One-year Increase In Age Research Articles

COVID-19 in-hospital mortality during the first two pandemic waves, at Helen Joseph Hospital, South Africa.

there has been significant global variation in Coronavirus Disease (COVID-19) mortality at different time points in the pandemic. Contributing factors include population demographics, comorbidities, health system capacity, prior infection with COVID-19, vaccinations, and viral variants. The study aims to describe COVID-19-related mortality of inpatients at Helen Joseph Hospital (HJH), over 12 months, during the first two waves of the COVID-19 pandemic in South Africa. The primary objectives were to describe the socio-demographic details, clinical characteristics, and hospital outcomes during the first and second waves of COVID-19. This included an assessment of the in-hospital case fatality ratio (CFR) of patients admitted with COVID-19. The secondary objectives were to compare the socio-demographic details, clinical characteristics, and outcomes between the two waves, and to determine risk factors associated with COVID-19-related mortality. this is a retrospective cohort study of all inpatient laboratory-confirmed COVID-19 cases at HJH from 1st May 2020 to 31st April 2021. Data were collected by the National Institute for Communicable Diseases (NICD). Bivariate analysis was performed to describe and compare the socio-demographic characteristics, clinical characteristics, and hospital admission outcomes between the two waves. Multivariate logistic regression was used to determine risk factors for COVID-19-related mortality. overall, 1359 patients were admitted, 595 in wave one, and 764 in wave two. Patients were predominantly male (52.4%), of Black African race (75.1%) with a mean age of 54.6 (standard deviation 15.4) years. The median length of stay was 8 days (interquartile range 5-14 days). In total, 73.2% (995) of patients required oxygen, 5.2% (71) of patients received mechanical ventilation, and 7.1% (96) were admitted to the high care and Intensive Care Unit (ICU). The most common comorbid illnesses were hypertension (36.7%, n=499), diabetes mellitus (26.6%, n=362), Human Immunodeficiency Virus (HIV) (10.8%, n=147), and obesity (11.0%, n=149). The in-hospital CFR during the first wave was 30.4% (181/595) and 25.5% (195/764) (p<0.001) in the second wave, and overall, in-hospital CFR was 27.7% (376/1359). The adjusted odds of death were 79% higher among patients admitted during wave one compared to wave two (aOR=1.79; 95% CI: 1.35-2.38). A one-year increase in age increased the odds of death by 4% (aOR=1.04; 95% CI: 1.03-1.05). The need for oxygen (aOR=2.17, 95%CI: 1.56-3.01) and ventilation (aOR=7.23, 95% CI: 4.02-13.01) were significant risk factors for mortality. prior to the availability of vaccines, COVID-19-related mortality was high and risk factors for mortality were consistent with national and international findings. This study reflects the impact of the pandemic on the South African public sector with limited resources and minimal ICU capacity.

Anesthetic management for transcatheter aortic valve replacement: A national anesthesia clinical outcomes registry analysis.

General anesthesia has traditionally been used in transcatheter aortic valve replacement; however, there has been increasing interest and momentum in alternative anesthetic techniques. To perform a descriptive study of anesthetic management options in transcatheter aortic valve replacements in the United States, comparing trends in use of monitored anesthesia care versus general anesthesia. Data evaluated from the American Society of Anesthesiologists' (ASA) Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry. Multivariable logistic regression was used to identify predictors associated with use of monitored anesthesia care compared to general anesthesia. The use of monitored anesthesia care has increased from 1.8% of cases in 2013 to 25.2% in 2017 (p = 0.0001). Patients were more likely ages 80+ (66% vs. 61%; p = 0.0001), male (54% vs. 52%; p = 0.0001), ASA physical status > III (86% vs. 80%; p = 0.0001), cared for in the Northeast (38% vs. 22%; p = 0.0001), and residents in zip codes with higher median income ($63,382 vs. $55,311; p = 0.0001). Multivariable analysis revealed each one-year increase in age, every 50 procedures performed annually at a practice, and being male were associated with 3% (p = 0.0001), 33% (p = 0.012), and 16% (p = 0.026) increased odds of monitored anesthesia care, respectively. Centers in the Northeast were more likely to use monitored anesthesia care (all p < 0.005). Patients who underwent approaches other than percutaneous femoral arterial were less likely to receive monitored anesthesia care (adjusted odds ratios all < 0.51; all p = 0.0001). Anesthetic type for transcatheter aortic valve replacements in the United States varies with age, sex, geography, volume of cases performed at a center, and procedural approach.

