Mantel-Haenszel Chi-square Test Research Articles

Long-Term Impact of Physical Activity on Mortality in Adults With Multimorbidity: A 12-Year Cohort Longitudinal Study From the Survey on Health, Ageing and Retirement in Europe.

While physical activity (PA) is known to reduce mortality in the general population, this relationship in individuals with multimorbidity (≥ 2 chronic conditions) is unclear. This longitudinal study aimed to investigate whether there is a long-term association between PA levels and mortality rates over a 12-year period in adults with multimorbidity. Data were obtained from eight waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), from 28 European countries. PA levels were self-reported via computer-assisted personal interviews. Mortality during the follow-up period was assessed using data obtained from caregivers through end-of-life interview. Multimorbidity was identified based on the presence of two or more 15 self-reported chronic diseases/conditions. Cox's regression analysis, adjusted for potential confounders, was used to assess the association between PA level and mortality. p-values were calculated using the Jonckheere-Terpstra test for continuous variables and the Mantel-Haenszel Chi-square test for categorical variables, stratified by PA level. The study included 9216 participants with multimorbidity (mean age 69 ± 10.1 years; 58.7% were women). Among those with multimorbidity, individuals with high PA level were significantly younger, more frequently men, less impaired in activities of daily living, less educated and less frequently obese than those with very low level of PA (p < 0.0001 for all comparisons). Over the 12 years of follow-up, mortality incidence was three times higher in individuals with multimorbidity and very low PA levels than those with multimorbidity and high levels of PA. After adjusting for confounders, the risk of mortality was significantly lower for participants with moderately low PA levels (HR = 0.64; 95% CI: 0.59-0.71; p < 0.0001), moderately high PA levels (HR = 0.53; 95% CI: 0.47-0.60; p < 0.0001) and high PA levels (HR = 0.49; 95% CI: 0.43-0.55; p < 0.0001) compared to those with very low PA levels. Findings from the present study suggest that people with multimorbidity who had lower levels of PA were three times more likely to die prematurely after 12 years than adults with multimorbidity and higher levels of PA at baseline. These findings underscore the importance of promoting physical activity in adults with multimorbidity to reduce the risk of premature mortality. Future longitudinal research is required to confirm/refute our findings. Further, intervention studies are needed to understand whether increasing levels of physical activity in this population subsequently reduces mortality risk.

Exploring the correlations between six serological inflammatory markers and different stages of type 2 diabetic retinopathy

To determine the correlations between six serological inflammatory markers, namely the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), and various stages of type 2 diabetic retinopathy (T2DR). Additionally, the diagnostic value of these markers in T2DR was evaluated. Clinical data were collected from a total of 397 patients with type 2 diabetes who visited the ophthalmology department at Mian Yang Central Hospital and the Affiliated Hospital of Southwest Medical University from January 2023 to December 2023. Based on the results of fundus photography, patients were categorized into a non-diabetic retinopathy group (NDR, n = 121), a non-proliferative diabetic retinopathy group (NPDR, n = 77), and a proliferative diabetic retinopathy group (PDR, n = 199). General patient information and systemic inflammatory markers, including the SII, SIRI, AIRI, NLR, PLR, and MLR, were compared among the groups, and their correlations with T2DR were analyzed. The SII values were found to be significantly higher in the PDR group compared to the NPDR group, which in turn were higher than those in the NDR group (P < 0.05). Similarly, the AISI values were significantly elevated in the PDR group compared to both the NPDR and NDR groups (P < 0.05). The SIRI and MLR values were significantly higher in the PDR group than in the NDR group (P < 0.05). Furthermore, the NLR and PLR values were significantly higher in the NPDR and PDR groups compared to the NDR group (P < 0.05). The Mantel‒Haenszel chi-square test revealed a significant linear trend between the SII and PLR and the incidence of PDR (P < 0.001), with the incidence of PDR increasing as the quartile levels of the SII and PLR increased. Multivariate logistic regression analysis indicated that, compared with NDR, a higher SII was found to be an independent risk factor for NPDR (ORSII = 1.002, p = 0.001) and PDR (ORSII = 1.002, P < 0.001). The ROC curve analysis suggested that the combined assessment of the six inflammatory indices had the highest accuracy in the evaluation of DR, with an area under the curve (AUC) of 0.69, a sensitivity of 54%, and a specificity of 75%. The results of this study indicate that the SII is an independent risk factor for T2DR. A close correlation was observed between the SII and PLR and the occurrence and progression of T2DR. The high accuracy of the combined diagnosis of T2DR via various serological inflammatory markers underscores their potential as early biological indicators for the diagnosis of T2DR.

Risks of Autologous Abdominal Free Flap Breast Reconstruction in Patients With Elevated Body Mass Index.

