Odds Ratio Research Articles

To assess the incidence, risk factors, causative microorganisms, and outcomes of post-keratoplasty infectious keratitis (PKIK), considering the differences in the type of keratoplasty and potential geographical variations. Electronic searches were conducted in four databases (PubMed/MEDLINE, Cochrane, Scopus, and Wiley) for studies reporting PKIK from 2009 to 2024. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eight studies were eligible for final analysis. The cumulative incidence of PKIK ranged from 1.80% to 18.77%. Compared to penetrating keratoplasty, endothelial keratoplasty showed a trend towards a lower risk of PKIK (log odds ratio - 1.33, 95% confidence interval (CI): - 2.96-0.30, p = 0.108). While gram-positive bacteria were the most common pathogens found to cause PKIK, it was estimated that 21% (95% CI 9-33%) of cases were attributed to fungal infections. Visual inspection of the plots indicates no influence of the geographical study site on the proportion of fungal infections. Several risk factors for PKIK were also identified. Severe visual impairment was commonly observed following treatment of PKIK. Topical quinolone can be used as first-line therapy despite the increasing antibiotic resistance rate of pathogens. In the last 15years, the cumulative incidence of PKIK has remained relatively low. Endothelial keratoplasty showed a trend towards a lower risk of PKIK compared to penetrating keratoplasty, with gram-positive bacteria remaining the predominant cause.

N-terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of cardiac stress, has been proposed as a potential prognostic biomarker for maternal adverse outcome in pre-eclampsia (PE). This study aimed to evaluate the predictive value of NT-proBNP for severe maternal adverse outcome in pregnancies with an established diagnosis of PE. This was a retrospective cohort study of singleton pregnancies diagnosed with PE ≤ 36 weeks of gestation that were assessed at the Medical University of Vienna between January 2018 and December 2023. Maternal serum levels of NT-proBNP, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured at the time of PE diagnosis. The primary outcome was the occurrence of a severe maternal adverse event, including intensive care unit admission, maternal death, pulmonary edema and severe neurological complications. Associations between severe maternal adverse outcome and Z-scores for NT-proBNP and the sFlt-1/PlGF ratio were analyzed using logistic and Cox regression models adjusted for gestational age at sampling and the Z-score of the other biomarker. The area under the receiver-operating-characteristics (ROC) curve (AUC) was used to assess the discriminative ability of the biomarkers. Of 130 women included in our cohort, 13 (10%) experienced severe maternal adverse outcome. NT-proBNP levels were significantly higher in this group (median, 688.0 (interquartile range (IQR), 249.6-1038.0) pg/mL vs 106.1 (IQR, 50.6-280.6) pg/mL; P < 0.001). Higher NT-proBNP Z-score was associated significantly with severe maternal adverse outcome (adjusted odds ratio, 3.24 (95% CI, 1.50-7.84); P = 0.005) and predicted shorter time-to-delivery with severe maternal adverse outcome(adjusted hazard ratio, 3.08 (95% CI, 1.47-6.44); P = 0.003) after adjusting for gestational age at sampling and sFlt-1/PlGF ratio Z-score. The sFlt-1/PlGF ratio was not associated significantly with these outcomes. ROC-curve analysis showed that NT-proBNP had superior discriminative performance compared with the sFlt-1/PlGF ratio (AUC, 0.75 (95% CI, 0.61-0.90) vs 0.67 (95% CI, 0.56-0.79)). The performance of both biomarkers improved when combined with gestational age at sampling (AUC, 0.82 (95% CI, 0.71-0.94) vs 0.76 (95% CI, 0.65-0.88)). NT-proBNP was a strong predictor of severe maternal adverse outcome and time-to-delivery in women diagnosed with PE, especially in early-onset cases. NT-proBNP may serve as a clinically accessible biomarker for risk stratification and surveillance in women with established PE. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

