Non-modifiable Risk Factors Research Articles

Purinergic signaling via P2X receptors and mechanisms of unregulated ATP release in the outer retina and age-related macular degeneration.

Age-related macular degeneration (AMD) is a chronic and progressive inflammatory disease of the retina characterized by photoceptor loss and significant central visual impairment due to either choroidal neovascularization or geographic atrophy. The pathophysiology of AMD is complex and multifactorial, driven by a combination of modifiable and non-modifiable risk factors, molecular mechanisms, and cellular processes that contribute to overall disease onset, severity, and progression. Unfortunately, due to the structural, cellular, and pathophysiologic complexity, therapeutic discovery is challenging. While purinergic signaling has been investigated for its role in the development and treatment of ocular pathologies including AMD, the potential crosstalk between known contributors to AMD, such as the complement cascade and inflammasome activation, and other biological systems, such as purinergic signaling, have not been fully characterized. In this review, we explore the interactions between purinergic signaling, ATP release, and known contributors to AMD pathogenesis including complement dysregulation and inflammasome activation. We begin by identifying what is known about purinergic receptors in cell populations of the outer retina and potential sources of extracellular ATP required to trigger purinergic receptor activation. Next, we examine evidence in the literature that the purinergic system accelerates AMD pathogenesis leading to apoptotic and pyroptotic cell death in retinal cells. To fully understand the potential role that purinergic signaling plays in AMD, more research is needed surrounding the expression, distribution, functions, and interactions of purinergic receptors within cells of the outer retina as well as potential crosstalk with other systems. By determining how these processes are affected in the context of purinergic signaling, it will improve our understanding of the mechanisms that drive AMD pathogenesis which is critical in developing treatment strategies that prevent or slow progression of the disease.

Incidence of stroke and its predictors among hypertensive patients in Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia, a retrospective follow-up study

BackgroundGlobally, one in three adults has hypertension, a condition that causes 51% of all deaths from stroke. Stroke is becoming a major public health problem and the most common cause of morbidity and mortality among non-communicable diseases in the world and Ethiopia. Therefore, this study assesses the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021.MethodsA hospital-based retrospective follow-up study design was used, simple random sampling technique was used to select 583 hypertensive patients that had follow-up registration between January 2018 and December 30th, 2020. Data were entered into Epi-data version 3.1 and exported to STATA version 14. The adjusted hazard ratio for each predictor with a 95% confidence interval was calculated using the Cox proportional hazards regression model, and a P-value ≤ 0.05 was used to denote statistical significance.ResultsFrom 583 hypertensive patients 106(18.18%) [95% CI 15–20] were developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI 0.79–1.19). Comorbidities (Adjusted hazard ratio(AHR): 1.88, 95% CI 1.0–3.5), stage two hypertension (AHR = 5.21, 95%CI 2.75–9.8), uncontrolled systolic blood pressure (AHR: 2, 95% CI 1.21–354), uncontrolled diastolic blood pressure (AHR:1.9, 95% CI 1.1–3.57), alcohol consumption (AHR = 2.04, 95%CI 1.2–3.49), age 45–65 (AHR = 10.25, 95%CI 7.47–11.1); and drug discontinuation (AHR = 2.05,95% CI 1.26–3.35) were independent predictors for the incidence of stroke among hypertensive patients.ConclusionThe incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors highly contributed to its incidence. This study recommends early screening of blood pressure, giving priority to comorbid patients and patients with advanced stage hypertension, and giving health education about behavioral risks and drug adherence.

Modifiable risk factors for dementia, cognition, and plasma phosphorylated tau 181 in a large-scale cohort of Australian older adults

Alzheimer’s disease (AD), the most common form of dementia, is preceded by years of silent pathological change. Our objective was to examine the associations between modifiable dementia risk factors, cognition, and plasma phosphorylated p-tau 181, a hallmark biomarker of AD in a large-scale community cohort. Participants (n = 738, mean age 65.41 years) from the Island Study Linking Ageing and Neurodegenerative Disease responded to online assessments collecting demographics, adherence to dementia risk factors and cognitive function, and provided a blood sample for analysis. We found less education was significantly associated with lower cognitive scores. Modifiable dementia risk factors were not associated with plasma p-tau 181. Further, we did not observe any significant relationships between plasma p-tau 181 and cognition. Nonmodifiable factors such as age, education, sex, and apolipoprotein E epsilon 4 displayed significant associations with cognition and plasma p-tau 181. In a cognitively healthy community cohort of Tasmanian Australians, we did not observe any associations between modifiable risk factors for dementia and plasma p-tau 181. Nonmodifiable risk factors were associated with both cognition and plasma p-tau. This contributes to a growing body of evidence investigating confounding factors in the interpretation of blood-based biomarkers for dementia.

