, oral hygiene, teaching aids and level of knowledge about oral cancer, oral hygiene, risk factors and oral self-examination. Results: the risk of suffering from oral cancer was high in 63 % of the patients between 35-59 years old in the study office. Before the intervention, bad knowledge predominated, representing 48,7 % of the sample, managing to raise it to good after the intervention by 96,3 % . The Wilcoxon test demonstrated highly significant differences. Conclusions: the main risk factors were: poor oral hygiene, smoking, consumption of hot or spicy foods and stress. The use of the website contributed to raising knowledge about oral cancer, the main risk factors associated with its appearance and oral self-examination, allowing the transformation of modes of action and the evaluation of the educational intervention implemented in high-risk patients between 35 and 35 years old as satisfactory

Impact of topography and added TiN-coating on adult human dermal fibroblasts after seeding on titanium surface in-vitro.

Complications of transcutaneous osseointegrated prosthetic systems (TOPS) focus on the metal-cutaneous interface at the stoma. Besides pain due to scare tissue as well as undefined neuropathic disorders, there is high evidence that the stoma presents the main risk causing hypergranulation and ascending infection. To restore the cutaneous barrier function in this functional area, soft-tissue on- or in-growth providing a vital and mechanically stable bio-artificial conjunction is considered a promising approach. In this study we assessed viability and proliferation of adult human dermal fibroblasts (HDFa) on modifications of a standard prosthetic titanium surface. Un-coated (TiAl6V4) as well as a titanium-nitrite (TiN) coated additive manufactured porous three-dimensional surface structures (EPORE®) were seeded with HDFa and compared to plain TiAl6V4 and polystyrene surfaces as control. Cell viability and proliferation were assessed at 24h and 7days after seeding with a fluorescence-based live-dead assay. Adhesion and cell morphology were analyzed by scanning electron microscopy at the respective measurements. Both EPORE® surface specifications revealed a homogenous cell distribution with flat and spread cell morphology forming filopodia at both measurements. Proliferation and trend to confluence was seen on un-coated EPORE® surfaces with ongoing incubation but appeared substantially lower on the TiN-coated EPORE® specification. While cell viability on both EPORE® specifications was comparable to plain TiAL6V4 and polystyrene controls, cell proliferation and confluence were less pronounced when compared to controls. The EPORE® topography allows for fibroblast adhesion and viability in both standard TiAl6V4 and - to a minor degree - TiN-coated specifications as a proof of principle.

Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study

BackgroundElderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF.MethodsA retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis.ResultsWe eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection.ConclusionEnhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.

RISK INDICATORS ASSOCIATED WITH THE INCIDENCE OF OBSTETRIC INJURY OF THE ANAL SPHINCTER DURING VAGINAL LABOR

Obstetrical lesions of the anal sphincter (LOEA) consists of third and fourth degree lacerations that can happen during vaginal labor. Its incidence is related to unfavorable outcomes in the health of the postpartum, such as anal incontinence, dyspareunia, sexual dysfunction, and negative repercussions on emotional and psychological health. Objective: To describe the main risk indicators associated with incidence of anal obstetric injury during vaginal labor. Methodology: This is an integrative review of the literature carried out in the indexed materials in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database - BDENF, Index Medicus for the Western Pacific (WPRIM) and Bibliographic Index Español en Ciencias de la Salud (IBECS), used the Health Sciences Descriptors (DeCS) in cross-over with the Boolean operator AND and OR, after the application of eligibility criteria were selected 13 studies to compose this review: are: It was evidenced that among the maternal risk indicators associated with LOEA, primiparity, episiotomy, body mass index (?), maternal age &lt; 20 years of age, Asian ethnicity, due to shorter perineal bodies, instrumental delivery, second stage of prolonged labor and previous pregnancy cesarean section history. Fetal factors such as vaginal delivery of pelvic presentation, use of maneuvers to facilitate expulsion and macrosomy, weight &gt; 4 kg were related to an increased risk for anal sphincter lesions. Concluding Considerations: It is observed that maternal and fetal factors are associated with a greater risk of developing anal sphincter lesions, so the identification by health professionals of the main risk indicators in a timely manner is of great importance in the prevention of greater maternal complications.

