Multivariate Regression Model Analysis Research Articles

Social acceptance of people living with HIV/AIDS and its correlates among students of Shiraz University of Medical Sciences, Iran

Introduction HIV/AIDS is not socially acceptable in most countries. People living with HIV/AIDS are stigmatized and pushed out of the community. The purpose of this study was to investigate the social acceptance of People living with HIV/AIDS and its correlates among the students of Shiraz University of Medical Sciences. Methods This is a cross-sectional study that measured the social acceptance score of people living with HIV/AIDS using a questionnaire. The study population consisted of all students who were studying at Shiraz University of Medical Sciences in 2023. Data were collected using stratified-systematic sampling from a sample of 464 students from 9 different faculties. Data collection was done using a researcher-made questionnaire with confirmed validity and reliability. Data analysis was done using SPSS version 23 and Stata version 16. The normality of the data was examined. Principal component analysis, T-test, one-way ANOVA, Pearson correlation, followed by regression model for multivariate analysis were used to investigate the relationship between quantitative and qualitative variables with the outcome variable. Results The results presented that the average social acceptance score of HIV/AIDS was 21.60 ± 3.83 out of 36. Seven variables including marital status, smoking status, ethnicity, religious degree, age, knowledge, and fear score of HIV/AIDS can potentially affect the social acceptance of people living with HIV/AIDS. The results also indicated a significant relationship between smoking status, ethnicity, and the social acceptance scores of people living with HIV/AIDS, with marital status approaching significance. Conclusion The results of this study are a warning for policy-makers and decision-makers in the field of HIV/AIDS. In order to increase the social acceptance of the people living with HIV/AIDS, this study recommends increasing knowledge through the use of targeted educational interventions. It is essential to implement comprehensive educational programs in universities that focus on raising awareness about the disease. Additionally, developing outreach initiatives that utilize social media can help disseminate information and promote safe practices within the community.

Psychological distress among students in Egypt and Jordan during the initial months of the Gaza war

BackgroundPsychological distress has significantly impacted students in Egypt and Jordan. These countries have faced many challenges, including the COVID-19 pandemic, the fallout from the conflict in Syria, and the war in Ukraine. These crises have had far-reaching consequences, affecting the economy, food security, and energy supplies, particularly with the increased number of refugees in these countries. Amid these existing complexities, the ongoing war in Gaza further exacerbates the situation, compounding mental health challenges. Therefore, this study aimed to analyze how the war in Gaza impacted the mental health of students in Egypt and Jordan.MethodsWe conducted a cross-sectional study involving students from Egypt and Jordan between December 2023 and January 2024. The questionnaire incorporated the Brief Symptom Inventory 18 (BSI-18) to assess the overall general distress score, as well as the domains of anxiety, somatization, and depression.ResultsA total of 1509 Jordanian and Egyptian students were included in the study, of which 66% were female. Approximately 18% of the students had an elevation (≥ 50) in their BSI-18 total score. Females scored significantly higher in general distress [30 (18–44.25) vs. 24 (11–41), p < 0.001], and all three dimensions. The univariate predictors for elevated general distress (≥ 50) were being Egyptian (OR 1.49, 95% CI 1.08 to 2.08, p = 0.014), watching social media multiple times a day (OR 3.04, 95% CI 1.97 to 4.69, p < 0.001), and having a Palestinian connection (friend, neighbor, colleague, or relative) (OR 1.63, 95% CI 1.23 to 2.16, p < 0.001). These three predictors were retained in the backward stepwise multivariate regression analysis model. The univariate predictors for moderate and marked general distress (≥ 57) were watching social media multiple times a day (OR 3.26, 95% CI 1.78 to 5.99, p < 0.001) and having a Palestinian connection (OR 1.49, 95% CI 1.05 to 2.14, p = 0.026). Only the former was retained in the backward stepwise multivariate regression analysis.ConclusionGeneral distress has increased among students in Egypt and Jordan throughout the War in Gaza. Mental, psychological, and social support activities are necessary for these students, particularly those watching social media multiple times daily. The development of coping skills to manage the additional stressors of war and socioeconomic status necessitates further research within this group of students.

Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors.

Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728-131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010-1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment.

Enhancing Sensing Performance of Capacitive Sensors Using Kirigami Structures.