The Kansas City Bleeding Index: A Clinical Assessment Tool to Predict Risk of Major Bleeding Events on Doac Therapy

BACKGROUND Direct oral anticoagulants (DOACs) are widely used medications for treatment and prevention of venous thromboembolism (VTE) and arterial thromboembolism (ATE). DOACs are favorable to the more traditional oral vitamin K antagonist (VKA)-as they do not require routine laboratory monitoring, generally have fewer drug interactions, and can be safely taken with all foods. However, DOACs can also increase the risk of bleeding events which can be severe and life-threatening. Moreover, many patients requiring DOAC therapy have chronic medical conditions, are of older age, and have history of cancers-putting them at increased risk of bleeding events. There have been multiple attempts to predict bleeding risk in patients that need DOACs, but no standard validated tool is preferred in clinical practice. Our study aims to quantify the risk of major bleeding while on DOAC therapy based upon patient characteristics. We hypothesized based upon prior evidence that a group of risk factors (Table 1) - liver disease, cerebral disease, heart disease, history of surgery, kidney disease, blood disorders, cancers, history of fall and type 2 diabetes mellitus - each increase the risk of bleeding during DOAC therapy. METHODS We retrospectively analyzed patient charts of 210,682 patients prescribed DOAC therapy (apixaban, rivaroxaban, edoxaban, betrixaban and dabigatran) who had a clinically significant bleeding event at 6 months and 5 years that required a hospital visit. ICD 9 and ICD 10 codes were used to search for bleeding events at different body sites and for risk factor groups based upon diagnosis. Kansas City Bleeding Index (KCBI) risk score from 0 to 9 increments was assigned depending upon the number of grouped risk factors present. Data was collected from the Health Facts database, which contains de-identified information from the electronic medical records of hospitals in which Cerner© has a data use agreement. Multivariate logistic regression modeling was used to calculate bleeding risk. RESULTS A total of 210,682 patients were reviewed, with an average age of 68 years old (18 to 90 years). KCBI risk scores in patients ranged from 0-7 (maximum score 9); however, none of the patients had risk of 8 or 9. Majority of patients had KCBI risk scores between 1 and 2. Of the 210, 682 patients, 7.07% had bleeding events by 6 months and 10.86% had bleeding events by 5years. KCBI risk score, Caucasian race, female gender and age were all statistically significant risk factors to predict bleeding risk at 6 months (Table 2; p value <0.05). With a one-point increase in KCBI risk score, the chance of bleeding at 6 months increased by 46.9%. Caucasian race was associated with protection from bleeding with a 21.2% less likely chance to have an event at 6 months. Female gender had a 5.2% less likely chance to have a bleeding event at 6 months. With one-year increase in age, the chance of a bleeding event at 6 months increased by 0.8%. At 5 years, KCBI risk score, Caucasian race and age were significant risk factors to predict bleeding (Table 2; p value < 0.05). With a one-point increase in KCBI score, the chance of bleeding at 5 years on DOACs increased by 40.6%. Again, Caucasian race was 18.5% less likely to have a bleeding event at 5 yrs. With a one-year increase in age, the chance of bleeding at 5 years increased by 0.8%. CONCLUSION Several risk factors exist that increase the risk of bleeding in patients on DOACs and calculating the actual risk in clinical setting is complicated. Younger age, female gender and Caucasian race were all associated with lower bleeding risk. KCBI risk score (Table 1), can be used to predict the likelihood of clinically significant bleeding requiring hospital visit based upon our study. A higher KCBI risk score correlates with a medically complex patient with higher bleeding risk requiring greater caution during anticoagulation. However, actual validation of the KBCI risk score as a bleeding predictor tool might be needed in a prospective study in an ambulatory setting. Nevertheless, it can be still used as a tool for predicting risk both at 6 months and 5 years, especially if the benefit of anticoagulation is low. Our study was limited by retrospective analysis, in-patient demographic, sicker patient condition, and clinically significant bleeding requiring hospital visit. Additionally, our patient demographic was predominantly Caucasian, limiting generalizability. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

DUCHENNE MUSCULAR DYSTROPHY RESPIRATORY PROFILES FROM REAL-WORLD REGISTRY DATA: A RETROSPECTIVE LONGITUDINAL STUDY

DUCHENNE MUSCULAR DYSTROPHY RESPIRATORY PROFILES FROM REAL-WORLD REGISTRY DATA: A RETROSPECTIVE LONGITUDINAL STUDY

High Prevalence and Lack of Parental Awareness of Pediatric Hypertension Among a Low-income Sample in Worcester, MA.