Machine learning algorithms to uncover risk factors of breast cancer: insights from a large case-control study.

This large case-control study explored the application of machine learning models to identify risk factors for primary invasive incident breast cancer (BC) in the Iranian population. This study serves as a bridge toward improved BC prevention, early detection, and management through the identification of modifiable and unmodifiable risk factors. The dataset includes 1,009 cases and 1,009 controls, with comprehensive data on lifestyle, health-behavior, reproductive and sociodemographic factors. Different machine learning models, namely Random Forest (RF), Neural Networks (NN), Bootstrap Aggregating Classification and Regression Trees (Bagged CART), and Extreme Gradient Boosting Tree (XGBoost), were employed to analyze the data. The findings highlight the significance of a chest X-ray history, deliberate weight loss, abortion history, and post-menopausal status as predictors. Factors such as second-hand smoking, lower education, menarche age (>14), occupation (employed), first delivery age (18-23), and breastfeeding duration (>42 months) were also identified as important predictors in multiple models. The RF model exhibited the highest Area Under the Curve (AUC) value of 0.9, as indicated by the Receiver Operating Characteristic (ROC) curve. Following closely was the Bagged CART model with an AUC of 0.89, while the XGBoost model achieved a slightly lower AUC of 0.78. In contrast, the NN model demonstrated the lowest AUC of 0.74. On the other hand, the RF model achieved an accuracy of 83.9% and a Kappa coefficient of 67.8% and the XGBoost, achieved a lower accuracy of 82.5% and a lower Kappa coefficient of 0.6. This study could be beneficial for targeted preventive measures according to the main risk factors for BC among high-risk women.

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment.

Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism occurring within the splanchnic venous system. Portal vein thrombosis is the most common presentation, while Budd-Chiari syndrome is the least common. Liver cirrhosis and abdominal solid cancer are the main local risk factors for SVT, whereas myeloproliferative neoplasms are the predominant systemic risk factors. Signs and symptoms of SVT are nonspecific and include abdominal pain, gastrointestinal bleeding, and ascites. Asymptomatic SVT is not uncommon, and the majority would be detected incidentally on routine abdominal imaging performed for the follow-up of liver diseases and tumors. The management of SVT aims to prevent thrombus progression, promote vessel recanalization, and prevent recurrent venous thromboembolism. Anticoagulation should be started early in order to increase the chances of vessel recanalization and reduce the risk of portal hypertension-related complications. Direct oral anticoagulants have been included in recent guidelines, as alternatives to vitamin K antagonists, after clinical stability has been reached; however, caution is required in patients with liver or kidney dysfunction. Treatment duration is based on the presence (or absence) and type (transient vs. permanent) of risk factors. This narrative review aims to summarize the latest evidence on SVT, with a particular focus on the anticoagulant treatment in special categories of patients (e.g., liver cirrhosis, solid cancer, myeloproliferative neoplasms, pancreatitis, incidentally detected SVT, Budd-Chiari syndrome, and chronic SVT).