Capacitive sensors have widespread applications in human-machine interaction, Internet of Things, and smart home systems due to their low cost, high sensitivity, and ease of integration. However, improving the sensitivity and sensing distance of capacitive sensors remains a challenging issue. This study proposes a novel capacitive sensor design method based on Kirigami structures, which enhances sensor performance by introducing specific cutting patterns into the conductive layer to leverage edge effects. Through experimental testing and statistical analysis, we systematically investigated the influence of Kirigami geometric parameters on sensor sensitivity and sensing distance. We designed and fabricated 12 different Kirigami structures, including circular flower patterns, array patterns, layered pointed flower patterns, and circular strip structures, and compared them with traditional non-cut structures. The results show that Kirigami structures significantly improved sensor performance. Compared to traditional sensors without Kirigami structures, optimally designed Kirigami capacitive sensors demonstrated approximately a 3-fold increase in sensitivity and up to 170 percent extension in sensing distance. Multivariate regression analysis and nonlinear models revealed complex relationships between Kirigami structural parameters and sensor performance. Notably, the circular strip (three-layer) structure exhibited the best performance, possibly due to its maximization of edge effects and optimization of electric field distribution. This study provides new design insights for developing high-performance capacitive sensors, with potential applications in improving smart home systems and indoor activity monitoring for solitary elderly individuals.

Epicardial adipose tissue and subclinical alterations in cardiac structure and function in early adulthood

Abstract Background Epicardial adipose tissue (EAT) is the visceral fat depot surrounding the heart and coronary arteries and shares the same microcirculation with myocardium. Under normal physiologic conditions EAT contains important cardioprotective properties such as cushioning the heart against mechanical stress, thermoregulation of the myocardium in hypothermia as well as balancing myocardial fatty acid homeostasis. Higher accumulation of EAT has been reported to independently associate with deleterious alterations in cardiac structure and function. However, majority of previously addressed study results are derived from older study population and in presence of cardiovascular diseases. Data on the associations of EAT and cardiac echocardiograpghically derived structural and functional parameters in a young and middle-aged population without prevalent cardiovascular disease is scarce. Purpose We aimed to address this knowledge gap by investigating the associations of echocardiographically measured EAT thickness and possible adverse subclinical alteration in cardiac structure and function in a population cohort of young and middle-aged adults. Methods This study participants were examined as part of the ongoing multi-centre longitudinal cohort, focusing on cardiovascular risk factors from childhood through adulthood. EAT thickness was measured by manual delineation from parasternal long-axis echocardiograms at end systole. Transthoracic and Doppler echocardiograpghy was performed and data on cardiac structural and functional parameters were derived comprehensively in accordance with EAE/ASE guidelines. Results In this study population (N=1677, men=770, women=897 ; age range 34-49 years) mean EAT thickness was 4.0 mm in whole population. In multivariable regression analysis models adjusted for age, sex, waist circumference and systolic blood pressure, significant independent associations of EAT and left atrial dimension (P&amp;lt;.0001) and various measures of left ventricular (LV) wall thickness such as LV mean wall thickness (P&amp;lt;.001), LV relative wall thickness (P&amp;lt;.001) as well as LV posterior wall thickness (P&amp;lt;.001) were observed. We found no significant associations between EAT thickness and cardiac functional and hemodynamic parameters after covariate adjustments in multivariable analysis models. Conclusion The findings of this study highlight that larger EAT thickness is associated with subclinical alteration in cardiac wall thicknesses in young and middle-aged adults. However, we found no associations between EAT thickness and cardiac functional parameters, which is perhaps due to the high cardiac adaptation properties in our relatively young study population. Therefore, further follow-ups is required to address long-term probable alterations in cardiac hemodynamics when the participants are older.