To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension. This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. Child's blood pressure percentile was determined via 2017 American Academy of Pediatrics (AAP) clinical practice guidelines and categorized as normal (< 90th percentile), elevated (≥ 90th percentile to < 95th percentile), or hypertensive (≥ 95th percentile). Bivariate multinomial logistic regression models assessed the relative risk ratio for potential correlates of blood pressure categorization and frequency distribution of parental awareness of blood pressure status was examined. Median child age was 8.1 years (IQR 6.5-9.9). Half were female, 61.8% were Latino and 15.8% were Non-Latino Black. Median body mass index (BMI) percentile was 83.6 (IQR 58.4-97.1) and 31.6% exceeded the 95th percentile. AAP criteria for hypertension and elevated blood pressure were met by 30.7% and 14.3% of children respectively. After full adjustment, the relative risk of categorization as hypertensive versus normal increased by a factor of 1.16 (95% CI 1.02-1.3) per 10-unit increase in BMI percentile, and 0.86 (95% CI 0.74-1.0) per one-year increase in age. Less than five parents (redacted due to low sample size) reported their child having a history of high blood pressure. In this low income, racially/ethnically diverse sample, we observed levels of hypertension and elevated blood pressure considerably higher than national estimates. However, in contrast, extremely low parental awareness was observed.

Analysis of sociodemographic and clinical factors associated with Lassa fever disease and mortality in Nigeria.

Over past decades, there has been increasing geographical spread of Lassa fever (LF) cases across Nigeria and other countries in West Africa. This increase has been associated with significant morbidity and mortality despite increasing focus on the disease by both local and international scientists. Many of these studies on LF have been limited to few specialised centres in the country. This study was done to identify sociodemographic and clinical predictors of LF disease and related deaths across Nigeria. We analysed retrospective surveillance data on suspected LF cases collected during January-June 2018 and 2019. Multivariable logistic regression analyses were used to identify the factors independently associated with laboratory-confirmed LF diagnosis, and with LF-related deaths. There were confirmed 815 of 1991 suspected LF cases with complete records during this period. Of these, 724/815 confirmed cases had known clinical outcomes, of whom 100 died. LF confirmation was associated with presentation of gastrointestinal tract (aOR 3.47, 95% CI: 2.79-4.32), ear, nose and throat (aOR 2.73, 95% CI: 1.80-4.15), general systemic (aOR 2.12, 95% CI: 1.65-2.70) and chest/respiratory (aOR 1.71, 95% CI: 1.28-2.29) symptoms. Other factors were being male (aOR 1.32, 95% CI: 1.06-1.63), doing business/trading (aOR 2.16, 95% CI: 1.47-3.16) and farming (aOR 1.73, 95% CI: 1.12-2.68). Factors associated with LF mortality were a one-year increase in age (aOR 1.03, 95% CI: 1.01-1.04), bleeding (aOR 2.07, 95% CI: 1.07-4.00), and central nervous manifestations (aOR 5.02, 95% CI: 3.12-10.16). Diverse factors were associated with both LF disease and related death. A closer look at patterns of clinical variables would be helpful to support early detection and management of cases. The findings would also be useful for planning preparedness and response interventions against LF in the country and region.

Findings on ovarian cyst resolution based on cyst diameter for the practicing physician (204)

Objectives: The purpose of this study was to characterize the resolution of ovarian cysts for the practicing physician in terms of cyst diameter. Ovarian cysts frequently resolve on their own, but little information on this resolution based on cyst diameter is available for use by examining physicians. The objective of this study was to analyze the resolution of incident ovarian cysts in relation to cyst diameter, structure, age, body habitus, and menopausal status using univariate and multivariate analyses. These categorizations are important to examining physicians for decisions on whether to continue monitoring the cyst or intervene surgically. Methods: A total of 2,638 women with incident cysts who underwent 51,356 TVUS examinations were analyzed for over 31.2 years in the University of Kentucky Ovarian Cancer Screening Program. Prevalent cysts were excluded as they would be examined with an undefined course of the first appearance when defining resolution time. Other exclusions included women with concurrent ovarian malignancies, cysts with solid components and cases where surgery interrupted the natural history of measured cysts. Out of all the women in the study, 3,897 cysts were collectively identified and studied in a univariant and multivariant analysis through a clustering of variables identified in the patients. Results: Total 2,424 of the 3,897 cysts in the study were resolved; the remaining 1,473 cysts were treated as right-censored observations in the analysis. When considering multivariate analysis, septated cysts were 53.6% more likely to resolve than unilocular cysts (HR: 1.536, p<0.05). For every centimeter increase in diameter, the hazard for resolution decreased by 32.5% (HR: 0.675, p<0.05). The resolution was 34.2% less likely for women using HRT when compared to the nonusers (HR: 0.658, p<0.05). For every one-year increase in age, the hazard for resolution decreased by 2.1% (HR: 0.979, p<0.05). Univariate analysis revealed similar results for these four factors. With univariate analysis, post-menopausal women’s cysts were 21.2% less likely to resolve than pre-menopausal women’s cysts; however, this finding was not significant in multivariate analysis. Objectives: The purpose of this study was to characterize the resolution of ovarian cysts for the practicing physician in terms of cyst diameter. Ovarian cysts frequently resolve on their own, but little information on this resolution based on cyst diameter is available for use by examining physicians. The objective of this study was to analyze the resolution of incident ovarian cysts in relation to cyst diameter, structure, age, body habitus, and menopausal status using univariate and multivariate analyses. These categorizations are important to examining physicians for decisions on whether to continue monitoring the cyst or intervene surgically. Methods: A total of 2,638 women with incident cysts who underwent 51,356 TVUS examinations were analyzed for over 31.2 years in the University of Kentucky Ovarian Cancer Screening Program. Prevalent cysts were excluded as they would be examined with an undefined course of the first appearance when defining resolution time. Other exclusions included women with concurrent ovarian malignancies, cysts with solid components and cases where surgery interrupted the natural history of measured cysts. Out of all the women in the study, 3,897 cysts were collectively identified and studied in a univariant and multivariant analysis through a clustering of variables identified in the patients. Results: Total 2,424 of the 3,897 cysts in the study were resolved; the remaining 1,473 cysts were treated as right-censored observations in the analysis. When considering multivariate analysis, septated cysts were 53.6% more likely to resolve than unilocular cysts (HR: 1.536, p<0.05). For every centimeter increase in diameter, the hazard for resolution decreased by 32.5% (HR: 0.675, p<0.05). The resolution was 34.2% less likely for women using HRT when compared to the nonusers (HR: 0.658, p<0.05). For every one-year increase in age, the hazard for resolution decreased by 2.1% (HR: 0.979, p<0.05). Univariate analysis revealed similar results for these four factors. With univariate analysis, post-menopausal women’s cysts were 21.2% less likely to resolve than pre-menopausal women’s cysts; however, this finding was not significant in multivariate analysis.