ABSTRACT Tobacco use is the leading cause of oral cancer worldwide, with India accounting for nearly one-third of the global oral cancer burden. Regular oral cancer screening (OCS) is crucial for early detection among tobacco users. This study examines how information, motivation, and behavioral (IMB) factors affect OCS behavior among tobacco users in Western India. In a cross-sectional study, 332 current tobacco users were recruited during 2023–2024 from a dental hospital and 15 dental camps in Daman, India. Using multivariable logistic regression and Structural Equation Modeling (SEM) analyses, we examined the association between IMB factors and OCS behavior. Only 8.73% of participants reported undergoing OCS. Higher OCS uptake was significantly associated with greater information about oral cancer risk factors, signs, symptoms, and screening [adjusted Odds Ratio (aOR) = 1.17, 95% confidence interval (CI): 1.08 to 1.26, p = 0.001]; personal motivation (aOR = 1.23, 95% CI: 1.12 to 1.35, p < 0.001); intention (aOR = 1.44, 95% CI: 1.11 to 1.88, p = 0.005) and objective skills (aOR = 2.14, 95% CI: 1.63 to 2.82, p < 0.001). The SEM analysis revealed that objective skills had a direct positive effect on OCS behavior, while information, personal motivation, social motivation and/or intention positively influenced OCS indirectly through objective skills and self-efficacy. These findings underscore the importance of IMB factors and need for public health interventions that enhance information, personal motivation, intention and objective skills. Strengthening these factors can improve OCS uptake, facilitating early oral cancer detection and prevention among tobacco users.

Oral mucositis (OM) is a frequent and debilitating complication of chemotherapy, yet little is known about its burden and management in Sudan. Therefore, this study aimed to determine the prevalence, characteristics, management, and factors associated with OM. A hospital-based cross-sectional study was conducted from April to June 2022 at Khartoum Oncology Hospital, Sudan, among chemotherapy patients, with OM severity graded per the World Health Organization criteria. The data were analyzed using SPSS version 27. Among the 340 patients, 258 (75.9%) were female, and 128 (37.6%) were aged 45-59 years. OM occurred in 127 (37.4%) patients, mostly with generalized lesions (96; 75.6%) and Grade 3 severity (76; 59.8%). Common complications included inability to eat (75; 59.1%) and taste changes (69; 54.3%). Only 36 (28.3%) patients received prescription medication, mainly miconazole gel (17; 47.2%); pain management was provided to 12 (11.5%) patients, and dental interventions were provided to two (0.6%) patients. In multivariable logistic regression, age (p = 0.035) and number of chemotherapy doses (p < 0.001) remained independent predictors, with lower odds for four to six doses (aOR (adjusted odds ratio) 0.152; 95% CI (confidence interval) 0.087-0.268), seven to ten doses (aOR 0.033; 95% CI 0.009-0.121), and more than ten doses (aOR 0.045; 95% CI 0.004-0.484) than for one to three doses. OM is moderately prevalent but often severe among Sudanese chemotherapy patients, with inadequate management and poor adherence to evidence-based practice. Implementing standardized oral care, clinician training, and patient education could reduce its burden and improve outcomes.

The long-term impact of COVID-19 vaccination on post-acute COVID-19 symptoms and associated quality of life (QoL) changes remains incompletely described. This study aimed to explore the impact of the timing of COVID-19 priming and booster doses, on reporting long COVID symptoms and associated QoL changes. Individuals who had PCR testing for SARS-CoV-2 processed in government hospitals in Northern Israel between 15th March 2021 and 15th June 2022 were invited to answer serial online surveys collecting information on SARS-CoV-2 infection, vaccination status and post-acute symptoms every 3-4 months for two years. Participants were categorized into groups based on the number of doses received prior to infection. We compared these groups over time in terms of reporting post-COVID symptom clusters and QoL, using population-average and mixed-effects regression models, respectively. A total of 4809 individuals are enrolled and respond to up to five follow-up surveys. Of these, 1377 (28.61%) report a positive SARS-CoV-2 test, while 3432 (71.39%) report a negative result. After adjustment for potential confounders, receiving at least three COVID-19 vaccine doses prior to infection is associated with a 34% reduction in the likelihood of reporting at least one long COVID symptom cluster compared to being unvaccinated (adjusted odds ratio [aOR] = 0.66, p = 0.022). Pre-infection vaccination is also associated with higher quality of life (QoL) scores (β = 0.07, p < 0.001). The estimated vaccine effectiveness of three pre-infection doses against long COVID over a two-year period is 26.5% (95% CI: 10.8-39.4). This protective effect remains stable over time. In contrast, vaccination received after infection shows no association with long COVID symptoms or QoL outcomes. Receiving at least three COVID-19 vaccine doses prior to SARS-CoV-2 infection provides a sustained protective effect against long COVID and its negative impact on quality of life for at least two years. The longer-term durability of this protection, the role of reinfection, and the influence of emerging viral variants remains to be investigated.

