Females Mean Age Research Articles

Laryngeal Cancer in Iranian Women

Laryngeal cancer is the most common malignant neoplasm in respiratory tract after lung cancer. The incidence is very different and male to female ratio has been decreased in previous decades. Different characteristics of laryngeal cancer in men and women have been described based on previous studies, so we decided to study its characteristics in Iranian women. This study's design is cross-sectional retrospective from 2010 to 2019 in Amir-Alam Hospital, Tehran University of Medicine. All patients with laryngeal cancer admitted to this hospital, were included. Females` records were studied exclusively. Among 1456 patients included in this study, 1391 were male and 65 were female(M/F=21.4:1). The mean age of males was 60.6 years and for females was 56.6. From 65 females, 60 were Squamous cell carcinoma and 5 were Sarcoma. Findings of 60 female SCC patients: The main risk factors were cigarette smoking and opium abuse. The subsite of tumor was supraglottic in 40%, glottis in 31% and transglottic in 29%. Treatment options were surgical (55%) and non-surgical (45%). Survival rates for one, two and five years were 84.3%, 67.4% and 44% respectively. Two-year survival of surgically treated patients is significantly better than non-surgically treated patients (P=0.048). The mean age of females was less than males. Two-year survival rate was better in surgically treated patients. The five-year survival of female patients was 44% and there is an emerging need for survival studies of male patients for comparison.

COMPARISON OF ENDOMETRIAL TISSUE SAMPLE BY MANUAL VACUUM ASPIRATION VERSUS DILATION & CURETTAGE IN FEMALES PRESENTING WITH ABNORMAL UTERINE BLEEDING

Abnormal uterine bleeding (AUB) is bleeding from uterine corpus , abnormal in volume, regularity, or timing.
 Objective: To compare the efficacy in terms of adequate endometrial sample received by pathologist of manual vacuum aspiration versus dilation & curettage in females presenting with abnormal uterine bleeding.
 Methods: It was a Randomized Controlled Trial performed in Department of Obstetrics & Gynecology, Lahore General Hospital, Lahore for one year (April 3, 2020 till april 2, 2021). 390 females were randomly divided in two groups by lottery method. In group A, females had endometrial sampling with MVA. In group B, it was by dilatation and curettage by single surgical team. Efficacy was labelled when a pathologist could identify the endometrial epithelium, gland, and stroma, and make particular diagnosis of sample.
 Results: The mean age of females in MVA group was 55.07 ± 6.10 years and 55.5 in D & C group ± 6.07 years. The mean duration of AUB in MVA group was 17.26 ± 4.12 months and in D &C group, it was 17.44 ± 2.51 months. In MVA group, 170(87.2%) cases had efficacy and in D & C group efficacy,it was in 181(92.8%) cases, the frequency of efficacy in both groups was statistically same i.e. p-value > 0.05. 
 Conclusion: Although the efficacy in D & C group was high but was not statistically significantly different than MVA.So being simple and quick procedure,MVA can be used as an outdoor procedure, with less blood loss, without general anesthesia

A PROSPECTIVE CLINICAL STUDY OF THYROID MALIGNANCIES AND THE ROLE OF SERUM TSH IN PREDICTING MALIGNANCY

Introduction: Serum TSH is an independent predictor of malignancy in thyroid nodules according to the recent publications. Thyroid malignancies could be screened by using this biochemical marker (TSH) as a preliminary step. In this study, we looked into the usefulness of TSH in predicting cancer as well as the typical clinical presentation of thyroid cancers. Aims And Objectives: To assess the value of serum TSH measurement as a biochemical predictor of malignancy in suspicious thyroid nodules and to study the clinical manifestations and management of different thyroid malignancies. Place of Study: NRI Medical College Materials And Methods: and General Hospital, chinnakakani. Study population: All patients presented to General Surgery Department of NRI medical college and hospital, chinnakakani with clinically suspicious thyroid swellings of malignancy during the study period. Duration of Study: This was done over period Of one year from August 2021 to August 2022. It has a follow up of 6 months. Most of the Results: patients were females.40 years is the mean age of malignancy.mean age in male is 59 years and the mean age in females is 38 years. It commonly manifested as a rapidly growing swelling in the thyroid with shorter duration or development of secondary symptoms in a long standing goiter. Most of the patients are presented with STN. Malignancy occurred more frequently in SNT (36%) than MNG (19%).%. Mean preoperative TSH values of benign illness is less compared to those with malignancy. Higher TSH readings were associated with an increased risk of cancer. Higher TSH levels are Conclusion: denitely used as a predictor. The FNAC can be reexamined in these circumstances where the TSH result is high to correlated with malignancy. In cases with clinically suspected malignant thyroid swelling with a benign FNAC report, TSH values may be conrm the diagnosis