Real Exchange Rate Depreciation and Domestic Tax Revenue Performance in Kenya

Purpose: Taxation plays a critical role in raising the resources needed for financing government activities in developing countries. On the other hand, the volatility of real exchange rates (RERs) has generated significant concern among academics and policymakers in view of its effects on macroeconomic variables such as tax revenue generation. This study therefore focused on real exchange rate depreciation on domestic tax revenue performance in Kenya. The study was guided Theory of Constraints. Methodology: The study employed an explanatory research design. Secondary data was collected from the CBK, KRA, and the World Bank. In this study time series data ranging from 2003 – 2023 was used to analyze the determinants of domestic tax revenue performance in Kenya. The hypotheses were tested at a significance level of .05 using the multiple regression analysis. A multivariate time series ARDL regression analysis model was used to analyze the data. Results: The study ARDL model concluded that Real exchange rate depreciation led to a notable decrease in domestic tax revenue performance, with β = -0.223945 and p = 0.000 &lt; 0.05. This effect is intensified when considering the lagged impact, where a one-period lagged depreciation results in an even greater reduction in tax revenue performance, β = -1.927412 and p = 0.0004 &lt; 0.05. Conclusion: The study recommended that government of Kenya should stabilize the exchange rate and prevent excessive depreciation by fostering a favorable trade balance and maintaining investor confidence. Additionally, future research could focus on the effects of fiscal Policy Changes on domestic tax revenue performance. Also, future studies could examine Impact of Global Economic Shocks on Domestic Tax Revenue.

Seroprevalence and associated risk factors for Trypanosoma evansi infection in equine in North of Egypt

This study determined the seroprevalence of Trypanosoma evansi infection and its associated risk factors in 200 equines across four Egyptian governorates based on CATT/T. evansi. Serological testing revealed T. evansi antibodies in 34.5% of the examined animals, exhibiting notable discrepancies among different governorates. Dakahlia exhibited the highest seroprevalence at 42.4%, while the lowest seroprevalence rate (12.5%) was reported in Gharbia. No significant differences were observed in seroprevalence among age groups or equine species. The multivariate regression analysis model identified pivotal risk factors, wherein the presence of flies increasing infection odds threefold and animals lacking routine insecticide treatment having four times higher odds of infection. Equines in poor health condition displayed double the odds of infection. Surprisingly, a history of venereal disease increased the odds of T. evansi infection. Notably, there were no substantial differences in infection rates based on the disposal of used syringes or prior mange history. These findings provide essential insights into the transmission patterns of T. evansi. Gaining a comprehensive understanding of these identified risk factors is crucial for developing effective methods to reduce the prevalence of T. evansi in populations of equids.

Evaluating for Evidence of Sociodemographic Bias in Conversational AI for Mental Health Support.

The integration of large language models (LLMs) into healthcare highlights the need to ensure their efficacy while mitigating potential harms, such as the perpetuation of biases. Current evidence on the existence of bias within LLMs remains inconclusive. In this study, we present an approach to investigate the presence of bias within an LLM designed for mental health support. We simulated physician-patient conversations by using a communication loop between an LLM-based conversational agent and digital standardized patients (DSPs) that engaged the agent in dialogue while remaining agnostic to sociodemographic characteristics. In contrast, the conversational agent was made aware of each DSP's characteristics, including age, sex, race/ethnicity, and annual income. The agent's responses were analyzed to discern potential systematic biases using the Linguistic Inquiry and Word Count tool. Multivariate regression analysis, trend analysis, and group-based trajectory models were used to quantify potential biases. Among 449 conversations, there was no evidence of bias in both descriptive assessments and multivariable linear regression analyses. Moreover, when evaluating changes in mean tone scores throughout a dialogue, the conversational agent exhibited a capacity to show understanding of the DSPs' chief complaints and to elevate the tone scores of the DSPs throughout conversations. This finding did not vary by any sociodemographic characteristics of the DSP. Using an objective methodology, our study did not uncover significant evidence of bias within an LLM-enabled mental health conversational agent. These findings offer a complementary approach to examining bias in LLM-based conversational agents for mental health support.

Impact of co-presence of malnutrition-inflammation-atherosclerosis factors on prognosis in lower extremity artery disease patients after endovascular therapy.