Objective While previous studies identified increased perinatal risks with younger age (18 years or younger) at childbirth, less is known about postpartum outcomes. This study examined postpartum outcomes in a first birth (primiparous) cohort of younger individuals compared to a standard risk population (age 25-30 years). Study Design A retrospective cohort study compared postpartum outcomes in primiparous patients 18 years or younger (n=520) compared to those aged 25-30 years (n=558). Outcomes are presented as adjusted odds ratios (aOR) to account for age related associations with race, and tobacco exposure. Results Younger birthing aged primiparous were more likely to be prescribed contraception at the time of hospital discharge (34.4% vs. 16.5%, aOR 2.07) than primiparous patients of a standard risk age (25-30 years at birth). They were also less likely to be breastfeeding at hospital discharge (78.4% vs. 97.1%, aOR 0.09). Additionally, younger patients were significantly less likely to attend postpartum visits (39.4% vs. 47.1%, aOR 0.67), although both groups had less than half of participants attending postpartum visits. Differences identified at hospital discharge persisted during postpartum care contraception use (87.2% vs. 77.8%, aOR 2.43) and breastfeeding (44.9% vs. 87.2%, aOR 0.12). There was also a trend in standardized postpartum depression screening, with 60.0% of the younger group screened, and 71.4% of the standard risk group screened. Conclusion Younger birthing age at first birth is associated with lower breastfeeding rates and higher contraception use, compared to primiparous standard risk patients. Furthermore, younger birthing patients appear to have a decreased rate of standardized screening for postpartum depression, although screening rates are low across groups. These data may help tailor birthing and postpartum programs to better address specific risks for younger patients.

Surgical-site infections (SSIs) represent a prevalent postoperative complication. Traditional antiseptics, such as povidone-iodine and chlorhexidine-alcohol, have demonstrated efficacy in diminishing SSIs incidence. A 1.5% aqueous olanexidine, a novel disinfectant, has shown superior bactericidal potency compared with 10% povidone-iodine in gastrointestinal surgery. However, no studies have compared the potential utility of 1.5% aqueous olanexidine with 10% povidone-iodine in neurosurgery. We aimed to evaluate the efficacy of 1.5% aqueous olanexidine and identify risk factors of SSIs in contemporary neurosurgery. We retrospectively analyzed data from patients who underwent neurosurgery between 2016 and 2022. SSIs were categorized as wound infection/epidural abscess and meningitis/brain abscess. All SSIs were defined as wound infection/epidural abscess or meningitis/brain abscess. We examined associations between SSIs and variables, such as age, sex, medical history, operation time and group, cerebrospinal fluid (CSF) leakage, emergent surgery, and use of 1.5% aqueous olanexidine. We retrospectively analyzed 1393 cases. Wound infection/epidural abscess occurred in 17 cases (1.2%), meningitis/brain abscess in 39 (2.8%), and all SSIs in 53 (3.8%). The incidence of all SSIs was 3.1% with 1.5% aqueous olanexidine and 5.8% with 10% povidone-iodine (P = .024). Although 1.5% aqueous olanexidine was not independently associated with wound infection/epidural abscess in multivariable analysis, its use was significantly inversely associated with all SSIs (adjusted odds ratio: 0.53; 95% CI: 0.28-0.99). CSF leakage was significantly associated with both wound infection/epidural abscess (17.43; 2.93-103.58) and meningitis/brain abscess (102.83; 18.09-584.56). Shunt, CSF drainage, and cranioplasty were associated with wound infection/epidural abscess (3.47; 1.29-9.37), meningitis/brain abscess (4.79; 2.28-10.08), and all SSIs (8.57; 3.20-22.92). Operation time was significantly associated with all SSIs (3.24; 1.20-8.72). Compared with 10% povidone-iodine, 1.5% aqueous olanexidine may be associated with the prevention of some SSIs in neurosurgical procedures.

Characterizing an intersection between heat-related illness and overdose deaths in Arizona: Analysis of data from the State Unintentional Drug Overdose Reporting System, 2019-2023.

