Non-modifiable Factors Research Articles

Factors influencing imaging clinical decision-making in low back pain management. A scoping review.

The use of diagnostic imaging in low back pain (LBP) management is often inappropriate, despite recommendations from clinical practice guidelines. There is a limited understanding of factors that influence the imaging clinical decision-making (CDM) process. Explore the literature on factors influencing imaging CDM for people with LBP and consider how these findings could be used to reduce inappropriate use of imaging in LBP management. Scoping review. This review followed the Preferred Reporting Items for Systematic Review extension for scoping reviews. A digital search was conducted in Medline, the Cumulative Index of Nursing and Allied Health Literature, Scopus, and the Cochrane Central Register of Controlled Trials for eligible studies published between January 2010-2023. Data reporting influences on imaging CDM were extracted. Data were then analysed through an inductive process to group the influencing factors into categories. After screening, 35 studies (5 qualitative and 30 quantitative) were included in the review, which reported factors influencing imaging CDM. Three categories were developed: clinical features (such as red flags, pain, and neurological deficit), non-modifiable factors (such as age, sex, and ethnicity) and modifiable factors (such as beliefs about consequences and clinical practice). Most studies reported non-modifiable factors. The results of this scoping review challenge the perception that imaging CDM is purely based on clinical history and objective findings. There is a complex interplay between clinical features, patient and clinician characteristics, beliefs, and environment. These findings should be considered when designing strategies to address inappropriate imaging behaviour.

Targeted Muscle Reinnervation

Background Targeted muscle reinnervation (TMR) has demonstrated efficacy in reducing neuroma and chronic pain. In this article, we investigated postoperative outcomes in our patient cohort, with a focus on the role of nonmodifiable factors such as patient age and gender. Methods Patients who had extremity TMR from April 2018 to October 2022 were reviewed. Outcomes of interest included patient age, gender, cause and type of amputation, delayed versus immediate TMR, as well as postoperative improvement in pain as assessed by numerical rating score (NRS). Results A total of 40 patients underwent TMR on 47 limbs. Mean age was 46.2 ± 17.0 years. Delayed TMR (27, 57.4%) was most commonly performed, followed by immediate and delayed-immediate at 11 (23.4%) and 9 (19.1%), respectively. Amputation level was most commonly above-knee in 20 (42.6%) patients, followed by below-knee (12, 25.5%), transhumeral (8, 17.0%), transradial (6, 12.8%), and shoulder (1, 2.1%). The median time interval between amputation and TMR was 12 months. The median preoperative NRS assessing residual limb pain (RLP) for patients who underwent delayed TMR was 10. The median postoperative NRS assessing RLP for all patients was 0 (interquartile range25–75: 0–5) and significantly improved compared with preoperative NRS (P < 0.001). At the last follow-up for limbs that had delayed and delayed-immediate TMR (n = 36), 33 (91.7%) limbs had more than 50% resolution of RLP. There was a significant difference in median postoperative NRS by gender (4 in men and 0 in women) (P < 0.05). Postoperative median NRS also favored younger patients (0, <50 years compared with 4.5, >50 years) (P < 0.05). Multiple linear regression analysis showed that, of different variables analyzed, only male gender and older age were predictive of poorer postoperative outcomes. Conclusion TMR showed high efficacy in our cohort, with improved short-term outcomes in women and younger patients.

Specification curve analysis to identify heterogeneity in risk factors for dementia: findings from the UK Biobank

BackgroundIn 2020, the Lancet Commission identified 12 risk factors as priorities for prevention of dementia, and other studies identified APOE e4/e4 genotype and family history of Alzheimer’s disease strongly associated with dementia outcomes; however, it is unclear how robust these relationships are across dementia subtypes and analytic scenarios. Specification curve analysis (SCA) is a new tool to probe how plausible analytical scenarios influence outcomes.MethodsWe evaluated the heterogeneity of odds ratios for 12 risk factors reported from the Lancet 2020 report and two additional strong associated non-modifiable factors (APOE e4/e4 genotype and family history of Alzheimer’s disease) with dementia outcomes across 450,707 UK Biobank participants using SCA with 5357 specifications across dementia subtypes (outcomes) and analytic models (e.g., standard demographic covariates such as age or sex and/or 14 correlated risk factors).ResultsSCA revealed variable dementia risks by subtype and age, with associations for TBI and APOE e4/e4 robust to model specification; in contrast, diabetes showed fluctuating links with dementia subtypes. We found that unattributed dementia participants had similar risk factor profiles to participants with defined subtypes.ConclusionsWe observed heterogeneity in the risk of dementia, and estimates of risk were influenced by the inclusion of a combination of other modifiable risk factors; non-modifiable demographic factors had a minimal role in analytic heterogeneity. Future studies should report multiple plausible analytic scenarios to test the robustness of their association. Considering these combinations of risk factors could be advantageous for the clinical development and evaluation of novel screening models for different types of dementia.

