Multivariate Poisson Regression Analysis Research Articles

A descriptive study on diagnostic timelines, and factors influencing delayed diagnosis among adult head and neck cancer patients at Uganda cancer institute.

Many patients with head and neck cancer (HNC) often present with advanced disease. This may result from delay in deciding to seek care, delay in reaching the healthcare facility and or delay in accessing care in the healthcare facility. We therefore set out to determine the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at the Uganda Cancer Institute (UCI). A cross-sectional study was conducted at UCI, patients with HNC were recruited. An interviewer administered questionnaire was used to collect data on sociodemographic factors and clinical characteristics, including timelines in months, from symptom onset to deciding to seek care, to reaching the health care facility and to definitive diagnosis. Multivariate Poisson regression analysis was used to calculate odds ratios (ORs) for the factors of association with delayed diagnosis. We recruited 160 HNC patients, and 134 patients were analyzed. The median age was 49.5 years (IQR 26.5), 70% (94 of 134) were male, 48% (69 of 134) had below secondary school education, 49% (65 of 134) had a household income < 54 USD. 56% (76 of 134) were sole bread winners, 67% (89 of 134) had good access road condition to the nearest health unit and 70% (91 of 134) presented with tumor stage 4. Median time from onset of symptoms to definitive diagnosis was 8.1 months (IQR 15.1) and 65% (87 of 134) of patients had delayed diagnosis. Good access roads (aOR: 0.26, p = 0.006), secondary school education (aOR: 0.17, p = 0.038), and household income > 136 USD (aOR: 0.27, p = 0.043) were associated with lower odds of delayed diagnosis. Being the sole bread winner (aOR: 2.15, p = 0.050) increased the odds of delayed diagnosis. Most of HNC patients (65%) at UCI had delayed diagnosis. A national care pathway for individuals with suspected HNC should be established and consider rotation of Ear, Nose and Throat surgeons to underserved regions, to mitigate diagnostic delay.

Surveillance colonoscopy findings in asymptomatic participants over 75 years of age.

Surveillance colonoscopy for colorectal cancer (CRC) is generally not recommended beyond 75 years of age. The study determined incidence and predictors of advanced adenoma and CRC in older individuals undergoing surveillance colonoscopy. This was a retrospective cohort study of asymptomatic older participants (≥75 years), enrolled in a South Australian CRC surveillance program who underwent colonoscopy (2015-2020). Clinical records were extracted for demographics, personal or family history of CRC, comorbidities, polypharmacy, and colonoscopy findings. The associations between clinical variables and advanced adenoma or CRC at surveillance were assessed with multivariable Poisson regression analysis. Totally 698 surveillance colonoscopies were analyzed from 574 participants aged 75-91 years (55.6% male). The incidence of CRC was 1.6% (11/698), while 37.9% (260/698) of procedures had advanced adenoma detected. Previous CRC (incidence rate ratio [IRR] 5.9, 95% CI 1.5-22.5), age ≥85 years (IRR 5.8, 95% CI 1.6-20.1) and active smoking (IRR 4.9, 95% CI 1.0-24.4) were independently associated with CRC diagnosis, while advanced adenoma at immediately preceding colonoscopy (IRR 1.6, 95% CI 1.3-2.0) and polypharmacy (IRR 1.2, 95% CI 1.0-1.5) were associated with advanced adenoma at surveillance colonoscopy in asymptomatic older participants (≥75 years). Advanced neoplasia was found in more than one third of the surveillance procedures completed in this cohort. Continuation of surveillance beyond age 75 yeasrs may be considered in participants who have previous CRC or are active smokers (provided they are fit to undergo colonoscopy). In other cases, such as past advanced adenoma only, the need for ongoing surveillance should be considered alongside participant preference and health status.

Determining individual suitability for neoadjuvant systemic therapy in breast cancer patients through deep learning.