Psychometric properties of the Greek translation of the Greek Short Dark Triad questionnaire (GSD3Q) in a subclinical sample

Introduction‘Dark Triad’ is a constellation of three conceptually distinct but empirically overlapping personality variables. The three members- Machiavellianism, narcissism and subclinical psychopathy – often show differential correlates but share a common core of callous-manipulation.ObjectivesTo validate an easy to use and valid measurement for subclinical populations examining the 3 factors of the dark triad of personality.MethodsA pool of items designed to circumscribe the classic conceptions of the Dark Triad constructs used for the Short Dark Triad were translated using the multiple forward and backward translation protocol. Participants consisted of 391 adults recruited from social media. Participants were then asked to rate their agreement with each of the 44 items generated for the GSD3Q).Results391 adults participated, 51 (13%) male, 340 (87%) female mean age 41.4(SD=10.8). Corrected Item-Total Correlation was used for the first reduction of items and then PCA with eigenvalues >1.5 was used for the reduction of the items loading lower than 0. 400 for each factor independently. Finally, Principal Axis Factoring with Varimax rotation led to 9 items for Machiavellianism (alpha coefficient=0.659), 8 items for Narcissism (alpha coefficient=0.659) and 10 items for Psychopathy (alpha coefficient=0.742). Strong correlations were found as expected between the 3 factors with lower between Machiavellianism and Narcissism r=.487 p=0.001 and higher between Psychopath and Narcissism r=.617 p=0.001.ConclusionsThe results of the current validation led to a 27 item, with 3 factors questionnaire with similar psychometric properties for non-clinical populations. Further validation is needed for clinical samples.Disclosure of InterestNone Declared

A 23-Year Observational Follow-Up Clinical Evaluation of Direct Posterior Composite Restorations.

The purpose of this observational follow-up clinical study was to observe the quality of posterior composite restorations more than 23 years after application. A total of 22 patients, 13 male and 9 female (mean age 66.1 years, range 50-84), with a total of 42 restorations attended the first and second follow-up examinations. The restorations were examined by one operator using modified FDI criteria. Statistical analysis was performed with the Wilcoxon Mann-Whitney U test and Wilcoxon exact matched-pairs test with a significance level of p = 0.05. Bonferroni-Holm with an adjusted significance level of alpha = 0.05 was applied. With the exception of approximal anatomical form, significantly worse scores were seen for six out of seven criteria at the second follow-up evaluation. There was no significant difference in the first and second follow-up evaluations in the grades of the restorations with regard to having been placed in the maxilla or mandible, as well as for one-surface or multiple-surface restorations. The approximal anatomical form showed significantly worse grades at the second follow-up when having been placed in molars. In conclusion, the study results show that significant differences regarding FDI criteria in posterior composite restorations occur after more than 23 years of service. Further studies with extended follow-up time and at regular and short time intervals are recommended.

Validity of age estimation methods and reproducibility of bone/dental maturity indices for chronological age estimation.