Obesity is widely recognized as a significant risk factor for postoperative complications of breast reconstruction. Despite extensive research, there remains a lack of consensus regarding the specific complications and outcomes experienced by patients with obesity who undergo deep inferior epigastric perforator (DIEP) flap reconstruction. To provide a clearer understanding of the challenges faced by patients with obesity, we present a single-center outcome analysis of individuals who underwent DIEP flap reconstruction. A cohort of 194 patients who underwent at least 1 DIEP flap was retrospectively analyzed at the University of Nebraska Medical Center utilizing electronic medical records. Patients who underwent DIEP flap breast reconstruction were organized into 5 categories using World Health Organization weight status by body mass index (BMI) obtained from the day of surgery. Surgical complications within 120 days and postsurgical complication-related procedural interventions were also evaluated and compared. Comparisons of variables of interest between weight groups were assessed using Mantel-Haenszel chi-square tests or Spearman correlations. Increases in patient weight category were associated with increased length of operation (P = 0.003), increased rates of breast fat necrosis (P = 0.04), breast wound dehiscence (P = 0.01), abdominal wound dehiscence (P = 0.02), numbers of abdominal complications (P = 0.001), and rates of requiring an intervention (P = 0.03). The findings imply that higher BMI values may lead to a higher likelihood of postoperative complications and the need for intervention. It is crucial for patients with obesity to be aware of the elevated risk associated with rising BMI values.

The Impact of Traditional Children's Games on Internet Use, Social Skills, and Stress Level: A Cross-Sectional Design.

Traditional games are essential for children's social inclusion due to cultural values and beliefs. This study was conducted to measure the impact of traditional children's games on internet use, social skills, and stress levels. A cross-sectional design was carried out. Children who had parental approval and agreed to participate were included in the study (n = 314). The data were collected using a questionnaire, the Perceived Stress Questionnaire (8-11 years), and the Social Skills Assessment Scale. Linear regression and multinomial logistic regression were performed to analyze the data. Mantel-Haenszel chi-square test was performed to assess the confounding factors for playing traditional games. The children's mean age was 11.58 (SD = 0.49), and 56.1% were girls. Children who did not play traditional games were more likely to use the internet than those who played traditional games (odds ratio [OR] = 2.16, p = .014). The social skills were significantly associated with daily internet use time (β = 0.164, p = .003), playing traditional games (β = 0.155, p = .008), and frequency of gaming per week (β = 0.123, p = .035). The stress levels were associated with gender (β = 0.120, p = .033) and academic level (β = 0.111, p = .048). Traditional game playing reduced the duration of one sitting and daily internet use. Moreover, outdoor gaming, frequency of playing games, and daily internet use duration were predictors of social skills, whereas being a girl and sixth-grade student were predisposing factors of stress level. Nurses could benefit from traditional games in reducing internet use and stress and improving social skills in children.

A Risk Tool for Evaluating Overuse Injury and Return-to-Play Time Periods in Youth and Collegiate Athletes: Preliminary Study.

Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods. (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury. Longitudinal cohort study. Level 3. Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves. The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04). STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study. Clinicians can use STAR to assess overuse injury risk in youth athletes.

Impact of Body Mass Index (BMI) and Age on in Vitro Fertilization (IVF) Outcome in Indian Patients with Polycystic Ovary Syndrome (PCOS)

Aim: The study evaluated the effect of body mass index (BMI) and age on in vitro fertilization (IVF) outcomes in women with polycystic ovary syndrome (PCOS). Methods: A retrospective study of 412 IVF cycles in PCOS patients aged between 20 and 40 years from January 2019 to 2022. Patients were divided into three groups based on their BMI-normal (18.5–24.9[Formula: see text]kg/m2), overweight (25–29.9[Formula: see text]kg/m2), and obese ([Formula: see text][Formula: see text]kg/m2). The patients were divided into two groups based on their age [Formula: see text] and [Formula: see text] years. The IVF cycle outcomes, clinical pregnancy (CPR), and live birth rates (LBR) were studied. The Mantel–Haenszel Chi-square test was used for statistics. Results: The oocyte yield and endometrial thickness, fertilization, CPR, and LBR were significantly higher in the normal BMI group. Similarly, oocyte yield, mature oocytes, and endometrial thickness were significantly higher in the younger age-group. Comparing the CPR in younger and older normal, overweight, and obese groups, it was observed to be highest in the younger, normal BMI group and lowest in the older, obese group. The LBR were significantly higher in the younger, normal-BMI group compared to the older, obese patients. Conclusion: Oocyte yield, CPR, and LBR were higher in the normal-BMI PCOS patients. The oocyte yield, endometrial thickness, and fertilization rates were higher in the younger age group. The CPR and LBR were significantly lower in the older obese patients. Patients with PCOS must be encouraged to normalize BMI before embarking on IVF. Timely treatment must be encouraged for better IVF outcomes.