The survival advantage of neoadjuvant systemic therapy (NST) for breast cancer patients remains controversial, especially when considering the heterogeneous characteristics of individual patients. To discern the variability in responses to breast cancer treatment at the individual level and propose personalized treatment recommendations utilizing deep learning (DL). Six models were developed to offer individualized treatment suggestions. Outcomes for patients whose actual treatments aligned with model recommendations were compared to those whose did not. The influence of certain baseline features of patients on NST selection was visualized and quantified by multivariate logistic regression and Poisson regression analyses. Our study included 94,487 female breast cancer patients. The Balanced Individual Treatment Effect for Survival data (BITES) model outperformed other models in performance, showing a statistically significant protective effect with inverse probability treatment weighting (IPTW)-adjusted baseline features [IPTW-adjusted hazard ratio: 0.51, 95% confidence interval (CI), 0.41-0.64; IPTW-adjusted risk difference: 21.46, 95% CI 18.90-24.01; IPTW-adjusted difference in restricted mean survival time: 21.51, 95% CI 19.37-23.80]. Adherence to BITES recommendations is associated with reduced breast cancer mortality and fewer adverse effects. BITES suggests that patients with TNM stage IIB, IIIB, triple-negative subtype, a higher number of positive axillary lymph nodes, and larger tumors are most likely to benefit from NST. Our results demonstrated the potential of BITES to aid in clinical treatment decisions and offer quantitative treatment insights. In our further research, these models should be validated in clinical settings and additional patient features as well as outcome measures should be studied in depth.

Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus.

Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort. Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM). Patients with TT showed lower BMI (24 vs. 26kg/m2) and preoperative Hb (11 vs. 14g/mL; all-p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49-3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10-1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49-2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04-2.49, p < 0.03). The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

Respiratory distress syndrome is associated with increased morbidity and mortality in late preterm births

Respiratory Distress Syndrome (RDS) is strongly associated with prematurity, including late preterm births. RDS has been shown to be associated with certain neonatal morbidities and mortality, but these associations are not well described among late preterm births. We sought to determine the association between RDS and adverse neonatal outcomes among late preterm (34-36 weeks) born singleton neonates. This is a retrospective cohort study using California's linked vital statistics-patient discharge data (2008-2019). We included singleton, non-anomalous births with gestational age of 34-36 weeks. Outcomes of interest were interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), neonatal sepsis, length of hospital stay, neonatal death and infant death. Chi-square and multivariable Poisson regression analyses were used to examine the association of RDS with outcomes at each gestational age. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were estimated. A total of 242,827 births were included, of which 11,312 (4.7%) had RDS. We found that among neonates with RDS, NEC was higher at 35 weeks (aRR= 3.97; 95% CI: 1.88, 8.41) and 36 weeks (aRR= 4.53; 95% CI: 1.45, 14.13). IVH, ROP, neonatal sepsis and length of hospital stay were significantly higher at 34-36 weeks' gestation in neonates with RDS. Neonatal death was significantly higher among neonates with RDS at 35 weeks (aRR=3.04; 95% CI: 1.58, 5.85) and 36 weeks (aRR=3.25; 95% CI: 1.59, 6.68). Infant death was also significantly higher at 35 weeks (aRR=2.27; 95% CI: 1.43, 3.61) and 36 weeks (aRR=2.60; 95% CI: 1.58, 4.28). We found that RDS was associated with IVH, ROP and sepsis at 34-36 weeks' gestation; while RDS was associated with neonatal death, infant death and NEC at 35 and 36 weeks. Clinicians should keep these outcomes in mind when making decisions about delivery timing and the potential benefits of antenatal steroids in pregnancies in the late preterm period as well as management of RDS in late preterm neonates.

Treatment Patterns and Survival Outcomes in Patients With Breast Cancer on Medicaid, Pre- and Post-Expansion.

