Mean Body Mass Index Research Articles

Prospective analysis of 246 fires of da Vinci SureForm SmartFire stapler in colorectal cancer: First Indian study.

One of the critical steps involved is the distal transection of the rectum in rectal cancer surgeries. Multiple staple firings have been proven to increase the rate of anastomotic leakage. In this study, we intended to learn the effectiveness of the robotic SureForm SmartFire (SS) stapling system and its application in robotic sigmoid colon and rectal procedures performed at our institution. Prospective study of patients who underwent surgeries for sigmoid/rectal cancer at our centre was considered. During the surgery, SS staplers were used, and its internal data log with regard to reload selection by the colour, reloads, clamp attempts and staple fires was considered along with intra- and post-operative outcomes. 246 firings were done in 147 cases with mean body mass index of 26.3 ± 4.3 kg/m2; mean blood loss was 53.6 ± 21.8 ml. None of our patients had stapler-related complications, and the mean length of stay was 7.18 ± 1.5 days. Average reloads used in robotic-low anterior resection (LAR) were 1.73 with the fire attempts beyond lap angle occurring only in robotic-assisted LAR (RA-LAR)/abdominoperineal resection in 87 fires (41%) with 120 instances of controlled and sequential pauses occurred in 246 fires once fire pedal was activated. Apart from oncological nodal and margin clearance in the carcinoma rectum surgery, obtaining adequate distal margin, sphincter preserving approach and distal transection of the rectum forms one of the key steps in the low anterior resection. Robotic SS staplers have 120° angulation in both axes with EndoWrist technology that has better manoeuvrability within the confines of the pelvis.

Prevalence of subclinical hypothyroidism in local adult obese population.

Objective: To find out the frequency of subclinical hypothyroidism (SCH) in local adult obese population and to determine the risk of cardiovascular events in patients with SCH using the 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator. Study Design: Cross Sectional & Descriptive study design. Setting: Medicine Ward, PAF Hospital, Islamabad. Period: 20th July 2023 to 20th January 2024. Methods: A total of 200 patients of both gender with Body Mass Index (BMI) greater than 28kg/m2 were included in the study. Blood samples were Collected from all patients and sent to the hospital laboratory for performing thyroid function tests and fasting lipid profile. Patients found to have SCH (TSH levels more than reference range with normal T3 and T4 levels) had their ten-year risk of cardiovascular events determined using the ASCVD Risk Calculator. A calculated 10 year ASCVD risk of ≥7.5% was concluded significant. Results: Age range in this study was from 20 to 65 years with mean age of 43.295±8.85 years, mean BMI 30.960±1.53 Kg/m2, mean TSH 2.904±1.29 mIU/L (normal range 0.27 to 4.2 mIU/ml), mean T3 103.230±6.86 ng/dL (normal range 94 to 170 ng/dL) and mean T4 was 10.092±1.26 μg/dL (normal range 5 to 11 μg/dL). Subclinical hypothyroidism was observed in 16% patients. Amongst these patients, increased cardiovascular event risk was present in 25% patients. Conclusion: Our study has concluded a high prevalence of subclinical hypothyroidism among obese adult patients and increased risk of cardiovascular events in patients with SCH.

Validation of the Japanese version of the Clinical Frailty Scale.

Among the many screening tools developed to detect frailty and disability in older adults, the Clinical Frailty Scale (CFS) is a valid, reliable, and easy-to-use tool and has been translated into several languages. The aim of this study was to demonstrate the validity of the Japanese version of the CFS (CFS-J). The necessary permissions were obtained from Rockwood and colleagues. The Japanese version was prepared by translation (English to Japanese) and verified by back translation (Japanese to English). Concurrent criterion validity was assessed by evaluating the extent to which CFS relates to the Frailty Index (FI), the Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA), and Performance Status (PS), using Kendall's tau. In total, 223 patients admitted to the geriatric ward of an acute hospital between June 2021 and March 2023 were analyzed in the validation study. Mean age was 84.9 ± 5.9 years (range, 67-101 years), 128 (57.4%) were women, and the mean body mass index was 20.9 ± 4.0 kg/m2. In a correlation analysis, significantly positive associations were found between the CFS-J and the FI (r = 0.713, P < 0.001), the FI-CGA (r = 0.691, P < 0.001), and PS (r = 0.669, P < 0.001) for numerical variables. Significant positive associations were also found between the CFS-J and the FI (r = 0.567, P < 0.001) and the FI-CGA (r = 0.591, P < 0.001) for categorical valuables. The CFS-J was found to be a valid instrument for identifying frailty in Japanese inpatients. Geriatr Gerontol Int 2025; ••: ••-••.