Prevalence of Early Vascular Aging Syndrome in Men Working Under Noise Exposure

Noise can be one of the factors provoking the premature development of changes in the artery wall associated with age. Aim: to assess the stiffness of the vascular wall and the prevalence of early vascular aging syndrome in men of working age, depending on contact with noise, smoking status and the presence of hypertension. Materials and methods. 148 men worked in noise and 90 men for whom the level of all harmful production factors in the workplace did not exceed the permissible standards were examined. The average age of the examined patients was 41.6 ± 9.9 years, 133 people (55.9 %) were smokers, 43 people (18.1 %) were obese, 47 people (19.7 %) had a complicated heredity, 132 people (55.5 %) had hypercholesterolemia, and 37 people (15.5 %) suffered from arterial hypertension (AH). Each of the patients suffering from hypertension received antihypertensive therapy. There were no significant differences in the structure of antihypertensive therapy in the compared groups of patients. The groups of surveyed were comparable in age, body mass index, prevalence of smoking, obesity and hypertension. All patients underwent volumetric sphygmography according to the standard procedure in the morning on the VaSera 1500N device (FukudaDenshi, Japan), the device automatically determined the cardio-ankle vascular index on the right and left (R/L — CAVI), the estimated age of the arteries. The syndrome of early vascular aging (EVA syndrome) was considered to be a clinical condition associated with an excess of the estimated age of the arteries of the patient’s passport age by 4 years or more (VaSera criteria). Results and discussion. After exclusion of smokers and hypertensive patients from the analysis and correction for age, the vascular wall stiffness index on the right and left in the main group of patients significantly exceeded the indicated indicator in the comparison group. R — CAVI was 7.2 [6.9; 7.9] and 7.05 [6.05; 7.45], respectively, p=0.02; L — CAVI was 7.3 [7.0; 7.9] and 6.85 [6.05; 7.65], respectively, p =0.007. In the group of people working in noise, the estimated age of the arteries significantly exceeded the passport age (p=0.004), whereas in the control group these indicators were comparable (p=0.27). The prevalence of EVA syndrome in the main group of patients was 14 cases (27.5 %), which was 8.6 times higher than the prevalence of EVA syndrome in the comparison group — 1 case (3.2 %); p=0.004. The comparability of the patient groups according to the main cardiovascular risk factors and the exclusion criteria from the study suggested that the identified changes in the state of the vascular wall are associated with the effects of noise on the body of the examined. Conclusion. Noise can be a factor that accelerates vascular aging. It is necessary to monitor the state of the cardiovascular system in persons working in noise.

Long-COVID-19 autonomic dysfunction: An integrated view in the framework of inflammaging

The recently identified syndrome known as Long COVID (LC) is characterized by a constellation of debilitating conditions that impair both physical and cognitive functions, thus reducing the quality of life and increasing the risk of developing the most common age-related diseases. These conditions are linked to the presence of symptoms of autonomic dysfunction, in association with low cortisol levels, suggestive of reduced hypothalamic-pituitary-adrenal (HPA) axis activity, and with increased pro-inflammatory condition. Alterations of dopamine and serotonin neurotransmitter levels were also recently observed in LC. Interestingly, at least some of the proposed mechanisms of LC development overlap with mechanisms of Autonomic Nervous System (ANS) imbalance, previously detailed in the framework of the aging process. ANS imbalance is characterized by a proinflammatory sympathetic overdrive, and a concomitant decreased anti-inflammatory vagal parasympathetic activity, associated with reduced anti-inflammatory effects of the HPA axis and cholinergic anti-inflammatory pathway (CAP). These neuro-immune-endocrine system imbalanced activities fuel the vicious circle of chronic inflammation, i.e. inflammaging. Here, we refine our original hypothesis that ANS dysfunction fuels inflammaging and propose that biomarkers of ANS imbalance could also be considered biomarkers of inflammaging, recognized as the main risk factor for developing age-related diseases and the sequelae of viral infections, i.e. LC.

Quantifying the Contribution of Soil Heavy Metals to Ecological and Health Risk Sources