Malnutrition and inflammation are common problems of adverse outcomes in various diseases as atherosclerosis. Recently, the concept of malnutrition-inflammation-atherosclerosis (MIA) syndrome is known to a crucial prognostic factor in patients with end-stage renal disease. We investigated the prognostic impact of the co-presence of MIA factors in patients with lower-extremity artery disease (LEAD) after endovascular therapy (EVT). This retrospective study included 284 patients with LEAD who underwent EVT. MIA factors were defined in patients with: low geriatric nutritional risk index (< 92) as "malnourished"; greater high-sensitivity C-reactive protein levels (≥ 0.1mg/dL) as "inflamed"; a history of coronary artery revascularization, lacunar or atherothrombotic brain infarction as "atherosclerotic". We examined the relationship between baseline characteristics and major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause mortality. Sixty-two patients (22%) died and 72 patients (25%) had MACCE, including all-cause death. Forty-four (16%) patients had every 3 of MIA (3-MIA) factors. The mean follow-up period was 737days. Multivariate Cox proportional hazards regression analysis models revealed that 3-MIA factors correlated significantly with all-cause death [hazard ratio (HR) 3.46, 95% confidence interval (CI) 1.89-6.34; p < 0.001] and MACCE (HR 2.91, 95% CI 1.62-5.22; p < 0.001), after adjusting for relevant factors. Kaplan-Meier analysis revealed that the rates of all-cause death (p < 0.001) and MACCE (p < 0.001) were significantly higher when the MIA factors overlapped and are observed in patients with chronic limb-threatening ischemia. Among patients with LEAD after EVT, the co-presence of MIA factors was an independent risk factor for all-cause death and MACCE.

Viral Suppression among Men Who Have Sex with Men Living With HIV on Risk Reduction Interventions in Mvita Sub-County, Mombasa County, Kenya

Purpose: The aim of this study was to compare viral load suppression levels among men who have sex with men (MSM) living with HIV who were put on risk reduction interventions versus a control group in Mvita sub-county, Mombasa County, Kenya between December 2020 and June 2021. Methodology: A quasi-experimental study design using quantitative methods was conducted among MSM living with HIV from December 2020 to June 2021. The study involved a questionnaire and various laboratory investigations. The respondent-driven sampling (RDS) was used to obtain the sample of respondents. A total of 114 HIV positive MSM completed the study and were all subjected to a battery of tests. Blood was drawn for alcohol, syphilis, hepatitis B, and viral load tests, while urine was used to screen for drugs and gonorrhoea. Half (57) of the HIV positive MSM were actively followed and risk reduction interventions such as adherence to ARVs, general counselling, and HIV prevention measures such as prompt treatment of STI/OI and condom use were offered after every 2 months. The control group (57) received no risk reduction interventions. Thereafter, both groups were asked to respond to a questionnaire. Since the study was carried out during COVID-19, the risk reduction interventions were conducted over the phone to minimize transmission. Log-binomial univariate and the multivariate regression analysis model was used to identify the variables which were associated with undetectable viral load. Undetectable viral load was defined as having an HIV viral load of less than 50 copies/ml. Data generated from the questionnaires were collected, cleaned, coded and analysed using STATA software, Version 17. Level of significance was fixed at 5% (95% confidence interval). Findings: Majority of MSM living with HIV were between 19-20 years and 49% were actively followed by the researcher and received risk reduction interventions while 54% were in the control group. However, the baseline demographic characteristics were not significantly different (all p&gt;0.05). MSM in the control group who were neither Christian nor Muslim (11%) and had a lower income (35%), were likely to have detectable viral load. However, MSM who had a higher income in both groups (1.8%), were likely to have undetectable viral load. MSM in the control group, who reported ever use of PEP/PrEP (44%), were likely to have detectable viral load while MSM who received interventions, who reported condom break more than once during anal sex (61%), who had more than one regular anal sex partner (61% both groups), and those who drunk more than 2 bottles of beer (33% both groups) were likely to have undetectable viral load. However, MSM who received interventions but used non-prescribed injectables drugs 1 to 2 times in a week (15%), were likely to have detectable viral load. MSM in the control group who reported being always high on alcohol during anal sex (19%), were likely to have detectable viral load but those chewing muguka (type of khat) (79%) were likely to have undetectable viral load. MSM who received interventions who reported feeling uneasy while seeking health services (75%), had detectable viral load while those in the control group who attended private clinics (42%), had undetectable viral load. Overall, after six months, the proportion of MSM achieving viral load suppression was significantly higher in the intervention group as compared to control group by 60% (95% CI 49‒70)), p-value &lt; 0.001. Unique Contribution to Theory, Practice and Policy: The study found out that majority of HIV positive MSM who received risk reduction intervention, had undetectable viral load as compared to those in the control group. HIV viral suppression is the desirable outcome for MSM on ART, since once achieved, MSM cannot transmit the virus to their sex partners. The Government/NGO should encourage peer-led HIV services to run the HIV programmes involving MSM with other stakeholders. Thus, many MSM will be able to access the HIV services where their needs will be addressed and supported in a non-judgemental environment.

