Multivariate Conditional Logistic Regression Research Articles

Clinical features and risk factors of invasive pulmonary aspergillosis in interstitial lung disease patients

BackgroundThe prevalence of invasive pulmonary aspergillosis (IPA) among patients with interstitial lung disease (ILD) is steadily increasing, leading to high mortality. The purpose of this study is to analyze the clinical features and risk factors of IPA in patients with ILD.Methods353 hospitalized ILD patients admitted in Nanjing Drum Tower Hospital from March 2023 and April 2024 were enrolled. The enrolled patients were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups.ResultsAmong 353 patients with ILD, 58 who suffered from IPA were identified. Among them, 2 (3.4%) episodes of proven IPA and 56 (96.6%) of probable IPA were diagnosed. The median age was 68.4 ± 8.6 years, and 35 patients were men. The forms of ILD included idiopathic pulmonary fibrosis (n = 21), interstitial pneumonia with autoimmune features (n = 13), rheumatoid arthritis related interstitial pneumonia (n = 11) and Sjögren′s syndrome (n = 4). The clinical features of IPA in ILD were cough (100.0%), dyspnea (93.1%) and fever (55.2%). Chest CT images showed reticulation (87.9%), traction bronchiectasis (84.5%), GGO (77.6%), honeycombing (69.0%), consolidation (44.8%) and pleural effusion (24.1%). The incidence of honeycombing and consolidation were higher in ILD patients with IPA compared to control group (P < 0.05). The main pathogens were A. fumigatus (50.0%) and A. flavus (29.3%). Following the diagnosis of IPA, all patients were treated with antifungal drugs. The overall survival rate after 90 days was 74.1%. Multivariate conditional Logistic regression analysis showed that lymphopenia (OR = 2.745, 95% CI 1.344–5.607) and honeycombing (OR = 2.915, 95% CI 1.429–5.949) were the risk factors of ILD with IPA (P < 0.05).ConclusionIPA is one of the major complications of ILD and its prognosis is poor. Lymphopenia and honeycombing increased the risk of IPA in ILD patients.

Impact of Cold Ischemia Time and Donor Age on Donation After Circulatory Death Kidney Transplant Outcomes: A UNOS Mate-Kidney Analysis.

The association between prolonged cold ischemia times (CIT), donor age, and outcomes in kidney transplant recipients (KTRs) from donors after circulatory death (DCD) remains uncertain. We aimed to compare allograft outcomes in DCD-donor KTRs according to CIT and age. UNOS database study (2010-2024) of DCD-donor KTRs on tacrolimus maintenance. We developed a mate-kidney analysis, comparing outcomes where one mate kidney had CIT >24 and the other ≤24h. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) using multivariable stratified Cox proportional hazards models. We compared outcomes across age groups (≥50 or <50 years) and 6-h-period CIT deltas between mate kidneys. We assessed delayed graft function (DGF) occurrence with multivariable conditional logistic regression. We included 4092 DCD-donor mate-kidney pairs. There were no differences between CIT >24 versus ≤24h in patient death (aHR 1.12, 95% CI 0.97-1.30), all-cause allograft failure (aHR 1.10, 95% CI 0.98-1.24), or DCGF (aHR 1.07, 95% CI 0.90-1.27). Similar results were observed when comparing outcomes by age group and 6-h-period CIT deltas between mate kidneys. Compared to shorter CITs, CITs >24h were associated with increased DGF likelihood (aOR 1.42, 95% CI 1.25-1.60), as were increasing CIT deltas. CITs >24h in DCD-donor KTRs were not associated with adverse allograft outcomes, irrespective of age group. However, prolonged CITs were associated with increased DGF likelihood. Increasing the acceptance of both mate kidney from DCD donors should be considered despite projected CITs >24h.