Urinary Incontinence and Care Seeking Among Wisconsin Women.

Women who identify as Black or African American are underrepresented in research about pelvic floor disorders. The objectives of this study were to describe the prevalence of and factors associated with urinary incontinence (UI) and UI care-seeking among adult women in a Wisconsin household survey. This was a cross-sectional analysis of data collected by the Survey of the Health of Wisconsin (SHOW). Using community engagement, individuals who identified as Black or African American were purposively oversampled in the 2018-2019 wave. Descriptive analyses compared women with and without UI, and those who had and had not sought care. Among 237 study participants, 46% (110) had UI: 46% mild, 36% moderate, and 18% severe. Most participants (84%) self-identified as non-Hispanic Black (84%), with a mean age of 49 ± 16 years and mean body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 34 ± 9; 62% were insured by Medicaid. The prevalence of UI was 44% among women who identified as non-Hispanic Black versus 59% (P = 0.085) among other women. Older age, obesity, needing help to read medical instructions, and identifying as a race other than non-Hispanic Black were significantly associated with UI. Among 110 women with UI, 53% had previously sought care. Rates of UI care seeking were similar (P = 0.32) among women who identified as non-Hispanic Black (55%) and those who identified as another race or ethnicity (43%). Needing help to read medical instructions emerged as a factor associated with UI diagnosis in this sample that included almost 200 women who identified as non-Hispanic Black.

COURSE OF MEASURED ENERGY EXPENDITURE OVER THE FIRST 10 DAYS OF CRITICAL ILLNESS: A NESTED PROSPECTIVE STUDY IN AN ADULT SURGICAL ICU

Background & aimsVarious factors may cause significant daily variations in energy expenditure in and between critically patients. This nested, prospective study (ClinicalTrials.gov Identifier: NCT04099108) in a predominantly trauma surgical ICU, aimed to determine the course of measured energy expenditure over the first 10 days of critical illness, and to identify factors contributing to energy expenditure. MethodsIndirect calorimetry was performed on alternate days from ICU Day 3±1 until Day 10±1. The mean daily measured energy expenditure, respiratory quotient and total energy delivery as a percentage of measured energy expenditure were modelled using linear mixed regression with two fractional polynomial terms to accommodate non-linear responses over time. ResultsFifty ICU patients (mean age 36.9+-11.8 years, Acute Physiology and Chronic Health Evaluation (APACHE II) 13.5±6.6, Sequential Organ Failure Assessment (SOFA) 4.5±3.2) were included. Mean body mass index (BMI) was 24.8±4.00 kg/m2 and mean ventilation duration 7.7±2.7 days. Mean daily measured energy expenditure showed a significant non-linear response (p=0.006) increasing over the first 4 days peaking on day 5 and then plateauing. Mean daily respiratory quotient increased over the first 7 days, thereafter plateauing with a slight downward trend from day 8 despite a progressive increase in total energy delivery as a percentage of measured energy expenditure. Mean daily measured energy expenditure was significantly lower in the early than in the late acute phases (p=0.024), whereas the late- and post-acute phases were similar. Age, sex and BMI significantly influenced measured energy expenditure. ConclusionMeasured energy expenditure showed a significant non-linear response over the first 10 days in ICU, increasing over the first 4 days peaking on day 5 then plateauing. The observed variability highlights the complexity of managing critically ill patients and the importance of personalised nutrition therapy. Additionally, the observed trend with a peak in measured energy expenditure around day five could inform timing and strategies for nutritional intervention in this patient cohort.

Correlation between Obesity and Left Atrial Enlargement in Patients Using Cardiac Magnetic Resonance

Objective: The correlation between left atrial (LA) enlargement and obesity has been previously reported. However, most studies primarily evaluated LA diameter using echocardiography, which is less accurate and reliable than assessing LA volume with cardiac magnetic resonance (CMR). This study aimed to explore the correlation between obesity and LA volume by using CMR imaging. Materials and Methods: We prospectively enrolled consecutive eligible patients aged 18 years or older who underwent CMR at a tertiary academic hospital. Clinical variables, including body mass index (BMI), were collected from the medical records. LA volume classification was based on the current guideline recommendations. Results: A total of 140 patients (41% men), with a mean age of 66.5 ± 10.5 years, were studied. The mean BMI was 25.7 ± 4.2 kg/m2. CMR parameters revealed an LA volume of 75.7 ± 22.5 mL, a left ventricular (LV) ejection fraction of 71.1 ± 9.5%, and an LV mass index of 46.1 ± 27.4 g/m2. Univariable analysis indicated that the factors affecting LA volume included BMI (r = 0.3, p &lt; 0.001), LV mass index (r = 0.3, p = 0.001), waist circumference (r = 0.3, p &lt; 0.001), male sex (p = 0.01), and hypertension (p = 0.01). In stepwise multivariable analysis, BMI (p &lt; 0.001), LV mass index (p = 0.02), and male sex (p = 0.03) were independently associated with LA volume. Conclusion: Obesity, as represented by BMI, was independently associated with LA enlargement. Other independent factors correlated with LA volume included the LV mass index and male sex.