This study aimed to compare the renal protective effects and safety profile of finerenone plus sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy versus monotherapy in patients with IgA nephropathy. The retrospective study evaluated 76 patients with biopsy-proven IgA nephropathy at the First Affiliated Hospital of Zhengzhou University (2023-2024). Participants were divided into three groups: finerenone plus SGLT2i group (n=26), finerenone monotherapy group (n=32), and SGLT2i monotherapy group (n=18). Changes in urinary protein-to-creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) at 3 and 6 months were evaluated. Safety assessments focused on hyperkalemia incidence and treatment-emergent adverse events. The combination therapy demonstrated superior proteinuria reduction compared to monotherapies, with median UPCR reductions of 40.89% at Month 3 and 54.62% at Month 6 versus 23.72%/30.88% (finerenone) and 24.69%/24.69% (SGLT2i) (all P<0.05). Significantly more patients achieved≥50% UPCR reduction in finerenone plus SGLT2i group at Month 6 (53.8%vs 25.0% and 22.2%, P=0.033). Logistic regression analysis demonstrated adjusted odds ratios ranging from 3.87 to 18.90 for finerenone plus SGLT2i therapy achieving≥50% proteinuria reduction (all P<0.05). Renal function parameters remained stable in all treatment groups without significant intergroup differences (all P>0.05). The safety profile showed comparable hyperkalemia incidence rates between groups (P=0.332). No severe adverse events or treatment withdrawals attributable to hyperkalemia were observed. Our study shows that combined finerenone-SGLT2i therapy has a more rapid and superior proteinuria reduction versus monotherapy in IgA nephropathy, with preserved renal function and good safety.

An increasing number of women of childbearing age are treated for attention-deficit hyperactivity disorder (ADHD). Limited evidence exists on risk of pregnancy loss associated with ADHD medication use in early pregnancy. To assess whether ADHD medication use during pregnancy is associated with increased risk of miscarriage. We conducted a nationwide, register-based, case-control study, using linked Norwegian data from Medical Birth Registry of Norway, Norwegian Patient Registry, Norwegian Control and Payment of Health Reimbursements Database and Norwegian Prescription Database. Among pregnant women with ADHD, those with miscarriage (n = 2993 cases) were matched with up to four live births (n = 10 305 controls) by maternal age and year of conception. ADHD medication exposure during pregnancy was defined as any use (one or more filled prescriptions) and categorised into tertiles of total defined daily doses (DDDs) as a proxy for dose. The main outcome was miscarriage (pregnancy loss before 20 weeks). Conditional logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals, adjusting for psychiatric comorbidities, psychotropic and teratogenic medications, and maternal age at conception. Of 13 298 pregnancies, 1389 (10.5%) were exposed to ADHD medications. Any ADHD medication use was associated with increased miscarriage risk (aOR 1.60, 95% CI 1.41-1.83). Methylphenidate (aOR 1.55, 95% CI 1.35-1.79), lisdexamfetamine (aOR 1.81, 95% CI 1.06-3.10) and atomoxetine (aOR 2.34, 95% CI 1.41-3.89) were associated with increased risks. Higher levels of medication exposure, categorised by DDD tertiles, were associated with increased odds of miscarriage, increasing from 1.14 (95% CI 0.91-1.42) for the lowest tertile to 2.11 (95% CI 1.71-2.60) for the highest. ADHD medication use during pregnancy is associated with increased miscarriage risk. However, filled prescriptions may not reflect actual use. Further research is needed to clarify these associations and refine risk estimates.

The uric acid (UA) to HDL-cholesterol ratio (UHR) has recently been proposed as a novel marker of cardiometabolic and inflammatory risk. This study aimed to investigate the association between UHR and infertility in U.S. women of reproductive age. We analyzed data from 2447 women aged 18 to 45 years in the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018 cycles. The primary outcome - infertility - was assessed based on self-reported responses from the reproductive health questionnaire of the National Health And Nutrition Examination Survey dataset, and was not clinically validated. UHR was calculated as the ratio of serum UA to HDL-C. Multivariable logistic regression models were constructed to evaluate the association between UHR and infertility risk. Women with infertility had significantly higher mean age, body mass index, UA levels, and log (UHR) values compared to non-infertile participants (all P <.01). In the fully adjusted model, each unit increase in log-transformed UHR was associated with a higher odd of infertility (OR = 2.04, 95% CI: 1.28-3.27, P = .01). Compared with the lowest quartile of UHR, the adjusted odds ratios for infertility were 1.72 (95% CI: 1.09-2.72) for Q2, 1.91 (95% CI: 1.17-3.12) for Q3, and 1.98 (95% CI: 1.15-3.41) for Q4 (P for trend = .017). Subgroup analyses revealed consistent associations across women aged ≥35 years, those living with a partner, never-smokers, women without diabetes mellitus or hypertension, and those with regular menstrual periods or a history of pelvic infection, although no significant interactions were observed. Elevated UHR is associated with an increased risk of infertility in reproductive-aged women, as observed in this cross-sectional analysis. However, due to the study's cross-sectional nature, causality cannot be inferred, and further prospective studies are needed to validate these findings.