Risk of seroconversion and seroreversion of antibodies to Chlamydia trachomatis pgp3 in a longitudinal cohort of children in a low trachoma prevalence district in Tanzania

BackgroundSerologic testing for chlamydial antibodies is one potential tool for trachoma monitoring. Understanding the dynamics of seroconversion and seroreversion in low endemic districts is critical for determining the value of using serology.Methodology/Principal findingsWe surveyed a random sample of 2536 children aged 1–9 years in Kongwa, Tanzania, over three years; 1719 (67.8%) participants had all three follow-ups. Surveys assessed trachomatous inflammation—follicular (TF), Chlamydia trachomatis infection, and anti-pgp3 antibodies. Mass drug administration occurred immediately after the first and second follow-up surveys. The cohort was classified into trajectories of change in serostatus, and risk factors were evaluated for seroconversion and seroreversion. We found that 86.2% of seropositives remained seropositive throughout the study, whereas 12.1% seroreverted. Seroreverters were younger (Odds Ratio [OR] = 0.88 for every one-year increase in age, 95% CI = 0.79–0.99). 84.5% of seronegatives remained seronegative, and 13.0% seroconverted. Seroconverters were also younger (OR = 0.92, 95% CI = 0.87–0.98). Seroconversion and seroreversion were not explained by indeterminate values for the intensity of antibody response. Less than 1% of the cohort had unstable changes in serostatus, mostly explained by values in the indeterminate range. TF and infection in the cohort declined over time, while seropositivity increased from 31.5% to 36.4%.Conclusions/SignificanceAntibody status is relatively stable over time. Both seroconversion and seroreversion occurred over the three years in this low endemic district, especially in younger children. Modeling seroreversion is important for accurate determination of seroconversion. The use of serology as a monitoring tool should target the younger aged children as they will most likely capture recent changes in serostatus.

P-106 Total motile sperm count and oral ovulation induction protocols are not predictors of success in donor insemination cycles: Results from a large retrospective cohort study