Patient perspectives in adverse event reporting after vaginal apical prolapse surgery

BackgroundMany clinical trials use systematic methodology to monitor adverse events (AE) and determine grade (severity), expectedness, and relatedness to treatments as determined by clinicians. However, patient perspective in the process remains lacking. ObjectivesTo compare clinician versus patient grading of AE severity in a urogynecologic surgical trial. Secondary objectives were to estimate the association between patient grading of AEs with decision-making and quality of life outcomes and to determine if patient perspective changes over time. Study DesignThis was a planned supplementary study, “Patient-Perspectives in Adverse Event Reporting” (PPAR), to a randomized trial comparing 3 surgical approaches to vaginal apical prolapse. In the parent trial, AEs experienced by patients were collected per a standardized protocol every 6 months where clinicians graded AE severity (mild, moderate, severe/life threatening). In this sub-study, we obtained additional longitudinal patient perspectives for 19 predetermined “PPAR AEs”. Patients provided their own severity grading (mild, moderate, severe/very severe/ life threatening) at initial assessment and at 12 and 36 months postoperatively. Clinicians and patients were masked to each other’s reporting. The primary outcome was the interrater agreement (kappa statistic, κ) for AE severity between the initial clinician and patient assessment, combining patient grades of mild and moderate. Association between AE severity and the Decision-Regret Scale (DRS), Satisfaction with Decision Scale (SDS), the Short-Form Health Survey-12 (SF-12), and Patient-Global Impression of Improvement (PGI-I) scores were assessed utilizing Spearman’s correlation coefficient (ρ) for continuous scales, Mantel-Haenszel chi-squared test for PGI-I, and T-tests or chi-squared tests comparing assessments of severe vs other grades. To describe patient perspective changes over time, the intra-observer agreement was estimated for AE severity grade over time using weighted kappa-coefficients. ResultsOf 360 patients randomized, 219 (61%) experienced a total of 527 PPAR AEs (91% moderate and 9% severe/life threatening by clinician grading). Mean patient age was 67 years, 87% were White, and 12% Hispanic. Of patients reporting any PPAR event, the most common were urinary tract infection (61%), de novo urgency urinary incontinence (35%), stress urinary incontinence (22%), and fecal incontinence (13%).Overall agreement between clinician and participant grading of severity was poor (κ=0.24 (95%CI 0.14, 0.34). Of 414 AEs clinicians graded as moderate, patients graded 120 (29%) mild, and 80 (19%) severe. Of 39 AEs graded severe by clinicians, patients graded 15 (38%) mild or moderate. Initial patient grading of the most severe reported AE was mildly correlated with worse DRS (ρ=0.2, p=0.01), SF-12 (ρ=-0.24, p<0.01) and PGI-I (p<0.01). There was no association between AE severity and SDS. Patients with an initial grading of “severe” had more regret, lower quality of life, and poorer global impressions of health than those whose worst severity grade was mild (p<0.05). Agreement between the patients’ initial severity and later timepoints was fair at 12 months (κ=0.48 (95% CI 0.39, 0.58)) and 36 months (κ=0.45 (95% CI 0.37, 0.53)). ConclusionsClinician and patient perceptions of AE severity are discordant. Worse severity from the patient perspective was associated with patient-centered outcomes. Including the patient perspective provides additional information for evaluating surgical procedures.

Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients.

Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions. The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes. The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022. Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts. Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample t-test. The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients (P < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes (P < 0.001). Male patients had a higher hospitalization and mortality rate (P < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome. Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.

Abstract P325: Perceptions of Primary Care Quality and Hypertension Control in the Eastern Caribbean

Introduction: The Caribbean region has high rates of uncontrolled hypertension, a condition that is predominantly managed in primary care. Though evidence shows patient perceptions of quality of care are associated with health outcomes, there is a paucity of research in the Caribbean. This study aimed to fill evidence gaps on the relationship between perceived quality of care and hypertension management in the Caribbean. Objective: To understand the role of quality-of-care perceptions in hypertension control in the Eastern Caribbean. Hypothesis: We assessed the hypothesis that individuals with higher perceived quality of primary care are more likely to achieve blood pressure control. Methods: We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECHORN) (N=2961). ECHORN is an ongoing longitudinal study of adults conducted across four island sites. Participants completed a self-reported health survey, clinical examination, and laboratory testing. Participants who were aware of their hypertension status and reported a clinic visit within the past year were included in this study. The main exposure, perceived quality of care (QOC), was measured by asking participants to rate the quality of their healthcare. Likert responses were used and categorized as poor/fair, good, and very good in analyses. The outcome, hypertension control, was defined by JNC-7 guidelines and used as a binary variable. Pearson and Mantel-Haenszel Chi-Square tests were used for analysis. Results: The final analysis included 470 participants. Forty-six percent of participants had controlled hypertension, and 54% did not. Younger persons and those with higher educational attainment were more likely to have controlled hypertension. Twenty-four percent ranked QOC as poor/fair, 47% as good, and 29% as very good. Forty-one percent of those who rated QOC as poor/fair, 44 percent of those who rated QOC as good, and 53 percent of those who rated QOC as very good had their hypertension controlled. Mantel-Haenszel Chi-Square results showed a statistically significant positive linear trend in the relationship between QOC and hypertension control. Conclusion: This study demonstrated a positive relationship between higher perceived QOC and hypertension control in the Eastern Caribbean. Due to the burden of hypertension and the lack of region-specific literature on quality of care, further research is warranted to explore dimensions of QOC that most influence hypertension control.