Thrombocytopenia is a common haematological abnormality in malaria patients, increasing the risk of mortality in both children and adults with Plasmodium falciparum and Plasmodium vivax infections. In Rwanda, data on the prevalence and associated factors of severe thrombocytopenia in malaria patients are limited. This study aimed to determine the prevalence and factors associated with severe thrombocytopenia among hospitalized patients with malaria attending Kigeme District Hospital, Southern Province, Rwanda. A cross-sectional study was conducted from December 2023 to November 2024 among malaria patients at Kigeme District Hospital, Rwanda. Using simple random sampling, 124 patients were selected while ensuring confidentiality throughout data collection, analysis, and reporting. Data were gathered via a structured form in Kobo Toolbox and later processed in Microsoft Excel. Information on demographic, clinical characteristic and laboratory investigations considered were those collected during the time of patients admission to the hospital. Binary logistic regression was employed to assess associations, with variables showing a p-value < 0.05 in bivariate analysis included in the multivariable model. Adjusted odds ratios (AOR) with 95% confidence intervals were computed, and statistical significance was set at p-value < 0.05. The study has shown that severe thrombocytopenia was 27.4% among patients with malaria. Factors associated with severe thrombocytopenia among patients with malaria were age group less or equal to 5years old (AOR = 5.17, 95%CI 1.674-16.259, p = 0.004), type infecting Plasmodium species (AOR = 3.4, 95%CI 2.41-8.3, p = 0.04) positive C-Reactive Protein (AOR = 3.45, 95%CI 2.23-3.56, P = 0.045), jaundice (AOR = 2.875, 95% CI 1.36-26.5, p = 0.045), epistaxis (AOR = 1.84, 95% CI 1.73-2.43, p = 0.042), high serum urea (AOR = 1.73, 95% CI 1.23-1.83, p = 0.001). On the other hand, patients with coma status (cerebral malaria) (AOR = 0.189, 95% CI 0.137-0.985, p = 0.028, Delay to seek medical care (AOR = 0.393, 95% CI 0.043-1.125, p = 0.082) were less likely associated with severe thrombocytopenia. This cross-sectional study found a 27.4% prevalence of severe thrombocytopenia in malaria patients. Key associated factors included less or equal to 5years old, positive C-reactive protein, type of Plasmodium infecting species, jaundice, epistaxis, and high serum urea levels, while cerebral malaria linked to a lower likelihood of thrombocytopenia. This highlight the need for early identification severe thrombocytopenia among severe malaria patients who are at high likelihood suffering severe thrombocytopenia. Further longitudinal studies are recommended to better understand the predictive value of these factors and their role in guiding clinical management.

Context Social science research, particularly qualitative data collection, is vital in wildlife conservation science. Aims While large representative samples are valuable, scaling qualitative data collection is often challenging due to its cumbersome nature. Therefore, it is necessary to explore the effectiveness of less time-intensive approaches. Methods This study explores the use of word association (three words to describe sharks) as qualitative data, analysed using both automated statistical tools in R Studio and manual content analysis. We employed word clouds, sentiment analysis, latent Dirichlet allocation, log-odds ratio, and content analysis to analyse 1006 words from 371 participants. Key results Results indicated that word clouds, sentiment analysis, and log-odds ratio were effective, while manual content analysis was better for categorising words than latent Dirichlet allocation. Conclusion Given the low participant burden, similar items should be considered in future surveys exploring human perceptions of wildlife contexts.