This systematic review sought to assess the validity of age estimation methods based on bone or dental maturity indices and their reproducibility through a meta-analysis of validation and reproducibility studies. A systematic online search was conducted in PubMed and Google Scholar. Cross-sectional studies were included. The authors excluded articles without information on validity and reproducibility outcomes, articles not written in English or Italian, and those where it was impossible to obtain pooled reproducibility estimates of Cohen's kappa or the intraclass correlation coefficient (ICC) due to a lack of information on the variability measure. The authors tried to follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. They also considered the PICOS/PECOS strategy to assess the research questions in their included studies; nevertheless, no particular guideline was reported to be consistently followed in their study. Twenty-three (23) studies were selected for data extraction and critical appraisal. The pooled male mean error of the age prediction was 0.08 years (95% CI: -0.12; 0.29), and the pooled female mean error was 0.09 years (95% CI: -0.12; 0.30). Studies using Nolla's method had a mean error closest to zero with a slight overestimation: mean male age prediction error of 0.02 (95% CI: -0.37; 0.41) and mean female age prediction error of 0.03 (95% CI: -0.34; 0.41). Haavikko's method had a mean error of -1.12 (95% CI: -2.29; 0.06) and -1.33 (95% CI: -2.54; -0.13) for males and females, respectively. Cameriere's method also underestimated the chronological age and was the only method with a higher absolute mean error for males than females (males: -0.22 [95% CI: -0.44; 0.00]; females: -0.17 [95% CI: -0.34; -0.01]). Overall, Demirjian's and Willems's methods tended to overestimate chronological age in both males (Demirjian: 0.59 [95% CI: 0.28; 0.91]; Willems: 0.07 [95% CI: -0.17; 0.31]) and females (Demirjian: 0.64 [95% CI 0.38; 0.90]; Willems: 0.09 [95% CI: -0.13; 0.31]). The prediction intervals (PI) overlapped zero for all methods, rendering the difference between estimated and chronological ages not statistically significant for males and females. Cameriere's method showed the smallest PI for both biological genders, while the Haavikko and other methods had the widest intervals. No heterogeneity was observed in inter-examiner (heterogeneity: Q = 5.78, p = 0.888) and intra-examiner (heterogeneity: Q = 9.11, p = 0.611) agreement, so a fixed-effects model was used. For inter-examiner agreement, the ICC ranged from 0.89 to 0.99, and the meta-analytic pooled ICC was 0.98 (95% CI 0.97; 1.00), which was near-perfect reliability. Concerning intra-examiner agreement, the ICCs ranged from 0.90 to 1.00, and the meta-analytic pooled ICC was 0.99 (95% CI 0.98; 1.00), which was also close to perfect reliability. This study recommended the Nolla and Cameriere methods as preferred approaches while mentioning that the Cameriere method was validated on a smaller sample size than Nolla's, thus requiring further testing on additional populations to better assess the mean error estimates by sex. However, the evidence in this paper is of very low quality and offers no certainty.

Abstract P552: Mendelian Randomization Analysis of Metabolites Associated With Severe Obesity in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Obesity remains a global public health burden, with 4.7 million premature deaths globally attributed to obesity. Severe obesity (SevO: defined as body mass index (BMI)≥40) is a major risk factor for other comorbidities, including heart disease and Type 2 Diabetes, which disproportionately impact historically marginalized populations, including Hispanic/Latinos. Based on BRFSS data, 24.5% of US Hispanic/Latino adults are projected to have severe obesity by 2030. However, the etiology of the underlying metabolic dysfunction remains unknown. To address this gap, we identified metabolites associated with SevO in genotyped participants aged ≥20 with 25 < BMI ≥ 40 and metabolic data in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We investigated cross-sectional associations between Blom-transformed metabolites and baseline SevO, adjusting for age, study center, background group, smoking status, and principal components of ancestry, stratified by sex (SUGEN), and meta-analyzed (SAS 9.4). For the top 20 metabolites, we extracted publicly available HCHS/SOL metabolite GWAS (mGWAS) summary statistics to derive metaboQTLs, and summary statistics from a multi-population meta-analysis of SevO (N>70,000) and implemented forward MR analysis using the MendelianRandomization R package (v0.3.0), which provides various robust causal estimation methods for summary data. Anthropometry and data for 640 known Metabolon metabolites were available for 551 females (mean age: 43.3 years, 27% SevO) and 371 males (mean age 43.4 years, 15% SevO). We identified Bonferroni-corrected significant SevO associations (p<0.05/640) for 224 metabolites in the meta-analysis. Of the top 20 metabolites associated with SevO, we excluded six with no genome-wide significant SNPs in the mGWAS. For the remaining 14, we included independent SNPs with p<1E-6 as instrumental variables in the MR for each metabolite. After excluding SNPs ±500kb from known BMI loci, two metabolites showed causal associations with SevO, cytidine (penalized robust MR-Egger: ß (SE) =0.121 (0.051), p=0.018) and indoleproprionate (penalized weighted median-MR: ß (SE) =-0.138 (0.043), p=0.001). Cytidine is a pyrimidine nucleoside consisting of D-ribose and cytosine, which is a precursor of cytidine triphosphate required in the one-carbon metabolism pathway to convert phosphatidylcholine (PC) to phosphatidylethanolamine (PE). PC biosynthesis is higher in adipose tissue macrophages in obese mice and humans. Indoleproprionate is a microbial metabolite of tryptophan produced by gut bacteria. Indoleproprionate levels have been shown to be associated with higher microbiome diversity and lower incidence of T2D. Our work points to future efforts to validate findings in other cohorts, including reverse MR to further elucidate the causal relationship between metabolites and severe obesity.