The Impact of Cholecystectomy on the Metabolic Profile of Patients Previously Submitted to Bariatric Surgery.

To evaluate the influence of late cholecystectomy following bariatric surgery on the postoperative evolution of weight loss and biochemical, metabolic, and micronutrient parameters. A retrospective study that assessed 86 patients who underwent cholecystectomy after at least 18 months of bariatric surgery. The analyzed variables included demographic data, comorbidities, weight loss, and biochemical, metabolic, and micronutrient parameters. Among the analyzed patients, 20 underwent gastric bypass (GB) and 66 underwent sleeve gastrectomy (SG). The GB group comprised 55% of women, with a mean age of 54.4 years and a mean preoperative body mass index (BMI) of 29.2kg/m 2 . The mean time elapsed between GB and cholecystectomy was 118.3±43.9 months. The sample of SG comprised 83.3% of women, with a mean age of 41.1 years and a mean preoperative BMI of 28.7kg/m 2 . The mean time elapsed between SG and cholecystectomy was 26.1±17.5 months. Both SG and GB groups showed a reduction in the mean BMI, but it was not statistically significant after cholecystectomy. In the metabolic, biochemical, and micronutrient evaluation, there was no statistically significant difference, except in the GB group, where an increase in vitamin D was observed after cholecystectomy with statistical significance. Cholecystectomy does not negatively impact the clinical and anthropometric evolution of patients previously submitted to bariatric surgery.

Changes in food preferences after oral semaglutide administration in Japanese patients with type 2 diabetes: KAMOGAWA-DM cohort.

This study aimed to investigate the effects of oral semaglutide on the changes in food preference of Japanese patients with type 2 diabetes. This retrospective multicenter study included 75 patients with type 2 diabetes who received oral semaglutide. The primary outcome was the change in the score of brief-type self-administered diet history questionnaire (BDHQ) score 3months after the initiation of oral semaglutide treatment. The secondary outcome was the change in the Control of Eating Questionnaire (CoEQ), HbA1c, and body mass index (BMI) after 3months. The median age, BMI, and HbA1c of the 23 participants were 64.0years, 26.9kg/m2, and 7.6% (59mmol/mol). The BDHQ results showed total energy was significantly reduced. Among the individual nutrients, carbohydrates most decreased. The CoEQ results particularly showed declines in cravings for something sweet, chocolate or chocolate flavored foods, and starchy foods, satisfaction at meals, frequency and intensity of food craving, difficulty of resisting the craving for food, and frequency of eating in response to cravings for food were significantly lower after 3months. The mean HbA1c and BMI significantly decreased. In Japanese patients with type 2 diabetes, oral semaglutide treatment decreased total energy intake and changed food preferences.

Peripheral Inflammatory and Metabolic Markers as Potential Biomarkers in Treatment-Resistant Schizophrenia: Insights from a Qatari Cohort.

Schizophrenia presents significant diagnostic and treatment challenges, particularly in distinguishing between treatment-resistant (TRS) and non-treatment-resistant schizophrenia (NTRS). This cross-sectional study analyzed routine laboratory parameters as potential biomarkers to differentiate TRS, NTRS, and healthy individuals within a Qatari cohort. The study included 31 TRS and 38 NTRS patients diagnosed with schizophrenia, alongside 30 control subjects from the Qatar Biobank. Key measurements included complete blood count, lipid panel, HbA1c, and ferritin levels. Our findings indicated elevated body mass index (BMI) and triglyceride (TG) levels in both patient groups compared to controls. The NTRS group also showed higher HbA1c levels. Variations in inflammatory markers were noted, with the NTRS group exhibiting a higher platelet/lymphocyte ratio (PLR). Multivariate analysis highlighted significant differences in platelet count, mean platelet volume (MPV), TG, HbA1c, BMI, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and ferritin among the groups. Linear regression analysis revealed that MLR and clozapine treatment were significantly correlated with the severity of schizophrenia symptoms. The Random Forest model, a supervised machine learning algorithm, efficiently differentiated between cases and controls and between TRS and NTRS, with accuracies of 86.87% and 88.41%, respectively. However, removing PANSS scores notably decreased the model's diagnostic effectiveness. These results suggest that accessible peripheral laboratory parameters can serve as useful biomarkers for schizophrenia, potentially aiding in the early identification of TRS, enhancing personalized treatment strategies, and contributing to precision psychiatry. Future longitudinal studies are necessary to confirm these findings and further explore the role of inflammation in schizophrenia pathophysiology and treatment response.