Breast Cancer Disparities Among Women in Underserved Communities in Northwest Indiana

Background: Breast cancer is the second most common cancer found in women, after skin cancers. Research has discovered that factors such as race, socioeconomic status, and education affect both screening levels and cancer staging at diagnosis. Black women as well as lower-income individuals usually have higher grade staging as well as higher mortality. Since Lake County medical systems serve both high and low-income communities we wanted to analyze breast cancer staging in Lake County to see how it compares to national trends. Methods: “Hospital A” provided data from 393 positive breast cancer diagnoses along with the clinical staging at diagnosis from January 2019 to December 2022 for both high and low-income neighborhoods. Using a Mantel-Haenszel chi-square test we compared staging levels among the different income neighborhoods as well as among different races. Results: When looking at total staging data from 2019-2022, there was a significant difference between the race category of "Black or African American" and "White" population staging data. White patients tend to have lower stages, during initial clinical diagnosis, compared to Black patients. The "Other" category, which included all other races that did not fit into the "Black or African American" or "White Category" such as Asians, also had lower staging upon diagnosis when compared to the “Black or African American” group but no statistically significant difference with the “White” population. Conclusion: Our data showed that in Lake County, Indiana there are disparities in cancer staging among both income levels as well as race. The lower-income areas in our study were correlated with a greater proportion of Black residents as compared to the higher income areas. This data shows that Lake County needs to be more proactive in screening its minority communities.

Validation of the Webb and Rivera Score in Predicting Complexity of Mohs Surgery Procedures: A Retrospective Study

Background: Mohs micrographic surgeries (MMSs) vary in complexity and corresponding procedural duration. Preoperative triage of MMS cases enables physicians to estimate procedure duration and create an efficient schedule. The Webb and Rivera (WAR) score is a quantitative formula developed to predict complexity in Mohs cases based on tumor diameter, history of recurrence, location, and aggressiveness. Patients are given a score between 0 and 5 based on this information, with increasing surgical complexity for higher scores. Purpose: We aim to assess the association between WAR score, the number of stages, and repair type used in MMS to determine its value for clinical practice. Methods: Data for WAR score calculation were collected and analyzed for patients with squamous cell carcinoma and/or basal cell carcinoma treated with MMS between 2019 and 2023. Analyses were performed to determine if there was significant heterogeneity across WAR score groups. The Mantel–Haenszel Chi-square tests were performed for ordered categorical variables (Mohs stage), and Chi-square tests were performed for nonordered categorical variables. The results were verified using Fisher’s exact test when more than 25% of cells had an expected count of &lt;5. Analyses were performed using SAS v9.4 (SAS Institute, Cary, NC). Results: Of the 712 patients who underwent MMS, 153 (21%) had a WAR score of 0, 270 (38%) had a WAR score of 1, 189 (26%) had a WAR score of 2, 75 (10%) had a WAR score of 3, 23 (3.2%) had a WAR score of 4, and 2 (0.2%) had a WAR score of 5. The average number of surgical stages increased as the WAR score increased, and the percentage of repairs using a flap or graft similarly increased for higher scores. While 86.2% of patients with a WAR score of 0 were cleared with one stage, this decreased to 75.5% with a score of 1, 74.6% with a score of 2, 72% with a score of 3, and 52.1% with a score of 4. Only two cases had a score of 5, both of which required two stages. In addition, only 13.7% of tumors with a WAR score of 0 required closure with a flap or graft, in comparison with 24.2% with a score of 1, 33.9% with a score of 2, 47.9% with a score of 3, and 47.7% with a score of 4. Conclusion: This study demonstrates that the WAR score is an effective predictive tool for identifying cases that may require multiple stages and more complex reconstructive techniques. Given that more complex cases will require increased operative time, a scheduling template that accounts for the level of complexity can lead to a more effective schedule. The WAR score may provide a practical tool for Mohs surgeons and their staff to triage incoming cases and design a schedule that allows for a consistent workflow.