Gender difference in crescentic glomerulonephritis; an eleven-year single-center study

Introduction: Crescentic glomerulonephritis is an essential kind of glomerulonephritis. According to its rapid progression and aggressiveness, recognizing its risk factors helps to manage a better treatment and outcome. Objectives: This study was designed to compare demographic, laboratory, and renal biopsy findings of patients with crescentic glomerulonephritis among males and females. Patients and Methods: This cross-sectional study compared age, gender, types of crescentic glomerulonephritis, serum creatinine, 24-hour proteinuria, the number of crescents, and percentage of fibrosis. Results: Of 169 patients with crescentic glomerulonephritis, 54.4% were males, and 45.6% were females. The mean age, serum creatinine level, and 24-hour proteinuria were 37.73±15.32 years, 2.06±1.35 mg/d, and 2084.82±1170.98 mg/d, respectively. Serum creatinine level and 24-hour proteinuria were not significantly different by gender. In addition, the number of crescents had no relationship with age and 24-hour proteinuria; however, it had a significant direct relationship with serum creatinine. Conclusion: According to our study, lupus nephritis affected women more than men, while other forms of crescentic glomerulonephritis were more common in males. Depending on the population, a significant relationship between the number of crescent and serum creatinine was detected. The mean age of females with crescentic glomerulonephritis was significantly lower than males.

MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series

BackgroundCancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ.MethodsThis multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients’ data were retrospectively collected from the clinical charts of seven recruiting Italian centres.ResultsMRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed.ConclusionsThis is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ.

Incidence of Perioperative Complications Associ-ated with Cardiac Surgery Under Cardiopulmo-nary Bypass

Introduction: Following cardiac surgery, complications such as cardiac, pulmonary, renal, and neurological diseases, infections like pneumonia or sepsis, and extended stays in the intensive care unit (ICU) and hospital are signs of both the quality of care and the quality of life. Therefore, it's critical to pinpoint the complications that put patients at risk for substantial postoperative morbidity and extended lengths of hospital stay. Aims & Objectives: To study nature and incidence of perioperative complications in patients undergoing cardiac surgery under cardiopulmonary bypass. Material & Methods: This study included 151 patients, of any age, either sex, planned for cardiac surgery under cardiopulmonary bypass (like Valve replacement, valve repairs, CABG, myxoma excision, Congenital Heart Diseases like ASD, VSD, TOF). The data regarding demographic profile and postoperative complications were collected. RESULTS; There were total of 151 patients in our study including 66 males (43.7%) and 85 females (56.3%). Age of the subjects ranged from 1 to 70 years with a mean of 26.39 ± 18.67 years (Median of 25 years). Mean age of males was 26.27 ± 20.72 years and mean age of females was 26.49 ± 17.03 years. About 51 % patients in our study had at least one of the complications. The most common complication was rhythm disorder which was present in 34.4% of all patients. ARDS developed in 1.3% of patients. Infections were present in 27 patients (17.9%). Dyselectrolytemia was present in 11 patients (7.3%). Conclusion: Cardiac surgery under cardiopulmonary bypass is associated with as cardiac, pulmonary, renal, and neurological diseases, infections like pneumonia or sepsis. The most common complication was rhythm disorder which was present in 34.4% of all patients. ARDS developed in 1.3% of patients. Infections were present in 27 patients (17.9%). Dyselectrolytemia was present in 11 patients (7.3%). Keywords: Cardiopulmonary Bypass (CPB), Length of stay (LOS).

Is the Postoperative Outcome after Intraarticular Distal Radius Fracture Influenced by Age and Gender? A PROM Study.

Although the most common fracture of the human body, so far, only few data concerning gender-specific outcomes after distal radius fracture exist. Typically, elderly women suffer from DRF due to a low-energy fall because of osteoporosis. The aim of this study was to analyze the outcome after a surgically treated intraarticular DRF with the help of patient-reported outcome measurement (PROM) and with special regard to gender and age impact. It is a retrospective case-control study in which all patients with an intraarticular DRF were enrolled. The control group was composed of healthy volunteers. Munich Wrist Questionnaire (MWQ) was used as Patient Related Outcome Measurement (PROM) for analyzing the outcome. Moreover, age, gender, handedness, fracture classification and follow-up interval were detected. The functional outcome of the fracture group was compared to a healthy control group. Analyses of gender, age and handedness-specific results compared to the healthy control groups were performed as well. 197 patients with distal radius fracture could be enrolled in the study (134 were female and 63 were male). Women (mean age 62 years) were significantly older than men (mean age 50 years). The control group comprised 110 healthy subjects, 71 females (mean age 56 years) and 39 males (mean age 53 years). The whole fracture group had significantly lower MWQ scores compared to the control group (p < 0.001). The male fracture group (90.6 ± 12.4) and the female fracture group (90.8 ± 11.4) had a significantly worse outcome compared to the corresponding control group (p < 0.001 male and p = 0.034 female). Although significantly younger, the male patients had a similar outcome compared to the female patients. Even elderly patients can reach the preoperative level after operative treatment of an intraarticular distal radius fracture. Although significantly younger than the female patients, men have significantly worse functional outcomes compared to their control and cannot perform better than the significantly older female patients. Gender might influence the outcome as well; however, age seems to have a greater impact on the outcome than gender.