Role of Dietary Management and Physical Activity in Control of Hypertension in Rural Areas of Punjab-A Cross-sectional Study

Introduction: As reported by WHO, hypertension is the third ‘killer’ disease, accounting for one in every eight deaths worldwide. Many modifiable and non-modifiable risk factors are found to be associated with the disease. The present study aims to determine the role of dietary management and physical activity in the control of hypertension in a given population. Material and Methods: A cross-sectional study was conducted that. Study included all hypertensive patients (290) from the field practice area of a tertiary care institute. A self-constructed, pretested questionnaire was used to enquire about the socio- demographic factors and other risk factors associated with hypertension. The data was analyzed using SPSS 23 and valid conclusions were drawn by using the chi-square test. Results: Out of 290 patients, 204 (70.3%) were females and 86 (29.7%) were males. Univariate analysis identified decreased salt intake, decreased fatty food consumption, physical activity, stress management, and spiritual help as highly significant factors affecting hypertension. On multivariate analysis, physical activity, stress management and spiritual help were found to be significant. Conclusion: The study showed that physical activity, stress management and spiritual help were significantly associated with hypertension control among the elderly. Measures should be taken to create awareness about lifestyle modifications in the control of hypertension.

Role of Lifestyle and Stress on Diabetes Mellitus: A Case-Control Study

Background: Type 2-diabetes mellitus (T2DM) is a chronic metabolic disease in which insulin resistance and reduced insulin with increased hepatic glucose production lead to hyperglycemia. The condition cannot be cured; however, the incidence can be delayed and the progression can be halted. This study researches the association of 2 modifiable risk factors- lifestyle and stress with Diabetes Mellitus. The study aimed to assess the role of stress and other lifestyle factors on the occurrence of diabetes mellitus. Studies on diabetes mellitus and its factors have not been done much in United Arab Emirates (UAE) so this research is aimed to determine the association between diabetes mellitus and, stress and lifestyle among residents of UAE. Methods: This case-control study was conducted in Ajman, United Arab Emirates. The participants were in the age group of 35 to 70 years. The duration of this study was six months. Patients with type-2 diabetes mellitus and without diabetes mellitus were chosen randomly, and data were collected using a questionnaire. After obtaining the questionnaire with the desired sample size, data analysis was carried out using SPSS-26. The Chi-square test was used to find an association between the categorical variables and a two-sided P-value < 0.05 was taken as significant. The sample size was calculated by taking the level of significance as 5% and the power of the study as 80%. As per the previous study, the stress in the general population reported was 30% and the crude OR for DM those who are stressed as 2.4. This basic information is used to calculate the minimum required sample size for this study. The case-control ratio is taken as 1:2. The total participants for this study was 195 (65 cases and 130 controls). The inclusion criteria were both male and female patients of all nationalities and the exclusion criteria were patients with other disease conditions such as CVD, cancer and pregnant women. Results: A total of 205 participants were included in the study (71 cases; 134 controls). The study results showed that the prevalence of diabetes mellitus was not associated with marital status, type of job, total income, exercise, BMI (Body mass index), and the nature of work seen in Table 1 and Table 2. The age of the participants and the prevalence of diabetes mellitus showed a significance of P<0.001. The psychologic stress also showed a significant association (P<0.05). This study also showed a significant association between the educational qualification of the participant and Diabetes mellitus. This study showed an association between age and diabetes, as well as stress and diabetes. Conclusion: This study shows age and stress are significantly associated with diabetes. Age is a non-modifiable risk factor, while stress is a modifiable risk factor, so reducing stress levels can help reduce the risk and progression of diabetes mellitus.

Sella Turcica Size in Women with Sheehan Syndrome-A Case-Control Study.