Clopidogrel and Aspirin Resistance and Its Interaction with Peripheral Arterial Disease Outcomes in the Indian Population

Objectives: The objective of the study was to ascertain adverse events (major adverse cardiac and limb events) events in patients of established peripheral arterial disease (PAD), on clopidogrel and aspirin antiplatelet therapy. Patients and Methods: Patients aged 18 years or over, with PAD were screened for participation in the study. Patients were considered to have symptomatic PAD if they met either of two criteria: a history of intermittent claudication, rest pain, or tissue loss of presumed atherosclerotic origin, with either ankle–brachial index &lt;0.85, previous leg amputation, peripheral vascular surgery, or percutaneous intervention; or angiographic or computed tomographic imaging of significant lower-extremity occlusive atherosclerotic disease. The patients took clopidogrel and aspirin at a dose ≥75 mg/day for at least 4 weeks before enrolment. Those with contraindications to antiplatelet usage were excluded from the study. Blood was used as genotyping material. Patient samples were genotyped for clopidogrel resistance (CR)-associated single-nucleotide polymorphism (SNPs) using Illumina Global Screening Array Ver 3 Bead Chip. Illumina Infinium Genotyping Assay protocol was implemented. Intensities of the beads’ fluorescence were detected using iScan Reader (Illumina Inc). Aspirin resistance (AR) was determined with the whole blood, point of care, turbidimetric cartridge-based method, platelet aggregation, and VerifyNow P2Y12 assay, and results were reported in platelet reactivity units (PRU), at a cutoff of 550 PRU. Results: The mean age was 58.4 (12.6) years with 90% males. The mean body mass index was 22.57 (3.54) kg/m2. The cohort comprised 58.9% smokers, 42% alcoholics, 33.5% diabetics, and 63% hypertensives. Limited efficacy of clopidogrel was observed in 52.38% of patients with loss of function (LOF) variations in the CYP2C19 gene. The mean duration of follow-up was 13.4 (4.7) months. Subjects with CYP2C19 LOF alleles showed more complications (39%) and the relationship between the LOF variation in the CYP2C19 gene and the adverse clinical outcomes (major adverse cardiac events [MACE] and major adverse limb events [MALE]) was found to be statistically significant (P = 0.11). CR and AR were found in 147 (50.3%) and 69 (23%) patients, respectively. Resistance to both the antiplatelets was found in 41 (14%) patients. Conclusion: In this largest observational study, the use of dual antiplatelet therapy in the Indian population with PAD on the MACE and MALE events was higher in the patients with CYP2C19 LOF alleles. The study found a statistically significant relationship between genetic testing results and clinical outcomes.

Assessing the Lifestyle-related Determinants among Employees Working in the IT Sector of Pune City

Abstract Background: The rising prevalence of non-communicable diseases (NCDs) among Indian IT professionals is concerning due to prolonged sitting, sedentary work hours, irregular sleep, limited diet variety, excessive consumption of ultra-processed foods, and heightened stress. This study aimed to assess lifestyle determinants in the IT population to predict future NCD risks. Methods and Materials: A cross-sectional study with 208 participants aged 21-60 years was conducted in Pune. Ethical approval and consent were obtained. Data from various IT sectors used a modified questionnaire incorporating Perceived Stress and IPAQ scales and inquiries on sleep patterns, BMI, ultra-processed food consumption, and substance use. Results: The participants had a mean age of 31.30 ± 6.26 years with a gender ratio of 1.63:1. The mean BMI was 24.41 ± 3.87 kg/m2, 31.3% were overweight, and 9.6% were obese. Before sleep, 89.5% engaged with electronic devices. The majority of participants experience stress, with 63.5% reported moderate stress and 3.4% high stress. Only 6.7% were physically active, and 56.3% were inactive. Gender showed no significant correlation with stress levels, consumption of ultra-processed foods, and Body Mass Index (BMI) study components. Participants were found to be actively engaged in substance abuse, with 15.4% smoking 6-10 cigarettes daily and about 20.2% consuming alcohol twice a week. Conclusion: Because of their lifestyle, this population will be at a high risk of major chronic NCDs and should be targeted for an early intervention program. It’s essential to prioritize preventive actions like adopting a more active lifestyle, implementing stress management techniques, and embracing healthier dietary choices to safeguard the well-being of individuals in this demographic.