Pre- and post-intervention survey on lung cancer awareness among adults in selected communities in KwaZulu-Natal, South Africa: A quasi-experimental study.

Lung cancer remains the number one cause of cancer mortality estimated at 1.8 million deaths. There are limited studies in resource poor countries regarding knowledge, attitudes and practices towards lung cancer. This study aimed to assess the effects of a lung cancer awareness intervention in selected communities in KwaZulu- Natal, South Africa. A quasi-experimental study design was conducted in the selected communities in KwaZulu-Natal. A community intervention was administered in the communities after a baseline survey. The intervention effects were assessed a month after implementation. There were statistical differences in the mean age (p<0.001) and proportion of males and females (p<0.001) at baseline and post-intervention. There were no differences in terms of smoking status (p=0.958), however, there was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). The mean knowledge score increased from 41.8% (95% CI 35.7 - 47.9) at baseline to 59.9 (95% CI 53.8 - 66.0) post-intervention (p<0.001). The proportion of participants who were aware that lung cancer can be detected early increased from 46.5% (95% CI 39.1 - 53.9) at baseline to 81.1% (95% CI 71.7 - 87.9) post-intervention (p<0.001). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on the level of lung cancer knowledge in the selected communities (p<0.001). Interventions increasing the recognition of signs and symptoms, focusing on the importance of early detection and health seeking behaviour (including screening), smoking cessation, and addressing the perceived health system barriers are required.

Poststroke Disability: Association Between Sex and Patient-Reported Outcomes.

Ischemic stroke (IS) is a leading cause of long-term disability with sex-specific differences in outcomes. Identifying the influential factors that contribute to sex-specific disparities in stroke outcomes, therefore, holds potential to develop individualized interventions for reducing long-term disability. Further, investigating the association between sex and Patient-Reported Outcome Measures (PROMs) provides additional information on the individual impact and heterogeneity of IS. We aimed to identify sex-specific differences in stroke outcomes and relationship with PROMs in IS patients with 3-month follow-up. Between February 2017 and February 2020, a total of 410 patients admitted with IS to the Massachusetts General Hospital, in Boston, were enrolled in this prospective cohort. At 3-month poststroke, patients were assessed for Barthel Index, modified Rankin Scale, and PROM-10 questionnaires. T scores for physical and mental health were determined from the summing of PROM-10 responses in each domain. Regression analysis was performed to identify sex-specific determinants of functional and patient-reported outcomes. At baseline, 242 participants were male (mean age, 65 years) and 168 were female (mean age, 70 years). Groups had similar rates of cardiovascular risk factors, admission National Institutes of Health Stroke Scale, and discharge modified Rankin Scale. At follow-up, male participants were more likely to have better rates of T Physical and Barthel Index. In regression analysis, PROMs T Physical (odds ratio, 1.06; P=0.01), Barthel Index (odds ratio, 1.06; P=0.01), and modified Rankin Scale score of ≥2 (odds ratio, 2.60; P=0.01) were associated with female sex. Female sex was also associated with lower scores for PROMs Physical subcomponents and with patient-reported general health and emotional problems. Women have worse outcomes after ischemic stroke, including objective measures of functional disability and patient-reported outcomes. Incorporating PROMs into IS outcome measures may offer additional insight into sex-specific differences in stroke recovery and outcomes.