18. SLEEP QUALITY AMONG ADOLESCENTS AGED 15-17 IN DA NANG, 2024: A CROSS-SECTIONAL STUDY

Objective: (1) To determine the prevalence of sleep disorders among adolescents aged 15 to 17 years; (2) To analyze factors associated with sleep quality in adolescents aged 15 to 17 years. Design, Setting, and Participants: Cross-sectional descriptive study. Among Adolescents aged 15-17 years old at Hoa Vang High School we collected 737 eligible participants for the study. Main Outcome Measures: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Associations between Sleep quality were evaluated with multivariable conditional logistic regression controlling for gender, exercise habits, sleep hygiene habits, pressure and expectations about academic performance (parental expectations, pressure for achievement, completing homework, extra classes). Results: The sleep quality of adolescents aged 15-17 at Hòa Vang High School is alarmingly low, with PSQI scores averaging 5.5±3.3 for 10th-grade students (15 years old), 6.1±3.3 for 11th grade (16 years old), and 6.4±3.5 for 12th grade (17 years old). The findings show that 47.5% of students have poor sleep quality, with a trend of worsening sleep quality with age. Additionally, most study participants go to bed relatively late. Factors associated with poor sleep quality include being female, excessive phone use before bed, academic pressure, homework load, and hours spent on daily extra classes. Addressing this issue requires appropriate sleep education and awareness for both students and parents. Conclusion: This study indicates an alarmingly low level of sleep quality among students at Hoa Vang High School, with a significant proportion experiencing poor sleep quality, and highlights several associated factors.

Comprehensive diagnostic value of VBQ scores and paravertebral muscle quality parameters in osteoporotic vertebral fractures

ObjectiveBoth vertebral bone quality (VBQ) scores and paravertebral muscle quality can predict osteoporotic vertebral fractures (OVF). This study aimed to compare the diagnostic value of opportunistic VBQ scores and sarcopenia for OVF and to determine if their combined use could enhance diagnostic efficacy. MethodsA total of 194 patients, matched 1:1 by age and sex, were included. VBQ scores and paravertebral muscle cross-sectional areas (CSA) were measured from lumbar MRI. Independent risk factors for OVF were determined using multivariate conditional logistic regression. The predictive value of VBQ and muscle-related parameters for OVF was assessed with receiver operating characteristic curves. ResultsVBQ, CSA, and degree of fat infiltration (DFF) showed significant differences between the fracture and non-fracture groups (p < 0.001). Multivariate analysis identified lower multifidus (MF) CSA, higher MF DFF, and higher VBQ as independent risk factors for OVF. Thresholds of 3.46 for VBQ and 11.83 cm2 for MF CSA yielded AUC values of 0.668 and 0.736, respectively, for predicting OVF. Combining VBQ and MF CSA notably enhanced the sensitivity and specificity of OVF diagnosis. ConclusionsThe predictive value of MF CSA in anticipating OVF was marginally superior to that of VBQ and MF DFF. Furthermore, the concurrent utilization of VBQ and MF CSA substantially enhanced the diagnostic accuracy of OVF. Considering that both VBQ and MF CSA can be opportunistically obtained during routine examinations, individuals with a VBQ ≥3.46 and MF CSA ≤11.83 cm2 should be categorized as high risk for OVF, warranting timely preventive measures.

Remnant cholesterol increases the risk of incident kidney stones: a nested case-control study in Chinese adults.

Kidney stones pose a significant healthcare burden worldwide. Dyslipidemia is a risk factor for kidney stones, but the relationship between remnant cholesterol (RC) and kidney stone risk is unknown. We aimed to investigate the association between RC and the risk of incident kidney stones. We conducted a nested case-control study based on data from Shanghai Kidney Stone Cohort conducted in Shanghai from December 2018 to February 2023. Propensity score matching was used to select 2550 incident kidney stone cases and 7650 controls from a total of 60,158 adults. Baseline fasting plasma samples were collected to measure RC, which was calculated as total cholesterol minus high-density lipoproteins cholesterol and low-density lipoproteins cholesterol. Multivariable conditional logistic regression and a restricted cubic spline were used to estimate the association between tertiles of RC and kidney stone risk. Subgroup and sensitivity analyses were also performed. The baseline RC of incident kidney stone cases and controls were 0.58 (0.57) and 0.54 (0.55), respectively. Incident kidney stones had much higher baseline RC levels than controls (P < 0.001). Higher baseline RC levels were significantly associated with increased kidney stone risk after adjustment for potential confounders (highest vs. lowest tertile: OR 1.16, 95% CI 1.04-1.30; per 1 mmol/L increase: OR 1.16, 95% CI 1.07-1.26). Restricted cubic spline showed a significant positive and linear dose-response relationship between RC and the risk of developing kidney stones (P-overall = 0.005, P-nonlinear = 0.482). Sensitivity analyses yielded consistent results. Elevated RC levels are associated with a greater risk of incident kidney stones in Chinese adults.