Quantifying the risk of soil heavy metal sources can identify the main pollution sources. It can provide a scientific basis for reducing the ecological and human health risks of soil heavy metals. Taking the shallow soil in a Pb-Zn mine watershed in northern Guangxi as a research object， ecological and human health risk assessments were conducted using potential ecological risk assessment （RI） and human health risk assessment （HRA）， and the source apportionment of soil heavy metals was completed using the absolute principal component-multiple linear regression receptor （APCS-MLR） model and random forest （RF） model. Then， a combined risk assessment model， consisting of RI， HRA， and APCS-MLR， was used to quantify the risk of soil heavy metal sources. The results showed that the contents of Pb， Zn， Cu， and Cd exceeded the environmental screening values for agricultural land with mean values of 342.77， 693.34， 61.27， and 3.08 mg·kg-1， respectively， and there was a certain degree of contamination. Pb， Cr， and As were the main health risk impact factors， with higher health risks for children than for adults. Three sources were identified： mining activities （Source Ⅰ）， soil parent material sources and original formation （Source Ⅱ）， and unknown sources. Pb， Zn， Cu， and Cd were mainly derived from Source Ⅰ， and Cr and As were controlled by unknown sources and Source Ⅱ. The source risk assessment results of soil heavy metals indicated that the potential ecological risk and non-carcinogenic risk were mainly from Source Ⅰ and Source Ⅱ， and carcinogenic risk was mainly from unknown sources. The unknown sources had a high proportion in source apportionment and risk assessment， and should be further researched to provide scientific basis for soil heavy metal control. The combined risk assessment model based on source analysis， focusing on the risk characteristics of different sources， can accurately identify high-risk pollution sources. It is a more reasonable and reliable risk assessment method.

Silymarin Reduced Insulin Resistance in Non-Diabetic Women with Obesity.

Silymarin has ameliorated obesity, type 2 diabetes (T2DM), and insulin resistance (IR) in combination with standard therapy, diet, or exercise in recent studies. Obesity and IR are the main risk factors for developing T2DM and other metabolic disorders. Today, there is a need for new strategies to target IR in patients with these metabolic diseases. In the present longitudinal study, a group of non-diabetic insulin-resistant women with type 1 and type 2 obesity were given silymarin for 12 weeks, with no change in habitual diet and physical activity. We used the Homeostatic Model Assessment for Insulin Resistance Index (HOMA-IR) to determine IR at baseline and after silymarin treatment (t = 12 weeks). We obtained five timepoint oral glucose tolerance tests, and other biochemical and clinical parameters were analyzed before and after treatment. Treatment with silymarin alone significantly reduced mean fasting plasma glucose (FPG) and HOMA-IR levels at 12 weeks compared to baseline values (p < 0.05). Mean fasting plasma insulin (FPI), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (Tg), indirect bilirubin, and C-reactive protein (CRP) levels decreased compared to baseline values, although changes were non-significant. The overall results suggest that silymarin may offer a therapeutic alternative to improve IR in non-diabetic individuals with obesity. Further clinical trials are needed in this type of patient to strengthen the results of this study.

Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy

ObjectiveTo observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI.Study designFrom January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals.ResultsOnly 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05).ConclusionsHysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.

Skin cancer screening: the experience in South Portugal.

The number of skin cancer cases and related deaths continues to increase worldwide, including in Portugal. The lack of efficient health care leaves the southern Portuguese population at risk of presenting skin lesions at later stages. An initiative for skin cancer screening and medical care follow-up was created by the nonprofit organization Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul (LPCC-NRS). Information was gathered from 4,398 participants in several Southern Portugal regions, from January 2021 to July 2022. Descriptive and lesion risk statistical analyses were applied. Participants' characteristics were described, and risk assessment was performed differentially between premalignant (n = 577) and malignant lesions (n = 176). The main risk factor for both was male gender. From the described suspicious malignant lesions, 31.8% were confirmed (n = 56), among which there were 43 basal cell carcinomas (BCC), 9 cutaneous melanomas (CM), and 4 squamous cell carcinomas (SCC). Data analysis pointed to a need for improved participant recruitment, especially of male participants, and health literacy assessment in future screenings.