Number of Retrieved Lymph Nodes during Esophagectomy Affects the Outcome of Stage III Esophageal Cancer in Patients Having Had Pre-Operative Chemo-Radiation Therapy.

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Methods: Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, "Free-To-Recurrence", and disease-free survival were assessed via Kaplan-Meier survival curves and the Cox regression model for multivariate analysis. Results: The dataset was stratified into two groups according to extent of lymph node dissection, with one group having <15 dissected nodes and the other having ≥15 dissected nodes. The group with <15 nodes exhibited a shorter "Free-To-Recurrence", worse disease-free survival, and lower overall survival. In multiple-variate analysis (Cox regression model), the number of dissected lymph nodes emerged as a significant factor influencing overall survival and freedom from recurrence. Conclusions: The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation.

Dietary diversity and associated factors among pregnant women attending antenatal care at public hospitals in North Shewa, Oromia, Ethiopia, 2023.

Adequate consumption of diversified food during pregnancy enables adequate intake of 11 important micronutrients. Pregnant women who consume an inadequate amount of diversified food during pregnancy are at a higher risk of delivering preterm babies, stillbirth, low birth weight, and small for gestational age newborns. This study aimed to assess dietary diversity (DD) and associated factors among pregnant women attending antenatal care (ANC) at public hospitals in North Shewa, Oromia, Ethiopia, 2023. An institution-based cross-sectional study was conducted on 400 pregnant women attending antenatal care. The study participants were selected using a systematic random sampling method. A pre-tested, structured, and interviewer-administered questionnaire was used to collect information about dietary diversity. The questionnaire was adapted from a validated and modified individual dietary diversity guideline, as recommended by the Food and Agriculture Organization (FAO) of the United Nations. The household food security level was determined using a standard set of questions derived from the Household Food Insecurity Access Scale (HFIAS) measurement guide. The data were entered into EpiData version 4.6 software and exported to Statistical Package for the Social Sciences (SPSS) version 24 for analysis. The results from the bivariate analysis of p < 0.25 were moved to the multivariable logistics regression analysis model. Any statistical test with a p < 0.05 at a 95% confidence interval (CI) was considered statistically significant. The study revealed that 55.4% of the pregnant women had adequate dietary diversity. Being an urban dweller [adjusted odds ratios (AOR = 2.4. 95% CI: 1.1, 5.18)], being a housewife (AOR = 3.44, 95% CI: 1.37, 8.68), being employed (AOR = 3.69, 95% CI: 1.12, 12.16), being a merchant (AOR = 3.43, 95% CI: 1.15, 10.24), being a daily laborer (AOR = 3.66, 95% CI: 1.0, 13.45), having a low average monthly household income of <500 Ethiopian birr (ETB) (AOR = 0.25, 95% CI: 0.07, 0.83), practicing home gardening (AOR = 2.5, 95% CI: 1.39, 4.5), meal frequency being three or more times per day (AOR = 2.9, 95% CI: 1.64, 5.09), and receiving dietary counseling during antenatal care (AOR = 3.56, 95% CI: 2.0, 6.35) were factors associated with the dietary diversity of the pregnant women. This study found that 55.4% of the pregnant women had adequate dietary diversity. Place of residence, women's occupation, average monthly household income, practicing home gardening, meal frequency per day, and receiving dietary counseling during antenatal care were strong predictors of adequate dietary diversity among pregnant women. Therefore, attention should be paid to pregnant women's diet by healthcare providers during antenatal care.