Cannabis use is associated with psychiatric comorbidities, and the use of elta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) produces different neurophysiological and pharmacological effects. This study estimated the strength of associations between vaping of THC and CBD with depressive and anxiety symptoms in adolescents. Observational data were drawn from three years of the nationally representative US National Youth Tobacco Survey (2021-2023). The survey adopted a probabilistic stratified, three-stage cluster design. The United States. A total of 69 899 adolescents aged 11 to 18, with 51.3% males. CBD and THC cannabis vaping behaviours; Patient Health Questionnaire 2-item and Generalised Anxiety Disorder 2-item, which respectively assess depressive and anxiety symptoms. Logistics regression analyses were conducted after multiple imputation and adjusting for covariates. Relative to those who did not vape, adolescents who vaped THC only [adjusted odds ratio (aOR) = 1.40, 95% confidence interval (CI) = 1.20-1.64] or dual CBD/THC (aOR = 1.51, 95% CI = 1.22-1.86) were more likely to experience depressive symptoms; whereas those who vaped CBD only (aOR = 1.74, 95% CI = 1.24-2.46) or THC only (aOR = 1.18, 95% CI = 1.01-1.38) were more likely to experience anxiety symptoms. When the sample was restricted to adolescents who had vaped cannabis products, those who only vaped CBD had a higher likelihood of experiencing anxiety symptoms (aOR = 1.51, 95% CI = 1.05-2.17), relative to those who exclusively vaped THC. Among adolescents, Δ-9-tetrahydrocannabinol (THC) vaping and dual THC/cannabidiol vaping might be associated with an increased risk of experiencing depressive symptoms. In contrast, adolescents who vape cannabidiol may have a higher likelihood of experiencing anxiety symptoms.

Background In spontaneously breathing preterm infants, less invasive strategies, such as continuous positive airway pressure (CPAP) and less invasive surfactant administration, have been increasingly implemented to reduce lung injury. In 2018, our center initiated a noninvasive neonatal resuscitation protocol incorporating these approaches as quality improvement (QI) initiatives. We aimed to evaluate the feasibility, safety, and effectiveness of this protocol by comparing respiratory outcomes before and after its implementation. Methods We retrospectively reviewed the medical records of 578 infants born at 25 + 0 to 29 + 6 weeks of gestation between 2014 and 2022 at Samsung Medical Center. Infants born in 2018 and those with severe congenital anomalies, delivery room deaths, or outborn status were excluded. The study population was divided into Period 1 (2014–2017, before noninvasive protocol implementation) and Period 2 (2019–2022, after protocol implementation) to assess the impact of QI initiatives on neonatal resuscitation practices. The year 2018 was excluded from the analysis as it represented a transitional period. We analyzed the rate of endotracheal intubation at birth and other respiratory outcomes, such as CPAP failure and bronchopulmonary dysplasia (BPD). Results The rate of initial intubation was significantly lower in Period 2 than in Period 1 [77.0% vs. 45.9%; adjusted odds ratio (aOR), 0.24; 95% confidence interval (CI), 0.15–0.40; P &amp;lt; 0.001], with declines observed across all gestational groups, particularly among infants ≥26 weeks’ gestation. The rate of postnatal steroid use for BPD prevention was also significantly lower in Period 2 (50.0% vs. 15.3%, aOR, 0.12; 95% CI, 0.07–0.21; P &amp;lt; 0.001). In Period 2, among 68 infants initially managed with CPAP during Period 2, 15 (22.1%) experienced CPAP failure within 48 h, and 24 (35.3%) experienced failure at any time during hospitalization. Despite these failures, no significant differences in the incidence of BPD, duration of invasive ventilation, or mortality were observed between the two periods. Conclusions Our findings suggest that even in extremely preterm infants, a noninvasive resuscitation strategy is feasible, associated with reduced postnatal steroid use, and does not worsen major neonatal outcomes, supporting its use as a viable alternative for those who do not require immediate intubation.