Perioperative variables associated with emergence delirium in children following strabismus surgery: A five-year retrospective single-center cohort study

ABSTRACT Background Emergence Delirium (ED) is common among children. Several factors have been linked to ED related to patient characteristics, anesthesia, or the type of surgery. Strabismus surgery has been associated with the development of ED. The aim of this study was to determine the perioperative variables associated with ED after strabismus surgery in children. Methodology A retrospective cohort study of children who underwent strabismus surgery from January 2018 to December 2022 was conducted. Data on factors leading to ED, including patient characteristics, preoperative anxiety, postoperative pain, surgery-related characteristics anesthesia-related characteristics, were analyzed. Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results Three-hundred-and-thirty-six children were included in the analysis. Fourteen percent of patients developed ED. Predictors of ED were age, multiple muscle surgery, binocular surgery. Midazolam premedication, intraoperative dexmedetomidine and fentanyl were associated with lower incidence of ED. On multivariable analysis, younger age (Odds Ratio (OR) = 1.05; p = 0.039), multiple muscle correction (OR = 1.91; p = 0.041), binocular surgery (OR = 1.85; p = 0.021) midazolam premedication (OR = 2.02; p = 0.007), intraoperative fentanyl administration (OR = 1.88; p = 0.031), and intraoperative dexmedetomidine administration (OR = 1.32; p < 0.001), were independent predictors of ED. Conclusion In this study, younger age, multiple muscle surgery, and binocular surgery were the main non-modifiable factors associated with ED in children following strabismus surgery. Administration of midazolam, dexmedetomidine, or fentanyl were associated with lower incidence of ED. Patients at higher risk for ED could be selected for prophylaxis against ED using these medications to prevent ED after strabismus correction surgery in children.

Exploring the self-efficacy of patients with diabetes: its role as a predictor of diabetes management and well-being.

Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes. An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being. A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P<0.001], having type 1 diabetes [OR=7.16, 95%CI, P=0.005], being Saudi [OR=7.67, (95%CI, P=0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P=0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P=0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P=0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P=0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P=0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P=0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P=0.021]. The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients.

Influence of Kinanthopometric Profile of National Level Male Judo Players of Tamil Nadu on Performance

Introduction: Anthropometric Aspects and Body composition are the crucial factors in explaining human physical status. Anthropometric advantage, a non-modifiable factor, significantly contributed to athletes' success in sports. The present study was studied to find out the relationship between the Kinanthopometric profiles and performance level of National-level male Judo players from Tamil Nadu, India. Method: 30 male Judo players were measured for their anthropometric parameters. Height, weight, circumferences, and skinfold thickness at various sites were measured. Body density was calculated, and body fat % was determined using Siri's Equation. A special Judo fitness test involved throwing partners using the ippon-seoi-nage technique in three periods with heart rate checks, and an index was calculated based on total throws and heart rate values. Results: An average height of 158.1 (± 8.5) cm was observed in the present study whereas that of weight was 63.7 (± 7.3) kg. Judo players were categorized into Endomorphic (30%), Mesomorphic (36.7 %) and Ectomorphic (33.4 %) body type. Mesomorphic players showed good performance, Ectomorphic players showed average performance, and Endomorphic players displayed poor performance when performances were analyzed using the Special Judo Fitness Test. This underscored a potential link between body type and Judo performance. Conclusion: The study concluded that body composition has a high impact on physical fitness and sports performance.

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts.