RISK FACTORS, MATERNAL, AND PERINATAL OUTCOME OF FETAL MACROSOMIA

Objective: Macrosomia is characterized by a birth weight exceeding 4000 g, regardless of gestational age, or &gt;90th percentile for gestational age. This condition is linked to significant risks of maternal and neonatal morbidity and mortality. Globally, the prevalence of infants weighing ≥4000 g is estimated to be 9%. Various risk factors contribute to the development of fetal macrosomia, including a high pre-pregnancy body mass index (BMI), excessive weight gain during the antenatal period, high parity, male gender of the fetus, prolonged pregnancy, and maternal diabetes mellitus. Methods: A retrospective cross-sectional study was undertaken in the Department of Obstetrics and Gynecology at GIMSR Teaching Hospital, over a 5-year period from May 2018 to May 2023. The study encompassed all singleton pregnancies with a birth weight equal to or exceeding 4000 g, irrespective of the delivery method. Maternal and neonatal records for the study population were systematically collected, and data were documented. Results: Throughout the study duration, there were 167 cases where the birth weight equalled or exceeded 4,000 g. Most common maternal complication was prolonged labor and postpartum hemorrhage. Shoulder dystocia was seen in 2.9% of all deliveries and 10.8% of all vaginal deliveries. Most common neonatal complication was hypoglycemia. Conclusion: The prevalence of macrosomia in our study was 3.86%. Main risk factors identified in our study were male gender, pre pregnancy BMI &gt;25, previous macrosomic births, and excessive weight gain during pregnancy.

High Airway Occlusion Pressure Is Associated with Dyspnea and Increased Mortality in Critically Ill Mechanically Ventilated Patients.

Rationale: Airway occlusion pressure at 100 ms (P0.1) reflects central respiratory drive. Objectives: We aimed to assess factors associated with P0.1 and whether an abnormally low or high P0.1 value is associated with higher mortality and longer duration of mechanical ventilation (MV). Methods: We performed a secondary analysis of a prospective cohort study conducted in 10 ICUs in France to evaluate dyspnea in communicative MV patients. In patients intubated for more than 24 hours, P0.1 was measured with dyspnea as soon as patients could communicate and the next day. Measurements and Main Results: Among 260 patients assessed after a median time of ventilation of 4 days, P0.1 was 1.9 (1-3.5) cm H2O at enrollment, 24% had P0.1 values >3.5 cm H2O, 37% had P0.1 values between 1.5 and 3.5 cm H2O, and 39% had P0.1 values <1.5 cm H2O. In multivariable linear regression, independent factors associated with P0.1 were the presence of dyspnea (P = 0.037), respiratory rate (P < 0.001), and PaO2 (P = 0.008). Ninety-day mortality was 33% in patients with P0.1 > 3.5 cm H2O versus 19% in those with P0.1 between 1.5 and 3.5 cm H2O and 17% in those with P0.1 < 1.5 cm H2O (P = 0.046). After adjustment for the main risk factors, P0.1 was associated with 90-day mortality (hazard ratio per 1 cm H2O, 1.19 [95% confidence interval, 1.04-1.37]; P = 0.011). P0.1 was also independently associated with a longer duration of MV (hazard ratio per 1 cm H2O, 1.10 [95% confidence interval, 1.02-1.19]; P = 0.016). Conclusions: In patients receiving invasive MV, abnormally high P0.1 values may suggest dyspnea and are associated with higher mortality and prolonged duration of MV.

Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients.

Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years. The mean operative age of the patients was 13 ± 7 years. The mean preoperative main coronal curve was 64° and improved by a mean of -39° postoperatively. The mean preoperative pelvic obliquity was 23°, which improved by a mean of -14° postoperatively. No decrease in the frontal or sagittal correction was observed during the last follow-up. The sitting posture improved in all cases. Twenty-nine patients (17%) had a postoperative infection: twenty-six were treated with local debridement and antibiotics, and three required hardware removal. Fourteen mechanical complications (8%) occurred: screw malposition (n = 6), skin prominence (n = 1), and connector failure (n = 1). This type of surgery is associated with a high risk for infection. Comorbidities, rather than the surgery itself, were the main risk factors that led to complications. The ilio-sacral screw was reliable and effective in correcting pelvic obliquity in NMS patients. The introduction of intraoperative navigation should minimize the risk of screw misplacement and facilitate revision or primary fixation.