Feasibility and Safety of Targeted Temperature Management During Interhospital Transport of Post-Cardiac Arrest Patients

Objectives Early initiation of targeted temperature management (TTM) is crucial for post-resuscitation care. Although TTM is initiated prior to transport and continued during interhospital transport (IHT), its feasibility and safety during IHT for cardiac arrest patients have not been thoroughly assessed. This study aims to evaluate the feasibility and safety of interhospital TTM for post-resuscitation patients. Methods A retrospective analysis of post-cardiac arrest patients transported by a dedicated critical care transport team between January 2016 and April 2023 was conducted. Adult patients resuscitated from cardiac arrest without mental recovery were enrolled. The study population was divided into those who received TTM during IHT (IHT-TTM group) and those who did not (non-IHT-TTM group). The primary outcome was body temperature drop during transport, with hypotension, or desaturation during transport considered as secondary outcomes. Multivariable conditional logistic regression analysis was performed after frequency matching. Results Among 593 post-cardiac arrest patients, 332 were included in the analysis after exclusions. Of these, 44 (13.3%) received TTM during IHT. Conditional logistic regression analysis showed significantly higher likelihood for a drop in body temperature during IHT for the IHT-TTM group, with an odds ratio (OR) of 12.91 (95%CI: 5.28–31.53). No significant association was found for hypotension (OR (95%CI): 0.72 (0.13–3.97)), or desaturation during IHT (0.65 (0.15–2.82)). Conclusions Administration of TTM during IHT for post-cardiac arrest patients appears to be feasible and safe. These findings support the implementation of dedicated critical care transport systems capable of providing TTM during IHT for post-cardiac arrest patients.

Association between ocular diseases and screen time and sedentary time derived from job-exposure matrices

After developing job-exposure matrices (JEMs) for screen and sedentary time, we aimed to assess the associations between the JEM-derived exposures and various ocular diseases. We collected data from patients hospitalized from 2005 to 2021. JEMs were developed from 41,718 patients with occupational information and screen and sedentary times. The adjusted means of screen and sedentary time were calculated for 143 occupational groups and categorized into three classes based on the tertiles. The associations between ocular diseases and these JEM-derived exposures were examined using multivariable conditional logistic regression for 727,589 patients. The odds ratios of the class with highest screen time were 1.05 (95% confidence interval, 1.01–1.09) for cataract, 1.24 (1.06–1.45) for primary open-angle glaucoma (POAG), 1.26 (1.06–1.49) for rhegmatogenous retinal detachment (RRD), 1.49 (1.26–1.76) for ptosis, and 0.39 (0.27–0.57) for pterygium. The odds ratios of the class with highest sedentary time were 1.05 (1.01–1.09) for cataract, 1.24 (1.05–1.46) for RRD, 1.68 (1.42–1.99) for ptosis, and 0.60 (0.42–0.84) for pterygium. Both screen and sedentary time were positively associated with cataract, RRD and ptosis. Interestingly, POAG had a positive association with only screen time. Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary."I have confirmed that the content is correct. No amendments are necessary.Please check article title if captured correctly."?>"I have confirmed that the content is correct. No amendments are necessary.

Exploring factors influencing COVID-19 severity: a matched case-control study.

COVID-19, first identified in December 2019, quickly became a global pandemic and remains a significant public health concern. Robust data is rare, especially in pregnant women. The symptoms of this disease range from mild to severe respiratory distress syndrome and mortality. The present study aimed to evaluate the factors influencing COVID-19 severity in women to be better prepared in case of a new epidemic. This retrospective matched case-control study based on body mass index, smoke, and drug use was conducted on all women hospitalized with COVID-19 at Afzalipour Hospital in Kerman, Iran from the beginning of 2020 to 2021. In this study, 130 female patients with COVID-19 were included, with 65 patients in the case group (moderate and severe cases of COVID-19) and 65 patients in the control group (mild cases of COVID-19). The data were entered into the Stata software, and to determine the effective risk factors for the severity of COVID-19 disease, both univariate and multivariable conditional logistic regression analyses were utilized, assuming individual matching. Finally, the odds ratios (OR), along with 95% confidence intervals (CI), were estimated. The average age of women in the case group was 36.92 ± 7.07 years, compared to 30.12 ± 6.27 years in the control group. Among all patients, 50% were pregnant, with a mean gestational age of 30.03 weeks. Significant factors affecting disease severity included age, education, employment status, place of residence, insurance coverage, comorbidities, and pregnancy status. The highest adjusted odds ratio for severe COVID-19 was associated with comorbidities (OR = 7.8, 95% CI: 2.3-11.1), while the lowest was associated with urban residence (OR = 2.8, 95% CI: 1.02-4.5). Overall, significant predictors of severe COVID-19 included age over 30, urban residence, lack of insurance, a short duration between diagnosis and hospitalization, comorbidities, and non-pregnancy. The study identified several significant predictors of severe COVID-19 among women, including age over 30, urban residency, lack of insurance coverage, presence of comorbidities, and non-pregnancy, all of which were associated with a heightened risk of severe illness. Notably, comorbidities emerged as the strongest predictor. These findings underscore the critical need for targeted interventions to protect vulnerable populations.