Sheehan syndrome is a common cause of hypopituitarism in developing countries. Among risk factors, in addition to post-partum haemorrhage, a smaller sellar volume is also believed to predispose to pituitary necrosis. Some earlier studies have reported smaller sellar volume in these patients but involved a small number of patients and lacked matched controls. The main of the present study was to study the sellar volume in a large cohort of patients with Sheehan syndrome and compare it with age- and parity-matched controls. Fifty women with Sheehan syndrome and an equal number of age- and parity-matched controls were studied. Baseline investigations, relevant hormonal assay, and MRI of pituitary were studied in all. Sellar volume was significantly lower in patients with Sheehan syndrome (334.50 ± 129.08 mm3 in patients as against 456.64 ± 169.25 mm3 in controls, P = 0.000). Far more women with Sheehan syndrome than controls had decreased sellar volume (40% vs. 12%). Patients with Sheehan syndrome have a smaller sellar volume that may be a non-modifiable risk factor for the development of post-partum pituitary necrosis.

The occurrence of chronic kidney disease among African American aged 65 years and above in the United States

This paper focuses on chronic kidney disease (CKD) among African American adults over 65 years old in the USA. CKD is a progressive illness that affects more than 800 million people worldwide, with a higher prevalence among older individuals, women, racial minorities, and those with comorbidities such as diabetes mellitus and hypertension. African Americans have a higher prevalence of CKD, along with risk factors such as obesity, diabetes, and hypertension. The paper investigates the occurrence of CKD in this population and explores the etiology of the disease, including non-modifiable risk factors like genetics and modifiable risk factors such as hypertension and metabolic factors.

Familial Analysis of Nonunion in a Genealogic Population Database Demonstrates No Evidence of Heritable Risk.

To determine whether there is evidence of heritable risk for nonunion using a large, state-wide population database. Database. Level 1 Trauma Center. All Utah residents from 1996 to 2021 who sustained a long bone fracture and their family members were included. The primary outcome was nonunion and the prevalence of nonunion among the patients' first-, second-, and third-degree relatives. The secondary objective was to identify demographic, injury, and socioeconomic risk factors associated with nonunion. In total, 150,263 fractures and 6577 nonunions (4.4%) were identified. This was highly refined to a 1:3 matched cohort of 4667 nonunions of 13,981 fractures for familial clustering analysis. Cox proportional hazards did not demonstrate excessive risk of nonunion among first- ( P = 0.863), second- ( P = 0.509), and third-degree relatives ( P = 0.252). Further analysis of the entire cohort demonstrated that male sex (relative risk [RR] = 1.15; P < 0.001), Medicaid enrollment (RR = 2.64; P < 0.001), open fracture (RR = 2.53; P < 0.001), age group 41-60 years (RR = 1.43; P < 0.001), and a history of obesity (RR = 1.20; P < 0.001) were independent risk factors for nonunion. Our results demonstrate no evidence of heritable risk for nonunion. Independent risk factors for nonunion were male sex, Medicaid enrollment, open fracture, middle age, and a history of obesity. Although it is important to identify modifiable and nonmodifiable risk factors, these results continue to support that the risk of nonunion is multifactorial, relating to injury characteristics, operative techniques, and patient-specific risk factors. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The association of apolipoprotein in the risk of ST-elevation myocardial infarction in patients with documented coronary artery disease

IntroductionCardiovascular disease (CVD) is the number one cause of death worldwide, in this case, acute coronary syndrome (ACS) or acute myocardial infarction (AMI) that developed from coronary artery disease (CAD). Several risk factors contribute to AMI. Non-modifiable risk factors are age, sex, race, and family history. Modifiable risk factors include dyslipidemia, hypertension, smoking, diabetes mellitus, as well as recent factors that are considered more specific such as homocysteine, lipoprotein a [Lp(a)], high sensitivity C- reactive protein (hs-CRP), and apolipoprotein. This study aimed to determine the role of apolipoprotein as a risk factor for STEMI. MethodsThis study combines three epidemiological designs: a descriptive and cross-sectional correlative study with 62 STEMI patients at the National Cardiovascular Center Harapan Kita and a comparative study of 62 STEMI patients and 20 non-ACS CAD patients at the Universitas Indonesia Hospital. Results and conclusionThe descriptive study showed the level of apoB 80.71 ± 28.3, apoA1 104.93 ± 27.8, apoB/apoA1 ratio 0.78 ± 0.22, and Lp(a) 6.85 (1.0–48.1). ApoB moderately correlates with LDLc (p < 0.001; r = 0.571). ApoA1 weakly correlates with HDLc (p = 0.005; r = 0.379). In comparative study, there were significant differences between the STEMI and non-ACS CAD groups on apoA1 (104.93 ± 27.8 vs. 137.48 ± 26.46), apoB/apoA1 ratio (0.78 ± 0.22 vs. 0.59 ± 0.15), and hs-CRP (2.88 [0.4–215] vs. 0.73 [0.15–8.9]). Multivariate analysis showed that the most significant risk factors for STEMI in this study were hypertension for modifiable factors and apoA1 for apolipoprotein. The apoA1 and apoB/apoA1 ratio examination can be suggested for people who have experienced plaque formation and are at risk for myocardial infarction.

Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?

Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction. We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups. A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis. Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population. level III Case Control Study.

Genetic risk factors of Alzheimer’s Disease disrupt resting-state functional connectivity in cognitively intact young individuals

BackgroundPast evidence shows that changes in functional brain connectivity in multiple resting-state networks occur in cognitively healthy individuals who have non-modifiable risk factors for Alzheimer’s Disease. Here, we aimed to investigate how those changes differ in early adulthood and how they might relate to cognition.MethodsWe investigated the effects of genetic risk factors of AD, namely APOEe4 and MAPTA alleles, on resting-state functional connectivity in a cohort of 129 cognitively intact young adults (aged 17–22 years). We used Independent Component Analysis to identify networks of interest, and Gaussian Random Field Theory to compare connectivity between groups. Seed-based analysis was used to quantify inter-regional connectivity strength from the clusters that exhibited significant between-group differences. To investigate the relationship with cognition, we correlated the connectivity and the performance on the Stroop task.ResultsThe analysis revealed a decrease in functional connectivity in the Default Mode Network (DMN) in both APOEe4 carriers and MAPTA carriers in comparison with non-carriers. APOEe4 carriers showed decreased connectivity in the right angular gyrus (size = 246, p-FDR = 0.0079), which was correlated with poorer performance on the Stroop task. MAPTA carriers showed decreased connectivity in the left middle temporal gyrus (size = 546, p-FDR = 0.0001). In addition, we found that only MAPTA carriers had a decreased connectivity between the DMN and multiple other brain regions.ConclusionsOur findings indicate that APOEe4 and MAPTA alleles modulate brain functional connectivity in the brain regions within the DMN in cognitively intact young adults. APOEe4 carriers also showed a link between connectivity and cognition.

The Association Between Body Mass Index and Parental History of Hypertension Among Young Indian Adults.

Hypertension is a disease of multifactorial etiology. Individuals with parental history of hypertension (PHH) have also been observed to be at an increased risk of developing hypertension in their adult life. However, there is a dearth of studies among youth. Obesity is one of the risk factors, and studies conducted among adults of all age groups have observed that there is a highly significant correlation between hypertension and body mass index (BMI). Hence, the association between the two factors, viz., parental history of hypertension and BMI, among the young Indian male and female population was analyzed in this study. This cross-sectional study conducted in Central India comprised 100 young adults between 18 and 25 years of age. On the basis of parental history of hypertension, the subjects were divided into two groups: group 1 comprised youth with parental history of hypertension and group 2 comprised youth without parental history of hypertension, involving 32 and 68 subjects in each of these groups, respectively. Anthropometric measurements were done using standard methods, and BMI was calculated. Statistical analysis was done using Epi Info software. The study subjects in both groups were comparable in age. The mean age of the study participants was 19.32 years and 19.45 years in group 1 and group 2, respectively. The study did not find any association between BMI and parental history of hypertension. The association between parental history of hypertension and BMI, the non-modifiable and modifiable independent risk factors, respectively, needs to be further explored in light of the iceberg phenomenon, multifactorial causation, and natural history of disease. It is worth mentioning that parental history of hypertension and other risk factors should be considered even if the BMI is normal as per Asian Indian cutoff levels.