Abstract Study question to investigate the effect of total motile sperm (TMS) count, and ovulation induction on clinical pregnancy rate in artificial insemination with donor (AID) cycles. Summary answer TMS count is not a predictor of sucess, and natural cycles are as effective as oral ovulation induction in donor inseminations What is known already There are inconsistent results regarding the effect of sperm parameters on success rates of artificial insemination with donor (AID). Besides, the use of gonadotropin stimulation for ovulation induction in this category of patients is questionable, and its effectiveness over natural cycles is not yet confirmed in the literature. Study design, size, duration Patients who underwent AID cycles at the university-affiliated fertility center-OVO clinic in Montreal, Canada between 2011 and 2015 were retrospectively selected. A total of 4333 AID cycles were performed on 1179 patients, resulting in 744 pregnancies. Participants/materials, setting, methods Cycles were divided into 8 groups based on TMS count: &amp;lt;0.5, [0.5-1[, [1-5[, [5-10[, [10-20[, [20-40[, [40-80[, and ≥80. A TMS of 10 to 20 million was selected as a reference level. Ovulation induction was divided into oral stimulation, combined oral and gonadotropin stimulation and gonadotropin-only stimulation, and compared to natural cycles. Regression analysis and a predictive model of clinical pregnancy in AID cycles were generated from patient demographic and cycle characteristics. Main results and the role of chance There was no significant difference in positive β-hCG result, clinical pregnancy, multiple pregnancy and miscarriage rates when comparing all ranges of TMS count to a reference of 10 to 20 million. When dividing patients based on the protocol for ovulation induction, clinical pregnancy rate was significantly higher in the gonadotropin-only stimulation group (OR 4.116,[1.379,12.287]) but not in other types of stimulation, as compared to natural cycles. hCG triggering resulted in a similar clinical pregnancy and miscarriage rates, but a higher multiple pregnancy rate when compared to urinary LH testing (7.7% versus 1.3%, p = 0.045). A multivariate logistic regression analysis for predictors of clinical pregnancy accounting for relevant demographic and cycle characteristics was conducted. No significant difference was noted in different ranges of TMS and the groups of ovulation induction. In this model, age was found to be a significant predictor. In particular, with every one-year increase in age, the odds of clinical pregnancy decreases by 6.4% (Adjusted OR 0.936; 95%CI [0.914, 0.958]). Limitations, reasons for caution In our study, cycles with TMS count below 1 million are limited. Thus, results should be viewed with caution in this group, without cycle cancellation, since clinical pregnancy can be achieved. Moreover, our results cannot be generalized on infertile couples given the characteristics of our population of interest. Wider implications of the findings Minimal or maximal cut-off values for TMS in AID cycles should not be used as indicators for cycle cancellation. Natural cycles are as successful as oral ovulation induction. hCG trigger, unless indicated, should not be used as it is associated with higher risk of multiple pregnancy without increasing clinical pregnancy. Trial registration number not applicable

`I forget everything!` Diagnostic Classification of Applicants with Forgetfulness to a Secondary Care Neurology Clinic, Izmir, Turkey

The objective of this study is to determine the frequency of neurological disease (ND), psychiatric disorder (PD), and subjective cognitive decline (SCD) diagnosis among patients admitted with forgetfulness to a secondary care neurology clinic and compare their demographic, family history characteristics and referral status. &#x0D; The outcomes of this cross-sectional study are either being diagnosed with ND, PD or SCD. The independent variables are age, gender, family history of dementia and referral from a physician. Multinomial regression model is fitted with age and gender to predict the major diagnostic group. &#x0D; Among 464 admissions with forgetfulness complaints less than a half of the applicants were diagnosed with an ND (44.4%) in total and it was lower in the younger age group (&lt; 65, 7.8%). One-year increase in age decreased the chance of having an SCD by 14.5% (Odds Ratio (OR): 0.9, 95% CI: 0.8-0.9) and having an ND by 14.8% (OR: 0.9, 95% CI: 0.8 - 0.9) relative to a PD . Women had 2.6 (95% CI: 1.4 - 5.0) times higher SCD diagnosis compared to men relative to having an ND diagnosis. &#x0D; In conclusion, this study shows that more than a half of the admissions are not associated with an ND and, mostly the young, women population admits neurology clinics with forgetfulness complaints without objective deficits for cognitive decline. In our opinion, the high frequency rates of this group should be considered carefully by policy makers.

A multivariate logistic model to predict odds of small bowel cancer by various risk factors.

e16307 Background: Small bowel cancer (SBC) is a rare malignancy, and current epidemiologic literature consists of small single-center studies describing various etiologic associations. Therefore, we evaluated the strength of association of various SBC risk factors using a nationally representative patient sample. Methods: We investigated the National Inpatient Sample 2019 employing International Classification of Diseases-10 (ICD-10) codes to include adult patients with SBC. Odds of SBC were tested for various risk factors individually using univariate logistic regression. In addition, a multivariate regression model was developed to test the odds of developing SBC while controlling for all other risk factors. Analyses were performed using STATA (v 14.2), considering 2 sided P&lt; 0.05 as statistically significant. Results: Out of 30,200,000 adult hospitalized patients in 2019, 9,629 had a diagnosis of SBC. Each one-year increase in age predicted a 4% increased odds of SBC. Males had 28% higher odds compared to females. Compared to whites, Blacks and Asians had higher odds of SBC while Hispanics did not. Smoking, alcohol, HIV, and low socioeconomic status were associated with higher odds of SBC while controlling for all other risk factors ( P &lt; 0.05). Disorders of lipid metabolism, hormone replacement therapy, prior cholecystectomy, celiac disease were associated with lower odds. Crohn’s disease, familial adenomatous polyposis (FAP), and Lynch syndrome were not significantly associated with higher odds of SBC ( P &gt; 0.05). Conclusions: FAP and Lynch syndrome appear to increase the risk of polyp formation in the small intestine but not SBC. The lower odds mentioned for certain variables are merely an association and do not imply a protective effect. The reliance on ICD-10 codes and the inability to distinguish between various cancer subtypes limits our conclusion and needs to be addressed in future studies.[Table: see text]

Prognostic Factors Associated With Mortality of Patients With COVID-19 Requiring Ventilator Management: A Retrospective Cohort Study.