The objective of this study was to evaluate the impact of Medicaid expansion on breast cancer treatment and survival among Medicaid-insured women in Ohio, accounting for the timing of enrollment in Medicaid relative to their cancer diagnosis and post-expansion heterogeneous Medicaid eligibility criteria, thus addressing important limitations in previous studies. Using 2011-2017 Ohio Cancer Incidence Surveillance System data linked with Medicaid claims data, we identified women aged 18 to 64 years diagnosed with local-stage or regional-stage breast cancer (n=876 and n=1,957 pre-expansion and post-expansion, respectively). We accounted for women's timing of enrollment in Medicaid relative to their cancer diagnosis, and flagged women post-expansion as Affordable Care Act (ACA) versus non-ACA, based on their income eligibility threshold. Study outcomes included standard treatment based on cancer stage and receipt of lumpectomy, mastectomy, chemotherapy, radiation, hormonal treatment, and/or treatment for HER2-positive tumors; time to treatment initiation (TTI); and overall survival. We conducted multivariable robust Poisson and Cox proportional hazards regression analysis to evaluate the independent associations between Medicaid expansion and our outcomes of interest, adjusting for patient-level and area-level characteristics. Receipt of standard treatment increased from 52.6% pre-expansion to 61.0% post-expansion (63.0% and 59.9% post-expansion in the ACA and non-ACA groups, respectively). Adjusting for potential confounders, including timing of enrollment in Medicaid, being diagnosed in the post-expansion period was associated with a higher probability of receiving standard treatment (adjusted risk ratio, 1.14 [95% CI, 1.06-1.22]) and shorter TTI (adjusted hazard ratio, 1.14 [95% CI, 1.04-1.24]), but not with survival benefits (adjusted hazard ratio, 1.00 [0.80-1.26]). Medicaid expansion in Ohio was associated with improvements in receipt of standard treatment of breast cancer and shorter TTI but not with improved survival outcomes. Future studies should elucidate the mechanisms at play.

Neighborhood child opportunity is associated with hospital length of stay following pediatric burn injury

IntroductionPediatric burns are associated with socioeconomic disadvantage and lead to significant morbidity. The Child Opportunity Index (COI) is a well-validated measure of neighborhood characteristics associated with healthy child development. We sought to evaluate the relationship between COI and outcomes of burn injuries in children. MethodsWe performed a single-institution retrospective review of pediatric (<16 years) burn admissions between 2015 and 2019. Based on United States residential zip codes, patients were stratified into national COI quintiles. We performed a multivariate Poisson regression analysis to determine the association between COI and increased length of stay. Results2095 pediatric burn admissions occurred over the study period. Most children admitted were from very low (n = 644, 33.2 %) and low (n = 566, 29.2 %) COI neighborhoods. The proportion of non-Hispanic Black patients was significantly higher in neighborhoods with very low (44.5 %) compared to others (low:28.8 % vs. moderate:11.9 % vs. high:10.5 % vs. very high:4.3 %) (p < 0.01). Hospital length of stay was significantly longer in patients from very low COI neighborhoods (3.6 ± 4.1 vs. 3.2 ± 4.9 vs. 3.3 ± 4.8 vs. 2.8 ± 3.5 vs. 3.2 ± 8.1) (p = 0.02). On multivariate regression analysis, living in very high COI neighborhoods was associated with significantly decreased hospital length of stay (IRR: 0.51; 95 % CI: 0.45–0.56). ConclusionChildren from neighborhoods with significant socioeconomic disadvantage, as measured by the Child Opportunity Index, had a significantly higher incidence of burn injuries resulting in hospital admissions and longer hospital length of stay. Public health interventions focused on neighborhood-level drivers of childhood development are needed to decrease the incidence and reduce hospital costs in pediatric burns. Type of studyRetrospective study Level of evidenceLevel III

Understanding the operators’ cloud change errors based on cognitive abilities and personality traits: An investigation integrated with quantitative and qualitative methods