Computed tomographic characterization of urinary stones in patients with urolithiasis from Southeast Mexico

Urolithiasis (UL) is a severe public health concern in southeastern Mexico. Computed tomography (CT) is the first-line diagnostic method for patients with suspected UL. The present study aimed to characterize stones in the entire urinary system using CT and to contribute to personalized treatment in patients with UL. Patients >18 years of age with suspected UL were enrolled. Characteristics of UL included stone size, location (kidney, ureters, and bladder), composition of the stone in Hounsfield units (HU), presence of staghorn stone(s), and obstructive uropathy. Patients were stratified according to sex and age to determine whether stone size and HU were dependent on hormonal factors in females and on prostatic hyperplasia in males. The Mann–Whitney U test was used to compare median values. Frequencies are expressed as percentages and were analyzed using the Mantel–Haenszel chi-squared test. A total of 1150 patients were included in this study, of whom 744 (64.7 %) had UL in only 1 anatomical location in the urinary system, and 406 (35.3 %) had stones in ≥2 anatomical locations. Localization and stone size differed between males and females (p < 0.05). Additionally, males exhibited differences in HU (p = 0.024) and frequency of obstructive uropathy (p = 0.10) when stratified according to age (≤50 and > 50 years). In addition, females exhibited statistical differences in HU (p = 0.010) and kidney stone size (p = 0.047) dependent on age (≤47 and > 47 years). In conclusion, findings suggest that HU and stone size differ in different anatomical structures of the urinary system. In addition, differences in stone size and composition may be associated with age and sex.

Chronic Myeloid Leukemia and Myocardial Infarction: A Nationwide Readmission Database Analysis

Introduction Chronic myeloid leukemia (CML) is a hematological malignancy with an excellent outcome. After advancements in CML treatment and the introduction of different Tyrosine kinase inhibitors (TKI), their life expectancy is equivalent to the normal population. As a result of that, coronary artery disease is anticipated to be the leading cause of death among CML patients. It was particularly noted that TKI use is associated with the risk of endothelial dysfunction and it associated risk of cardiovascular events, including myocardial infarction. In this study, we compare the outcome of PCI in patients with CML to their matched non-CML group. Method The National readmission database (NRD) was searched from January 2016 to December 2020 for the study population. Adults above (age ≥ 18 years) with chronic myeloid leukemia hospitalized with a primary diagnosis of myocardial infarction, ST Elevation Myocardial Infarction (STEMI), and Non-ST-elevation myocardial infarction (NSTEMI) were identified using ICD 10 code. The primary outcomes were in-hospital mortality and 30-day readmission, and the secondary outcome was to compare the complications. The weighting of patient-level observations was implemented to obtain national estimates. Multivariate regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cutoff P-value of 0.2. Variables deemed important determinants of the outcomes based on literature were forced into the models. For readmission comparison, we used the time-to-event Cox regression analysis. Propensity matching was done by the Greedy method. Proportions were compared using the Mantel-Haenszel Chi-square test or Fisher exact test, and continuous variables were compared using the Student t-test. All P values were two-sided, with .05 as the threshold for statistical significance. Results Out of 2727619 patients with myocardial infarction, 2124 CML patients were identified, and 888 CML patients had Percutaneous Coronary Intervention (PCI). Patients' baseline characteristics and major outcomes were compared (table 1). The mean age of CML patients was 68.34 ± 11.14 (P&amp;lt;0.001). The analysis showed no significant difference between CML and non-CML patients after PCI for the primary outcome of death 0.93 (CI 0.49-1.80) P value 0.527 and 30 days readmission rate 1.41 (0.99-2.01) P value 0.056. Also, there was no statistical significance in developing major complications, including cardiac arrest, coronary artery dissection, cardiac tamponade, stroke, thrombosis, major bleeding, AKI, and dialysis. Discussion and Conclusion Patients with hematologic malignancies, including chronic myeloid leukemia, are at increased risk of thrombosis. In CML, thrombosis can be venous or arterial (myocardial infarction, cerebrovascular accidents, and peripheral artery disease). Arterial thrombosis in CML is primarily linked to using different TKIs, and thrombotic events were reported with the second-generation TKIs like nilotinib, dasatinib, and ponatinib more often than with first-generation TKIs. The mechanism of TKI use-associated thrombosis is likely related to TKI-associated endothelial dysfunction and vascular toxicity that lead to accelerated atherosclerosis and subsequent vascular thrombosis. This increased risk might lead to an assumption of an increased risk of complications with vascular intervention like PCI. Some studies showed that PCI for hematological cancer patients with STEMI have no significant difference regarding in-hospital mortality. This analysis of patients with CML with myocardial infarction ( STEMI and NSTEMI ) showed no statistically significant difference in outcome after PCI between the two groups. There were no significant differences in mortality, 30 days readmission rate, and other complications post PCI. Therefore, diagnosis of chronic myeloid leukemia shouldn't prevent patients from receiving routine therapy and intervention because of the theoretical risk of thrombosis. This information aid in patient counseling and achieving the objective of maintaining a normal quality of life for chronic myeloid leukemia patients.