Factors related to the return to work of head and neck cancer patients diagnosed between 2004–2011 in Belgium: a multivariate Fine-Gray regression model analysis

BackgroundThis study aims to identify the key factors that underlie the return to work (RTW) of head and neck cancer (HNC) patients in Belgium.MethodsWe used data from the EMPCAN database linking data from the Belgian Cancer Registry and the Crossroads Bank for Social Security. We selected HNC patients aged 18–60 at diagnosis who became inactive on the labour market during the follow-up time observed (n = 398). Fine-Gray regression models were used to examine associations between clinical, socio-demographical and work-related factors and RTW over a follow-up of almost 8 years (2004–2011).ResultsThe overall RTW was 21.6%. Stage IV at diagnosis and the use of chemoradiation were associated with a decreased RTW probability but this effect was attenuated by age-adjusted analyses. Multivariate analysis shows that the probability of RTW decreases with age and depends on the household composition. Patients who live alone (SHR 2.2, 95% CI 1.0 – 4.5) and patients who live with another adult and child(ren) (SHR 2.1, 95% CI 1.1 – 4.0) are more likely to RTW than patients who live with another adult without children.ConclusionsThe cumulative incidence of RTW in HNC patients is associated with age and household composition but not with treatment modalities or stage. In future research, this model could be applied to larger cancer patient groups for more accurate estimations. These insights are of importance to better support patients and for informing tailored policy measures which should take into account the sociodemographic profile of HNC patients to tackle societal and health-related inequities and burden of work inactivity.

The influence of anthropometric parameters on the concentration of globulin that binds sex hormones during the menopausal transition.

To determine the effect of body mass index (BMI) and waist-hip ratio (WHR) on the concentration of circulating sex hormone-binding globulin (SHBG) throughout the menopausal transition. This cross-sectional study included 150 women divided into three groups: premenopausal (n=50), perimenopausal (n=50), and postmenopausal (n=50). The processing of the test women consisted of three phases: interview, blood sampling and determination of BMI and WHR. The SHBG concentration was determined from the blood, and BMI and WHR were measured. The BMI and WHR of the postmenopausal women were significantly higher comparing to the other two groups, while the postmenopausal SHBG was significantly lower compared to the premenopausal concentration. In all three groups, a significant negative correlation was found between SHBG and BMI (Rho= -0.385; p<0.05), and between SHBG and WHR (Rho= -0.411; p<0.05). By the univariate regression analysis model, it was determined that BMI (β= -0.594; p<0.001) and WHR (β= -0.407; p=0.003) were independently negative predictors of SHBG in postmenopausal women, while in the multivariate regression analysis model only BMI as an independently negative predictor of SHBG in postmenopausal women was found (β= -0.263; p=0.024). The value of SHBG during the menopausal transition decreases and women with higher BMI and WHR have lower values of SHBG regardless of the duration of menopause. Considering the connection between SHBG and anthropometric parameters, and the drop in its values upon entering and passing through the menopausal transition as such it can be used as a predictor for an increased risk of cardiovascular diseases and metabolic syndrome in a selected group of women.

Nomogram for prediction of hepatocellular carcinoma recurrence after liver resection

BackgroundHepatocellular carcinoma (HCC) is a common malignancy with high mortality. Liver resection (LR) is a curative treatment for early-stage HCC, but the prognosis of HCC patients after LR is unsatisfactory because of tumor recurrence. Prognostic prediction models with great performance are urgently needed. The present study aimed to establish a novel prognostic nomogram to predict tumor recurrence in HCC patients after LR. MethodsWe retrospectively analyzed 726 HCC patients who underwent LR between October 2011 and December 2016. Patients were randomly divided into the training cohort (n = 508) and the testing cohort (n = 218). The protein expression of 14 biomarkers in tumor tissues was assessed by immunohistochemistry. The nomogram predicting recurrence-free survival (RFS) was established by a multivariate Cox regression analysis model and was evaluated by calibration curves, Kaplan-Meier survival curves, time-dependent areas under the receiver operating characteristic (ROC) curves (AUCs), and decision curve analyses in both the training and testing cohorts. ResultsAlpha-fetoprotein [hazard ratio (HR) = 1.013, P = 0.002], portal vein tumor thrombosis (HR = 1.833, P < 0.001), ascites (HR = 2.024, P = 0.014), tumor diameter (HR = 1.075, P < 0.001), E-cadherin (HR = 0.859, P = 0.011), EMA (HR = 1.196, P = 0.022), and PCNA (HR = 1.174, P = 0.031) immunohistochemistry scores were found to be independent factors for RFS. The 1-year and 3-year AUCs of the nomogram for RFS were 0.813 and 0.739, respectively. The patients were divided into the high-risk group and the low-risk group by median value which was generated from the nomogram, and Kaplan-Meier analysis revealed that the high-risk group had a shorter RFS than the low-risk group in both the training (P < 0.001) and testing cohorts (P < 0.001). ConclusionsOur newly developed nomogram integrated clinicopathological data and key gene expression data, and was verified to have high accuracy in predicting the RFS of HCC patients after LR. This model could be used for early identification of patients at high-risk of postoperative recurrence.