While cloud services make industrial data convenient, they also expose it to cloud incidents. Operators' error in cloud change activities is a leading factor for cloud incidents, which have received relatively less attention in cloud security research. This study conducted a two-stage research process using an integrated approach to explore the stable individual factors related to cloud change errors. First, in the qualitative research, content analysis based on interviews and historical documents was conducted to extract the operator's cognitive abilities and personality traits and develop hypotheses. Five cognitive abilities and six personality traits were extracted. Second, quantitative research based on an experiment was conducted to test relationships between operators' different types of cloud change errors and 1) cognitive ability and 2) personality traits, respectively. Results of error type comparisons suggested that operators generated more uncorrected errors than corrected errors and more operational errors than omission errors in cloud change activities. The multivariate Poisson regression analysis suggested that cognitive abilities of sustained attention, divided attention, and long-term memory negatively predicted the number of operators' total errors, uncorrected errors, and operational errors. Regarding personality traits, with the increase in resilience capacity and carefulness and the decrease in self-esteem, the number of different types of errors reduced, except for omission errors. Working memory and risk-taking propensity were also significant predictors of the number of uncorrected errors with negative and positive coefficients, respectively. Logical reasoning, emotional stability, and sense of responsibility were not observed as predictors of cloud change errors. The present findings have several implications for the industry and cloud providers to enhance industrial cloud data security regarding human cognitive abilities and personality traits.

Association Between Changes in Haematological Parameters and Mortality in Patients Hospitalized Due to Severe COVID-19 in a Peruvian Reference Hospital

Objective: To determine the association between changes in haematological parameters and mortality in patients hospitalized due to severe COVID-19 at a Peruvian reference hospital from April to December 2020. Materials and Methods: Observational, analytical, historical cohort study based on the review of clinical records of patients hospitalized due to severe COVID-19 from April to December 2020. We evaluated changes in common haematological parameters, including white blood cells (WBCs), lymphocytes, neutrophils, and platelet counts, as well as the neutrophil-to-lymphocyte ratio (NLR) on the third and seventh days of hospitalization compared with admission values in the deceased and nondeceased groups. Changes in haematological parameters were expressed as median and interquartile ranges (IQR). Multivariate Poisson regression analysis was further done to evaluate the effect of haematological changes in mortality, adjusting for gender, age, and comorbidities. Results: We included 1033 cases, of which 68.05% were male. Deceased patients had a significant increase in total WBC on the third day (1.0 *103/μL; IQR -1.7 to 5.4) and the seventh day (1.6*103/μL; IQR -1.9 to 4.9) compared to their admission values. The neutrophil count in the deceased patients also increased on the third day (1.2; IQR -1.7 to 4.9) and seventh day (1.9; IQR-1.5 to 5.8), as did the NLR ratio on the third day (0.2; IQR -0.4 to 1.6) and seventh day (0.7; IQR -0.2 to 2.2). Surviving patients showed an opposite trend in these parameters. In contrast, platelet counts increased on the third day (49*105/μL; IQR -0.3 to 1.3) and the seventh day (90*105; IQR 0.0 to 2.0) in surviving patients, whereas deceased patients did not show significant changes. All these differences remained statistically significant in the adjusted analysis. Conclusion: An increase in total WBC, neutrophils, and NLR at the third and seventh days compared to admission values was associated with higher mortality in patients hospitalized due to COVID-19, while an increase in platelet count was associated with decreased mortality. Monitoring these changes can help in identifying those patients with higher mortality risk.

Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan

BackgroundWhile heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP...

Impact of Short-Term Exposure to Nitrogen Dioxide (NO2) and Ozone (O3) on Hospital Admissions for Non-ST-Segment Elevation Acute Coronary Syndrome.