AimThere are few reports on the prognostic factors associated with mortality in coronavirus disease (COVID-19) patients with critical disease. This study assessed prognostic factors associated with mortality of patients with critical COVID-19 who required ventilator management.MethodsThis single-center, retrospective cohort study used medical record data of COVID-19 patients admitted to an emergency ICU at a hospital in Japan between March 1, 2020 and September 30, 2021, and provided with ventilator management. Multivariable logistic regression was used to identify factors associated with mortality.ResultsSeventy patients were included, of whom 29 (41.4%) died. The patients who died were significantly older (median: 69 years) (interquartile range [IQR]: 47-82 years) than the patients who survived (62 years [38-84 years], p<0.007). In addition, patients who died were significantly less likely to have received steroid therapy than patients who survived (25 [86.2%] vs. 41 [100%], p=0.026). In the multivariable analysis, age was identified as a significant prognostic factor for mortality and the risk of death increased by 6% for every one-year increase in age (OR: 1.06; 95% CI: 1.00-1.13; p=0.048). Medical history was not a risk factor for death.ConclusionAge was a predictor of mortality in critically ill patients with COVID-19. Therefore, the indications for critical care in older patients with COVID-19 should be carefully considered.

Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach.

Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.

Correlates of concurrent use of stimulants and opioids among people who access harm reduction services in British Columbia, Canada: Findings from the 2019 Harm Reduction Client Survey.

During a public health overdose emergency driven by fentanyl in British Columbia (BC), Canada, a parallel increase in concurrent use of methamphetamines may be contributing to the risk of overdose. Concurrent use refers to the use of stimulants and opioids one after the other, or together. Describing substance use practices and elucidating correlates of concurrent use can inform harm reduction service provision and prevent overdose events. This cross-sectional study analyzed the 2019 Harm Reduction Client Survey administered at 22 harm reduction sites across BC and sampled individuals aged 19 and older. Bivariable and multivariable logistic regression models identified correlates of concurrent use of stimulants and opioids in the last three days. The study sample was composed of 574 individuals who used stimulants and/or opioids, among whom 307 (53.5%) reported concurrent use. Compared with individuals who used stimulants and/or opioids separately, the odds of concurrent use were significantly increased (OR=2.74, 95%CI 1.71-4.51) while the adjusted odds were increased (aOR=1.79, 95%CI 0.98-3.34) among individuals who experienced an opioid overdose. Further, the adjusted odds of concurrent use decreased with every one-year increase in age (aOR=0.97, 95%CI 0.95-0.99), among individuals with paid work (aOR=0.58, 95%CI 0.33-0.99), and stable housing (aOR=0.61, 95%CI 0.37-1.02). The adjusted odds of concurrent use increased among individuals who used drugs daily (aOR=3.78, 95%CI 2.28-6.40), used tobacco (aOR=2.03, 95%CI 1.09-3.87), used benzodiazepines (aOR=3.72, 95%CI 1.76-8.41), owned a naloxone kit (aOR=1.94, 95%CI 1.15-3.31), used observed consumption sites (aOR=2.51, 95%CI 1.57-4.07), and were prescribed opioid agonist therapy (aOR=2.92, 95%CI 1.81-4.77). Individuals who used stimulants and opioids concurrently tend to be younger, without paid work or housing. They were engaged in harm reduction and treatment services, yet used illicit drugs with unknown concentration daily. Improving access to age-appropriate services and expanding the availability of both legal and regulated stimulants and opioids may further reduce harms of concurrent use.

Vitamin D Status in Relation to the Clinical Outcome of Hospitalized COVID-19 Patients