P306 Serum tryptophan metabolites as a biomarker for disease severity in patients with IBD

Abstract Background The levels of tryptophan (TRP) metabolites such as kynurenine (KYN), kynurenic acid (KYNA), quinaldic acid, 3-hydrocynynene, anthranilic acid, picolinic acid (PA) and xanthurenic were determined systematically in inflammatory bowel disease (IBD). Previous studies found a negative correlation with TRP levels and IBD disease activity. However, there is no data about serum levels of TRP metabolites and their correlation with severity of IBD. We aimed to determine the correlation between the levels of TRP, its metabolites and the clinical, laboratory, and endoscopic findings of the disease activation including fecal calprotectin. Methods A total of 115 patients, 77 (66.4%) with UC and 38 (33.6%) with CD, were included. Forty three % (n=49) of the patients were female. 57 % (n=66) were male. The mean age of females and males were 42.07±13.39 and 44.23± 10.04 years, respectively. Patients were categorized according to their disease activity: Sixty-five (57%) of the patients were in remission and 50 (43%) were active. The predictive value of the disease activity was evaluated by the levels of serum tryptophan, its metabolites and the fecal calprotectin levels. Results At a cut-off value of ≤11328.41 ng/ml of tryptophan, the sensitivity to predict disease activation is 76.9% and the specificity is 71.7%. On the other hand, at a cut-off value of ≥89.60 µg/g of fecal calprotectin, the sensitivity of detecting disease activation was 88.1% and the specificity was 80.0%. Calprotectin, sedimentation, CRP, KYN/TRP values were found to be significantly higher in patients in the active period than in patients in remission (p&amp;lt;0.001, p&amp;lt;0.001, p&amp;lt;0.007 respectively). KYNA, TRP, and PA values were found to be statistically significantly lower in patients in the active phase compared to those in remission (p=0.01, p&amp;lt;0.001, p=0.022 respectively). Conclusion Serum TRP levels were lower in increased disease activity. Quinolinic acid levels did not differ between active patients and patients in remission. Quinolinic acid, which is the metabolite of TRP degradation, was increased with active disease. However, fecal calprotectin still had superior predictive value for IBD disease activity. Further studies are needed to assess the TRP pathway for the disease severity and disease course in IBD.

The Outcome of Bicolumnar Acetabular Fracture Treated by Single Anterior Ilioinguinal Approach

Background: Acetabular fracture therapy, being complicated, is generally treated by non-operative methods due to a lack of surgeons’ expertise in pelvis surgery. The surgical exposure and reduction of acetabular fractures may become more direct and practical with the altered technique since it is closer to the acetabular quadrilateral plate. This study aimed to determine the efficacy of a single anterior illio-inguinal approach for the management of a Bi-columnar acetabulum fracture. Methods: Sixty patients, fulfilling the selection criteria were selected for descriptive case series from Orthopedic Surgery Department at Lahore General Hospital, from 02-12-2020 to 02-06-2021. After informed consent, surgery was performed on all patients under general anesthesia. Patients were followed-up and evaluated for efficacy in OPD after 12 weeks of surgery with a Harris hip score. All demographic and other information was recorded on a Proforma. SPSS 22 was used to assess data. Post-stratification, efficacy was compared by using chi-square, p-value ≤0.05 was considered significant. Results: Out of 60 patients, 45(75 %) were male, whereas 15(25%) were female (Mean age 52.71±10.50yrs). The Mean of duration fracture (in days) and Harris score are 11.03±5.29 and 2.83±0.45 respectively. The efficacy concerning lateral side was 60% for left side and 26.7% for right side. Efficacy was higher in less than 10 days old fractures at 55.0% while after 10 days it was 31.7%. We found that the percentage of efficacy was 86.7%. Conclusion: The current study concluded that the anterior illio-inguinal approach is highly effective (p=0.001) in the management of acetabular fractures. Keywords: Acetabulum; Pelvic; Fracture; General Surgery.

Investigation of the Relationship between Sagittal Skeletal Nasal Profile Morphology and Malocclusions: A Lateral Cephalometric Film Study.