In the context of recent climate change, global warming, industrial growth, and population expansion, air pollution has emerged as a significant environmental and human health risk. This study employed a multivariable Poisson regression analysis to examine the association between short-term exposure to atmospheric pollutants (nitrogen dioxide-NO2, sulfur dioxide -SO2, ozone-O3, and particulate matter with a diameter less than 10 μm-PM10) and hospital admissions for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Daily data on NSTE-ACS admissions, air pollutants, and meteorological variables were collected from January 2019 to December 2021. Elevated NO2 concentrations were associated with a higher risk of NSTE-ACS hospitalization, notably in spring (OR: 1.426; 95% CI: 1.196-1.701). Hypertensive individuals (OR: 1.101; 95% CI: 1.007-1.204) and those diagnosed with unstable angina (OR: 1.107; 95%CI: 1.010-1.213) exhibited heightened susceptibility to elevated NO2 concentrations. A 10 μg/m3 increase in NO2 during spring at lag 07 (OR: 1.013; 95% CI: 1.001-1.025) and O3 in winter at lag 05 (OR: 1.007; 95% CI: 1.001-1.014) was correlated with an elevated daily occurrence of NSTE-ACS admissions. Short-term exposure to various air pollutants posed an increased risk of NSTE-ACS hospitalization, with heightened sensitivity observed in hypertensive patients and those with unstable angina. Addressing emerging environmental risk factors is crucial to mitigate substantial impacts on human health and the environment.

Automated titanium fastener vs. hand-tied knots for prosthesis fixation in infective endocarditis.

To date, there is no evidence regarding the safety of automated titanium fastener compared with hand-tied knots for prosthesis fixation in infective endocarditis. Between January 2016 and December 2022, a total of 220 patients requiring surgery for infective endocarditis were included in this retrospective analysis. The primary study endpoint was re-endocarditis during follow-up. The secondary study endpoints included stroke onset, all-cause mortality, and a composite outcome of either re-endocarditis, stroke, or all-cause mortality during follow-up. Suture-securing with an automated titanium fastener was performed in 114 (51.8%) patients, whereas the conventional technique of hand knot-tying was used in 106 (48.2%) patients. The risk of re-endocarditis was significantly lower in the automated titanium fastener group, as shown in a multivariable proportional competing risk regression model (adjusted sub-hazard ratio 0.33, 95% confidence interval 0.11-0.99, p = 0.048). The multivariable Cox proportional hazards regression analysis showed that the automated titanium fastener group was not associated with an increased risk of stroke-onset or attaining the composite outcome, respectively, (adjusted hazard ratio 0.54, 95% confidence interval 0.27-1.08, p = 0.082), (adjusted hazard ratio 0.65, 95% confidence interval 0.42-1.02, p = 0.061). Also, this group was not associated with an increased risk of all-cause mortality, as demonstrated in the multivariable Poisson regression analysis (adjusted incidence-rate ratio 1.42, 95% confidence interval 0.83-2.42, p = 0.202). The use of automated titanium fastener device seems to be safe for infective endocarditis. Analyses of larger cohorts are required.

Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study.

This study aimed to investigate the incidence of and risk factors for stillbirth in an Indian population. We conducted a secondary data analysis of a hospital-based cohort from the Maternal and Perinatal Health Research collaboration, India (MaatHRI), including pregnant women who gave birth between October 2018-September 2023. Data from 9823 singleton pregnancies recruited from 13 hospitals across six Indian states were included. Univariable and multivariable Poisson regression analysis were performed to examine the relationship between stillbirth and potential risk factors. Model prediction was assessed using the area under the receiver-operating characteristic (AUROC) curve. There were 216 stillbirths (48 antepartum and 168 intrapartum) in the study population, representing an overall stillbirth rate of 22.0 per 1000 total births (95% confidence interval [CI]: 19.2-25.1). Modifiable risk factors for stillbirth were: receiving less than four antenatal check-ups (adjusted relative risk [aRR]: 1.75, 95% CI: 1.25-2.47), not taking any iron and folic acid supplementation during pregnancy (aRR: 7.23, 95% CI: 2.12-45.33) and having severe anemia in the third trimester (aRR: 3.37, 95% CI: 1.97-6.11). Having pregnancy/fetal complications such as hypertensive disorders of pregnancy (aRR: 1.59, 95% CI: 1.03-2.36), preterm birth (aRR: 4.41, 95% CI: 3.21-6.08) and birth weight below the 10th percentile for gestational age (aRR: 1.35, 95% CI: 1.02-1.79) were also associated with an increased risk of stillbirth. Identified risk factors explained 78.2% (95% CI: 75.0%-81.4%) of the risk of stillbirth in the population. Addressing potentially modifiable antenatal factors could reduce the risk of stillbirths in India.

Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study.

This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.

Geographical variation in hotspots of stunting among under-five children in Ethiopia: A geographically weighted regression and multilevel robust Poisson regression analysis.

Childhood stunting is a global public health concern, associated with both short and long-term consequences, including high child morbidity and mortality, poor development and learning capacity, increased vulnerability for infectious and non-infectious disease. The prevalence of stunting varies significantly throughout Ethiopian regions. Therefore, this study aimed to assess the geographical variation in predictors of stunting among children under the age of five in Ethiopia using 2019 Ethiopian Demographic and Health Survey. The current analysis was based on data from the 2019 mini Ethiopian Demographic and Health Survey (EDHS). A total of 5,490 children under the age of five were included in the weighted sample. Descriptive and inferential analysis was done using STATA 17. For the spatial analysis, ArcGIS 10.7 were used. Spatial regression was used to identify the variables associated with stunting hotspots, and adjusted R2 and Corrected Akaike Information Criteria (AICc) were used to compare the models. As the prevalence of stunting was over 10%, a multilevel robust Poisson regression was conducted. In the bivariable analysis, variables having a p-value < 0.2 were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval is presented to show the statistical significance and strength of the association. The prevalence of stunting was 33.58% (95%CI: 32.34%, 34.84%) with a clustered geographic pattern (Moran's I = 0.40, p<0.001). significant hotspot areas of stunting were identified in the west and south Afar, Tigray, Amhara and east SNNPR regions. In the local model, no maternal education, poverty, child age 6-23 months and male headed household were predictors associated with spatial variation of stunting among under five children in Ethiopia. In the multivariable multilevel robust Poisson regression the prevalence of stunting among children whose mother's age is >40 (APR = 0.74, 95%CI: 0.55, 0.99). Children whose mother had secondary (APR = 0.74, 95%CI: 0.60, 0.91) and higher (APR = 0.61, 95%CI: 0.44, 0.84) educational status, household wealth status (APR = 0.87, 95%CI: 0.76, 0.99), child aged 6-23 months (APR = 1.87, 95%CI: 1.53, 2.28) were all significantly associated with stunting. In Ethiopia, under-five children suffering from stunting have been found to exhibit a spatially clustered pattern. Maternal education, wealth index, birth interval and child age were determining factors of spatial variation of stunting. As a result, a detailed map of stunting hotspots and determinants among children under the age of five aid program planners and decision-makers in designing targeted public health measures.

Incidence of glaucoma filtration surgery from disease onset of open-angle glaucoma.

To investigate the rate and risk factors of undergoing glaucoma filtration surgery (GFS) in patients with newly diagnosed open-angle glaucoma (OAG). This is a population-based historic cohort study, consisting of 9420 patients older than 45 years diagnosed with OAG during 1997-2010. Follow-up spanned from 1997 to 2017. We obtained data for trabeculectomy (TRE), deep sclerectomy (DS), and glaucoma drainage implant (GDI) surgeries from national administrative healthcare registers by hospital billing data. We plotted the cumulative incidence of GFS and carried out a multivariate Poisson regression analysis adjusted for age, sex, hospital district, systemic comorbidities, and the number of IOP-lowering drugs. We reported incidence rate ratios (IRR) with 95% confidence intervals (CI) for GFS after the onset of OAG. The cumulative incidence of GFS at 5 years from OAG onset was 3.1% and at 10 years 5.4%. Age over 80 years at baseline was associated with lower GFS incidence (IRR 0.51, CI 0.31-0.84). Thenumber of IOP-lowering drugs in the first 2 years of treatment correlated withthe risk of GFS increasingfrom (IRR 3.23, CI 2.32-4.50) for two drugs, (IRR 7.44, CI 5.28-10.47) for three and to (IRR 14.95, CI 10.38-21.52) for four drugs. This study characterized the treatment path of OAG from diagnosis to surgical intervention refining the role of GFS among glaucoma therapies.