Coronavirus Disease (COVID-19) is a newly emerged infectious disease that first appeared in China. Vitamin D is a steroid hormone with an anti-inflammatory protective role during viral infections, including SARS-CoV-2 infection, via regulating the innate and adaptive immune responses. The study aimed to investigate the correlation between serum 25-hydroxyvitamin D (25[OH]D) levels and clinical outcomes of COVID-19. This was a retrospective study of 126 COVID-19 patients treated in NMC Royal Hospital, UAE. The mean age of patients was 43 ± 12 years. Eighty three percentage of patients were males, 51% patients were with sufficient (> 20 ng/mL), 41% with insufficient (12–20 ng/mL), and 8% with deficient (<12 ng/mL) serum 25(OH)D levels. There was a statistically significant correlation between vitamin D deficiency and mortality (p = 0.04). There was a statistically significant correlation between 25(OH)D levels and ICU admission (p = 0.03), but not with the need for mechanical ventilation (p = 0.07). The results showed increased severity and mortality by 9 and 13%, respectively, for each one-year increase in age. This effect was maintained after adjustment for age and gender (Model-1) and age, gender, race, and co-morbidities (Models-2,3). 25(OH)D levels (<12 ng/mL) showed a significant increase in mortality by eight folds before adjustments (p = 0.01), by 12 folds in Model-1 (p = 0.04), and by 62 folds in the Model-2. 25(OH)D levels (< 20 ng/mL) showed no association with mortality before adjustment and in Model-1. However, it showed a significant increase in mortality by 29 folds in Model-3. Neither 25(OH)D levels (<12 ng/mL) nor (< 20 ng/mL) were risk factors for severity. Radiological findings were not significantly different among patients with different 25(OH)D levels. Despite observed shorter time till viral clearance and time from cytokine release storm to recovery among patients with sufficient 25(OH)D levels, the findings were statistically insignificant. In conclusion, we demonstrated a significant correlation between vitamin D deficiency and poor COVID-19 outcomes.

Refractive Errors and Their Associated Factors in Schoolchildren: A Structural Equation Modeling

ABSTRACT Purpose To determine the prevalence of myopia and hyperopia in Shahroud schoolchildren and their risk factors Methods Optometric examinations including the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic and cycloplegic refraction using retinoscopy were done for students. Generalized Structural Equation Modeling (GSEM) was used to determine direct and indirect effects of independent variables on myopia and hyperopia. Results The data of 5581 students with a mean age of 9.24 ± 1.7 years were used in this study. The prevalence of myopia was 5.0% (95%CI: 4.3–5.7) and the prevalence of hyperopia was 4.8% (95%CI: 4.0 − 5.5) in all schoolchildren. According to the GSEM results, the odds of myopia in rural areas were 0.55 compared to urban areas. A one-unit increase in the ocular AL increased the odds of myopia by 4.91 times. The interaction of sex and age on myopia was significant such that in girls, the odds of myopia increased by 20% for every one-year increase in age while no significant change was seen in boys. A one-unit increase in the ocular AL decreased the odds of hyperopia by 0.49 times. Moreover, the interaction of outdoor activity hours and sex on the prevalence of hyperopia was significant such that increased outdoor activity reduced the odds of hyperopia in girls while no significant correlation was found in boys. Conclusion Myopia and hyperopia had moderate prevalence. Axial Length had the largest direct association on myopia and hyperopia. Age and outdoor activity had weak associations on refractive errors.

Perceived control and length of stay post coronary artery bypass graft surgery

Background &amp; Aim: Patients undergoing CABG might have increased complications postoperatively, especially prolonging post-operative Length of Stay (LOS). Perceived Control (PC) affects LOS post CABG and complications among different cardiac populations. However, this relation is not well-studied post CABG. This study aimed to determine whether PC was an independent predictor of LOS among patients post CABG.&#x0D; Methods &amp; Materials: A prospective observational design was used. A consecutive sample consisted of 220 patients from four hospitals in Amman, Jordan, who underwent elective CABG between July 2020 and January 2021. PC was assessed using the Arabic Version of the Control Attitude Scale-Revised. LOS and other necessary information were retrieved from the patients' medical records. Data were analyzed using stepwise multiple regression.&#x0D; Results: 169 males and 51 females participated in this study. Age, female gender, as well as PC were found to be independent predictors for the hospital LOS. On the one hand, advanced age and female gender increased the hospital LOS, while higher levels of PC were protective. A one-year increase in age increased hospital LOS by 0.16 days, being female increased hospital LOS by 0.17 days, and a one-point increase in PC levels decreased LOS by 0.33 days. On the other hand, only female gender and PC were independent predictors for the ICU LOS. Similarly to hospital LOS, the female gender increased ICU LOS by 0.18 days while the one-point increase in PC decreased the ICU LOS by 0.21 days.&#x0D; Conclusion: PC was an independent predictor that affects LOS after CABG. Increasing PC among this population, especially females and the elderly, might improve outcomes of their CABG surgery decrease hospital's LOS and the resultant morbidity.