A Review of Primary. Secondary, and Tertiary Prevention Strategies for Alzheimer’s Disease

This paper explores the non-modifiable and modifiable risk factors for Alzheimer’s, as well as the Alzheimer’s primary prevention, secondary prevention, and tertiary prevention strategies that can be implemented. Alzheimer's is the sixth leading cause of death in the United States and the most expensive chronic disease (Alzheimer’s Association, 2020). It has a detrimental physical, psychological, and financial impact on patients and caregivers (Alzheimer’s Association, 2020). People can reduce their risk of developing Alzheimer’s by eating a healthy diet, using hearing aids for hearing loss, engaging in regular physical activity, spending time with other people, doing mentally stimulating activities, reducing alcohol consumption, and avoiding tobacco (Livingston et al., 2020). Early screening and diagnostic tools are important because they allow people living with Alzheimer’s to establish an effective care plan and to take advantage of treatments, which are most effective in the early stages of the disease (Guzman-Martinez et al., 2021). Some screening and diagnostic tools include biomarkers, scalable screening technologies, and cognitive assessments (Guzman-Martinez et al.,18 2021). Primary and secondary prevention strategies must address the needs of minority populations, who have a higher risk of developing Alzheimer’s compared to the general population (Livingston et al., 2020). Federal public health initiatives, such as the National Alzheimer’s Project Act, the Dementia Prevention Action Plan, and the Behavioral Risk Surveillance System, play an important role in Alzheimer’s public health research, surveillance, and prevention strategies (Chong et al., 2021; Kelley et al., 2018).

A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review.

Older adults are at high risk of developing delirium in the emergency department (ED);however, it is often missed or undertreated. Improving ED delirium care is challenging in part due to a lack of standards to guide best practice. Clinical practice guidelines (CPGs)translate evidence into recommendations to improve practice. To critically appraise and synthesize CPG recommendations for delirium care relevant to older ED patients. We conducted an umbrella review to retrieve relevant CPGs. Quality of the CPGs and their recommendations were critically appraised using the Appraisal of Guidelines, Research, and Evaluation (AGREE)-II;and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence (AGREE-REX)instruments. A threshold of 70% or greater in the AGREE-IIRigour of Development domain was used to define high-quality CPGs. Delirium recommendations from CPGs meeting this threshold were included in the synthesis and narrative analysis. AGREE-IIRigour of Development scores ranged from 37% to 83%, with 5 of 10 CPGs meeting the predefined threshold. AGREE-REXoverall calculated scores ranged from 44% to 80%. Recommendations were grouped into screening, diagnosis, risk reduction, and management. Although none of the included CPGs were ED-specific, many recommendations incorporated evidence from this setting. There was agreement that screening for nonmodifiable risk factors is important to define high-risk populations, and those at risk should be screened for delirium. The '4A's Test' was the recommended tool to use in the ED specifically. Multicomponent strategies were recommended for delirium risk reduction, and for its management if it occurs. The only area of disagreement was for the short-term use of antipsychotic medication in urgent situations. This is the first known review of delirium CPGs including a critical appraisal and synthesis of recommendations. Researchers and policymakers can use this synthesis to inform future improvement efforts and research in the ED. This study has been registered in the Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6.

Prevalence and risk factors of hypertension among adolescents living in Ghana

ABSTRACT This study assessed the prevalence of and risk factors for hypertension among adolescents in two selected districts in Ghana. The data were analyzed using SPSS version 24. Multivariate logistic regression analyses were conducted to determine the risk factors of hypertension among adolescents. The overall prevalence of high blood pressure (BP) was 11.6%. The non-modifiable risk factors that predicted high BP were district of residence (Adjusted odds ratio [AOR] = 0.328, 95% confidence interval [CI] = 0.328–0.203), age (AOR = 1.540, 95%CI = 1.240–1.913), relationship status (AOR = 1.960 95%CI = 1.059–3.628) and possessing a phone (AOR = 0.538, 95%CI = 0.325–0.890). The modifiable risk factors that predicted high BP were high BMI, not checking BP regularly, and not having an awareness of salt intake. In accordance with these results, prevention programs must focus on adolescent knowledge, lifestyle practices, and attitudes toward control measures. It is important to incorporate health education in school curricula to promote a healthy lifestyle and limit the risks associated with high BP.

MACHINE LEARNING IN HYPERTENSION DETECTION: A STUDY ON WORLD HYPERTENSION DAY DATA

Objective: Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection. We aimed to explore whether a machine learning (ML) algorithm can help identifying individual predictors of hypertension. Design and method: We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. Demographic information (age, sex, BMI), self-reported information on cardio- vascular risk factors (hypertension, diabetes, smoking, high cholesterol, kidney disease, family history of cardiovascular diseases), sleep complaints (snoring, witnessed apneas, daytime sleepiness) and prior cardiovascular diseases (previous cardio and cerebrovascular events, previous myocardial infarction) as well as information about the awareness of hypertension and its health consequences were collected through the questionnaire. We computed the performance (sensitivity and specificity) of standard screening programmes as recommended by World Health Organisation and of five different ML algorithms, exploiting different balancing techniques (oversampling and undersampling). Results: A total of 20206 individuals (mean age 50.89 years, 51.65% females) have been included for analysis. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others (Table 1). However, Random Forest provides the most interesting balance between sensitivity and specificity with a greater Area Under the Curve compared to the standard screening programs (Table 1). Conclusions: Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models. Table 1: Performance in the test set of the three experimented schemes, original, oversampling and undersampling the training set, and of the medical protocol evaluation.