The aim of this study was to evaluate the relationship between skeletal sagittal nasal profile morphology and sagittal skeletal malocclusions. Regarding lateral cephalometric films, the study was conducted in a total of 135 individuals without any prior orthodontic treatment (mean age of 17.91 ± 1.91), including 49 males (mean age 17.91 ± 1.16) and 86 females (mean age 17.78 ± 1.91 years). The groups were divided into two groups as male and female according to gender, and three groups as skeletal Class 1, Class 2, and Class 3 according to the Steiner's ANB angle. In addition, skeletal groups were compared within groups by dividing into two groups of male and female. A total of eight parameters, three skeletal sagittal angular (SNA, SNB, and ANB angles), four nasal linear (R-A, N-A, N-ANS, and N-R distances) and one nasal angular (N1-N2/N2-R angle), were measured on each cephalometric film. The arithmetic mean and standard deviation of all measured nasal parameters were calculated. For statistical analysis, independent sample t-test and one-way analysis of variance (One-Way ANOVA) were used for normally distributed data, and Mann Whitney U and Kruskal Wallis tests were used for data that did not show normal distribution. For statistical analysis, p < 0.05 was considered significant. R-A, N-A, and N-ANS linear nasal parameters differed significantly between the male and female groups, which were evaluated regardless of the skeletal groups, with a higher rate in males (p < 0.05). N-R linear nasal parameter showed a statistically significant difference between skeletal malocclusion groups, which were evaluated regardless of gender. N-R distance was found to be significantly longer in skeletal Class 3 individuals than in Class 1 and 2 individuals (p < 0.05). There was no statistically significant difference in nasal bone concavity angle in all groups (p > 0.05). R-A and N-A linear nasal parameters showed statistically significant differences between male and female sex groups in all skeletal malocclusion classes (p < 0.05). At first, results showed that males had longer measurements than females in all linear nasal parameters. Second, longer measurements were found in all linear nasal parameters in skeletal Class 3 individuals than those in skeletal Class 1 and Class 2 individuals. Third, the nasal bone concavity angle was greater in skeletal Class 2 individuals than the others.

Efficacy of mobile health-technology integrated care based on the ‘Atrial fibrillation Better Care’ (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial

The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster-randomized trial showed that a mobile health (mHealth)-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway approach reduced the risk of adverse events in atrial fibrillation (AF) patients. Whether this benefit can be applied to both males and females is unclear, especially given the suboptimal management and poorer cardiovascular outcomes in females with AF. In this post-hoc analysis, we performed a sex-stratified analysis of the mAFA-II trial. Between June 2018 and August 2019, adult AF patients were enrolled across 40 centers in China. The primary outcome was the composite of stroke, thromboembolism, all-cause death, and re-hospitalization. The effect of mAFA intervention according to sex was evaluated through adjusted Cox-regression models. Among the 3,324 patients enrolled in the trial, 2,062 (62.0%) patients were males (mean age: 67.5 ± 14.3 years; 1,021 allocated to mAFA intervention) and 1,262 (38.0%) were females (mean age: 70.2 ± 13.0; 625 allocated to mAFA intervention). A significant risk reduction of the primary composite outcome in patients allocated to mAFA intervention was observed in both males (adjusted hazard ratio [aHR] and 95% confidence interval [CI] 0.30 [0.17–0.52]) and females (aHR [95%CI] 0.50 [0.27–0.92]), without statistically significant interaction (p = 0.225). Sex-based interactions were observed for other secondary outcomes, including all-cause death (p = 0.026) and bleeding events (p = 0.032). A mHealth-technology implemented ABC pathway was similarly effective in reducing the risk of adverse clinical events both in male and female patients. Secondary outcomes showed greater benefits of mAFA intervention in men.

Seasonal variation in swelling of lower extremity edema in patients with chronic venous insufficiency

ObjectiveWe had observed that some patients with chronic venous insufficiency (CVI) had reported their lower extremity edema was worse during warmer weather. Limited research is available regarding the seasonal variation in lower extremity edema. Patients with CVI were questioned to determine whether they had experienced significant seasonal variation in their lower extremity edema and which factors might be associated with such variation. MethodsConsecutive patients with lower extremity edema were asked whether the edema was worse in the summer or warmer weather. Data was collected between June 2017 and August 2020. A total of 1683 patients (age range, 16-102 years; mean ± standard deviation, 62 ± 14.3 years). Of the 1683 patients, 1157 were female (mean age, 62 ± 14.13 years) and 526 were male (mean age, 62.5 ± 13.82 years). Data were also collected on the presenting symptoms, degree of venous reflux of the great saphenous vein (GSV) reported from the most recent duplex ultrasound, and the season at the time of questioning. For statistical analysis, χ2 goodness-of-fit tests and one-way analysis of variance tests were used. ResultsOf the 1683 patients, 56.6% had reported worsening of their lower extremity edema during warmer weather, including 62.7% of the female patients and 37.3% of the male patients. The female patients had reported significantly more worsening of their lower extremity edema (P = 7.06e-18). Female patient age was associated with whether they had experienced worsening (P = .02), with more younger patients reporting worsening. Male patient age was not associated with whether they had reported worsening (P = .97). No significant differences were found in the degree of presenting symptoms between those who had and had not reported worsening (P = .58). Also, no significant differences were found in the degree of venous reflux between the right (P = .61) and left (P = .89) GSV between those who had and had not reported worsening. The season in which the patients had presented during the study period was associated with whether they had reported worsening edema. The patients who had been questioned in the winter (December, January, February) and summer (June, July, August) had reported more worsening of their edema in the warmer months (P = .008 and P = .0002, respectively). The patients who had been questioned in the spring (March, April, May) and fall (September, October, November) had not reported significantly more worsening of their edema in the warmer months (P = .167 and P = .119, respectively). ConclusionsOf the 1683 patients surveyed, 56.6% had reported worsened edema in the warmer weather. The women (especially the younger women) in the present study had experienced significant worsening, although the men had not. The degree of GSV venous reflux and severity of the presenting symptoms of the patients was not associated with whether worse edema had been reported. However, the season in which the patients had been questioned was associated with the report of worsening edema. The patients questioned in the coldest and warmest months had reported significantly more worsening. The patients questioned in the milder months had not reported significantly more worsening. These findings suggest that a sex and age bias exists in the seasonal variation of lower extremity edema in patients with CVI.