Osteoarthritis (OA) stands as a prevalent and progressively debilitating clinical condition globally, impacting joint structures and leading to their gradual deterioration through inflammatory mechanisms. While both non-modifiable and modifiable factors contribute to its onset, numerous aspects of OA pathophysiology remain elusive despite considerable research strides. Presently, diagnosis heavily relies on clinician expertise and meticulous differential diagnosis to exclude other joint-affecting conditions. Therapeutic approaches for OA predominantly focus on patient education for self-management alongside tailored exercise regimens, often complemented by various pharmacological interventions primarily targeting pain alleviation. However, pharmacological treatments typically exhibit short-term efficacy and local and/or systemic side effects, with prosthetic surgery being the ultimate resolution in severe cases. Thus, exploring the potential integration or substitution of conventional drug therapies with natural compounds and extracts emerges as a promising frontier in enhancing OA management. These alternatives offer improved safety profiles and possess the potential to target specific dysregulated pathways implicated in OA pathogenesis, thereby presenting a holistic approach to address the condition's complexities.

Relationship Between Dietary Intakes and Elevated Diastolic Blood Pressure Among Children: A Cross-Sectional Study Using Wearable Devices.

Elevating systolic blood pressure (SBP) and diastolic blood pressure (DBP) independently influences clinical outcomes and adverse cardiovascular events. Blood pressure can be affected by modifiable (such as diets and physical activities) and non-modifiable factors (such as age and gender). Elevated blood pressure (EBP or formerly prehypertension) during childhood is associated with hypertension incidence in later adulthood. This cross- sectional study investigated modifiable risk factors for blood pressure among children (aged 3-12). We employed wearable devices to monitor the blood pressure of 45 preschool and primary school children and analyze this data with secondary blood pressure data of their parents from electronic medical records. EBP phenotypes in children (offspring) were not related to their parent's blood pressure phenotypes (P = 0.15 and 0.19 for SBP). Consumption of high saturated fat (P = 0.032), copper (P = 0.026), and vitamin B12 (P = 0.032) was associated with a significant increase in DBP. Daily sodium intakes between normal and DBP hypertensive groups were not significantly different (P = 0.75). This study indicates that dietary intakes of high saturated fat, copper, and vitamin B12, but not parental blood pressure statuses, determine high diastolic blood pressure among children regardless of daily sodium intake. Early dietary consumption behavioral adaptation should be considered to prevent further hypertension in adulthood.

Modifiable and Non-Modifiable Factors Associated with Gastric Cancer

Numerous studies have investigated the associations between dietary components, behavioral patterns, and susceptibility to gastric cancer (GC). Diet and lifestyle cover a spectrum of both protective and harmful factors associated with GC. Additionally, non-modifiable factors such as age, gender, blood type, family history, and genetic predispositions may influence GC development. This review aims to explore the interplay between modifiable and non-modifiable factors, along with dietary habits and lifestyle practices, in relation to GC risk and the potential underlying mechanisms. We have synthesized the primary findings of observational studies (case-control and cohort), systematic reviews, and meta-analyses pertaining to preventive and deleterious factors affecting the incidence of gastric cancer. A literature search was conducted on Google Scholar, MEDLINE (PubMed), ScienceDirect, and Scopus for articles published in English from 2001 to 2024. The main search terms included body weight and body fat; diet; fruits and vegetables; meats and processed meats; fried and fast foods; milk and dairy products; salty foods; food and dietary patterns; fat and sweets intake; alcohol consumption; smoking; physical activity; age; sex; family history; blood type; genetics; and medication, and the risk of gastric cancer. Unhealthy dietary patterns, consumption of fried and fast foods, salty foods, alcohol, and smoking have been associated with an increased risk of GC. Non-modifiable factors such as advanced age, male sex, family history, genetics, and blood type A were linked to an elevated risk of GC. Conversely, physical activity and high consumption of fresh fruits and vegetables may prevent GC occurrence due to the presence of antioxidants, fiber, and polyphenols. While many studies have demonstrated that dietary patterns loaded with red and processed meats were associated with a high risk of GC, others have yielded inconclusive results. Controversial findings regarding the relationship between body weight and body fat, medications, milk and dairy products, and fat and sweets consumption with the risk of GC were also observed. Adequate diet modification and addressing preventable factors may play a pivotal role in reducing the incidence of gastric cancer.

Healthy Habits, Physical Activity, Stress, and Food Consumption Trends in Chilean Adults with Irritable Bowel Syndrome during the COVID-19 Pandemic.