Real-World Evidence of Indapamide-Induced Rhabdomyolysis: A Retrospective Analysis of Electronic Health Records.

Previous research and pharmacovigilance monitoring activities have suggested a potential association between indapamide use and rhabdomyolysis. This study aims to investigate the potential causal relationship between the use of indapamide and rhabdomyolysis. A case-control study conducted using electronic health records data, between July 1, 2016 and December 31, 2022. Patients who have rhabdomyolysis event (cases) were matched to four controls bases on age, gender, and date. We examined the odds for indapamide exposure through three risk periods: current use, recent use, and former. The study outcome was ascertained through the presence of CK level over 1000 U/L (i.e., rhabdomyolysis event). Subsequently, a multivariable conditional logistic regression analysis was utilized to assess the causal association of indapamide exposure on the likelihood of developing rhabdomyolysis, while accounting for potential confounding variables. The study population consisted of 2965 cases and 11 860 controls. The results of the conditional logistic regression analysis indicated a lack of association between exposure to indapamide for the current users with an odds ratio (OR) of 0.6 (95% confidence intervals (CI): 0.39-1.05). The odds of recent indapamide use among cases was lower than controls (OR 0.2; 95% CI: 0.14-0.47). Lastly, the OR for former use of indapamide was 0.1 (95% CI: 0.07-0.23). In this study, we did not find association between indapamide use and rhabdomyolysis regardless timing of exposure.

Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy - a retrospective register-based study.

The risk of hyperkalemia in relation to different combinations of antihypertensive therapy remains to be elucidated. In this Danish register-based study, we aimed to investigate the risk of developing hyperkalemia in relation to different combinations of antihypertensive therapy. Using incidence density matching, we matched a hyperkalemic patient to five normokalemic patients on eGFR groups, age, sex, and time between study entry and date of potassium measurement. Combination therapies were subdivided into eight groups: beta blockers (BB) + calcium channel blockers (CCB), BB + renin angiotensin system inhibitors (RASi), BB + RASi + mineralocorticoid receptor antagonists (MRA), CCB + RASi, CCB + RASi + thiazides, CCB + thiazides, RASi + thiazides, and other combinations. Multivariable conditional logistic regression was used to estimate the odds of hyperkalemia within 90 days for each of the eight antihypertensive combination therapies. A total of 793 patients with hyperkalemia were matched to 3598 normokalemic patients. In multivariable analysis, odds of developing hyperkalemia when being treated with BB + RASi + MRA was 1.95 (95% CI, 1.39-2.72) compared to RASi + thiazides (reference). CCB + thiazides (OR, 0.76 [95% CI, 0.45-1.28]) and CCB + RASi + Thiazid (OR 0.81 [95% CI, 0.51-1.28]) were among the others not significantly associated with hyperkalemia. Combinations of BB + RASi + MRA were significantly associated with an increased risk of developing hyperkalemia within 90 days of initiating treatment. Patients treated with BB + RASi + MRA within 90 days of treatment initiation, were associated with an increased hyperkalemia risk. When treating hypertensive patients with combination antihypertensive therapy, identifying and monitoring patients with a high risk of dyskalemias is a crucial goal to avoid serious adverse effects and detrimental outcomes related to dyskalemia.

The association between drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a case-control study.