Thrombospondin 2 is a novel biomarker of essential hypertension and associated with nocturnal Na+ excretion and insulin resistance

ABSTRACT Background Thrombospondins (TSPs) play important roles in several cardiovascular diseases. However, the association between circulating (plasma) thrombospondin 2 (TSP2) and essential hypertension remains unclear. The present study was aimed to investigate the association of circulating TSP2 with blood pressure and nocturnal urine Na+ excretion and evaluate the predictive value of circulating TSP2 in subjects with hypertension. Methods and Results 603 newly diagnosed essential hypertensive subjects and 508 healthy subjects were preliminarily screened, 47 healthy subjects and 40 newly diagnosed essential hypertensive subjects without any chronic diseases were recruited. The results showed that the levels of circulating TSP2 were elevated in essential hypertensive subjects. The levels of TSP2 positively associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and other clinical parameters, including homeostasis model assessment of insulin resistance (HOMA-IR), brachial-ankle pulse wave velocity, and serum triglycerides, but negatively associated with nocturnal urine Na+ concentration and excretion and high-density lipoprotein cholesterol. Results of multiple linear regressions showed that HOMA-IR and nocturnal Na+ excretion were independent factors related to circulating TSP2. Mantel–Haenszel chi-square test displayed linear relationships between TSP2 and SBP (χ2 = 35.737) and DBP (χ2 = 26.652). The area under receiver operating characteristic curve (AUROC) of hypertension prediction was 0.901. Conclusion Our study suggests for the first time that the circulating levels of TSP2 may be a novel potential biomarker for essential hypertension. The association between TSP2 and blood pressure may be, at least in part, related to the regulation of renal Na+ excretion, insulin resistance, and/or endothelial function.

Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study

In respiratory infections, anemia is both a consequence of acute inflammation and a predictor of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Data from all adult patients admitted for COVID-19 in University Hospital “P. Giaccone” Palermo, and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 to 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox’s regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. p values were calculated using the Student’s t test for continuous variables and the Mantel–Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox’s regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95% CI 43–48%). Patients with anemia were significantly older (p < 0.0001), reported more co-morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR = 2.68; 95% CI: 1.59–4.52) and of risk of severe COVID-19 (OR = 2.31; 95% CI: 1.65–3.24). The propensity score analysis substantially confirmed these analyses. Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline pro-inflammatory profile and higher incidence of in-hospital mortality and severe disease.

Trend and associated factors of cesarean section rate in Ethiopia: Evidence from 2000-2019 Ethiopia demographic and health survey data.

The world health organization considers cesarean section (CS) prevalence of less than 5% suggests an unmet need. On the other hand, a prevalence of more than 15% may pose to risk to mother and child, however, access to CS in a resource-limited country like Ethiopia was much lower than the aforementioned level, Therefore, this was the first study to determine the trend of CS, and factors that influence it. This was done based on the five Ethiopia Demographic and Health Surveys. Trend analysis was done separately for rural and urban. The significance of the trend was assessed using the Extended Mantel-Haenszel chi-square test. The factors on CS delivery were identified based on DHS 2016 data. A multi-level logistic regression analysis technique was used to identify the factors associated with cesarean section delivery. The analysis was adjusted for the different individual- and community-level factors affecting cesarean section delivery. Data analysis was conducted using STATA 14.1 software. The rate of cesarean section increased from 5.1% in 1995 to 16% in 2019 in an urban area and 0.001 in 1995 to 3% in a rural area, the overall increment of CS rate was 0.7% in 1995 to 2019 at 6%. The odds of cesarean section were higher among 25-34 years (AOR = 2.79; 95% CI: 1.92, 4.07) and 34-49 years (AOR = 5.23;95% CI: 2.85,9.59), among those educated at primary school level (AOR = 1.94; 95% CI: 1.23,3.11), secondary education (AOR = 2.01; 95% CI: 1.17, 3.56) and higher education (AOR = 4.12; 95% CI: 2.33-7.29)with multiple pregnancies (AOR = 11.12; 95% CI: 5.37, 23.), with obesity (AOR = 1.73; 95% CI: 1.22, 2.45), living in an urban area (AOR = 2.28; /95% CI: 1.35-3.88), and increased with the number of ANC visit of 1-3 and 4th(AOR = 2.26; 95% CI: 1.12, 4.58), (AOR = 3.34; 95% CI: 1.12, 4.58), respectively. The odds of cesarean section are lower among parity of 2-4 children (AOR = 0.54; 95% CI: 0 .37, 0.80) and greater than four birth order (AOR = 0.42;95% CI: 0.21,0.84). In Ethiopia, the CS rate is below the WHO recommended level in both urban and rural areas, thus, intervention efforts need to be prioritized for women living in a rural area, empowering women's education, encouraging co-services such as ANC usage could all help to address the current problem.

Association between hemoglobin glycation index and diabetic kidney disease in type 2 diabetes mellitus in China: A cross- sectional inpatient study.