The COVID-19 pandemic has increased stress levels in the population due to radical lifestyle changes caused by containment measures. Studies suggest that high levels of stress may be related to the development of irritable bowel syndrome (IBS). This study aims to explain how quarantine habits and lifestyles acted as risk factors for the frequency of this syndrome during the COVID-19 pandemic. An observational study was conducted with 34 Chilean participants (average age 24.5 ± 3.85 years), of whom 21 (62%) were female. Surveys on consumption trends and lifestyles created by the authors were administered. Additionally, we used the global physical activity questionnaire (GPAQ) and the depression anxiety stress scales (DASS-21) to assess psychological stress and the Rome IV criteria to assess IBS. Significant differences were found between individuals with better healthy habits compared to those with poor healthy habits. The former showed lower sedentary activity (32%, p = 0.005), only 27% were fast eaters (vs. 44%, p = 0.001), had shorter nap intervals (14% vs. 28%, p = 0.03), and higher vegetable consumption (p = 0.02). There were 20 cases (59%) of IBS, with a strong association with the female sex (p = 0.004), where females were 15 times more likely to develop it compared to males (p = 0.008). Additionally, when alcohol consumption was added to females, there was a higher likelihood of developing this syndrome (p = 0.009), as individuals who consumed alcohol were 12 times more likely to develop it compared to those who did not (p = 0.02). Among other factors, it was observed that 57% of those with the syndrome consumed drinks more often (p = 0.02) but consumed fewer nuts (p = 0.009). In conclusion, IBS has a multifactorial etiology, and correcting individual habits such as alcohol consumption could potentially prevent or delay its development. Therefore, it is important to maintain healthy lifestyles, regardless of non-modifiable factors such as gender, in order to better cope with this syndrome.

Genotype-phenotype associations in CRB1 bi-allelic patients: a novel mutation, a systematic review and meta-analysis.

The goal of the study was to search for novel bi-allelic CRB1 mutations, and then to analyze the CRB1 literature at the genotypic and phenotypic levels. We screened various variables such as the CRB1 mutation types, domains, exons, and genotypes and their relation with specific ocular phenotypes. An emphasis was given to the bi-allelic missense and nonsense mutations because of their high prevalence compared to other mutation types. Finally, we quantified the effect of various non-modifiable factors over the best-corrected visual acuity oculus uterque (BCVA OU) using multivariate linear regression models and identified genetic interactions. A novel bi-allelic missense in the exon 9 of CRB1; c.2936G > A; p.(Gly979Asp) was found to be associated with rod-cone dystrophy (RCD). CRB1 mutation type, exons, domains, and genotype distribution varied significantly according to fundus characteristics, such as peripheral pigmentation and condition, optic disc, vessels, macular condition, and pigmentation (P < 0.05). Of the 154 articles retrieved from PubMed, 96 studies with 439 bi-allelic CRB1 patients were included. Missense mutations were significantly associated with an absence of macular pigments, pale optic disc, and periphery pigmentation, resulting in a higher risk of RCD (P < 0.05). In contrast, homozygous nonsense mutations were associated with macular pigments, periphery pigments, and a high risk of LCA (P < 0.05) and increased BCVA OU levels. We found that age, mutation types, and inherited retinal diseases were critical determinants of BCVA OU as they significantly increased it by 33% 26%, and 38%, respectively (P < 0.05). Loss of function alleles additively increased the risk of LCA, with nonsense having a more profound effect than indels. Finally, our analysis showed that p.(Cys948Tyr) and p.(Lys801Ter) and p.(Lys801Ter); p.(Cys896Ter) might interact to modify BCVA OU levels. This meta-analysis updated the literature and identified genotype-phenotype associations in bi-allelic CRB1 patients.

The Importance of Circulation in Airway Management: Preventing Post-Intubation Hypotension in The Trauma Bay.