Bullous pemphigoid (BP) is an autoimmune skin disease that affects mainly older people. Numerous drugs have been previously associated with BP based on case series and small hospital-based studies. More reliable and precise estimates of associations between a broad selection of drugs/vaccines and BP will enable greater awareness of potential increased risk of BP following certain medicines and help identify clinical, histological and genomic characteristics of drug-induced BP for different types of culprit drugs. Greater awareness could lead to earlier recognition or suspicion of BP and referral to a dermatologist for diagnosis. Earlier diagnosis may lead to less aggressive treatment and improved well-being. To determine the association between drugs/vaccines commonly prescribed to older people and BP risk. We conducted a population-based nested case-control study between 1998-2021 using electronic primary care records from the Clinical Practice Research Datalink. We matched BP cases with up to 5 controls. Exposures were drugs/vaccines commonly prescribed to older people. We used multivariable conditional logistic regression adjusting for multiple drug use. For antibiotics, we considered prescriptions may be prescribed for undiagnosed symptoms of BP which resemble skin infection (protopathic bias) in a sensitivity analysis. Antibiotics were the therapeutic group associated with the highest risk of BP (OR: 4.60; 95%CI 4.40-4.80). However, after adjusting for protopathic bias, the OR reduced to 2.08 (95%CI 1.99-2.17). After adjusting for protopathic bias, of all antibiotic classes and subclasses, penicillins and penicillinase-resistant penicillins had the strongest associations with BP risk (OR: 3.44; 95%CI 3.29-3.60; sensitivity analysis OR; 1.74; 1.66-1.84 and OR: 7.56; 95%CI 7.15-8.00; sensitivity analysis OR: 2.64; 95%CI 2.45-2.85, respectively). Other drugs strongly associated with increased risk were gliptins (OR: 2.77; 95% CI 2.37-3.23), and second-generation antipsychotics (OR: 2.58; 95%CI 2.20-3.03). Healthcare professionals need to be aware of BP risk in older people particularly when prescribing penicillinase-resistant penicillins, gliptins, and second-generation antipsychotic drugs to recognise and manage BP early. Due to the low prevalence of disease, we do not suggest avoidance of drugs/vaccines to prevent BP. Further research should consider recency, dosage, and duration of antibiotic treatments.

Roles of NR1I3 and NR1H4 polymorphisms in the susceptibility to antituberculosis drug-induced liver injury in China: a case‒control study.

The pathogenesis of antituberculosis drug-induced liver injury (AT-DILI) remains largely unknown. The current investigation aimed to determine the genetic contribution of the nuclear receptor subfamily 1 Group I member 3 (NR1I3) and nuclear receptor subfamily 1 Group H member 4 (NR1H4) genes to the risk of AT-DILI in the Chinese population. A 1:4 matched case‒control study was conducted, and five single nucleotide polymorphisms (SNPs) in the NR1I3 and NR1H4 genes were detected and assessed. Utilizing a multivariate conditional logistic regression model, the effects of haplotype and genotype on the risk of AT-DILI were examined. Extended subgroup analysis was carried out based on sex. The distribution of the peak value of serum liver enzymes also compared among different genotypes. 224 AT-DILI cases and 896 controls were included in this study. No significant difference was observed in genotypes or haplotypes frequencies between AT-DILI cases and controls. However, comparisons of liver function indicators revealed significant differences in the peak values of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) among patients with different genotypes of NR1H4 rs56163822 (GG vs. GT vs. TT, 27.1 U/L vs. 26.0 U/L vs. 23.0 U/L, p = 0.020; 34.0 U/L vs. 31.0 U/L vs. 30.6 U/L, p = 0.008; 15.5μmol/L vs. 15.0μmol/L vs. 13.7μmol/L, p = 0.029, respectively), as well as in the peak values of ALT and AST among male patients with different genotypes of NR1H4 rs56163822 (29.0 U/L vs. 26.9 U/L vs. 22.6 U/L, p = 0.002; 34.0 U/L vs. 32.0 U/L vs. 30.5 U/L, p = 0.019, respectively). Based on this 1:4 individual-matched case‒control study, the SNP rs56163822 in the NR1H4 gene may be linked to the susceptibility to AT-DILI in Chinese patients receiving anti-TB treatment. Further studies in larger varied populations are needed to validate our findings.