To investigate the association between Hemoglobin Glycation Index (HGI) and Diabetic Kidney Disease (DKD) in Chinese type 2 diabetic individuals and to construct a risk score based on HGI to predict a person's risk of DKD. We retrospectively analyzed 1622 patients with type 2 diabetes mellitus (T2DM). HGI was obtained by calculating the fasting plasma glucose (FPG) level into the formula, and they were grouped into low HGI group (L-HGI), medium HGI group (H-HGI) and high HGI group (H-HGI) according to tri-sectional quantile of HGI. The occurrence of DKD was analyzed in patients with different levels of HGI. Multivariate logistics regression analysis was used to analyze the risk factors of DKD in patients with T2DM. A total of 1622 patients with T2DM were enrolled in the study. Among them, 390 cases were DKD. The prevalence of DKD among the three groups was 16.6%, 24.2% and 31.3%. The difference was statistically significant (P = 0.000). There were significant differences in age (P=0.033), T2DM duration (P=0.005), systolic blood pressure (SBP) (P=0.003), glycosylated hemoglobin (HbA1c) (P=0.000), FPG (P=0.032), 2-hour postprandial plasma glucose (2h-PPG) (P=0.000), fasting C-peptide FCP (P=0.000), 2-hour postprandial C-peptide (2h-CP) (P=0.000), total cholesterol (TC) (P=0.003), low density lipoprotein cholesterol (LDL-C) (P=0.000), serum creatinine (sCr) (P=0.001), estimated glomerular filtration rate (eGFR) (P=0.000) among the three groups. Mantel-Haenszel chi-square test showed that there was a linear relationship between HGI and DKD (x2=177.469, p < 0.001). Pearson correlation analysis showed that with the increase of HGI level the prevalence of DKD was increasing (R= 0.445, P=0.000). It was indicated by univariate logistic regression analysis that individuals in H-HGI was more likely to develop DKD (OR: 2.283, 95% CI: 1.708~ 3.052) when compared with L-HGI. Adjusted to multiple factors, this trend still remained significant (OR: 2.660, 95% CI: 1.935~ 3.657). The combined DKD risk score based on HGI resulted in an area under the receiver operator characteristic curve (AUROC) of 0.702. High HGI is associated with an increased risk of DKD. DKD risk score may be used as one of the risk predictors of DKD in type 2 diabetic population.

New-onset prediabetes, diabetes after acute pancreatitis: A prospective cohort study with 12-month follow-up.

Acute pancreatitis (AP) is known to result in endocrine dysfunction (prediabetes,diabetes). The objective of this study was to determine the temporal incidence of endocrine dysfunction after onset of AP and determine the risk factors in Indian patients. In this prospective study, enrolled patients diagnosed with AP between February 2019 and May 2019 were followed at 3, 6, and 12 months until May 2020. Patients with recurrent AP, chronic pancreatitis, and pre-existing endocrine dysfunction were excluded. Demographic and disease severity (clinical, laboratory, and radiological) data were recorded. Mann-Whitney U and Chi-square tests were used to compare groups. Temporal trend for development of endocrine dysfunction was evaluated using the Extended Mantel Haenszel Chi-square test for trend. Logistic regression was used to identify independent risk factors. Eighty-six patients (males 66, median [IQR] age 33.0 [26.0-44.2] years) who fulfilled enrolment criteria were finally analyzed. The most common etiology was alcohol (n=31 [36%]) followed by gallstones (n=17 [19.8%]). The proportion of patients with moderately severe acute pancreatitis and severe AP were 59.3% and 15.1%, respectively. Overall, the frequency of prediabetes and diabetes increased temporally across the follow-up period. These were 2 (2.33%) and 1 (1.16%) at 3 months, 11 (12.8%) and 5 (5.81%) at 6 months, and 20 (23.2%) and 9 (10.5%) at 1 year, respectively. On multivariable logistic regression, intervention for walled-off necrosis (WON) emerged as the single independent risk factor for endocrine dysfunction (odds ratio 9.01 [2.3-35.5]; p=0.002). Endocrine dysfunction is frequent after an episode of AP. Intervention for WON is an independent risk factor for endocrine dysfunction.

Radiation Sparing Reduced Intensity Conditioning for Allogeneic Cell Transplantation in Patients with Dyskeratosis Congenita Comparable to Standard of Care: A Phase III Single Institution Trial