Bioinformatics Analysis of the Expression and Prognostic Value of PLAU Gene in Wilms' Tumor.

Autophagy and immunity play important roles in the growth of malignant tumors and are promising targets for tumor therapy. This study was conducted to identify differentially expressed immune genes related to autophagy in Wilms' tumor (WT) and analyze their correlation with the disease prognosis. The public data of WT and normal kidney tissues were downloaded from TCGA, ImmPort, and GeneCards databases to obtain differentially expressed immune genes associated with autophagy. Survival analysis, ROC curve, and clinical relevance filtering were used to screen the key gene plasminogen activator urokinase (PLAU). The univariable and multivariable Cox regression model analyses were used to analyze the prognostic factors of overall survival (OS) in patients with WT. Then, GO enrichment, KEGG pathway analysis and GSEA were used to enrich and analyze differentially expressed genes. The relationship between PLAU gene expression and tumor microenvironment and infiltration of immune cells was analyzed, as well as between the expression of PLAU and epigenetic modifications. PLAU gene expression was associated with survival and prognosis in WT patients and was an independent prognostic indicator of OS in patients. The GO, KEGG, and GSEA analysis results suggested that PLAU may be involved in RNA transcription and epithelial cell migration. High expression of PLAU was also associated with increased immune cell infiltration and a higher presence of antitumor immune cells. The low expression of PLAU in WT was related to DNA methylation and may be also co-regulated by miR-342-3p. PLAU can be used as an independent prognostic biomarker for WT. Low expression of PLAU is associated with poor prognosis in WT patients. Evidence on the prognostic value of PLAU gene and the pathways that may be associated with its expression is invaluable for the development of new therapies for WT.

Time to recovery from severe pneumonia and its predictors among pediatric patients admitted in South West Region governmental hospitals, South West Ethiopia: Prospective follow-up study

BackgroundThe Ethiopian Federal Ministry of Health has been working by introducing vaccines, and integrating the management of newborn and child illnesses to prevent pneumonia, pneumonia-related hospitalization, and mortality. Despite these attempts, the prevalence of pneumonia and the proportion of hospitalizations have increased. Little is known about recovery time from severe pneumonia and its predictors in pediatric patients in the study area. Therefore, this study aimed to determine the time to recovery from severe pneumonia and its predictors in pediatric patients admitted to government hospitals in the southwest Region. Methods and MaterialsA hospital-based prospective follow-up study was conducted among 791 pediatric patients admitted with severe pneumonia at a governmental hospital in the South West Region, of Ethiopia. A systematic sampling technique was used to recruit participants. Data were entered into Epi-data 4.4.2.1 and exported to STATA 14 for analysis. The assumptions of Cox proportional hazard models and goodness of fit were assessed using the Shoenfield residual and Cox-Snell, respectively. Bivariate and multivariable Cox regression models were used to identify the predictors of time to recovery. Variables with a p-value of <0.05 at a 95 % confidence level in multivariable Cox regression model analysis were declared statistically significant predictors of time to recovery. ResultsThis study revealed that 641 (81.04 %) participants recovered with an incidence rate of 12.48 per 100 person-day observations. The median time to recovery was 5 days. Rural residence [AHR=0.82; 95 % CI 0.69–0.97], hypoxemia [AHR=1.25; 95 % CI 1.01- 1.55], danger sign, [AHR=1.77; 95 % CI 1.28- 2.45], comorbidity [AHR=0.60; 95 % CI 0.50- 0.7] and history of previous respiratory infections [AHR=0.76; 95 % CI 0.64- 0.90] were found significant predictors of time to recovery from severe pneumonia. ConclusionIn this study, the recovery rate from severe pneumonia among pediatric patients was low and the time to recovery was slightly prolonged with a median time to recovery of five days. Rural residence, hypoxemia, danger signs, comorbidity, and history of previous respiratory infections were independent predictors of time to recovery among pediatric patients. Therefore, the Ethiopian Federal Ministry of Health, family, community leaders, healthcare providers, and other stakeholders should provide timely initiation of advanced diagnosis, appropriate therapeutic interventions, and proper follow-up for pediatric patients with severe pneumonia to reduce mortality.