Second Trimester Screening Markers of Fetal Chromosomal Abnormalities Other than Common Trisomies: A Case-Control Study

Background: To enhance the efficacy of maternal serum screening (MSS), we conducted an analysis to examine the correlation between certain factors identified during second-trimester screening (STS) and fetal chromosomal abnormalities, excluding the common trisomies (trisomies 13, 18, and 21). Additionally, specific risk factor ranges were established for each category. Methods: A retrospective 1:3 matched case-control study was conducted. Case data were obtained from 311 STS samples of fetal chromosomal abnormalities other than common trisomies, with testing performed in the Prenatal Diagnosis Center of the Maternal and Child Health Care Hospital of Sichuan Province in China between 6 January 2013 and 12 April 2023. A total of 933 controls were matched accordingly. Univariate and multivariable conditional logistic regression analyses were implemented and sensitivity analysis was performed. Results: Multivariable logistic analyses revealed that the independent risk factors for fetal chromosomal abnormalities other than common trisomies were ultrasonographic structural abnormalities (odds ratio (OR) = 3.038; 95% confidence interval (CI), 1.774–5.202; p &lt; 0.001); free β-human chorionic gonadotropin (free β-hCG) as multiples of the median (MoMs) of ≤0.34 (OR = 3.006; 95% CI, 1.803–5.013; p &lt; 0.001), 2.82–3.53 (OR = 1.884; 95% CI, 1.321–2.688; p &lt; 0.001), 3.54–4.67 (OR = 1.949; 95% CI, 1.300–2.923, p = 0.001), and ≥4.68 (OR = 1.730; 95% CI, 1.045–2.866; p = 0.033); and a trisomy 21 (T21) risk of 1/271–1/1000 (OR = 2.434; 95% CI, 1.706–3.472; p &lt; 0.001), 1/101–1/270 (OR = 3.330; 95% CI, 2.300–4.821; p &lt; 0.001), and ≥1/100 (OR = 3.441; 95% CI, 2.178–5.438; p &lt; 0.001). Conclusions: Ultrasonographic structural abnormalities, free β-hCG MoMs, and T21 risk were identified as independent risk factors for fetal chromosomal abnormalities (with the exception of common trisomies) in STS. Our findings thus provide data to support clinical decision-making.

Association of erythrocyte fatty acid compositions with the risk of pancreatic cancer: A case-control study.

Pancreatic cancer (PC) is one of the most fatal malignancies, which has attracted scientists to investigate its etiology and pathogenesis. Nevertheless, the association between erythrocyte fatty acids and PC risk remains unclear. This study aimed to evaluate the association between levels of erythrocyte fatty acids and PC risk. The erythrocyte fatty acid compositions of 105 PC patients and 120 controls were determined by gas chromatography. Cases and controls were frequency matched by age and sex. Multivariable conditional logistic regression model and restricted cubic spline were applied to estimate the odds ratio with 95% confidence interval (OR, 95% CI) of erythrocyte fatty acids and PC risk. Our main findings indicated a significant negative association between levels of erythrocyte total monounsaturated fatty acids (MUFA) and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of PC (ORT3-T1 = 0.30 [0.14, 0.63] and ORT3-T1 = 0.15 [0.06, 0.33], respectively). In contrast, erythrocyte n-6 polyunsaturated fatty acids, specifically linoleic acid (LA) and arachidonic acid (AA) levels, were positively associated with PC incidence (RT1-T3 = 4.24 [1.97, 9.46] and ORT1-T3 = 4.53 [2.09, 10.20]). Total saturated fatty acid (SFA), especially high levels of palmitic acid (16:0), was positively associated with the risk of PC (ORT3-T1 = 3.25 [1.53, 7.08]). Our findings suggest that levels of different types of fatty acids in erythrocytes may significantly alter PC susceptibility. Protective factors against PC include unsaturated fatty acids such as n-3 PUFA and MUFA.

Long-Term Outcomes of Traditional Chinese Medicine in the Treatment of Granulomatous Lobular Mastitis: A Two-Year Follow-Up Study on Recurrence and New Occurrence Rates with Analysis of Risk Factors.