To identify the modifiable and non-modifiable risk factors associated with post-intubation hypotension (PIH) among trauma patients who required endotracheal intubation (ETI) in the trauma bay. ETI has been associated with hemodynamic instability, termed PIH, yet its risk factors in trauma patients remain under-investigated. This is a prospective observational study at a level I trauma center over 4 years (2019-2022). All adult (≥18) trauma patients requiring ETI in the trauma bay were included. Blood pressure was monitored both pre- and post-intubation. Multivariable logistic regression analysis was performed to identify the modifiable and non-modifiable factors associated with PIH. 708 patients required ETI in the trauma bay, of which, 435 (61.4%) developed PIH. The mean (SD) age was 43 (21) and 71% were male. Median [IQR] arrival GCS was 7 [3-13]. Patients who developed PIH had a lower mean (SD) pre-intubation SBP (118 (46) vs. 138 (28), P<0.001) and higher median [IQR] ISS (27 [21-38] vs. 21 [9-26], P<0.001). Multivariable regression analysis identified BMI>25, increasing ISS, penetrating injury, spinal cord injury, Pre-intubation PRBC requirements, and diabetes mellitus as non-modifiable risk factors associated with increased odds of PIH. In contrast, pre-intubation administration of 3% hypertonic saline and vasopressors were identified as the modifiable factors significantly associated with reduced PIH. More than half of the patients requiring ETI in the trauma bay developed PIH. This study identified modifiable and non-modifiable risk factors that influence the development of PIH, which will help physicians when considering ETI upon patient arrival. Level III, Prognostic Study.

Determining specific profiles of patients at risk of relapsing

AbstractBased on the available literature and the studies presented by the previous speakers, Dr. Andreu will provide a summary of predictive and protective factors associated with mood relapse or recurrence in bipolar disorder, with a special focus on the distinction between modifiable and non-modifiable factors and on the identification of specific phenotypes at higher risk of relapse. The speaker will also mention the role of psychotherapeutic and pharmacological treatments, and will summarize the available evidence regarding lithium response.Disclosure of InterestNone Declared

IJCM_156A: A Cross-sectional study on the Prevalence of Risk Factors of Breast Cancer and Awareness of Breast Cancer Screening in Women of age group 30 to 70 years in Karamadai Block of Coimbatore Health Unit District

Background: Breast cancer, the most common malignancy among women globally, recorded over 2.26 million new cases and almost 685,000 deaths in the same year. Evidence indicates breast cancer risk links to both modifiable and non-modifiable lifestyle factors. Promoting education and access to screening programs is crucial for early detection and intervention in breast cancer. This approach ultimately enhances the effectiveness of prevention efforts and reduces complications and mortality of breast cancer. Objective: To estimate the prevalence of risk factors of breast cancer and to assess the awareness of breast cancer screening in women of age group 30-70 years in Karamadai Block of Coimbatore Health Unit District. Methodology: A cross sectional study was conducted among 150 women in Coimbatore using a semi-structured questionnaire and statistical analysis was done using SPSS 21 version. Results: Out of 150 participants, the mean age of subjects was 50 ± 11 years, with 98% being married women. The prevalence of modifiable and non- modifiable risk factors of breast cancer were found to be 61% and 9% respectively. 54% were aware of government facility-based breast cancer screening. But only 25% had undergone screening for breast cancer. Individuals who underwent breast cancer screening in the last one year found to be aware of breast cancer screening compared to those who did not. (OR 2.5, 95% CI 2.02-3.18). Conclusion: Awareness and screening for breast cancer are low among the study participants. Women =30 years of age attending all outpatient departments in any health facility should be educated regarding the importance of screening of breast cancer.

Age-Related Hypertension: A Cross-Sectional Analysis of Influencing Factors

Background:Hypertension is characterized by high blood pressure, with systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg, and it commonly affects the elderly population. There are two types of risk factors for hypertension, namely modifiable and non-modifiable factors. Method: This research employed a quantitative method with an analytical survey design using a case-control method. The sample size consists of 60 respondent, selected using a purposive sampling technique. Results: Statistical tests indicated a significant correlation for variables such us family history (?-value 0.0001), salt consumtion (?-value 0.0001), stress/anxiety (?-value 0.005), and compliance with a healthy lifestyle (?-value 0.003), with the occurrence of hypertension. On the other hand, age (?-value 0.278), gender (?-value 0.091), obesity status (? value 0.390), smoking status (?-value 0.243), and caffeine/coffee consumtion habits (?-value 0.196) did not show any significant correlation with hypertension occurrence. Conclusion: Family history, salt consumtion, stress/anxiety, and compliance with a healthy lifestyle are factors affecting the occurrence of hypertension in the elderly at Sokaraja 1 Public Health Care Center. However, age, gender, obesity status, smoking status, and caffeine/coffe consumtion habits do not contribute to hypertension.