P-676. Risk Factors Associated with Longer Hospital Stay in Elderly Patients with Respiratory Syncytial Virus Infections

Abstract Background Annually, 3-7% of healthy older patients and 4-10% of high-risk adults develop respiratory syncytial virus (RSV) infections. Elderly patients above 65 years of age, with congestive heart failure, chronic lung disease, or weakened immune systems are at high risk for severe RSV infections. Little is known about the factors that are associated with the length of hospital stay (LOS) among these elderly individuals. Methods A multicenter historical cohort study was conducted on elderly patients ( &amp;gt;65 years of age) hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2022. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed after IRB approval. LOS was categorized as below the mean LOS or at the mean and above. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0. Results Of 239 patients, the mean (sd) age of the cohort was 78.3 + 8.4 years, 157 (65.7%) were female and 176 (73.6%) were white. The mean body mass index (BMI) was 29.5 + 8.8 kg/m2. The mean Charlson Weighted Index of Comorbidity (CWIC) score was 2.4 + 2.0. The mean hospital LOS was 7.5 + 5.1 days. Prolonged LOS was noted in 89 (37.2%) patients. Factors associated with longer LOS ( &amp;gt;7.5) in univariable analysis were chronic lung disease, solid tumors, CWIC score, smoking status, home oxygen, oxygen requirement during hospitalization, qSOFA, abnormal admission chest x-ray (CXR), lower respiratory tract infection, and respiratory failure requiring intubation. The multivariable logistic regression revealed that predictors for prolonged LOS among elderly patients were smoking status (OR, 2.2; 95% CI 1.2-4.0), abnormal admission CXR (OR, 2.1; 95% CI 1.2-3.7), and respiratory failure requiring intubation (OR, 9.4; 95% CI 2.6-34.4). Conclusion Our study finds that patient’s smoking status, abnormal admission CXR and respiratory failure requiring intubation were significantly associated with prolonged LOS among elderly patients with RSV infections. Knowing these risk factors may help identify patients who would benefit from early interventions to mitigate the duration of hospitalization. Disclosures All Authors: No reported disclosures

P-2029. Results from a Phase 1 First in Human Study of Pemivibart: An Extended Half-Life Monoclonal Antibody (mAb)

Abstract Background Pemivibart (PEM) is a half-life extended recombinant human monoclonal IgG1 antibody that targets the SARS-CoV-2 spike protein receptor binding domain. PEM has been granted emergency use authorization (EUA) for the pre-exposure prophylaxis of COVID-19 in certain adults and adolescents with moderate-to-severe immune compromise.Table 1.Preliminary Pharmacokinetic Parameter Estimates of Pemivibart [Mean ± SD] Methods This is an ongoing Phase 1, first in human, randomized, blinded, placebo (PBO) controlled, single ascending dose study conducted in healthy participants (ppts) aged 18-65 years to evaluate PEM administered by slow IV push. Ppts were randomized 8:2 in one of 3 cohorts (n=8 PEM, n=2 placebo): PEM 1500 mg, 2500 mg, and 4500 mg. The primary objective was to assess the safety and tolerability of PEM. Secondary endpoints included serum pharmacokinetic (PK) parameters (estimated using non-compartmental analysis methodology) and immunogenicity. The trial will continue through 12 months; here we summarize the data through the 6-month timepoint.Figure 1:Mean ± Standard Deviation Serum Pemivibart Dose-Normalized Concentration-Time Profile Results Thirty ppts were randomized (24 PEM, 6 PBO); 28 ppts received the full dose as planned; two ppts received approximately 93% of the full dose of study drug due to an administration error. In the PEM arm, the median age was 32.5 years, 13.3% of ppts were 55 years or older, most ppts were white (83.3%) and not Hispanic or Latinx (93.3%). Mean body mass index was 25.78 kg/m2 across all ppts and similar between cohorts and study arms. There were no deaths, serious adverse events (SAEs), or AEs leading to permanent study drug discontinuation. Infusion-related adverse events occurred in 4 ppts (2 each in Cohort 2 and 3, respectively); these events were self-limited and resolved within 5 minutes without treatment. No unexpected safety signals were observed. PEM demonstrated linear PK with apparent dose-proportional exposure and extended serum half-life (mean 46, 44, and 50 days in Cohort 1, 2, and 3, respectively [Table 1]). No substantial anti-drug antibodies (ADAs) have been observed. Conclusion In this Phase 1 study of PEM administered by slow IV push at doses up to 4500 mg, no AEs leading to study drug discontinuation, or SAEs were reported to date in healthy adults. PEM demonstrated linear and dose-proportional PK. Complete trial data to be presented. Disclosures Anna Holmes, PhD, Invivyd, Inc.: employee|Invivyd, Inc.: Stocks/Bonds (Private Company) Yong Li, PhD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company) Deepali Gupta, BSc, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company) Ed Campanaro, MS, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company) Lida Mehr, B.S., Invivyd, Inc.: Advisor/Consultant Anuja Raut, M.S., Invivyd, Inc.: Advisor/Consultant Amanda Copans, Pharm.D., Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company) Kristin Narayan, Ph.D., Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company) Kathryn Mahoney, PharmD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds (Public Company)

Machine learning web application for predicting varicose veins utilizing global prevalence data.