Patients with clinically cured granulomatous lobular mastitis (GLM) still face a high probability of recurrence and new occurrence. To evaluate the long-term efficacy of traditional Chinese medicine (TCM) in treating GLM and to hypothesize potential risk factors for recurrence or new occurrence. A retrospective analysis was conducted on GLM patients treated with TCM at Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine from January 2016 to July 2021. We analyzed general data, two-year recurrence and new occurrence rates, and 12 risk factors associated with recurrence or new occurrence. This cross-sectional study included 261 GLM patients with an average age at onset of 31.95 years (primarily aged 31-40). The two-year recurrence rate for GLM was 1.53%, and the new occurrence rate was 4.21%. Univariate and multivariate conditional logistic regression analyses revealed that a history of inverted nipples was associated with the risk of both recurrence and new occurrence of GLM (HR = 8.672, 5.375, P < 0.05), and menstrual irregularity was related to a higher risk of recurrence (HR = 13.172, P < 0.001). A history of inverted nipples is identified as a potential risk factor associated with the long-term recurrence and new occurrence of GLM, while menstrual irregularity is associated with recurrence. Despite this, patients with GLM undergoing TCM demonstrate low rates of long-term recurrence and new occurrence after achieving clinical cure, underscoring the effectiveness of TCM. This study lays the groundwork for a long-term effectiveness strategy to guide future GLM treatments.

Difference in risk factor profile for abdominal aortic aneurysm and thoracic aortic aneurysm

ObjectivePrevious studies suggest partly different risk factor profiles of thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs), but prospective data are scarce. The purpose of this prospective population-based case-control study was to investigate differences in risk factor profile between TAAs and AAAs. MethodsParticipants in two prospective population-based studies, the Västerbotten Intervention Project (VIP) and the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, between 1986 and 2010, underwent cardiovascular risk assessments, including blood samples, oral glucose tolerance test, blood pressure readings, and a self-reported health questionnaire. All individuals who were later diagnosed with TAAs or AAAs were identified. Age, sex, and time-matched controls were selected from the same cohorts, aiming at four controls/case. Adjusted odds ratios (aORs) for potential risk factors for later diagnosis of TAAs and AAAs, respectively, were estimated by multivariate conditional logistic regression analyses. ResultsFrom a total of 96,196 individuals with prospectively collected data in the VIP/MONICA cohort, a total of 236 individuals with AAAs (181 men and 55 women) and 935 matched controls, and 168 individuals with TAAs (115 men and 53 women) and 662 controls were included. The average age at baseline examination was 57.0 ± 5.7 years for AAA cases and controls, and 52.1 ± 8.8 years for TAA cases and controls. Mean time between baseline examination and diagnosis of AAAs/TAAs was 12.1 and 11.7 years, respectively. There was a clear difference in risk factor profile between AAAs and TAAs. Smoking, hypertension, and coronary artery disease were significantly associated with later diagnosis of AAAs, with highest aORs for a history of smoking (aOR, 10.3; 95% confidence interval [CI], 6.3-16.8). For TAAs, hypertension was the only positive risk factor (aOR, 1.7; 95% CI, 1.1-2.7), whereas smoking was not associated. Diabetes was not associated with either AAAs or TAAs; neither was self-reported physical activity. ConclusionsIn this prospective, population-based, case-control study, risk factor profile differed between AAAs and TAAs. This suggests a partially different etiology for TAAs and AAAs.

Carbonated Beverage, Fruit Drink, and Water Consumption and Risk of Acute Stroke: the INTERSTROKE Case-Control Study.

Cold beverage intake (carbonated drinks, fruit juice/drinks, and water) may be important population-level exposures relevant to stroke risk and prevention. We sought to explore the association between intake of these beverages and stroke. INTERSTROKE is an international matched case-control study of first stroke. Participants reported beverage intake using food frequency questionnaires or were asked "How many cups do you drink each day of water?" Multivariable conditional logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations with stroke. We include 13,462 cases and 13,488 controls; mean age was 61.7±13.4 years and 59.6% (n=16,010) were male. After multivariable adjustment, carbonated beverages were linearly associated with ischemic stroke (OR 2.39 [95% CI 1.64-3.49]); only consumption once/day was associated with intracerebral hemorrhage (ICH) (OR 1.58 [95% CI 1.23-2.03]). There was no association between fruit juice/drinks and ischemic stroke, but increased odds of ICH for once/day (OR 1.37 [95% CI 1.08-1.75)] or twice/day (OR 3.18 [95% CI 1.69-5.97]). High water intake (>7 cups/day) was associated ischemic stroke (OR 0.82 [95% CI 0.68-0.99]) but not ICH. Associations differed by Eugeographical region-increased odds for carbonated beverages in some regions only; opposing directions of association of fruit juices/drinks with stroke in selected regions. Carbonated beverages were associated with increased odds of ischemic stroke and ICH, fruit juice/drinks were associated with increased odds of ICH, and high water consumption was associated with reduced odds of ischemic stroke, with important regional differences. Our findings suggest optimizing water intake, minimizing fruit juice/drinks, and avoiding carbonated beverages.