Outcomes in Lower Limb Amputation Rehabilitation

Abstract Introduction: Lower leg amputations affect mobility and can be solved with prosthesis. Despite being included in the Package of Rehabilitation Interventions created by the World Health Organisation, there are lacks in rehabilitation outcome research. Objectives: Reveal the rehabilitation outcomes and, secondarily, determine predictors of prosthesis use for at least two years. Methods: Retrospective cohort study of patients with major lower limb amputations aged between 18 and 70 years with no other disabilities. Rehabilitation outcomes and the predictors of prosthesis use at discharge (time II) compared to the two-year follow-up (time III) were evaluated. Results: 703 patients were included. At time II, 95.73% (673) completed the treatment, with a prosthetic gait rate of 73.12%. Age was a predictor for prosthetic gait, as each one-year increase in age corresponded to a 3.29% decrease in prosthesis use. At time III, 54.21% of the patients had higher prosthetic gait performance, for 2 years at least, requiring a new device. Conclusion: The rehabilitation ensures mobility though high-performance prosthetic gait regardless of age, sex, or aetiology, for at least 2 years from rehabilitation discharge. Though with a lower prosthesis use rate with increasing age.

The Sequential Change in Left Ventricular Function among Various Cardiovascular Diseases: A 12-Year Study.

Background: This 12-year study aimed to compare the longitudinal change in left ventricular diastolic dysfunction (LVDD) between healthy elderly, coronary artery disease (CAD), and hypertension (HTN) patients. Methods: From 2008 to 2020, 1476 patients were included, and 3181 echocardiography examinations were conducted. Finally, 130 participants (36 healthy elderly (79.39 ± 9.51 years old), 51 with CAD (68.31 ± 12.09 years old), and 43 with HTN (68.31 ± 12.09 years old)) with more than a 10-year follow-up period were included in the final analysis. Results: The change in diastolic function was different among these subjects according to the integrated score index (elderly vs. HTN, p = 0.01; CAD vs. HTN, p = 0.01), septal E/e′ ratio (elderly vs. HTN, p < 0.001; CAD vs. HTN, p = 0.01), lateral E/e′ ratio (elderly vs. HTN, p < 0.001; CAD vs. HTN, p < 0.001), and NYHA functional class (elderly vs. HTN, p = 0.03; CAD vs. HTN, p < 0.001). Additionally, per one-year increase in age, the integrated score index increased 0.2 in the healthy elderly, 0.15 in the CAD, and 0.06 in the HTN patients (all p < 0.05). Conclusion: Under aggressive treatment, diastolic function was relatively preserved in HTN subjects with aging in comparison with elderly and CAD subjects.

Clinical Features and Changes in Insulin Requirements in People with Type 2 Diabetes Requiring Insulin When Hospitalised with SARS-CoV-2 Infection

Background Uncontrolled hyperglycaemia before and during hospitalisation is a risk factor for adverse outcomes in people with diabetes and SARS-CoV-2 infection. Insulin often at high doses is frequently required to manage hyperglycaemia associated with SARS-CoV-2 infection during hospitalisation. However, there is limited information on the clinical features and sequelae of people with type 2 diabetes (T2DM) not previously on insulin that require insulin as a new treatment when hospitalised with SARS-CoV-2 infection. Aims To describe the clinical features and insulin treatment sequelae of 113 people with T2DM that required insulin as a new treatment when hospitalised with SARS-CoV-2 infection. Methods A single-centre study of 113 people with T2DM who were not on insulin before their admission for SARS-CoV-2 infection. The primary aim of our study was to identify clinical and biochemical features that were associated with the need for insulin as a new treatment in people with known T2DM not on insulin treatment at the time of hospitalisation for SARS-CoV-2 infection. We also describe changes in insulin requirements at time of discharge from hospital and 6 weeks later during the first wave of SARS-CoV-2 infection (April–March 2020) in the UK. Clinical, biochemical, and anthropometric data were collected from electronic health records. Results We observed that of 113 people with T2DM, 35% (n = 39) needed insulin as a new treatment during their hospitalisation for SARS-CoV-2 infection. People requiring insulin were younger, had a higher preadmission HbA1c, were more frequently on oral medication for diabetes before the admission, and were more likely to be obese (body mass index ≥30 kg/m2), with p ≤ 0.001 for all. In multivariable logistic regression analyses, we observed that younger age and higher HbA1c before admission were independently associated with needing insulin, with one-year increase in age associated with decreased odds of needing insulin initiation (OR 0.91, 95% CI 0.83–0.99), and increasing preadmission HbA1c by 1 mmol/mol associated with an increased odds of insulin initiation (OR 1.05, 95% CI 1.002–1.11) (p < 0.05 for both). Of the 39 people with T2DM who required insulin as a new treatment, 28% remained on insulin at the time of discharge with their insulin dose falling from 1.26 U/kg within the first 7 days of admission to 0.39 U/kg at discharge. At 6 weeks after discharge, 24% of people remained on insulin. Conclusion More than one-third of people with T2DM not previously treated with insulin required new insulin treatment when hospitalised with SARS-CoV-2 infection, and of this group, 24% remained on insulin at 6 weeks after discharge. This study highlights the important variations of insulin requirements in people with T2DM new to insulin and the importance of a dedicated team for patient education and close follow-up.