Busting Breast Cancer Myths: A Deep Dive into Epidemiology, Risk Factors and Effective Management

Breast cancer is marked by uncontrolled cell growth leading to invasive tumors in the breast ducts and lobules. Risk factors include modifiable elements like lifestyle choices and nonmodifiable factors such as age and genetic mutations. Global epidemiology sheds light on prevalence and contributing factors, crucial for prevention and management. Classification involves histopathological and molecular criteria, encompassing various subtypes. Diagnosis relies on imaging techniques like mammography and biopsies, with minimal radiation exposure. Treatment includes hormone treatment, targeted therapy, radiation, chemotherapy, surgery, and immunotherapy, with immune checkpoint inhibitors such as PD-1 and PDL-1 being used in particular. The intricate tumor microenvironment involves diverse cell types and factors like hypoxia and exosomes, presenting challenges and opportunities for therapeutic advancements in the breast cancer management.

Variation in Lymph Node Assessment for Colon Cancer at the Tumor, Surgeon, and Hospital Level.

We hypothesized that tumor- and hospital-level factors, compared with surgeon characteristics, are associated with the majority of variation in the 12 or more lymph nodes (LNs) examined quality standard for resected colon cancer. A dataset containing an anonymized surgeon identifier was obtained from the National Cancer Database for stage I to III colon cancers from 2010 to 2017. Multilevel logistic regression models were built to assign a proportion of variance in achievement of the 12 LNs standard among the following: (1) tumor factors (demographic and pathologic characteristics), (2) surgeon factors (volume, approach, and margin status), and (3) facility factors (volume and facility type). There were 283,192 unique patient records with 15,358 unique surgeons across 1,258 facilities in our cohort. Achievement of the 12 LNs standard was high (90.3%). Achievement of the 12 LNs standard by surgeon volume was 88.1% and 90.7% in the lowest and highest quartiles, and 86.8% and 91.6% at the facility level for high and low annual volume quartiles, respectively. In multivariate analysis, the following tumor factors were associated with meeting the 12 LNs standard: age, sex, primary tumor site, tumor grade, T stage, and comorbidities (all p < 0.001). Tumor factors were responsible for 71% of the variation in 12 LNs yield, whereas surgeon and facility characteristics contributed 17% and 12%, respectively. Twenty-nine percent of the variation in the 12 LNs standard is linked to modifiable factors. The majority of variation in this quality metric is associated with non-modifiable tumor-level factors.

Microsurgical treatment of ruptured intracranial aneurysms: An Ethiopian experience

IntroductionIn this ambispective cohort study, the authors share their experience with surgical outcomes of intracranial aneurysms in a resource-limited setting. MethodsThe study spans a 10-year period (January 2010 to December 2022) at Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. Patient data, aneurysm characteristics, preoperative, intraoperative, and postoperative factors, along with patient outcomes, were collected using a structured questionnaire. Data analysis employed SPSS version 25, utilizing descriptive statistics and Multivariable logistic regression to identify independent predictors of outcomes. The primary outcome measure was the Glasgow Outcome Scale (GOS) at discharge. ResultsThe study included 71 patients with ruptured intracranial aneurysms, with 63 aneurysms clipped in 62 patients. No sex predilection was observed. Aneurysms were predominantly in the anterior cerebral circulation (98.6%), with 60.6% in the anterior communicating artery. Aneurysm size was less than 10 mm in 75.76% of cases. Favorable outcomes were achieved in 83.9% of patients, while 16.10% had unfavorable outcomes. Unfavorable outcomes correlated with a worsening neurological grade assessed by the Glasgow Coma Scale (GCS). The occurrence of delayed vasospasm and hemiparesis showed strong predictive value. ConclusionThe study demonstrated acceptable mortality and favorable outcomes. Patient outcomes in ruptured cerebral aneurysms were primarily influenced by non-modifiable factors, such as GCS on admission and neurological deficit. GCS exhibited a superior predictive value for outcomes compared to commonly used WFNS and Hunt–Hess scales in patients with intracranial aneurysms.

Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry.

Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation. The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72h) vs. success (no receipt of dialysis for ≥ 72h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation. A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]). Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.

Does Inclement Weather Increase the Risk of Cardioembolic Stroke in Kashmir Valley?

Background Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather. Results A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures. Conclusion Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.