This study aimed to develop a web-based machine learning (ML) model to predict the lifetime likelihood of developing varicose veins using global disease prevalence data. We utilized data from a systematic review, registered under PROSPERO (CRD42021279513), which included 81 studies on varicose vein prevalence across various geographic regions. The data used to build the ML model included disease prevalence as the outcome (%), along with the following predictors: mean age, gender distribution (%), mean body mass index (BMI) of the study cohort, and the mean gravity field of the study region (mGal), representing variations in Earth's underground mass distribution that influence blood and fluid redistribution in the human body, affecting disease prevalence. After standardizing the outcome and predictors, the model was trained using neural network regression implemented with the TensorFlow.js library and deployed as a web-based ML application. After 406 epochs of training, and upon achieving a validation loss (mean squared error) of 0.9, training was stopped due to no further improvement. The achieved test loss was 0.49, and the mean absolute error (MAE) was 0.56, corresponding to an up to 6.7% difference between the predicted and true disease probabilities (calculated as MAE x σ, where σ is the standard deviation of the mean disease prevalence = 0.56 x 11.9 = 6.7). The likelihood of developing varicose veins, as predicted by the model, showed the strongest correlation with age (0.78), followed by gravity anomaly (0.30), BMI (0.27), and gender (0.15). This study summarizes research on the prevalence of varicose veins by developing a web-based ML model to predict an individual's likelihood of developing the disease. Using data reported in the literature, the ML algorithm provides a non-discriminatory predictive baseline, offering a valuable tool for future investigations into disease epidemiology.

Correlation of Head Circumference with Body Mass Index in A Group of Elderly Sri Lankan Population

Introduction: Accurate estimation of the body mass index (BMI) is important in assessing nutritional status, risk of myriad of medical conditions including hypertension, coronary heart disease, adult-onset diabetes mellitus and dementia. However, emergency settings and immobility make it difficult to obtain personal stature and weight using standard methods. Thus, the need for an alternate method of BMI prediction arises. Objective: Goal of this study was to propose population, age and gender specific regression formula for BMI estimation using HC for an elderly Sri Lankan population. Material &amp; methods: Personal stature, weight and HC was recorded in a total of 156 cadavers (age: 55 – 89 years);(male: n=74; female: n=82). Results: The HC (cm) (male: 54.09 ± 3.28; female: 52.88 ± 2.83) was significantly different (P&lt; 0.01) between the genders. There was no statistically significant difference between mean BMI (Kg/m2) of male (20.32 ± 4.08) and female (20.93 ± 2.20). Correlation coefficient between HC and BMI was 0.09 in males and 0.04 in females indicating a weak positive linear relationship between the two parameters. Linear regression formulae for the prediction of BMI using HC were derived as follows: male: 14.04 + 0.15(HC); female: 20.03 + 0.02(HC).Discussion: BMI prediction formulae that require a measuring tape as the only tool to record the HC provide a simple, cost effective and objective method for patients who are unable to stand or weighed. Accurate prediction of BMI will in turn reduce potential errors in pharmacological interventions that may occur when it is estimated only by visual observation in emergency settings. Complementary studies are necessary to evaluate the applicability of these equations in other age groups too.

Contemporary Cementless Patellar Implant Survivorship: A Systematic Review and Meta-Analysis of 3,005 Patellae.