Profile of a large cohort of children with persistent fetal vasculature and their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia.

To present the profile of a large cohort of children with persistent fetal vasculature (PFV) and identify their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia. This was a single-center study. Medical records of children diagnosed with persistent fetal vasculature between January 1990 and January 2020 at King Khaled Eye Specialist Hospital (KKESH), Riyadh, were reviewed. Data were collected on PFV type, presenting features, management, and visual acuity. Poisson regression with robust error variance was used to identify the predictors of poor visual outcome. Data of 175 eyes of 170 children with PFV were analyzed. Most had unilateral disease (n = 165, 96.2%), and over half of them (57.1%) were males. The main presenting complaints were leukocoria (n = 126, 72.0%), followed by smaller eye (n = 36, 20.6%), poor vision (n = 15, 8.6%), and strabismus (n = 13, 7.4%). Anterior, posterior, and combined PFV were present in 30.9%, 10.9%, and 58.3% eyes, respectively. In eyes with measurable visual acuity (n = 124), BCVA at the last follow-up was ≥20/100, <20/100-20/400, CF/HM and LP/NLP in 11 (8.9%), 32 (25.8%), 43 (34.7%), and 38 (30.6%) eyes, respectively. In the multivariable poisson regression analysis, eyes with posterior PFV were approximately two times more likely to have a BCVA of CF or worse than those with anterior PFV (Adjusted incidence ratio: 1.82 (95%: 1.23, 2.70; P = 0.003). Compared with eyes with primary or secondary IOL implantation, aphakic eyes or those with no cataract surgery were significantly more likely to have BCVA of CF or worse (adjusted incidence ratio: 1.84 [95%: 1.18, 2.86], p = 0.007 and adjusted incidence ratio: 1.64 [95%: 1.08, 2.50], p = 0.020, respectively). The prognosis of PFV varies depending on the severity of the disease. Patients with posterior PFV had worse visual outcome than anterior or combined type. Whether primary or secondary, IOL implantation increases the probability of having BCVA better than CF.

Patients hospitalized for Acute Coronary Syndrome with Diabetes Mellitus affected by Non-Alcoholic Fatty Liver Disease have Greater Risk of Mortality and Worse Clinical Outcomes

BackgroundDiabetes mellitus (DM) and Acute Coronary Syndromes (ACS) are global diseases affecting millions worldwide. Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition that predisposes to adverse outcomes. There is limited scientific evidence of clinical outcomes of NAFLD in patients with ACS&DM. Hence, we sought to investigate this population. MethodsWe queried NIS between 2017-2020 for adult patients who were hospitalized with ACS&DM and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant. ResultsThere were 2,579,880 hospitalizations with ACS&DM and 116,895 (4.5%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 67.7 vs. 69.2 yrs; males 57.5% vs 57.7%; Caucasians 60.8% vs 63.1%; STEMI 12.3% vs 10.7%, PCI 13.7% vs 22.2%, HF 60% vs 53.2%; HTN 16.8% vs 26.8%; pulmonary hypertension (PH) 11.8% vs 8.8%; AF 32.3% vs 27.5%; AKI 63.7% vs 36.9%; DKA 5.9% vs 3%; obesity 23.1% vs 26.2%; anemia 22.2% vs 17.2%; history of MI 11.4% vs 16.9%; stroke 4.4% vs 3.3%, COPD 23.1% vs 23.7, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). ConclusionACS&DM cohort demonstrated significantly higher mortality, worse clinical outcomes, and resource utilization. They were younger, predominantly Caucasian, with more frequent STEMI, HF, PH, AF, AKI, DKA, and anemia. NAFLD is associated with cardiac complications, GIB, anemia and renal impairment. Awareness of NALFD and its early identification is important to improve health outcomes. Further research is necessary to describe long-term outcomes in this population.