Depression is common in the elderly and has been linked with poor tuberculosis treatment outcomes. We conducted a prospective multicenter cohort study of adult aged ≥ 65 years with active tuberculosis in the Republic of Korea between 2020 and 2022. Sociodemographic and clinical data were obtained by interview. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with a score ≥10 indicating a depressive episode. Logistic regression analyses were conducted to identify factors associated with depressive episodes and evaluate their association with treatment outcomes. Among the 361 elderly individuals with active tuberculosis who completed the questionnaire, 69 (19.1%) were classified as having a depressive episode. Depressive episodes were significantly associated with unemployment, higher comorbidity burden, and the presence of tuberculosis-related symptoms such as cough and constitutional symptoms. Functional impairment was reported in 39.6% (143/361) of all participants and increased with the greater severity of depressive symptoms. Suicidal ideation was observed in 19.7% (71/361) of all participants and was independently associated with alarming tuberculosis symptoms. Among the participants with rifampin-susceptible tuberculosis, those with depressive episodes had significantly lower treatment success rates (64.7% vs. 79.1%, p = 0.012). In multivariable logistic regression analysis, depression remained independently associated with reduced odds of treatment outcomes (adjusted odds ratio, 0.478; 95% confidence interval, 0.261-0.878). In elderly individuals with tuberculosis, depressive episodes are associated with functional impairment, suicidal ideation, and poor treatment outcomes. Routine mental health assessments at tuberculosis diagnosis may help improve clinical outcomes in aging populations.

The role of postoperative tibial sesamoid position (TSP) in hallux valgus (HV) recurrence remains controversial, and studies on its impact after third-generation minimally invasive HV surgery are limited. This study analyzed the association between postoperative TSP and outcomes after minimally invasive transverse distal metatarsal osteotomy (MITO) for HV correction. This retrospective cohort study included 118 patients who underwent MITO between July 2018 and August 2022 with ≥24 months of follow-up. Patients were grouped by 1-month postoperative TSP based on Hardy and Clapham classification (grades I-III: normal; grades IV-VII: outlier). Clinical outcomes were assessed using visual analog scale pain scores, Foot and Ankle Outcome Scores, and Medical Outcomes Study Short Form Health Survey-36 physical component summary scores. Radiologic evaluation included hallux valgus angle (HVA), first-to-second intermetatarsal angle (1-2 IMA), and TSP measurements. Recurrence and complications were also analyzed. This study analyzed 165 feet (normal: 122 feet; outlier: 43 feet) with a mean follow-up of 35.6 months (range, 24-70 months). The outlier group showed consistently greater HVA (43.8 degrees vs 32.7 degrees preoperatively; 8.7 degrees vs 4.8 degrees at 1 month; 12.8 degrees vs 5.1 degrees at last follow-up), 1-2 IMA (15.6 degrees vs 13.0 degrees preoperatively; 5.7 degrees vs 3.7 degrees at 1 month; 6.6 degrees vs 4.5 degrees at last follow-up), and TSP (7 vs 6 preoperatively; 4 vs 2 at 1 month; 5 vs 2 at last follow-up) at all time points (all P < .001), with greater HVA increase from 1 month postoperatively to last follow-up (P < .001). Functional scores improved similarly in both groups. On multivariable analysis, an outlier TSP at 1 month independently predicted recurrence (adjusted odds ratio 13.24, 95% CI 3.40-51.58), with good discrimination (area under the curve 0.838). Recurrence (P < .001) and reoperation rates for symptomatic recurrence (P = .017) were significantly higher in the outlier group. Postoperative TSP on anteroposterior standing radiographs at 1 month after surgery was associated with HV recurrence after MITO surgery. Precise correction of TSP may be essential to reduce the likelihood of HV recurrence.

Purpose This study aimed to develop and validate the Carbapenem-Resistant Acinetobacter baumannii Risk Scoring System (CRAB-RSS), a novel predictive model designed to assess the risk of carbapenem-resistant A. baumannii (CRAB) infection in intensive care unit (ICU) patients. Methods A retrospective cohort analysis was performed on 412 patients (315 with CRAB and 97 with carbapenem-susceptible A.baumannii [CSAB]) from 2020 to 2024. Three independent risk factors were identified: mechanical ventilation (adjusted odds ratio [aOR] = 3.2, 95% confidence interval [CI]: 1.8–5.6), prior carbapenem exposure (≥48 hours; aOR = 1.89, 95% CI: 1.32–2.71), and hospitalization duration exceeding 14 days (aOR = 1.67, 95% CI: 1.25–2.23). Results The model demonstrated robust discriminative ability, with an area under the receiver operating characteristic curve (AUROC) of 0.887 in the derivation cohort and 0.918 in the validation cohort, along with satisfactory calibration (Brier score: 0.094 versus 0.088). Its performance was significantly superior to that of the Sequential Organ Failure Assessment (SOFA) score (ΔAUROC = +0.21). Conclusions CRAB-RSS is a quantitative risk stratification tool derived from a single-center cohort for CRAB infections in intensive care unit patients, demonstrating superior performance to SOFA in local validation. External multicenter validation is warranted before broad clinical implementation. Its innovative features include: (1) a fixed-weighting design (e.g., assigning a baseline score of 2 points for mechanical ventilation), and (2) reliance on only three readily obtainable clinical variables to complete the assessment. Decision curve analysis revealed that the application of CRAB-RSS could reduce unnecessary carbapenem use by 28%–42% across probability thresholds of 10%–30%, with a maximum reduction of 38% achieved at the 20% threshold.