Historically, cementless patellar implants were fraught with issues of fixation and polyethylene wear. However, contemporary cementless patellar implants incorporate modern technologies for implant design and offer the potential for improved biological fixation and longevity. As such, an evaluation of the performance of modern cementless patellae is needed. The purpose of this study was to perform a systematic review and meta-analysis of contemporary cementless patellar implants used during primary total knee arthroplasty (TKA), with a particular focus on aseptic loosening of the patellar component.A systematic review of the literature was performed from January 2000 to February 22, 2024. We included all peer-reviewed studies that reported the number of revisions in patients who had cementless patellae placed in 2000 or later during primary TKA. Reviews and case reports were excluded. Out of 639 studies, 13 were included with a total of 3,005 cementless patellae analyzed. The mean patient age was 64 years and the mean body mass index (BMI) was 31 kg/m2. Meta-analyses were performed to calculate the pooled revision rate per person-year of revision for aseptic loosening of the patellar component and revision for any patellar failure.Upon analysis of 13 studies involving a total of 3,005 cementless patellae, the revision rate for aseptic loosening of the patella was 0.2 per 1,000 person-years and the revision rate for any patellar failure was 1 per 1,000 person-years.Contemporary cementless patellar implants showed an overall revision rate of 1 per 1,000 person-years, demonstrating excellent longevity. The high survivorship, together with a low rate of loosening, show the utility and effectiveness of these implants. Given the nature of biologic fixation, these results are promising for long-term implant stability but additional follow-up is warranted.

Intraindividual Comparison of Image Quality Between Low-Dose and Ultra-Low-Dose Abdominal CT With Deep Learning Reconstruction and Standard-Dose Abdominal CT Using Dual-Split Scan.

The aim of this study was to intraindividually compare the conspicuity of focal liver lesions (FLLs) between low- and ultra-low-dose computed tomography (CT) with deep learning reconstruction (DLR) and standard-dose CT with model-based iterative reconstruction (MBIR) from a single CT using dual-split scan in patients with suspected liver metastasis via a noninferiority design. This prospective study enrolled participants who met the eligibility criteria at 2 tertiary hospitals in South Korea from June 2022 to January 2023. The criteria included (a) being aged between 20 and 85 years and (b) having suspected or known liver metastases. Dual-source CT scans were conducted, with the standard radiation dose divided in a 2:1 ratio between tubes A and B (67% and 33%, respectively). The voltage settings of 100/120 kVp were selected based on the participant's body mass index (<30 vs ≥30 kg/m2). For image reconstruction, MBIR was utilized for standard-dose (100%) images, whereas DLR was employed for both low-dose (67%) and ultra-low-dose (33%) images. Three radiologists independently evaluated FLL conspicuity, the probability of metastasis, and subjective image quality using a 5-point Likert scale, in addition to quantitative signal-to-noise and contrast-to-noise ratios. The noninferiority margins were set at -0.5 for conspicuity and -0.1 for detection. One hundred thirty-three participants (male = 58, mean body mass index = 23.0 ± 3.4 kg/m2) were included in the analysis. The low- and ultra-low- dose had a lower radiation dose than the standard-dose (median CT dose index volume: 3.75, 1.87 vs 5.62 mGy, respectively, in the arterial phase; 3.89, 1.95 vs 5.84 in the portal venous phase, P < 0.001 for all). Median FLL conspicuity was lower in the low- and ultra-low-dose scans compared with the standard-dose (3.0 [interquartile range, IQR: 2.0, 4.0], 3.0 [IQR: 1.0, 4.0] vs 3.0 [IQR: 2.0, 4.0] in the arterial phase; 4.0 [IQR: 1.0, 5.0], 3.0 [IQR: 1.0, 4.0] vs 4.0 [IQR: 2.0, 5.0] in the portal venous phases), yet within the noninferiority margin (P < 0.001 for all). FLL detection was also lower but remained within the margin (lesion detection rate: 0.772 [95% confidence interval, CI: 0.727, 0.812], 0.754 [0.708, 0.795], respectively) compared with the standard-dose (0.810 [95% CI: 0.770, 0.844]). Sensitivity for liver metastasis differed between the standard- (80.6% [95% CI: 76.0, 84.5]), low-, and ultra-low-doses (75.7% [95% CI: 70.2, 80.5], 73.7 [95% CI: 68.3, 78.5], respectively, P < 0.001 for both), whereas specificity was similar (P > 0.05). Low- and ultra-low-dose CT with DLR showed noninferior FLL conspicuity and detection compared with standard-dose CT with MBIR. Caution is needed due to a potential decrease in sensitivity for metastasis (clinicaltrials.gov/ NCT05324046).

Evaluation of the Treatment Process with Home Exercise Program and Telerehabilitation in Patients with Breast Cancer-Related Lymphedema: A Case-Control Study.