CARDIOVASCULAR EVENTS IN TYPE 2 DIABETIC PATIENTS

Objective: Cardiovascular diseases represent the first cause of death of patients with type 2 diabetes. The aim of our work is to identify the prevalence of cardiovascular disease in type 2 diabetes. Design and method: This is a retrospective descriptive study conducted over a period of three years (January 2013- January 2016) including type 2 diabetic patients followed up at the nephrology consultation of Mongi slim hospital. Clearance was calculated according to the MDRD formula. The stage of chronic kidney disease (CKD) was defined according to the KDIGO 2012 classification. Results: Our study included 42 patients with diabetic kidney disease followed at our nephrology consultation. The mean age was 63.3 [31-80] with a sex ratio M/F = 1.47. Eighty-eight percent of our patients had hypertension. At the first consultation our patients already had macrovascular disease: 4 patients were suffering from peripheral artery disease, 4 patients had heart failure, a history of ischemic stroke was found in 4 patients and acute coronary syndrome in 11 patients. Regarding cardiovascular risk factors, obesity was found in 13 patients, 6 patients were smokers and 25 patients (59.5%) had dyslipidemia with a mean cholesterol level of 4.48 +/- 1.09 mmol/l. The mean fasting blood glucose level was 10.5 +/-5.23 mmol/l and a mean glycated hemoglobin was 8.24 +/-2.22%. The renal impact was as follows: chronic kidney disease stage 3A in 12 patients (28.6%), stage 3B in 14 patients (33.3%), stage 4 in 6 patients (14.3%) and stage 5 in 2 patients. During the course of the study, 7 patients had an acute coronary syndrome and 1 patient had an ischemic stroke. Conclusions: Diabetes is a cardiovascular risk factor in itself. Although nothing can be done about the non-modifiable risk factors (heredity, age, gender), it is possible to act early and effectively on the other modifiable factors.

Breast cancer disparities: A literature review of the last five years.

e18686 Background: Breast cancer (BC) disparities are differences in cancer measures. Some of the disparities in BC among Black women and males include but are not limited to the disproportionate high mortality rates impacted by access to screening mammograms, the effect of breast density, access to genetic testing, genetic predisposition to triple-negative BC (TNBC), and other social constructs that prevent obtaining BC screening. We highlight disparities in BC among women of minority and lower socioeconomic status, discuss factors contributing to this racial disparity, and design innovative solutions to address these disparities. Methods: The PRISMA statements were followed for conducting this literature review. A comprehensive staged literature search was performed on PubMed, EMBASE, clinicaltrial.gov, Web of Science, and Cochrane Library, identifying relevant Medical Subject Headings (MeSH) keywords. Two investigators performed an independent literature search using the search terms. A third reviewer resolved conflicts. Articles with a publication date before 2017, those written in languages other than English, and those without data on BC Disparity were excluded. Results: Using the Mesh framework outlined, we accumulated 4125 studies. Studies were further screened for relevance to this project, leading to the inclusion of 35 studies. The literature shows that both non-modifiable and modifiable risk factors contribute to these racial disparities. The expression of cytokines and other chemical messengers in the tumor microenvironment is differential and prevalent in Black women. Furthermore, this tumor microenvironment is impacted by non-genetic risk factors, including obesity, consumption of alcohol and tobacco, and poverty. Another critical component of racial disparities in BC includes the social element of poorer medical care for women in the US. For example, lower breastfeeding rates in Black women are highly influenced by social factors, although it was found that breastfeeding is protective against TNBC. In addition, poor and near-poor women were less likely to receive sentinel lymph node biopsy and radiation after breast-conserving surgery than high socioeconomic-status women. Conclusions: In our study, we highlight how black women have higher mortality rates at any age of diagnosis than white women. It exemplifies the need to advocate for better healthcare for minority women. Precision cancer prevention is the key to addressing BC disparity based on geographic, socioeconomic, and racial factors. Rural healthcare centers in high-risk areas outside the catchment of existing National Cancer Institutes (NCI) can play a vital role in screening and managing BC survivors. We will need a multidisciplinary platform of investigators, including but not limited to internists using digital tools to improve breast cancer education and awareness of primary healthcare providers and community workers.