Expressed emotion is an attitude, feeling, and emotional reaction of primary caregivers toward people with schizophrenia. High levels of expressed emotion in primary caregivers are linked to a higher relapse rate in those with schizophrenia than in families with low levels of expressed emotion. Despite the critical role of caregivers in the management of schizophrenia, there is limited research on their expressed emotions in eastern Ethiopia. To assess expressed emotions and associated factors among primary caregivers of people with schizophrenia receiving treatment at public hospitals in Harari Regional State and Dire Dawa Administrative City from June 1 to June 30, 2024. A hospital-based, cross-sectional study was conducted among 414 participants at public hospitals in Harari Regional State and Dire Dawa city Administrative. A systematic sampling method was used to select study participants. The expressed emotions were assessed via family questionnaires. Data entry and analysis were performed via Epi-Data 4.6 and STATA version 14, respectively. Bivariable and multivariable logistic regression were used to evaluate the associations between independent and outcome variables. Variables with p values < 0.05 were considered statistically significant, and adjusted odds ratios and 95% confidence intervals were used to determine the strength of the associations. The prevalence of highly expressed emotions in this study was 48.31% (95% CI 43.51-53.14%). A duration of caregiving of more than 8 years (AOR 2.74; 95% CI 1.02, 7.33), severity of illness (AOR 3.45; 95% CI 1.89; 6.28), severe burden (AOR 4.34; 95% CI 2.03, 9.28), perceived stigma (AOR 2.59; 95% CI 1.53, 4.41), and poor social support (AOR 3.54; 95% CI 1.74, 7.19) were significantly associated with highly expressed emotion. This study revealed that the prevalence of expressed emotion is significantly high. The duration of caregiving; perceived stigma, burden, and severity of illness; and social support of the study participants were significantly associated with expressed emotion. Promote policies that ensure better coordination of care between mental health professionals, primary care providers, and social services to create a more comprehensive care plan.

This study aimed to evaluate the impact of antenatal corticosteroid (ACS) administration prior to delivery on neonatal outcomes in extreme preterm neonates delivered between 21 and 23 weeks of gestation.This retrospective cohort study used data from the National Center for Health Statistics Vital Statistics database. Linked birth and infant death data files from 2015 to 2021 were included in the analysis. The study included singleton, nonanomalous pregnancies that were delivered between 21 and 24 weeks of gestation. Analysis was limited to births with known ACS status. The outcomes of interest were infant mortality, 5-minute Apgar score < 6, and neonatal intensive care unit admission. Univariate analysis was performed to determine the association between exposure and outcome. Logistic regression analysis was performed to determine the association, adjusting for potential confounders.There were 50,671 births included in the analysis. In this group, 15,601 (31%) received ACS prior to delivery. ACS administration prior to delivery was associated with lower neonatal death rate between 21 and 24 weeks (32.9 vs. 56.1%, p < 0.0001, adjusted odds ratio [aOR]: 0.53 [0.51-0.56]). Sub-analysis based on delivery at each gestational week demonstrated a protective effect at 21 weeks (70.1 vs. 80.7%, p = 0.001, aOR: 0.56 [0.34-0.91]); at 22 weeks (54.1 vs. 75.9%, aOR: 0.40 [0.35-0.47]); at 23 weeks (39.1 vs. 50.9%, aOR: 0.65, aOR [0.61-0.70]); and at 24 weeks (24.6 vs. 30.1%, aOR: 0.78 [0.73-0.83]).ACS administration in extreme preterm neonates born between 21 and 24 weeks was associated with improved survival. · ACSs lowered neonatal death from 56.1 to 32.9% at 21 to 24 weeks.. · Greatest survival benefit was seen at 22 weeks with a 60% risk reduction.. · ACSs were linked to higher use of ventilation, surfactant, and antibiotics..