Background: This study aimed to evaluate and compare the effectiveness of telerehabilitation (TR) and home exercise program (HEP) in patients with breast cancer-related lymphedema and the patients' compliance with these treatment processes. Methods and Results: 23 patients were prospectively included in the HEP group and 22 patients in the TR group, who were followed up in the Lymphedema Outpatient Clinic of the Department of Physical Medicine and Rehabilitation of a University Hospital. These patients were randomized. The volume difference between the extremities of the patients was calculated with the truncated cone formula, before and after treatment. The patients' pain, tightness, heaviness, and stiffness symptoms associated with lymphedema were questioned using a numerical scale. The patients' functionality and participation in daily life activities were evaluated with disabilities of arm, shoulder, and hand Quick Questionnaire (Quick-DASH) and the Lymphedema Life Impact Scale (LLIS). Patients' treatment satisfaction and compliance with treatment were questioned using Likert scales. A total of 45 patients were included in the study. The mean age and body mass index were similar between the groups (p ≥ 0.05). In the evaluations performed, no significant differences were observed within groups or between groups in terms of volume difference, quick DASH, pain, tightness, heaviness, stiffness, and LLIS scores (p ≥ 0.05). Patient satisfaction was significantly higher in the TR group (p ≤ 0.001). During treatment follow-up, only one person from the TR group missed the 5th-week checkup (4.5%), whereas five patients from the HEP missed the 5th-week checkup and three missed the 8th-week checkup. Overall, eight patients discontinued treatment (34%). Conclusion: Although there were no significant differences in clinical assessments between TR and HEP groups, patient satisfaction, and treatment adherence were significantly higher in the TR group.

Short-term outcome of metabolic surgery versus intensive medical therapy among obese type 2 diabetics: a quasi-experimental study

Objective: To compare the short-term outcomes of metabolic surgery and intensive medical therapy in the management of diabetes mellitus among obese persons with type 2 diabetes mellitus. Methods: The quasi-experimental study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March 2018 to February 2019, and comprised obese type 2 diabetes mellitus patients of either gender aged 20-65 years. Those undergoing metabolic and bariatric surgery were assigned group A, while those undergoing intensive medical therapy formed control group B. All patients were followed up for 6 months to monitor their metabolic profile, including body mass index, glycosylated haemoglobin and fasting plasma glucose. Data was analysed using SPSS 20. Results: Of the 72 patients, 36(50%) were in group A; 23(63.9%) females and 13(36.1%) males with mean age 41.2 years (SD± 10.2). The remaining 36(50%) patients were in group B; 22(61.1%) males and 14(38.9%) females with mean age 42.5 years (SD ± 10.6) (p&gt;0.05). At 6 months, mean body mass index, glycosylated haemoglobin and fasting plasma glucose values were significantly lower in group A compared to group B (p&lt;0.001). There were 33(91.7%) patients in group A with remission of diabetes compared to 1(2.8%) patient in group B (p&lt;0.001). Conclusion: Bariatric surgery was found to produce a good early outcome in the management of diabetes in the obese population, leading to remission post-surgery. Key Words: Bariatric surgery, Metabolic surgery, Obese T2DM, Diabetes remission, Diabetes.

Cachectic biomarkers as confounders behind the obesity paradox in patients with acute decompensated heart failure.

Obesity is a risk factor for heart failure (HF) development but is associated with a lower incidence of mortality in HF patients. This obesity paradox may be confounded by unrecognized comorbidities, including cachexia. A retrospective assessment was conducted using data from a prospectively recruiting multicenter registry, which included consecutive acute heart failure patients. A low, normal, and high body mass index (BMI) was defined as <20 kg/m2, 20-25 kg/m2, and ≥25 kg/m2, respectively. Cachexia was defined as a combination of BMI < 20 kg/m2 and any biochemical abnormalities including albumin, hemoglobin, or C-reactive protein. Patients with either of the three biochemical abnormalities were categorized as those with cachectic biomarkers. Two-year all-cause, cardiac, and noncardiac mortality were evaluated. This study evaluated 3314 patients (mean BMI, 22 ± 4 kg/m2 [low BMI with cachexia, 828 (25%); low BMI without cachexia, 273 (8%); normal BMI, 1584 (48%); high BMI, 629 (19%)]). Overall, an increase of 1 point in BMI was associated with a decreased incidence of all-cause mortality (adjusted hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.90-0.94; p < 0.001). Regardless of the mode of death, the low BMI with cachexia indicated the worst prognosis, while the low BMI without cachexia showed a similar prognosis to the normal BMI. Cachectic biomarkers, which were observed more frequently in the low BMI, predicted a higher incidence of 2-year all-cause mortality across the BMI categories (adjusted HR for the low BMI, 1.90; 95% CI, 1.30-2.77; p = 0.001; adjusted HR for the normal BMI, 1.94; 95% CI, 1.34-2.79; p < 0.001; adjusted HR for the high BMI, 3.60; 95% CI, 1.61-8.08; p = 0.002). BMI could be only a surrogate marker. The cachectic biomarkers may reflect the underlying conditions and contribute to elucidating the obesity paradox.