Introduction Dyskeratosis congenita (DKC) is a rare form of inherited multiorgan disease caused by mutations affecting telomere maintenance. Complications include bone marrow failure (BMF), pulmonary and liver fibrosis, and predisposition to malignancy. Allogeneic hematopoietic cell therapy (alloHCT) can rescue affected individuals from hematologic complications. However, toxicity from alkylator and radiation exposure can be lethal or potentially expedite DKC-specific organ complications. In this single institution phase III clinical trial, we aimed to demonstrate non-inferior short-term alloHCT outcomes with a radiation sparing reduced intensity conditioning (RIC) regimen while monitoring for long-term reductions in systemic toxicity. Methods We compared two consecutive cohort of patients with DKC requiring alloHCT for BMF or myelodysplastic syndrome (MDS). Both received RIC with fludarabine 200 mg/m2, cyclophosphamide 50 mg/kg, and alemtuzumab 1 mg/kg. The earlier cohort (4/2006-8/2012) additionally received 200 cGy total body irradiation ("TBI"), while the latter (11/2015-2/2021) "Non-TBI" cohort did not. We restricted our analysis to bone marrow (BM) and peripheral blood stem cell (PBSC) recipients. AlloHCT milestones including neutrophil engraftment, graft failure, disease progression, acute and chronic graft-versus host disease (GvHD), serious infections, and overall survival were prospectively recorded. The cumulative incidence of time-dependent events was compared between cohorts using the Fine-Gray test with death as a competing risk. Infection density over the first 100 days after alloHCT was calculated using the Mantel-Haenszel chi-square test for incidence density. Estimates of overall survival were calculated by Kaplan-Meier curves. Results The TBI cohort included 12 patients aged 2.2-52.2 years (median 20.5), 11 with SAA and 1 with MDS. Stem cell sources were unrelated donor BM in 8, sibling donor PBSCs in 2, and sibling BM in 1, with a median follow-up of 1531 days (range 83-3960). The comparable Non-TBI group included 10 patients aged 1.7-65.9 years (median 9.8), 8 with SAA and 2 with MDS/RAEB. Stem cell donor sources were unrelated donor BM in 8 and sibling BM in 2, with a median follow-up of 870 days (range 303-2420). Neutrophil engraftment occurred at a median of 13 days in the TBI cohort and 8.5 days in the Non-TBI cohort (p<0.001; Fig 1a). Cumulative incidence of acute GvHD by day 100 for the TBI cohort was 0.08 (95% CI <0.01, 0.32) compared to 0.1 (95% CI <0.01, 0.37) for the Non-TBI cohort (p=0.74). Cumulative incidence of chronic GvHD by 3 years for the TBI cohort was 0.17 (95% CI 0.02, 0.43) compared to 0.1 (95% CI <0.01, 0.37) for the Non-TBI cohort (p=0.7). With regard to serious infections the first 100 days after alloHCT, there were no fungal infections in either group and infection density of viral infections, bacteremia, and pneumonia episodes was equivalent between cohorts. In the TBI cohort, one case was recorded as a late graft failure at day +1371, however upon retrospective review, this patient maintained 10% BM cellularity with 100% donor chimerism and experienced cytopenias and death likely resulting from Epstein-Barr viremia and possible post-transplant lymphoproliferative disease. In the Non-TBI cohort, one patient experienced non-neutropenic graft failure/rejection at day +28. A second Non-TBI patient demonstrated graft failure in the form of MDS recurrence at day +359. There was no statistically significant difference in overall survival between the two groups (p=0.4; Fig 1b, Table 1), with the 5.5 years median survival of the TBI cohort and the median survival not achieved for the Non-TBI cohort. Conclusions A successful alloHCT conditioning regimen for DKC must provide myeloablation to allow for sustained donor engraftment and immunosuppression to decrease GvHD risk, while limiting an unfavorable toxicity profile to which DKC patients are more susceptible. Elimination of TBI from the RIC regimen demonstrated equivalent overall survival, acute and chronic GvHD incidence, and day +100 infection density with an expedited neutrophil engraftment and no increase in graft failure risk. While there appears to be a trend toward less lethal DKC late effects like pulmonary failure and secondary malignancy, definitive assessment of such outcomes requires further longitudinal follow-up of both cohorts. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Status of Serum Uric Acid and Hyperuricemia among Adults in China: China Nutrition and Health Surveillance (2015)

ObjectiveThe purpose of this study was to determine the serum uric acid levels and the prevalence of hyperuricemia among Chinese adults in 2015 and compare the differences between urban and rural areas, as well as the differences between eastern, central, and western regions. MethodsA national representative sample of 180,208 participants were included using a stratified, multistage, and random sampling method. The demographic characteristics and blood samples were collected to determine the serum uric acid levels and prevalence of hyperuricemia among subgroups using complicated sampling weight. A t-test or ANOVA was used for normally-distributed data. The Kruskal-Wallis rank test was used for skewed-distributed data. The Mantel-Haenszel chi-square test was used to compare the difference in categorical variables. ResultsThe weighted mean uric acid level in Chinese adults was 310.4 μmol/L (317.5 μmol/L in urban areas and 302.9 μmol/L in rural areas). The weighted average values of uric acid in eastern, central, and western China were 315.5 μmol/L, 303.5 μmol/L, and 310.4 μmol/L, respectively. The weighted prevalence of hyperuricemia in Chinese adults was 14.6%, with a prevalence of 16.5% in urban areas and 12.5% in rural areas. The weighted prevalence of hyperuricemia in eastern, central, and western China was 16.0%, 12.5%, and 14.8%, respectively. ConclusionThe uric acid level in Chinese adults is relatively high. Effective actions are warranted to improve this metabolic abnormality.