Risk factors of diphtheria outbreak in damt district of Al Dhalea Governorate, 2023 -Yemen: a case–control study

BackgroundIn Yemen, diphtheria has become an important health problem since 2017 when diphtheria re-emergence as a consequence of war and the collapse of the health system. In 2023, there has been a 57% increase in diphtheria cases compared to 2021 and 2022. Damt district of Al Dhalea Governorate had the highest reported cases for year 2023. The study aims to determine the risk factors associated with diphtheria outbreak in Damt District.MethodsA retrospective matched case–control (1:2) was used. All confirmed cases based on the WHO case definition reported from Damt district during 2023 were considered cases. Two age-matched (± 5years) neighborhood controls were recruited per case. A pretested questionnaire was used for collecting data during household interviews including demographic and household characteristics, knowledge of diphtheria, vaccination status, contact with a case of diphtheria, and travel history. Frequency and proportion for quantitative and median with interquartile range (IQR) for quantitative variables. Chi-square and Mann–Whitney tests to compare the distribution of categorical and numerical variables between cases and controls. Univariate and multivariate conditional binary logistic regression, and Adjusted Odds ratio (AOR) with a 95% confidence interval at P < 0.05 were used to identify risk factors.ResultsA total of 118 cases and 236 controls were enrolled, 56% were females (63% of cases vs. 53% of controls). The median (IQR) age was 14 (9,22) years for cases vs 12(7,23) of control, it was significantly higher for females than males in the case group: (16(10,29) Vs 10(6,18), P < 0.001) and control group: (15(8,25) vs 12(7,18), p-value = 0.022). Partial vaccination status AOR = 13.7(6.1–31.1), P-value < 0.001), contacts with a case of diphtheria AOR = 8.5(2.3–31.0), P value < 0.001) and Female gender, AOR = 3.3(CI; 1.1–9.5, P value = 0.029), were the main risk factors.ConclusionsPoor vaccination and contact with a case of diphtheria were the main contributors to diphtheria in the Damt district particularly among adult females. Increasing the vaccination coverage with a diphtheria-containing vaccine through routine immunization as well as tetanus-diphtheria vaccine for childbearing age females along with community awareness regarding protection measures during home care of diphtheria cases. Vaccination services as well as gender barriers related to Td vaccination should be investigated.

Association of Race or Ethnicity With Extended-Spectrum Beta-Lactamase Production in Escherichia Coli: A Case Control Study.

There are limited and conflicting data regarding the impact of race or ethnicity on the rate of gram-negative antimicrobial resistance. This study was performed to determine whether there is a difference in extended-spectrum beta-lactamase (ESBL) Escherichia coli infection or colonization in minoritized patients when compared to White patients from a diverse US Midwestern city. A case control study was performed, with controls with non-ESBL E. coli matched 1:1 to patients with ESBL-producing E coli based on age, sex, and ZIP code. A variety of other evidence-based factors for ESBL Enterobacterales infection and colonization were collected via chart review. Multivariate conditional logistic regression assessed the odds of minoritized patients as compared to White patients, while controlling for other common risk factors for ESBL Enterobacterales. A total of 364 matched pairs were included in the analysis. Females were the majority of the sample (91%), with median age of 65 years. The majority of the sample identified as White (73%), followed by Hispanic (14%) and Black (10%). Urine cultures made up the majority of the cultures in the sample (97%), and this was similar between ESBL and non-ESBL groups. While controlling for these risk factors for ESBL E coli, minoritized patients had a statistically significant greater odds of ESBL-producing E coli (odds ratio, 2.53; 95% confidence interval, 1.68-3.82). In our sample, which is demographically similar to the United States, minoritized patients had higher odds of ESBL-producing E coli. Further research on the drivers for this disparity is needed.

Outcomes of emergency general surgery admissions in patients experiencing homelessness: A matched cohort study

BackgroundHousing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission. MethodsWe conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest. ResultsThe study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35–0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78–4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09–3.19, P = .02). ConclusionCompared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.