Patients hospitalized for Acute Decompensated Heart Failure with Diabetes Mellitus affected by Non-Alcoholic Fatty Liver Disease have Greater Risk of Mortality and Worse Clinical Outcomes

BackgroundDiabetes mellitus (DM) and Heart Failure (HF) are global diseases affecting millions worldwide. Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition that predisposes to adverse outcomes. There is limited scientific evidence of clinical outcomes of NAFLD in patients with DM who were hospitalized for Acute Decompensated Heart Failure (ADHF). Hence, we sought to investigate this population. MethodsWe queried NIS between 2017-2020 for adult patients who were hospitalized with ADHF&DM and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant. ResultsThere were 4,148,725 hospitalizations with ADHF&DM and 183,885 (4.4%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 67.8 vs. 70.5 yrs; males 56.6% vs 53%; Caucasians 63.7% vs 62.7%; systolic HF 58.4% vs 54.3%; diastolic HF 61% vs 64.8; STEMI 2.9% vs 1.3%, HTN 1.8% vs 2.2%; pulmonary hypertension (PH) 22.7% vs 19.3%; AF 44.6% vs 42.7%; AKI 57.9% vs 41.3%; DKA 1.8% vs 0.7%; obesity 68.6% vs 65.4%; anemia 24.6% vs 21.4%; history of MI 12.6% vs 16.2%; stroke 2.1% vs 1.5%, COPD 33.2% vs 37.1, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). ConclusionADHF&DM cohort demonstrated significantly higher mortality, worse clinical outcomes, and resource utilization. They were younger, predominantly Caucasian males, with more frequent systolic HF, STEMI, PH, AF, AKI, DKA, obesity, stroke, and anemia. NAFLD is associated with cardiac and renal impairment, complications during hospitalization and the need for ICU-level care. Awareness of NALFD and its early identification is important to improve health outcomes. Further research is necessary to describe long-term outcomes in this population.

Impact of Multiplex Polymerase Chain Reaction Test in Patients With Meningitis or Encephalitis.

The objective of this study was to evaluate the impact of the FilmArray meningitis/encephalitis panel (FAME) on length of stay (LOS) and duration of antimicrobial treatment in children and adults in a Japanese community hospital. This retrospective cohort study was conducted in Japan between January 2016 and December 2022. We included hospitalized patients with cerebrospinal fluid (CSF) samples and those aged <2 months or who had 5 or more white blood cells/μL in the CSF. To compare the days of therapy (DOT) and LOS between the pre-FAME and FAME periods, multivariate Poisson regression analyses were conducted without an offset term. The number of cases undergoing pathogen-specific polymerase chain reaction increased from 3.7% in the pre-FAME period to 57.5% in the FAME period (P < .001). The pathogen identification rate also increased during the FAME period, from 0.4% to 18.7% (P < .001). While the antibacterial DOT was not statistically different between the 2 periods (adjusted rate ratio [aRR], 1.06 [95% confidence interval {CI}, 1.00-1.13]; P = .063]), the antiviral DOT was significantly shorter in the FAME period (aRR, 0.80 [95% CI, .71-.89]; P < .001). This study revealed a significant reduction in antiviral use during the FAME period, whereas LOS and antibacterial use did not decrease. Given the possibility of factors (eg, the COVID-19 pandemic) affecting the epidemiology of meningitis and encephalitis, the indications and impact of the FAME test should be evaluated with continuous monitoring of the epidemiology of meningitis and encephalitis and its clinical impact.