Age and sex trend differences in hemoglobin levels in China: a cross-sectional study

BackgroundBoth age and gender are the influence factors of hemoglobin concentration. However, the changing trend of hemoglobin levels between males and females with age remains unclear. This study aimed to explore their changing characteristics in different genders.MethodsA cross-sectional study was conducted in Physical Examination Center of the First Affiliated Hospital of Wannan Medical College in Wuhu, China from 2014 to 2016. The generalized linear model was applied to explore the relationship between age, gender and hemoglobin levels.ResultsAmong the 303,084 participants, the mean age for females and males was 46.9 ± 13.4(15–98) and 48.1 ± 13.7(14–98) years old, respectively. Generalized smoothing splines showed that hemoglobin levels increased up to age 25 and then decreased in men; in women the levels increased up until age 20, and then decreased, with slight increase again (β = 0.244, P < 0.01). After dividing all participants into hyperglycemia and normal groups, only the normal female group showed a significant upward trend (β = 0.257, P < 0.01) between ages 50–59.ConclusionsHemoglobin concentration changes with age and the curve is different in males and females. The slightly upward trend of female hemoglobin in the age range of 50–59 years old should be considered in developing the reference range of hemoglobin making.

PREDICTIVE VALUE OF NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) IN EARLY DETECTION OF GESTATIONAL DIABETES MELLITUS (GDM) AMONG PREGNANT WOMEN IN FIRST TRIMESTER OF PREGNANCY

Background &amp; Objective: A substantial number of pregnant women develop gestational diabetes mellitus (GDM). Various biomarkers are being used to diagnose gestational diabetes mellitus. Early detection of GDM can done by using inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and the platelet- to-lymphocyte ratio (PLR) that are rapid, inexpensive and easy to use in different clinical setting. The objective of this study was to evaluate diagnostic accuracy of raised neutrophil to lymphocyte ratio for detection of gestational diabetes mellitus taking OGTT as gold standard.&#x0D; Methods: This was a cross-sectional study held in Department of Obstetrics and Gynecology CMH Lahore from November, 2018 –May, 2020. After approval from hospital ethical review committee and taking an informed consent, 473 pregnant women enrolled in first trimester between age 18-35 years, fulfilling the inclusion criteria were included whereas known diabetics, patients with cardiovascular disorders, previous history of GDM were excluded. Blood samples in sterilized manner were drawn and sent to hospital laboratory for analysis of NLR. Then they were screened during 24-28 weeks of gestation for diagnosis of gestational diabetes mellitus on OGGT. The females were labelled for positive NLR and GDM as per operational definition. Diagnostic accuracy of NLR was calculated for development of gestational diabetes mellitus.&#x0D; Results: Mean age of females was 26.72 ± 4.90 years and mean gestational age was 15.50 ± 1.67 weeks. 94(19.9%) females who had raised neutrophil to lymphocyte ratio while 397(80.1%) females had normal neutrophil to lymphocyte ratio and there were 90(19%) females who had gestational diabetes mellitus while rests of 383(81%) did not have gestational diabetes mellitus. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of NRL was 95.56%, 97.91%, 91.49%, 98.94% and 97.46%, respectively.&#x0D; Conclusion: The study concluded that raised neutrophil to lymphocyte ratio is significantly high among gestational diabetes mellitus and NLR has a high diagnostic accuracy for predicting gestational diabetes mellitus.