Malnutrition and Obesity in Patients with COPD Exacerbation, Insights from the National Inpatient Sample.

The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes. This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE. Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis. The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge. Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.

Comparison of cardiovascular disease risk association with metabolic unhealthy obesity identified by body fat percentage and body mass index: Results from the 1999-2020 National Health and Nutrition Examination Survey.

Cardiovascular disease (CVD) risk among individuals across different categories of metabolic obesity phenotypes is controversial. The study used body fat percentage (BFP) or body mass index (BMI) to categorize obese status and to investigate the association between metabolic obesity phenotypes and CVD risk in a nationally representative population. This cross-sectional study included 49463 adult participants in National Health and Nutrition Examination Survey from 1999 to 2020. Metabolic healthy status was defined by the absence of metabolic syndrome according to the revised National Cholesterol Education Program Adult Treatment Group definition. Obesity was identified by BFP, assessed by dual-energy X-ray absorptiometry scan, and BMI. The primary outcome was CVD prevalence. The multivariable logistic regression model and restricted cubic spline analyses were used to examine the associations between metabolic obesity phenotypes and the risk of CVD. Among 49463 adult participants, 32.12% were metabolically unhealthy, 34.10% were overweight, 37.94% were obese; and 8.41% had CVD. Compared with metabolic healthy normal weight, metabolic healthy obesity, and metabolic unhealthy normal weight/overweight/obesity were all associated with increased CVD risk with adjusted odds ratios (95% confidence intervals) of 1.45 (1.14-1.85), 2.80(1.53-5.11), 2.55(1.88-3.47), and 2.96(2.18-4.02), respectively. Nonlinear dose-response relationships between BFP and CVD were observed both in metabolically healthy and unhealthy participants (both P for non-linearity<0.0001). When obesity was defined with BMI, there were a similar prevalence of obesity, and similar associations between metabolic obesity phenotypes and CKD risks. Metabolic healthy and unhealthy obesity were both associated with higher risks of CVD, whether using BFP or BMI to define obese status. It suggests that metabolic obesity phenotype is a risk factor for CVD.

Compromised cardiac autonomic function in non-diabetic subjects with 1 h post-load hyperglycemia: a cross-sectional study

BackgroundA compromised cardiac autonomic function has been found in subjects with insulin resistance related disorders such as obesity, impaired glucose tolerance (IGT) and type 2 diabetes and confers an increased risk of adverse cardiovascular outcomes. Growing evidence indicate that 1 h plasma glucose levels (1hPG) during an oral glucose tolerance test (OGTT) ≥ 155 mg/dl identify amongst subjects with normal glucose tolerance (NGT) a new category of prediabetes (NGT 1 h-high), harboring an increased risk of cardiovascular organ damage. In this study we explored the relationship between 1 h post-load hyperglycemia and cardiac autonomic dysfunction.MethodsPresence of cardiac autonomic neuropathy (CAN) defined by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV), assessed by 24-h electrocardiography were evaluated in 88 non-diabetic subjects subdivided on the basis of OGTT data in: NGT with 1 h PG < 155 mg/dl (NGT 1 h-low), NGT 1 h-high and IGT.ResultsAs compared to subjects with NGT 1 h-low, those with NGT 1 h-high and IGT were more likely to have CARTs defined CAN and reduced values of the 24 h time domain HVR parameters including standard deviation of all normal heart cycles (SDNN), standard deviation of the average RR interval for each 5 min segment (SDANN), square root of the differences between adjacent RR intervals (RMSSD), percentage of beats with a consecutive RR interval difference > 50 ms (PNN50) and Triangular index. Univariate analyses showed that 1hPG, but not fasting and 2hPG, was inversely associated with all the explored HVR parameters and positively with CARTs determined presence of CAN. In multivariate regression analysis models including several confounders we found that 1hPG was an independent contributor of HRV and presence of CAN.ConclusionSubjects with 1hPG ≥ 155 mg/dl have an impaired cardiac autonomic function.