A case-control study of 10,757 individuals to assess potentially modifiable risk factors, including stress, for breast cancer among Chinese patients in Hong Kong.

e22522 Background: Breast cancer is the most common cancer in women worldwide. Both intrinsic and environmental factors contribute to the disparities in breast cancer incidence across different regions. In Hong Kong, the incidence has been increasing in the past decades. With over 4700 women diagnosed in 2019, breast cancer is responsible for 27% of all female cancers in Hong Kong. Apart from intrinsic non-modifiable risk factors, some risk factors are modifiable and may reduce cancer risk. Methods: We conducted a case-control study that involved breast cancer patients from the Hong Kong Breast Cancer Registry with matched healthy controls from the community between 2014 and 2017. A standardized written questionnaire was used through face-to-face interviews of all study participants. The questionnaire collected information on participants’ demographics, general health, smoking history and other lifestyle factors including physical activity, self-assessed dietary habits (balanced, vegetarian, meat and dairy-rich diets), self-perceived stress levels (measured with a 4-point Likert scale, and high stress level was defined as having over 50% of the participant’s time with stress being scored 3 or above out of a Likert scale of 4), body mass index, family history, menstrual and reproductive history, and history on the use of oral contraceptives and hormone replacement therapy. Multiple logistic regression was fitted to compare all risk factors. Results: A total of 5,186 breast cancer patients and 5,571 controls were recruited. Modifiable risk factors that were shown to be associated with an increased risk of breast cancer included self-perceived high stress level (adjusted odd ratios [aOR] = 3.44; 95% CI = 3.13-3.78), meat-rich diet (aOR = 1.77; 95% CI = 1.54-2.04), dairy-rich diet (aOR = 3.33; 95% CI = 2.01-5.52), overweight/obese status (aOR = 1.21; 95% CI = 1.10-1.32), delayed child-bearing (aOR = 2.23; 95% CI = 1.79-2.79), nulliparity (aOR = 1.21; 95% CI = 1.08-1.35) and ever use of oral contraceptives (aOR = 1.34; 95% CI = 1.22-1.47), while exercise (OR = 0.62; 95% CI = 0.56-0.68) and breast-feeding (aOR = 0.76; 95% CI = 0.69-0.83) were associated with reduced risk. Conclusions: In Hong Kong, high stress level, meat- and dairy- rich diet, overweight/obese, reproductive history and use of oral contraceptives were identified to be modifiable risk factors for breast cancer. Adjusting these factors through lifestyle modification may curb the increasing trend of breast cancer incidences in the coming decades.

CLINICO-DEMOGRAPHIC PROFILE AND CLINICAL OUTCOME OF YOUNG ADULT PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE ADMITTED IN QUIRINO MEMORIAL MEDICAL CENTER

In patients younger than 40 years old, aneurysmal subarachnoid hemorrhage (aSAH) is an extremely rare condition. Despite the fact that the clinical features of aSAH have been the subject of extensive research in the general population, there is still some debate regarding the formation of aneurysms and their rupture in the young population. Behaviors such as smoking, excessive alcohol consumption, and the use of sympathomimetic medications are all considered risk factors for aSAH. Being female, the existence of an unruptured cerebral aneurysm, a history of hereditary and family history of aSAH, and certain genetic syndromes all contribute to an increased risk of subarachnoid hemorrhage. An ambidirectional cohort study is utilized in the study on thepatients who are from 19-55 years old admitted at Quirino Memorial Medical Center, Quezon City. The respondents are selected using convenience sampling based on the inclusion and exclusion criteria of the study. The result showed that the Hunt and Hess score still play a significant role in determining the prognosis of young patients with ruptured aSAH. In addition, the survivability of patients in this population does not solely depend on the presence of any behavioral and non-modifiable risk factors for aSAH such as the Modified Fisher Grade Score, location, number, and type of aneurysms on radiographic findings but the clinical outcome and long-term functional outcome depend on the interplay of the above-mentioned factors, as well as the clinical condition of the patient on admission and the interventions given.